公共卫生研究摘要 (2025-12-10)
共收录 58 篇研究文章
1. Neurologic Sequelae After Ebola Virus Disease in Children in Liberia: An Observational Study.
期刊: Neurology 发表日期: 2026-Jan-13 链接: PubMed
摘要
The West Africa Ebola virus disease (EVD) outbreak resulted in over 28,000 individuals infected, primarily in Liberia, Guinea, and Sierra Leone. Data from previous outbreaks indicate lasting health problems in survivors. The long-term neurologic impact of EVD remains largely unknown. The aim of this study was to characterize the neurologic and neurocognitive sequelae of EVD in pediatric survivors of the 2015 outbreak in Liberia. In this cross-sectional observational study conducted in Monrovia, Liberia, pediatric survivors of acute EVD aged younger than 18 years at the time of infection and older than 2 years at the time of the visit, along with their asymptomatic close contacts as controls, were seen at a median of 18 months after EVD. The single clinic visit included a neurologic history and symptom questionnaire, neurologic examination, and neurocognitive testing. Seropositive survivors and seronegative controls were included in analyses, with the t test used for continuous variables and the χ2 or Fisher exact test used for categorical variables. The cohort included 31 EVD cases and 41 controls, with a median age of 11 years (44% female). Neurologic symptoms that were reported significantly more frequently in cases than in controls included arm/leg weakness (67.7% vs 4.9%, p < 0.0001); problems with sitting, standing, or walking (22.6% vs 4.9%, p = 0.031); difficulty seeing (38.7% vs 9.8%, p = 0.003); difficulty understanding speech (32.3% vs 0%, p < 0.0001); fecal incontinence (19.4% vs 0%, p = 0.0051); and lack of motivation (22.2% vs 0%, p = 0.0052). EVD cases more often demonstrated disability than controls on the modified Rankin Scale. EVD cases “either sometimes or often” faced consequences for poor behavior, became upset for unknown reasons, and had difficulty completing tasks independently more often than controls on executive function assessment. There was no significant difference between groups in individual neurologic examination components, frequency of uveitis, or cognitive test scores. Numerous neurologic symptoms were reported more commonly in EVD cases than in controls, suggesting that EVD may have a lasting effect on the nervous system. Limitations included small sample size and reliance on participant self-report. Our findings highlight the importance of long-term clinical monitoring of pediatric EVD survivors, given the potential impact on childhood development.
2. From Childhood to Adulthood: A Mixed-Methods Exploration of Social Environments and Psychological Well-Being in Predominantly Black American Urban Communities.
期刊: Journal of community psychology 发表日期: 2026-Jan 链接: PubMed
摘要
Neighborhood environments may significantly impact psychological well-being, particularly in Black American communities where historical inequities and resilience factors intersect. This mixed-methods study investigates retrospective perceptions of childhood and current neighborhood social environments and their associations with loneliness and psychological distress in adulthood. Data were drawn from the Think PHRESH study, an ancillary project to the Pittsburgh Hill/Homewood Research on Neighborhood Change and Health (PHRESH). A mixed-methods design integrated survey data from 739 participants (77.5% female; mean age = 63.37) and qualitative interviews with 56 residents (60.7% female; mean age = 65.95). Measures assessed childhood and adulthood neighborhood social cohesion, collective child-rearing, current neighborhood safety, satisfaction, loneliness, and distress. A mixed-methods expansion approach was used, where qualitative themes informed quantitative model development. Thematic analysis was applied to qualitative data, and regression analyses examined associations between neighborhood factors and mental health. Participants reported significantly higher childhood social cohesion (M = 4.47, SD = 0.70) than adulthood (M = 3.22, SD = 0.69). Qualitative findings highlighted declines in community engagement and safety. Regression analyses showed greater current social cohesion (b = -0.61, SE = 0.25, p = 0.02), neighborhood safety (b = -0.48, SE = 0.21, p = 0.02), and satisfaction (b = -0.55, SE = 0.18, p = 0.002) were associated with lower distress, while higher satisfaction was linked to lower loneliness (b = -0.08, SE = 0.03, p = 0.002). Findings highlight the importance of policies that enhance neighborhood social environments, particularly in predominantly Black urban communities affected by structural inequities.
3. Decompression illness in breath-hold divers: insights from an online survey.
期刊: Diving and hyperbaric medicine 发表日期: 2025-Dec-20 链接: PubMed
摘要
Breath-hold divers can surface with neurological symptoms consistent with nitrogen buildup in tissues or gas entry into the arterial circulation, collectively termed decompression illness (DCI). While DCI has historically been attributed to diving with compressed air, breath-hold divers have reported similar syndromes. The causes, diagnosis, and management of DCI in breath-hold divers is poorly understood. We developed an online survey that queried breath-hold divers on the symptoms they experienced during decompression illness events and the medical management of each event. A total of 36 (31 M, 5 F) breath-hold divers filled out the survey. A majority identified as recreational freedivers, competitive freedivers, and/or spearfishers with an average age of 45 years and 18 years of breath-hold diving experience. Of those surveyed, 33 (92%) held a certification from an accredited training agency. A total of 18 (50%) reported experiencing DCI, with 21 DCI incidents reported by 13 individuals from 1999-2024. Sixteen (76%) of DCI incidents occurred during training, with an average depth of 83.4 m and average speed of 1.0 m∙s-1. Thirteen (62%) percent of DCI incidents occurred while diving to depths shallower than a previous personal best. The most common symptoms were weakness, numbness, slurred speech, and fatigue. The most common treatment modalities were surface oxygen, in-water recompression, and hyperbaric oxygen therapy. Sixteen divers (76%) had partial or complete resolution of their symptoms. The top cited contributors to the DCI incidents were depth, short surface interval between dives, and pulmonary barotrauma. Breath-hold divers can experience DCI even when diving within their limits. The most cited contributors to DCI were depth, short surface interval between dives, and pulmonary barotrauma. Most divers’ symptoms resolved after treatment with surface oxygen, in-water recompression, and/or hyperbaric oxygen therapy.
4. The process, logistics and governance behind a high-stakes novel intervention: the use of extracorporeal membrane oxygenation (ECMO) in the hyperbaric chamber.
期刊: Diving and hyperbaric medicine 发表日期: 2025-Dec-20 链接: PubMed
摘要
A multi-trauma patient receiving extracorporeal membrane oxygenation (ECMO) developed severe disseminated vaso-invasive fungal disease. In the absence of any remaining treatment escalation options, hyperbaric oxygen treatment (HBOT) was considered as a last effort at gaining disease control. Previously, the use of modern ECMO devices had not been validated for hyperbaric use at our centre or, to the best of our knowledge, at any other centre around the world. We had, however, identified a potentially hyperbaric compatible ECMO device and had commenced a validation process. The aim of this report is to highlight the practical, operational and governance processes undertaken to safely provide HBOT utilising ECMO at short notice. A detailed risk assessment, development of risk reduction strategies and workflows, emergency out-of-session ethics review, clinical innovations committee review, legal advice, executive approvals and informed consent were undertaken over a 32-hour period prior to commencing HBOT. We present the identified risks, governance approvals, workflow, staffing model, chamber layout and safety checklist utilised to successfully deliver thirteen HBOT sessions to a patient on venovenous (VV) ECMO. Through an extensive and coordinated effort involving multiple specialties and disciplines at our service, we were able to safely deliver HBOT to a patient supported by VV ECMO.
5. Novel use of hyperbaric oxygen treatment for treatment-resistant disseminated Saksenaea and Fusarium in a patient on extracorporeal membrane oxygenation (ECMO): a case report.
期刊: Diving and hyperbaric medicine 发表日期: 2025-Dec-20 链接: PubMed
摘要
Filamentous soil moulds such as Saksenaea and Fusarium are angioinvasive fungi responsible for severe disseminated infections. Saksenaea causes zygomycosis, with disseminated cases having over ninety percent mortality. Fusarium, a hyphomycetes mould, can also cause disseminated infections in immunocompromised individuals, with high mortality. We describe the case of a normally healthy 20-year-old male who survived major traumatic injuries resulting from an aviation incident. He subsequently developed disseminated cutaneous zygomycetes (Saksenaea) and Fusarium infection with associated immunosuppression, multiorgan dysfunction and sepsis. Treatment strategies included repeated and extensive surgical debridement (inferior orbital region to carotid sheath in the neck, to a depth of buccal mucosa and zygomatic bone in the cheek), antifungal agents including intravenous (IV) liposomal amphotericin B and voriconazole, and IV immunoglobulin and granulocyte colony stimulating factor. Despite maximal medical and surgical treatment, disease control was not achieved. After multi-specialty consensus that current management had failed to control the disease process, hyperbaric oxygen treatment (HBOT) was added to standard therapy on an experimental basis based on several case reports, pathophysiological rationale, and institutional experience with angioinvasive Mucor. The patient was on venovenous extracorporeal membrane oxygenation for all HBOT sessions; details are reported separately. Thirteen treatment sessions (243 kPa [2.4 atmospheres absolute], 95 min) were successfully delivered. Local and systemic disease control was achieved within several days of commencing HBOT, and after a prolonged period of rehabilitation and reconstruction, the patient was discharged home. We conclude that HBOT may have an important role in the management of angioinvasive fungal disease.
6. Hyperbaric oxygen treatment and pulmonary air-containing lesions.
期刊: Diving and hyperbaric medicine 发表日期: 2025-Dec-20 链接: PubMed
摘要
Pulmonary barotrauma is a rare but serious complication of hyperbaric oxygen treatment. Pulmonary air-containing lesions may predispose pulmonary barotrauma by causing air trapping during changes in environmental pressure. This study aimed to investigate whether pulmonary air-containing lesions cause pulmonary barotrauma during hyperbaric oxygen treatment. This study retrospectively analysed data from individuals who presented to the Undersea and Hyperbaric Medicine Clinic at Gülhane Training and Research Hospital, Health Sciences University, between 2017 and 2022. The relationship between presence of pulmonary air-containing lesions on computed tomography and pulmonary barotrauma was evaluated. Gas containing lesions were not associated with an increased risk of pulmonary barotrauma. The incidence of pneumothorax during hyperbaric oxygen was extremely low (0.0059% per session, 0.15% per patient). Pulmonary air-containing lesions, including bullae, were not associated with an increased risk under standard hyperbaric oxygen treatment protocols. Routine chest computed tomography screening is not warranted due to the low complication rate. Nevertheless, clinical evaluation and informed consent are essential, particularly for patients with underlying lung disease. Further studies are needed to improve risk assessment.
7. Molecular mechanisms underlying p62-dependent secretion of the Alzheimer-associated ubiquitin variant UBB+1.
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
UBB+1, a ubiquitin variant protein resulting from a frameshift in the ubiquitin-B gene, is a pathological hallmark of Alzheimer disease (AD). At the cellular level, UBB+1 disrupts the ubiquitin-proteasome system while inducing autophagy. Notably, UBB+1 itself is secreted via autophagosome-like vesicles. Here, we demonstrate that UBB+1 can be removed from the cell by degradative and secretory autophagy. Sequestosome 1 (SQSTM1)/p62 functions as a pivotal ubiquitin receptor for UBB+1, recognizing its ubiquitin domain and facilitating loading into autophagosomes. Oligomerization of SQSTM1/p62 was critical to isolate UBB+1 in bodies preventing its aggregation. Intriguingly, both gain- and loss-of-function SQSTM1/p62 suppressed UBB+1 secretion, causing intracellular retention: SQSTM1/p62 knockout led to UBB+1 accumulation in insoluble aggregates, while its overexpression promoted the formation of p62-UBB+1 bodies. We further identified distinct roles for SNARE-mediated membrane fusion in secretory autophagy of UBB+1. Specifically, the R-SNARE SEC22B and the Q-SNAREs Syntaxin-4 and SNAP23 participated in UBB+1 exocytosis. Disruption of SEC22B impaired the fusion of UBB+1-containing autophagosomes with the plasma membrane, reducing UBB+1 secretion without affecting its intracellular turnover. Inhibition of lysosomes partially stabilized UBB+1 indicating that degradation and secretion are complementary processes that determine the fate of UBB+1. This study elucidates the dual roles of autophagy in managing neurotoxic proteins, highlighting SQSTM1/p62 as a key mediator of UBB+1 trafficking and secretion. Although ubiquitin typically acts as a degradation signal, our findings reveal a rare instance of a ubiquitin-related protein driving secretory autophagy. These findings advance our understanding of cellular mechanisms underlying the clearance of misfolded proteins in neurodegenerative diseases.
8. Vibrio cholerae biofilm matrix assembly and growth are shaped by a glutamate-specific TAXI/TRAP protein.
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
Biofilms are critical for the environmental persistence, survival, and infectivity of Vibrio cholerae, the causative agent of cholera. Here, we find that GluP, a glutamate-specific TRAP-TAXI protein, is an uncharacterized matrix component that plays a critical role in biofilm architecture. Loss of GluP reduces biofilm corrugation, expands colony size, and disperses cells from microcolonies, arguing that this factor maintains biofilm structure and organization. While GluP does not affect the abundance or localization of known matrix proteins, its absence reduces Vibrio exopolysaccharide (VPS) production. We determined the crystal structure of GluP, which revealed that GluP binds glutamate, and its biofilm-related phenotypes depend on this binding capability. We further examined the role of GluP in V. cholerae growth under defined conditions where L-glutamate serves as a carbon source, nitrogen source, or both. GluP-deficient strains specifically showed reduced growth when glucose was the carbon source and glutamate the nitrogen source. This defect is dependent on glutamate binding by GluP and highlights its role in coordinating nutrient acquisition and biofilm formation. Importantly, both biofilm assembly and growth defects occurred independently of the predicted membrane component of the Glu TRAP-TAXI system, GluQM. These findings indicate that GluP plays a dual role in biofilm assembly and growth, providing insight into its functional importance in V. cholerae physiology.
9. Droplet-on-demand mass spectrometry reveals curvature-dependent interfacial reactivity in aqueous microdroplets.
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
Water microdroplets offer a chemical environment that can dramatically accelerate reaction rates compared to bulk-phase solutions and even drive chemical transformations not found in bulk solutions. While mass spectrometry has proven indispensable for studying microdroplet chemistry, current methods rely on ensemble-averaged data from polydisperse droplet populations, obscuring the molecular details and droplet-size dependencies of reactions in individual droplets. Here, we present a piezoelectric-driven droplet-on-demand platform that enables direct mass spectrometric analysis of single, size-controlled microdroplets. We demonstrate a broad range of reactions occurring within isolated droplets. These reactions yield products comparable to those generated in conventional spray-based microdroplet systems, confirming that enhanced reactivity is intrinsic to the microdroplet environment. Crucially, we reveal a pronounced droplet-size-dependent reactivity, with smaller droplets exhibiting markedly higher activity per unit surface area. This consistent trend across different reaction types underscores the pivotal role of curvature-modulated interfacial electric fields in governing microdroplet reaction dynamics. Higher electric field strengths cause more radicals to be formed, but these radicals recombine with one another, removing them for reactions with other substrates. Consequently, as our experimental data show, there is an optimum droplet size to yield the highest product reaction rate.
10. Advances in leishmaniasis therapy: preparation, characterization and in vitro evaluation of poly (lactic acid) polymeric nanoparticles with the drug candidate SB-83.
期刊: Nanotechnology 发表日期: 2025-Dec-09 链接: PubMed
摘要
Leishmaniasis, a vector-borne disease transmitted by phlebotomine sandflies and caused by protozoa of the genus Leishmania, constitutes a significant public health challenge, with approximately one million new cases reported annually. Current therapeutic options are constrained by issues related to toxicity, suboptimal efficacy, and elevated costs. This study details the formulation, lyophilization, physicochemical characterization, and in vitro assessment of poly(lactic acid) (PLA) nanoparticles encapsulating SB-83, a novel antileishmanial compound, with the aim of enhancing its therapeutic profile. The nanoparticles were prepared via the nanoprecipitation method, yielding spherical particles with mean diameters ranging from 146,4 to 239 nm. The lyophilization process was capable to obtain NPs with excellent stability and particle recovery and shows influence in SB-83 delivery. Encapsulation efficiency varied between 65% and 86%, contingent upon the specific preparation method. A sustained release of SB-83 from the nanoparticles was observed over a period of up to 96 hours. In vitro analyses confirmed the efficacy of SB-83-loaded nanoparticles against both promastigote and amastigote forms of Leishmania (L.) amazonensis, demonstrating a substantial increase in the selectivity index to 50% and a reduction in cytotoxicity toward macrophages by more than 85%. Collectively, these findings indicate that PLA nanoparticles loaded with SB-83 offer a promising drug delivery platform for the treatment of leishmaniasis, providing prolonged release, enhanced efficacy and selectivity against the parasite, and decreased adverse effects. These results underscore the potential of nanoparticle-based systems as innovative and effective therapeutic strategies for leishmaniasis.
11. Text Message (SMS) Microlearning for Tobacco Use Disorder: Pre-Post Pilot Study of Clinician Confidence.
期刊: JMIR medical education 发表日期: 2025-Dec-09 链接: PubMed
摘要
Clinicians are central to treating tobacco use disorder, yet practical training is inconsistent, and confidence varies. Brief, text message-based microlearning may offer a low-burden way to strengthen foundational competencies in busy clinical settings. This paper aims to evaluate whether a short SMS microlearning series improves clinicians’ self-reported confidence in managing tobacco use disorder. We conducted a single-arm, pre-post educational pilot at an academic medical center. A brief formative survey (13 items; 106 respondents) identified local knowledge gaps and informed message topics and sequencing. The 13-day series delivered 1 concise message per day with key teaching points and links to curated resources. The prespecified primary outcome was self-reported confidence in managing tobacco use disorder (1-100 scale) measured immediately before and after the series. Of the 34 clinicians who signed up, 22 completed the baseline questionnaire and enrolled (attendings: n=4, 18%; trainees: n=18, 82%). Changes in confidence among participants with paired ratings were tested with a paired t test. Engagement with embedded links was recorded. All enrolled participants completed the 13-day series; none unsubscribed. Postintervention confidence ratings were provided by 18 participants. Mean confidence increased from 60 (SD 16) at baseline to 85 (SD 10) after the series (t17=-10.71; P<.001). Embedded links were opened in 67% (178/266) of messages. Free-text feedback was predominantly positive and emphasized the convenience, clarity, and point-of-care usefulness of brief messages. A brief SMS microlearning series was associated with a substantial improvement in clinicians’ confidence to manage tobacco use disorder, with high completion and evidence of engagement. This low-cost, scalable approach appears practical for busy clinicians. Findings should be interpreted cautiously given the single-arm design, self-selection, and reliance on self-reported confidence rather than objective knowledge or clinical outcomes. Future studies should include a validated knowledge assessment, a randomized comparison, broader sampling, and follow-up to assess durability and impact on care.
12. A Mobile App to Enhance Awareness of Vaccination in Adults With Psoriasis and Atopic Dermatitis: Development and Preliminary Evaluation Study.
期刊: JMIR formative research 发表日期: 2025-Dec-09 链接: PubMed
摘要
Patients with psoriasis and atopic dermatitis are at increased risk of several vaccine-preventable diseases. Despite this increased susceptibility to infections, vaccination uptake in adults with psoriasis and atopic dermatitis, especially if treated with biologics and other systemic immunomodulators, is insufficient. As mobile health technologies may support behavior change, a mobile app called DermatoVax was developed to raise awareness of immunization in adult patients with psoriasis and atopic dermatitis. This paper aims to describe the processes of development of the DermatoVax app and its initial evaluation in terms of technical verification and physicians’ quality rating. The app was conceived in a user-centered fashion. Its core component was the vaccine checker, which allows the app to produce a sharable list of recommended vaccines, immunization timings, and eventual precautions from a short set of input data. App prototypes were extensively piloted, and feedback from potential end users was obtained to refine the app content. The readability of the textual narratives was measured using the Italian-specific Gulpease index, which ranges from 0 to 100, where 100 indicates the best readability. The quality of the final version was evaluated by 46 medical doctors (n=29, 63% dermatologists and n=17, 37% public health physicians) using a validated Italian user version of the Mobile App Rating Scale (uMARS). Iterative steps during the app development process allowed us to increase its user-friendliness and comprehensibility. Proper functioning of the checker was confirmed through the correct and complete generation of recommended vaccine lists for 50 mock patients with psoriasis and atopic dermatitis. An overall Gulpease index of 41.0 was observed for the final textual narratives, suggesting acceptable readability properties for patients with a high school diploma. Of a maximum of 5 points, the average uMARS score was 4.22 (SD 0.49). Ratings provided by dermatologists (mean 4.28, SD 0.48) were similar (P=.33) to those provided by public health physicians (mean 4.12, SD 0.51). However, the mean uMARS scores for the quality dimensions of aesthetics (3.88, SD 0.78) and engagement (3.89, SD 0.68) were lower than those for information (4.64, SD 0.42) and functionality (4.47, SD 0.46), suggesting margins for improvement. The app’s perceived impact was notably high, with over 80% of physicians agreeing that its use would significantly improve patient awareness (39/46, 85%) and knowledge (41/46, 89%) of vaccination, leading to increased vaccination uptake (37/46, 80%). DermatoVax is a promising tool to raise awareness of immunization in adult patients with psoriasis and atopic dermatitis. Further assessment of the app, such as its effectiveness in increasing vaccination uptake, is warranted.
13. Feasibility of Hemolytic Disease of the Fetus and Newborn Case Ascertainment and Assessing Its Impact on Prenatal and Postnatal Outcomes: Protocol for Observational Studies.
期刊: JMIR research protocols 发表日期: 2025-Dec-09 链接: PubMed
摘要
Hemolytic disease of the fetus and newborn (HDFN) is a rare but serious condition caused by maternal-fetal red blood cell antigen incompatibility. In an affected pregnancy, maternal immunoglobulin G antibodies cross the placenta and target fetal or neonatal red blood cells, leading to hemolysis, hyperbilirubinemia, and anemia. Although routine screening and alloimmunization prevention programs have contributed to the decline in HDFN in the United States, further understanding of its epidemiology is still needed. This protocol aims to provide an overview of the study design, methodology, and analytical approach used to investigate the epidemiology, treatment, and health care resource use of HDFN within a large integrated health care system. We conducted a retrospective cohort study of pregnant women who received obstetric care in the Kaiser Permanente Southern California (KPSC) health care system from January 1, 2008, to June 30, 2022. To identify HDFN cases, we used a novel methodology developed by KPSC researchers combining structured data and detailed clinical information extracted from unstructured records via a natural language processing-assisted chart review process. Chi-square and Wilcoxon rank sum tests were used to compare the distributions of maternal and infant demographic characteristics, as well as medical and perinatal conditions, by HDFN status. We also evaluated the association between HDFN and adverse perinatal outcomes using logistic regression models. Planned analyses using this unique cohort will include describing the annual prevalence, health care resource use, and treatment patterns of mothers and infants by HDFN status. The study population consisted of 464,711 pregnancies, of which 136 (0.03%) were HDFN cases confirmed by chart review, resulting in 138 (0.03%) births (n=137, 0.99% live births and n=1, 0.01% stillbirth). The mean age at pregnancy was 29.8 (SD 5.7) years, and the population was racially and ethnically diverse. We present an overview of the methodology developed by KPSC clinicians and researchers on the epidemiology, treatment, and health care resource use of HDFN within a large and demographically diverse population of pregnant women. Our novel methodology, combining both structured and unstructured data and a natural language processing-assisted chart review process, ensures the successful identification of true cases to carry out pharmaco-epidemiological studies. DERR1-10.2196/77836.
14. Development and Implementation of an Internal Quality Control and External Quality Assessment Information System for a Regional Medical Laboratory Center: Pilot Design and Implementation Study.
期刊: JMIR formative research 发表日期: 2025-Dec-09 链接: PubMed
摘要
The Regional Medical Laboratory Center (RMLC) integrates laboratory departments from hospitals with different levels to optimize resource allocation, enhance testing efficiency, and promote the sharing of professional expertise. Despite these benefits, ensuring consistent quality control (QC) across the RMLC presents a significant challenge due to diverse equipment, procedures, and staff expertise levels. To address these challenges, this study provided an information tool called iLab, developed by Shenzhen Huikang Information Technology Co, Ltd, for managing internal quality control (IQC) and external quality assessment (EQA). This study aimed to develop and implement an integrated informatics platform managing IQC and EQA across RMLC. We integrated 4 software programs to manage IQC and EQA, laboratory information system (LIS) supplied by Shanghai Tengcheng Medical Tech-Info Co, Ltd; Quality Control Box (QCBOX) and Quality Control EQA Center (QCEC) provided by Bio-Rad Laboratories (Shanghai) Co, Ltd; and the iLab electronic recording system. The platform centralizes QC data processing, with QCBOX and QCEC handling operational workflows, while iLab oversees documentation, analytics, and approval processes. It was successfully deployed in August 2023 across a pilot network comprising 5 district hospitals, 1 central laboratory, and 4 community health stations in Shenzhen’s Luohu District. By leveraging the LIS-QCBOX data flow, the platform streamlined the entire IQC process, which incorporated interlaboratory comparisons and iLab-facilitated postanalysis management. Concurrently, EQA was enhanced through electronic documentation, multirule analysis of acceptable data, regional proficiency testing via QCEC, and measurement uncertainty (MU) estimation. By September 2025, the platform supported 114 users, integrating 133 instruments and 859 active QC items, and generated 2331 monthly IQC analysis reports, 340 EQA multirule analyses, and 289 MU reports. Comparative analysis revealed marked improvements in key metrics from 2023 (preimplementation) to 2024 (postimplementation): the IQC implementation rate rose from 97.79% to 99.87% (P<.001), the report error rate decreased from 0.048% to 0.027% (P<.001), and the intralaboratory turnaround time compliance rate increased from 95.49% to 95.71% (P<.001). The annual EQA unacceptable rate dropped from 0.34% in 2023 to 0% in 2024. The number of ISO (International Organization for Standardization) 15189-accredited test items increased from 203 in 2022 to 206 in 2024. The iLab system establishes a scalable framework for standardized IQC and EQA management in RMLC, demonstrating significant potential to enhance regional laboratory quality.
15. Unraveling the Factors Associated With Digital Health Intervention Uptake: Cross-Sectional Study.
期刊: JMIR mHealth and uHealth 发表日期: 2025-Dec-09 链接: PubMed
摘要
Chronic noncommunicable diseases (NCDs) remain a leading health challenge worldwide, and reducing modifiable lifestyle risk factors is a key prevention strategy. Digital health interventions (DHIs) offer scalable, cost-effective tools to support healthy behaviors, but concerns persist about their equitable reach and uptake across population groups. This study aimed to examine how socioeconomic factors, health status, lifestyle behaviors, and attitudes and experiences related to the use of electronic services (e-services) are associated with the uptake of a DHI. In this cross-sectional study, we invited (through mail or SMS) a subgroup of 6978 participants aged 20-74 years from the population-based Healthy Finland survey to take part in a DHI. The DHI, delivered via the web-based BitHabit app, aimed to support the adoption of healthy lifestyle habits. Uptake was defined as successful registration, agreeing to the terms of use, and accepting the invitation to participate. Predictor variables were drawn from national registry and self-reported survey data and included socioeconomic status, health indicators, lifestyle behaviors, and attitudes and experiences related to the use of e-services. Adjusted logistic regression models were used to identify significant predictors of DHI uptake. Of the final sample of 6975 participants, 1287 (18.5%) started using the DHI. Uptake was significantly higher among women (adjusted odds ratio [aOR] 1.69, 95% CI 1.49-1.93), middle-aged individuals (aOR 1.47, 95% CI 1.21-1.79), and those with higher income (aORs 1.76-1.97, 95% CIs 1.37-2.59) and more years of education (aOR 1.10, 95% CI 1.08-1.12). Healthier lifestyle indicators, including better diet quality (aOR 1.07, 95% CI 1.04-1.10), less frequent smoking or nonsmoking (aORs 1.59-2.29, 95% CIs 1.08-3.12), sleep (aOR 0.58, 95% CI 0.37-0.86), higher functional capacity (aOR 1.06, 95% CI 1.02-1.11), and good overall current health (aOR 1.46, 95% CI 1.15-1.89), were associated with increased likelihood of DHI uptake. The strongest predictors were related to the use of e-services: Individuals who used e-services (aORs 2.48-6.08, 95% CIs 1.19-11.92) reported higher competence to use e-services (aORs 2.00-4.10, 95% CIs 1.44-5.92), had low concerns about data security (aORs 1.37-1.76, 95% CIs 1.03-2.33), believed in the benefits of digital services (aOR 1.04, 95% CI 1.02-1.05), and had better internet connections had higher odds of uptake. Our findings show that DHI uptake is associated with socioeconomic status, health and lifestyle factors, and, especially, individuals’ experience and attitudes toward e-services. Individuals with lower education levels, lower income, and poorer health and lifestyle habits are less likely to adopt DHIs, raising concerns about potential digital health inequities. These results underscore the need for targeted strategies to reduce barriers and ensure more equitable reach and engagement in future DHI implementations.
16. Development of an Ecological Momentary Assessment Study to Identify Real-Time Predictors of Physical Activity Among Older People With HIV: Protocol for a 2-Phase Mixed Methods Study.
期刊: JMIR research protocols 发表日期: 2025-Dec-09 链接: PubMed
摘要
People with HIV are aging rapidly and face accelerated aging-related comorbidities, including cardiovascular diseases and cognitive impairment, due to prolonged HIV-associated inflammation. Physical activity (PA) is a well-established intervention to mitigate these risks; yet, most older people with HIV remain sedentary. Despite considerable efforts to understand PA determinants and design interventions for people with HIV, outcomes have been suboptimal. The overarching goal of this project is to use an ecological momentary assessment (EMA) approach to capture ecologically valid relationships between the personal experiences of older people with HIV and PA, as they engage in their normal daily activities. This study will adopt a 2-phase mixed methods research design. The first phase focuses on developing the EMA questionnaire through in-depth interviews with older people with HIV to explore the relevance of candidate real-time predictors of PA, identified using the capacity, opportunity, motivation-behavioral framework and literature review, to their daily experiences. These interviews will validate and refine the constructs for the EMA survey. In phase 2, a 2-week EMA study will collect data from 70 sedentary older people with HIV through smartphone surveys (3 times per day) and Fitbit-measured step counts and moderate to vigorous intensity PA minutes. Multilevel modeling will be used to examine how these factors predict daily PA levels. This research project was funded in June 2024. To date, 13 eligible participants have completed the qualitative interviews. All participants agreed that the constructs of EMA survey are relevant to their PA experiences and acknowledged their time-varying nature. On the basis of the participants’ input, the EMA survey has been finalized. By advancing the understanding of real-time determinants of PA, this study addresses a critical gap in the literature and offers a foundation for designing just-in-time adaptive interventions that provide tailored, context-specific support to enhance PA engagement and promote healthy aging among older people with HIV. DERR1-10.2196/81238.
17. Data Visualization Support for Interdisciplinary Team Treatment Planning in Clinical Oncology: Scoping Review.
期刊: Journal of medical Internet research 发表日期: 2025-Dec-09 链接: PubMed
摘要
Complex and expanding datasets in clinical oncology applications require flexible and interactive visualization of patient data to provide physicians and other medical professionals with maximum amount of information. In particular, interdisciplinary tumor conferences profit from customized tools to integrate, link, and visualize relevant data from all professions involved. Our objective was to identify and present currently available data visualization tools for tumor boards and related areas. We wanted to provide an overview of not only the digital tools currently used in tumor board settings but also of the data they include, their respective visualization solutions, and their integration into hospital processes. This scoping review was based on the scoping study framework by Arksey and O’Malley and attempted to answer the following research question: “What are the key features of data visualization solutions used in molecular and organ tumor boards, and how are these elements integrated and used within the clinical setting?” The following electronic databases were searched for articles: PubMed, Web of Science, and Scopus. Articles were deemed eligible if published in English in the last 10 years. Eligible articles were first deduplicated, followed by screening of titles and abstracts. Full-text screening was then conducted to decide on article selection. All included articles were analyzed using a data extraction template. The template included a variety of meta-information, as well as specific fields aiming to answer the research question. The review process started with 2049 articles, of which 1014 (49.49%) were included in the title and abstract screening. A total of 5.47% (112/2049) of the publications were eligible for full-text screening, leading to 2.93% (60/2049) of the publications being eligible for final inclusion. They covered 49 distinct visualization tools and applications. We discovered a variety of innovative visualization solutions, most often driven by the complexity of omics data, represented in 96% (47/49) of the tools. Tables remained the most used tool for the visualization of data types described in the articles. Approximately one-third of the identified tools (16/49, 33%) were systematically evaluated in some form. For most discovered tools (37/49, 76%), there was no documentation of implementation into the clinical routine. A significant number of applications (21/49, 43%) were available through open-source access. There is a wide range of projects providing visualization solutions for tumor boards and clinical oncology applications. Among the few tools that have made their way into clinical routine settings, there are both commercial and academic solutions. While tables for a variety of data types remain the dominant visualization strategy, the complexity of omics data appears to be the driving force behind many visualization innovations in the domain of tumor boards. RR2-10.2196/53627.
18. Proactively Delivered Digital Mental Health Support for Health Care Workers: Usability and Acceptability Evaluation.
期刊: JMIR formative research 发表日期: 2025-Dec-09 链接: PubMed
摘要
Health systems are investing in mental health and well-being support tools and resources for health care workers (HCW). Considering the mental health strain facing HCWs, there is a need to optimize the current mental health delivery model. This study aimed to evaluate the usability and acceptability of a proactive digital mental health approach (Cobalt+;Penn Medicine), which included services proactively sent to HCWs via text messaging, including (1) monthly automated text messaging reminders and links to Cobalt, and (2) bimonthly text-message-based measures of depression and anxiety. This study used the System Usability Scale (SUS), Net Promoter Score (NPS), and open-ended questions to capture Cobalt+ participants who received proactive digital mental health tools and resources. Descriptive summary statistics were used for SUS and NPS outcome measures, and a chi-square test was used to detect group differences. Open-ended questions were analyzed using a qualitative open coding process by 2 coders. Research team members calculated interrater agreement (Cohen κ above 0.80). A total of 162 of 642 HCWs randomized to Cobalt+ (25.2%) visited Cobalt due to a proactive text message and completed usability and acceptability measures. The mean age was 38.9 years, most were female (90.7%), 56.8% White, 53.1% married or partnered, and 34.6% engaged in shift work. The mean SUS score was 74.43 (median score 72.5). Participants said they mostly “browsed” the online mental health platform. Cobalt+ received an NPS of 13.7. When asked to elaborate on their experience, 2 categories (eg, positive and negative experiences) with 13 subcategories were identified. Most participants noted the brief process that helped prioritize mental health: “Forget otherwise. Puts in forefront of my mind,” and “Your texts do remind me to take stock of my current feelings.” A proactive digital mental health approach may help overcome barriers in the uptake of services that are otherwise passively available to HCWs. This study demonstrated that the proactive approach is generally usable, modestly acceptable, and further supplemented by HCW feedback. These findings suggest the approach’s viability and the need for additional research toward improvement and broader implementation. ClinicalTrials.gov NCT05028075; https://clinicaltrials.gov/study/NCT05028075.
19. Access to Specialized Medical Training in Spain and Determinants of Failure in the National Entrance Examination: Econometric Modeling Study.
期刊: JMIR formative research 发表日期: 2025-Dec-09 链接: PubMed
摘要
The process of accessing specialized medical training in Spain is a complex issue, involving not only the evaluation of medical knowledge acquired throughout university training but also the interaction of factors of a contextual and structural nature, which can influence the results obtained in the entrance examination. In this context, research on the variables that determine performance in this test is of great relevance form not only an academic but also a social and economic point of view. The interaction among factors such as academic performance, gender, nationality, and timing offers a unique opportunity to evaluate the functioning of the educational system at a critical moment in its recent history. Research that has focused specifically on access to specialized medical training has shown mixed results on how these factors impact examination performance. This study aimed to approximate the factors that determine failure in the entrance test for specialized medical training in Spain with the aim of better understanding the extent to which differences based on sex, nationality, and the context of the COVID-19 pandemic contribute to explaining such failure. We carried out econometric modeling of the final results obtained in the entrance examination to specialized medical training and identified the explanatory factors that determine the results, their relevance, effect, and significance. Econometric modeling provides a rigorous framework for estimating the causal effect of different variables on the final examination score. It helps identify not only which variables have an impact on performance but also to what extent they do so and under what conditions. Based on the results obtained in the 2019-2021 test calls (7217 eliminated candidates), academic records (P<.001) and examination scores (P<.001), together with demographic factors including sex (P=.54) and nationality (P<.001), and calendar year (P<.001) were determinants of the behavior observed in the final results. Our results do not indicate whether being male or female favors or decreases the final grade obtained; however, being Spanish constitutes a relevant explanatory factor in our final results. The calendar effect, directly related to the COVID-19 pandemic, allows us to quantify the negative impact on the final results. This study investigated the impact of factors such as sex, nationality, and the COVID-19 pandemic on access to specialized medical training in Spain. Empirically, not being Spanish acts as an unfavorable fixed characteristic in the baseline econometric model, but it becomes favorable when considering the candidate’s academic record. The impact of language is not perceived as a limiting factor; the test exclusively evaluates knowledge of medical content. The negative effects of the COVID-19 pandemic are visualized in the final scores.
20. Patterns of Prior Induced Abortions and the Likelihood of Subsequent Natural Pregnancy Loss: Exploratory Application of Pregnancy Outcome Sequencing.
期刊: JMIR formative research 发表日期: 2025-Dec-09 链接: PubMed
摘要
Research concerning the long-term health consequences of induced abortion is constrained by both the limitations in the availability of data necessary to construct complete reproductive histories, as well as the limitations in the analytical methods necessary to interpret them. This study aims to determine the association of induced abortion and the likelihood of a subsequent natural loss by applying the pregnancy outcome sequence (POS), a research construct that defines the number and order of all pregnancy outcomes (births, induced abortions, natural losses) in each woman’s reproductive history. Using the Medicaid Analytic eXtract files from the Centers for Medicare and Medicaid Services Chronic Conditions Warehouse, we identified a study population of 508 unique POSs, representing 5455 women, each of whom had 1 to 16 pregnancy outcomes, for a total of 14,198 pregnancies. We applied an exploratory iterative sequential analytical approach, which included aggregate POS correlation analysis, logistic multiple regression, and simultaneous CIs (Agresti and Tukey-Kramer methods). We also established counting methods to populate the data tables for each analytical phase. Overall, we found evidence to conclude that both prior abortions and natural losses are significantly associated with the risk of subsequent natural losses. For abortion, there is evidence of a dose-response relationship from 0 to 3 abortions and the likelihood of subsequent natural loss. For natural loss, the risk of a subsequent natural loss is significant after 2 natural losses and between the first and second. There is no association of prior births, or any combination of birth/abortion or birth/natural loss, with the risk of subsequent natural loss. Limitations imposed by the skewed distribution of the number of total pregnancies per reproductive history, resulting in small cell sizes, and exclusion of important covariates, restrain assurance in the results. The POS demonstrates that the order and combinations of pregnancy outcomes may result in varying conclusions that were previously undetectable. Therefore, further methodological development is indicated.
21. Digital Health Technologies: Learnings and Perspectives From a Patient Engagement Stakeholder Expectations Matrix Study.
期刊: Journal of medical Internet research 发表日期: 2025-Dec-09 链接: PubMed
摘要
As digital health technologies become increasingly integrated into health care systems worldwide, there is growing recognition that their full potential can be realized only when development is rooted in patient engagement (PE). Despite its proven value in clinical research and health care delivery, PE remains insufficiently embedded in digital health design and implementation. This perspective paper explores the current state of PE in digital health through findings from the Stakeholder Expectations Matrix program developed by Patient Focused Medicines Development. Drawing from 37 in-depth interviews across 6 key stakeholder groups, complemented by insights gathered during a multisession cocreation track at the Patient Engagement Open Forum, this paper highlights differing perspectives on digital health, the barriers to meaningful engagement, and the fragmented nature of data governance and technology adoption. Findings point not only to significant gaps in shared understanding, infrastructure, and policy but also to clear opportunities for collaboration, including early recommendations for building a more inclusive and patient-centered digital health ecosystem, one that supports sustainable innovation, trust, and systemwide impact.
22. Policing as a Structural Determinant of Health.
期刊: Annual review of public health 发表日期: 2025-Dec-09 链接: PubMed
摘要
Policing in the United States functions as a structural determinant of health, with direct and collateral impacts that extend well beyond maintaining order and public safety. This review synthesizes recent evidence (from 2015 to 2025) on the relationship between policing and health. Using a rapid evidence assessment, we examine peer-reviewed and gray literature to capture physical, mental, and community-level outcomes, as well as pathways and mechanisms that link policing to health. Findings indicate that police use of force results in significant injury and deaths annually, disproportionately affecting communities of color. Beyond direct effects, policing contributes to chronic stress, trauma, and economic strain across community and occupational ecosystems. These collateral impacts compound existing structural inequities. Despite promising alternatives to police responses, evidence gaps and reliance on cross-sectional studies limit causal inference. Future research should strengthen data systems, focus on causal research, and integrate public health priorities into public safety strategies.
23. Surgeons' and payers' perceptions of barriers to accessing bariatric and metabolic surgery in Argentina: An exploratory qualitative study.
期刊: Medwave 发表日期: 2025-Dec-09 链接: PubMed
摘要
Bariatric and metabolic surgery is a safe and effective method for treating clinically severe obesity. In Argentina, Law 26 396 and its amendments establish the regulatory framework for its coverage. However, administrative, regulatory, and financial barriers limit effective access to it, with gaps remaining in its scope and understanding. This study aimed to explore surgeons’ and health insurance providers’ perceptions of the implementation of bariatric and metabolic surgery in Argentina, within the framework of Law 26 396, and to identify the barriers that impede effective, timely access. We conducted an exploratory qualitative study comprising 16 in-depth virtual interviews with eight surgeons specializing in bariatric and metabolic surgery and eight health insurance officers of the Argentine healthcare system, conducted between November and December 2024. The sampling was intentional. The interviews were recorded, transcribed, and coded. A thematic and recursive analysis was conducted, enabling us to identify emerging categories. We identified multiple barriers and challenges to the effective implementation of bariatric and metabolic surgery in Argentina, including geographic inequalities, heterogeneity in surgical module agreements, administrative and bureaucratic restrictions related to variability in the interpretation of the law and its requirements, high costs, and the imposition of quotas that delay timely access, among others. The implementation of bariatric and metabolic surgery presents structural and functional challenges that affect equitable and timely access. Although Law 26 396 and its subsequent regulations established a regulatory framework for its coverage, tensions among healthcare system actors and regional disparities have resulted in heterogeneous implementation. Administrative and financial barriers persist, affecting its effective and timely practice. We highlight the need to strengthen coordination between physicians and health insurance providers, promoting opportunities for dialogue that optimize authorization and funding processes. La cirugía bariátrica y metabólica es un método seguro y eficaz para tratar la obesidad clínicamente grave. En Argentina, la Ley 26 396 y sus modificatorias establecen el marco normativo para su cobertura. Sin embargo, barreras administrativas, regulatorias y financieras limitan su acceso efectivo, persistiendo vacancias en su alcance y comprensión. El objetivo del documento es explorar percepciones de cirujanos y financiadores respecto a la implementación de la cirugía bariátrica y metabólica en Argentina, en el marco de la referida ley identificando barreras que influyen en el acceso efectivo y oportuno. Estudio cualitativo exploratorio basado en 16 entrevistas en profundidad, virtuales, a ocho médicos cirujanos especialistas en cirugía bariátrica y metabólica y a ocho financiadores del sistema de salud argentino entre noviembre y diciembre de 2024. El muestreo fue intencional. Las entrevistas fueron grabadas, transcritas y codificadas. Se realizó un análisis temático y recursivo que permitió abordar categorías emergentes. Identificamos múltiples barreras y desafíos en la implementación efectiva de la cirugía bariátrica y metabólica en Argentina. Entre ellos destacan desigualdades geográficas, heterogeneidad en los acuerdos de los módulos quirúrgicos, restricciones administrativas y burocráticas relacionadas con la variabilidad en la interpretación de la ley y sus requisitos, altos costos e imposición de cupos que retrasan el acceso oportuno, entre otros. La implementación de la cirugía bariátrica y metabólica presenta desafíos estructurales y funcionales, que afectan el acceso equitativo y oportuno. Si bien la Ley 26 396 y sus reglamentaciones posteriores establecieron un marco normativo para su cobertura, las tensiones entre actores del sistema de salud y características geográficas han generado una aplicación heterogénea de la normativa. Dicha aplicación enfrenta barreras administrativas y financieras que impactan en su práctica efectiva y oportuna. Destacamos la necesidad de fortalecer la articulación entre médicos y financiadores, promoviendo instancias de diálogo que permitan optimizar los procesos de autorización y financiamiento.
24. Adoption of Machine Learning in US Hospital Electronic Health Record Systems: Retrospective Observational Study.
期刊: Journal of medical Internet research 发表日期: 2025-Dec-09 链接: PubMed
摘要
While machine learning (ML) technologies have shifted from development to real-world deployment over the past decade, US health care providers and hospital administrators have increasingly embraced ML, particularly through its integration with electronic health record (EHR) systems. This evolving landscape underscores the need for empirical evidence on ML adoption and its determinants; however, the relationship between hospital characteristics and ML integration within EHR systems remains insufficiently explored. This study aimed to examine the current state of ML adoption within EHR systems across US general acute care hospitals and to identify hospital characteristics associated with ML implementation. We used linked data between the 2022-2023 American Hospital Association Annual Survey and the 2023-2024 American Hospital Association Information Technology Supplement Survey. The sample includes 2562 general and acute care hospitals in the United States with a total of 4055 observations over 2 years. Applying inverse probability weighting to address nonresponse bias, we used descriptive statistics to assess ML adoption patterns and multivariate logistic regression models to identify hospital characteristics associated with ML adoption. Overall, about 75% of the hospitals had adopted ML functions within their EHR systems in 2023-2024, and the majority tended to adopt both clinical and operational ML functions simultaneously. The most commonly adopted individual functions were predicting inpatient risks and outpatient follow-ups. ML model evaluation practices, while still limited overall, showed notable improvement. Multivariate regression estimates indicate that hospitals were more likely to adopt any ML if they were not-for-profit (4.4 percentage points, 95% CI 0.6-8.2; P=.02), large hospitals (15 percentage points, 95% CI 9.4-21; P<.001), operated in metropolitan areas (4.3 percentage points, 95% CI 0.8-7.8; P=.02), contracted with leading EHR vendors (20.6 percentage points, 95% CI 17.1-24; P<.001), and affiliated with a health system (26.8 percentage points, 95% CI 22.4-31.3; P<.001). Similar patterns were observed for predicting the adoption of both clinical and operative ML. We also identified specific hospital characteristics associated with the adoption of individual ML functions. ML adoption in hospitals is influenced by organizational resources and strategic priorities, raising concerns about potential digital inequities. Limited quality control and evaluation practices highlight the need for stronger regulatory oversight and targeted support for underresourced hospitals. As the integration of ML into EHR systems expands, disparities in both adoption and oversight become increasingly critical. To ensure the equitable, safe, and effective implementation of ML technologies in health care, well-designed policies must address these gaps and promote inclusive innovation across all hospital settings.
25. Isoscapes as a Regional-Scale Tool for Tracing Groundwater Uranium Cycling in the Northern Plains, United States.
期刊: Environmental science & technology 发表日期: 2025-Dec-09 链接: PubMed
摘要
Groundwater uranium (U) contamination poses a significant health risk, particularly in Native American communities reliant on private wells. This study examines groundwater U cycling in a tribal region in South Dakota that participates in the Strong Heart Water Study based on samples from 140 private wells. We measured U concentrations, δ238U, (234U/238U), and redox-sensitive elements, including iron (Fe), manganese (Mn), nitrate (NO3-), selenium (Se), and vanadium (V). Uranium concentrations range from 0.4 to 48.2 μg/L, with 5% exceeding the U.S. EPA maximum contaminant level of 30 μg/L. Spatial patterns in δ238U and (234U/238U) delineate distinct redox regimes: oxidizing zones in the northeast show higher U (median = 18 μg/L) and positive δ238U values (from 0.08 to 0.30‰), while reducing zones in the southwest display lower U (median = 10 μg/L) and large negative δ238U values (from -0.61 to -0.30‰). The (234U/238U) values (from 1.53 to 3.07, median of 2.03) serve as a tracer of source proximity, with lower values (1.53-1.80) indicating shorter travel distance relative to the U source and higher values (1.80-2.50) reflecting U transported farther along flow paths. Cluster and uniform manifold approximation and projection (UMAP) analyses identify three geochemical environments consistent with oxidizing, reducing, and intermediate redox conditions. Constructing the first δ238U and (234U/238U) isoscapes for a sandstone aquifer, we show that U is released by oxidative dissolution in the northeast and removed under reducing conditions in the southwest and that the northeastern zone may require continuous monitoring and intervention for exposure reduction.
26. Combining ACL Reconstruction with Lateral Extra-Articular Tenodesis Reduces Long-Term Osteoarthritis Risk Versus Isolated ACL Reconstruction: A Systematic Review and Meta-Analysis.
期刊: The Journal of bone and joint surgery. American volume 发表日期: 2025-Dec-09 链接: PubMed
摘要
Lateral extra-articular tenodesis (LET) is increasingly used to augment anterior cruciate ligament reconstruction (ACLR), particularly in patients with high-grade rotatory instability. Despite demonstrated biomechanical advantages, the long-term effect of LET on posttraumatic osteoarthritis (OA) remains unclear. We hypothesized that adding LET to ACLR reduces development of long-term moderate-to-severe radiographic OA, particularly after meniscectomy. We performed a PRISMA-compliant systematic review and meta-analysis, which was registered with PROSPERO. PubMed, Cochrane CENTRAL, and Scopus were searched through March 2025. Eligible randomized controlled trials (RCTs) or comparative cohort studies reported radiographic moderate-to-severe OA after ACLR with versus without LET, with a minimum follow-up of 5 years. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using a random-effects model. Six studies with 444 patients (mean follow-up, 13.1 years) were included. LET was associated with a significant reduction in moderate-to-severe OA in the lateral compartment. Subgroup analysis showed a significant reduction in lateral OA as measured using both the Kellgren-Lawrence (K-L) (OR, 2.87; 95% CI, 1.2 to 6.9; p = 0.02) and International Knee Documentation Committee (IKDC) classifications (OR, 4.38; 95% CI, 1.5 to 12.7; p = 0.01). In contrast, no significant difference was found in the medial compartment for either the K-L (OR, 1.26; 95% CI, 0.7 to 2.4; p = 0.49) or IKDC classification (OR, 2.06; 95% CI, 0.6 to 6.8; p = 0.24). In meniscectomized knees, LET significantly reduced OA risk, especially as measured with the IKDC (OR, 6.14; 95% CI, 1.7 to 22.6; p = 0.01) compared with the K-L classification (OR, 3.61; 95% CI, 1.1 to 12.3; p = 0.04). In contrast, although LET also reduced OA risk in non-meniscectomized knees, the difference was not significant. Compartment-specific OA data were unavailable within the meniscal subgroups. This meta-analysis, the first to assess the long-term effect of LET on OA, indicated that LET significantly reduces moderate-to-severe OA risk, particularly in the lateral compartment and among meniscectomized knees. Findings support selective LET use during ACL reconstruction, especially in cases with compromised meniscal integrity, to help mitigate OA progression. Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
27. DICER1 mutational analysis of pleuropulmonary blastoma: a single institutional experience.
期刊: Japanese journal of clinical oncology 发表日期: 2025-Dec-09 链接: PubMed
摘要
DICER1 syndrome is a relatively recently identified hereditary tumor predisposition syndrome, strongly associated with pleuropulmonary blastoma (PPB) and other neoplasms, but its actual status in Japan is unclear. We retrospectively performed germline DICER1 gene analysis in patients with suspected PPB at our institute between 2003 and 2022. Relevant clinical data were extracted from the medical records. Six patients with PPB were identified, of whom four harbored pathogenic germline variants in DICER1. Only one patient had a family history of childhood or juvenile cancer. Genetic testing of unaffected family members was performed in two families, revealing three asymptomatic carriers, including one infant carrier. Two of the three carriers underwent active surveillance, and no new tumors were detected on follow-up at 6 and 2.5 years after diagnosis, respectively. A high prevalence of DICER1 germline variants was observed in patients with PPB, consistent with previous studies. Family history alone may be insufficient to suspect DICER1 syndrome, and thus, proactive genetic testing of family members is advisable in all cases of PPB.
28. Long-term association between body size in adolescence or early adulthood and future fracture risk.
期刊: Journal of bone and mineral metabolism 发表日期: 2025-Dec-09 链接: PubMed
摘要
Body size is known to influence bone mass and fracture risk throughout life; however, the critical period at which body size most strongly affects later fracture risk remains unclear. Herein, we investigated whether body size in adolescence or early adulthood is more strongly associated with future fracture risk, hypothesizing a stronger association for adolescence. Participants included health examination attendees in the Okazaki region of the Japan Multi-Institutional Collaborative Cohort Study aged 35-79 years. Overall, 2152 males (mean age 58.5 ± 10.9 years) and 1900 females (54.9 ± 10.2 years) were analyzed. In the primary survey (2007-2011), participants recalled body size in junior high school and their 20 s. In the secondary survey, conducted approximately 5 years later, participants self-reported fracture history in the past year. Associations between recalled body size and fracture risk were examined using logistic regression. Females with a thin body size in junior high school had a higher fracture risk than those with a normal body size (OR 2.29; 95% CI 1.10-4.76). However, a thin body size in the 20 s showed no association (OR 0.83; 95% CI 0.33-2.06). Additionally, no significant associations were observed for overweight females or males in either period. In females, a thin body size in adolescence may be more strongly associated with future fractures than in early adulthood. Our findings provide a basis for future research confirming these associations with objective measures and longer follow-up.
29. Review no. 1: designing clinical kidney research using real-world data: research questions, data sources, and analytical skills.
期刊: Clinical and experimental nephrology 发表日期: 2025-Dec-09 链接: PubMed
摘要
This review series provided methodological guidance for clinical kidney research using real-world data, building on the “Hands-on R Seminar for Clinical Research: acute kidney injury (AKI) Detection and estimated glomerular filtration rate (eGFR) Slope Estimation from Creatinine Data,” held at the 68th Annual Meeting of the Japanese Society of Nephrology in 2025. The seminar offered participants mock datasets, R scripts, and practical exercises to set up analysis environments and conduct data analyses, alongside brief lectures on conducting clinical research on AKI and eGFR decline. This series expands and complements the seminars. In Part 1, we provide an overview of the key components essential for successful clinical kidney research. First, formulating a robust research question is crucial, grounded in clinical experience and informed by up-to-date evidence. Common outcomes or exposures in clinical kidney studies include eGFR slope (as a marker of chronic kidney disease progression), AKI incidence, and initiation of kidney replacement therapy. Second, identifying appropriate data sources is necessary. In addition to primary data collection, routinely collected electronic health records and real-world databases (including disease registries) have become more accessible. Here, we summarize real-world databases in Japan, particularly those that include serum creatinine and urine test results. Finally, researchers require proper data handling and analytical skills. We highlight kidney research-specific techniques, such as AKI detection and eGFR slope calculation from longitudinal creatinine data. Subsequent articles in this series (Part 2 and beyond) will detail each specific method and include practical R commands.
30. Amyloid A amyloidosis associated with Streptococcus suis infection in a young commercial pig with wild-type serum amyloid A.
期刊: Veterinary research communications 发表日期: 2025-Dec-09 链接: PubMed
摘要
Amyloid A (AA) amyloidosis is a progressive disease caused by the deposition of AA, an abnormally folded protein derived from serum amyloid A (SAA), in organs throughout the body. AA amyloidosis occurs in various mammals and birds but is extremely rare in commercial pigs. A possible reason for this is that a variant SAA is crucial for the onset of AA amyloidosis in pigs. However, AA amyloidosis with wild-type SAA was recently reported in microminipigs, which are the smallest laboratory pigs, leaving the importance of this variant unclear. This is a report of the involvement of wild-type SAA in AA amyloidosis in 4-month-old three-way crossed pigs (Landrace, Large White, and Duroc: LWD). Using immunohistochemistry, transmission electron microscopy, mass spectrometry, and DNA sequencing, we determined that the amyloid fibrils were derived from wild-type SAA without detectable variant, which is a rare finding in commercial pigs. This finding suggests that AA amyloidosis can occur in commercial pigs regardless of the presence of the SAA variant.
31. Does Creative Bibliotherapy delivered in schools improve mental health-related outcomes for 5-16 year olds? A systematic review.
期刊: Arts & health 发表日期: 2025-Dec-09 链接: PubMed
摘要
There is an increasing need for effective interventions for child and adolescent mental health promotion, with mixed evidence to date on what works. Creative Bibliotherapy has promise as a pragmatic, school-based approach. We undertook a systematic review of experimental or quasi-experimental studies of Creative Bibliotherapy designed to be delivered by teachers in schools to improve any mental health related outcome for children aged 5-16. Of 3405 unique reports retrieved, 23 met the inclusion criteria. The majority were student research dissertations (n = 12); conducted in North America (n = 17); conducted in children aged 12 or under (n = 17). Of the 13 (57%) which reported positive impact on mental health outcomes, authors described the selection of diverse and appropriate materials; structured interaction; and trained delivery by school-based practitioners as important to success. These were neither necessary nor sufficient conditions. Few studies were well defended against risk of bias. There are promising indications that Creative Bibliotherapy in schools can improve mental health and its contributors but, to date, no strong evidence. Much of the literature pre-dates widespread adoption of reporting guidelines, and few designs were robustly defended against bias. Whilst interventions such as Creative Bibliotherapy fit uneasily within experimental evaluation paradigms, many interventions identified in this review could be evaluated with stronger trial designs to identify both positive and negative effects, and (more importantly) the contexts and conditions under which they are likely to improve children’s mental health.
32. The Differential Impact of Emotional Support on Social Problem-Solving and Mental Health Among Latina Immigrant Survivors of Adverse Childhood Experiences.
期刊: Research in nursing & health 发表日期: 2025-Dec-09 链接: PubMed
摘要
Adverse childhood experiences (ACEs) are often positively associated with mental health conditions. We examined whether emotional support attenuates the association between ACE clusters and both social problem solving and mental health assessments (depression, anxiety, post-traumatic stress disorder (PTSD) symptoms). A convenience sample of 336 Latina immigrant women completed questionnaires about their ACEs, emotional support, social problem-solving, and depression, anxiety, and PTSD symptoms. Using PROCESS SPSS Macro version 4.0 we conducted four separate moderation analyses. We identified 5 ACEs clusters from our sample (n = 336): Global ACEs (15.5%), Community Violence and Physical Abuse (23.8%), Physical and Emotional Abuse (21.4%), Household Dysfunction with Physical and Emotional Abuse (16.7%), and Low ACEs (22.6%). Emotional support served as a protective moderator with differential effects, providing the greatest benefit to women who experienced high levels of abuse. For social problem-solving abilities, significant interactions emerged for the Physical and Emotional Abuse and Household Dysfunction clusters, indicating that as emotional support increases, the difference in social problem-solving between these high-ACE clusters and the Low ACEs cluster decreased. For PTSD symptoms, women in the Global ACEs cluster showed significantly higher symptoms than the Low ACEs group when emotional support was low. The clusters did not differ at high emotional support levels, indicating that adequate social support can reduce the negative effects of ACEs on both PTSD symptoms and effective problem-solving. These findings underscore the need for trauma-informed, culturally responsive care models that integrate ACE screening and guide future interventions to strengthen social support networks for ACE survivors.
33. Effectiveness of a Cardiovascular Management System on Triple Risk Factor Control in High-Risk Older Adults: Protocol for a Randomized Controlled Trial.
期刊: JMIR research protocols 发表日期: 2025-Dec-09 链接: PubMed
摘要
Cardiovascular disease (CVD) remains a leading cause of morbidity and mortality in China. Although the National Basic Public Health Services Program provides annual health checkups for older adults, postscreening management of CVD risk factors such as hypertension, dyslipidemia, and diabetes is often inadequate. The CardioCare system is a digital cardiovascular management platform that integrates risk prediction, personalized health interventions, and continuous engagement to address these gaps. This trial aims to evaluate the effectiveness of the CardioCare system in improving triple risk factor control (simultaneous control of blood pressure, lipids, and glycemia) at 12 months among high-risk adults. Secondary objectives include assessing changes in estimated 10-year CVD risk, individual clinical parameters, medication adherence, lifestyle modification, system engagement, usability, satisfaction, and cost-effectiveness. This is a single-center, parallel-group, superiority randomized controlled trial with a 1:1 allocation ratio. A total of 300 adults aged ≥50 years with an estimated 10-year CVD risk of >10% and no previous CVD diagnosis will be recruited from the Health Management Center of the First Affiliated Hospital of Sun Yat-sen University in Guangzhou, China. Participants will be randomized to receive either the CardioCare system intervention or minimal usual care for 12 months. The intervention includes risk stratification and communication, weekly personalized SMS text messages or WeChat messages, and cardiologist oversight. The primary outcome is the proportion of participants achieving triple risk factor control at 12 months. Secondary outcomes include clinical, behavioral, usability, and economic measures. Analyses will follow the intention-to-treat principle, with multiple imputation for missing data. This trial was funded on October 28, 2024. Recruitment is scheduled to begin in January 2026 and conclude in April 2026, with follow-up completed by June 2027. Data analysis will commence in mid-2027, and the main findings are expected to be published by the end of 2027. As of manuscript submission, recruitment has not yet started. This trial will provide robust evidence on the clinical effectiveness and cost-effectiveness of the CardioCare system in managing multiple cardiovascular risk factors among high-risk adults. The findings will inform the potential for scaling this intervention within health checkup centers and integrating it into national chronic disease management strategies.
34. Microbe-Diet Interactions and Personalized Nutrition.
期刊: Annual review of food science and technology 发表日期: 2025-Dec-09 链接: PubMed
摘要
Nutrition plays a fundamental role in shaping human health across the life course, influencing both host physiology and the composition and function of the gut microbiota. In turn, the gut microbiota modulates the effects of dietary intake, creating complex bidirectional interactions with profound implications for metabolic health. Although the concept of personalized nutrition offering tailored dietary advice based on observable traits, environmental factors, and genotype has gained prominence, growing evidence supports the promise of precision nutrition that also considers individual microbiome profiles. This approach is particularly relevant for addressing diet-related conditions such as obesity and type 2 diabetes, where interindividual variability in response to the same diet is well documented. Advances in high-throughput sequencing, metabolomics, and machine learning are driving predictive models that can forecast personalized dietary outcomes. However, methodological heterogeneity, lack of consistency, and limited representation of diverse populations in current studies present significant barriers. Ethical challenges, including data privacy and equitable access to personalized nutrition tools, also warrant urgent attention. To realize the full potential of microbiome-informed nutrition, greater harmonization of research methods, robust validation across large and diverse cohorts, and an interdisciplinary framework are essential.
35. Expectant Management vs Medication for Patent Ductus Arteriosus in Preterm Infants: The PDA Randomized Clinical Trial.
期刊: JAMA 发表日期: 2025-Dec-09 链接: PubMed
摘要
The management of patent ductus arteriosus (PDA) in preterm infants is controversial. To determine whether expectant management compared with active treatment of a protocol-defined PDA in preterm infants decreases the incidence of death or bronchopulmonary dysplasia (BPD). A randomized clinical trial including infants born at 22 to 28 weeks’ gestation and diagnosed with a protocol-defined PDA between the age of 48 hours and 21 days at screening. The trial was conducted from December 2018 to December 2024 at 33 hospitals within the National Institute of Child Health and Human Development Neonatal Research Network. The final date of follow-up was June 2025. Infants with PDA were randomized to expectant management (n = 242) or active treatment (n = 240; acetaminophen, ibuprofen, or indomethacin) to close the PDA. The primary outcome was death or BPD at 36 weeks’ postmenstrual age. The secondary outcomes included the components of the primary outcome and other morbidities of prematurity. A total of 482 infants were randomized (median gestational age, 25 weeks [IQR, 24 to 27 weeks]; median birth weight, 760 g [IQR, 620 to 935 g]). The trial was stopped for futility and safety after the 50% interim analysis for the primary outcome due to higher survival in the expectant management group. The incidence of death or BPD was 80.9% (195/241) of infants in the expectant management group vs 79.6% (191/240) of infants in the active treatment group (adjusted risk difference, 1.2% [95% CI, -5.7% to 8.1%]; P = .73). The incidence of death before 36 weeks’ postmenstrual age was 4.1% (10/241) of infants in the expectant management group vs 9.6% (23/240) of infants in the active treatment group (adjusted risk difference, -5.6% [95% CI, -10.1% to -1.2%]; P = .01). Infections resulting in death occurred in 0.8% (2/241) of infants in the expectant management group vs 3.8% (9/240) of infants in the active treatment group. In extremely preterm infants with a protocol-defined PDA, death or BPD did not differ between the expectant management group and the active treatment group. Survival was substantially higher with expectant management. ClinicalTrials.gov Identifier: NCT03456336.
36. Micro and nanoplastic inhalation during pregnancy elicits uterine endothelial dysfunction in Sprague Dawley rats by impeding nitric oxide signaling.
期刊: American journal of physiology. Heart and circulatory physiology 发表日期: 2025-Dec-09 链接: PubMed
摘要
Micro and nanoplastic (MNP) detection in human tissues demonstrates that exposure at any life stage is inevitable. We have previously demonstrated that pulmonary exposure to this emerging environmental contaminant impairs endothelial function in the uterine vasculature of nonpregnant and pregnant rats. However, neither the mechanism of this dysfunction nor the role of the endothelial-derived vasodilator, nitric oxide (NO), have been interrogated. Therefore, we assessed uterine macro- and microvascular reactivity in Sprague Dawley rats to determine the mechanistic role of NO signaling in endothelial dysfunction after repeated (gestational day 5-19) MNP inhalation during pregnancy. Results identified that MNP exposure reduced fetal growth and impaired endothelial-dependent dilation in the uterine microcirculation, which control placental perfusion and resource availability to the fetus. Levels of activated endothelial nitric oxide synthase (eNOS), phosphorylated on Ser1176, were substantially decreased (<50%) in uterine vessels from exposed rats. This suggests MNP inhalation limited NO production and bioavailability. Endothelial function was partially restored by supplementation of arterial segments with the eNOS cofactor tetrahydrobiopterin (BH4), demonstrating that exposed vessels were BH4-deficient. Partial restoration was also achieved by incubation with the reducing agent, DTT, suggesting that exposed vessels contained physiologically relevant levels of reactive oxygen and nitrogen species. Increased 3-nitrotyrosine residues and decreased thioredoxin protein expression further suggest MNP fosters nitrosative and oxidative stress in the uterine vasculature, impairing eNOS and endothelial-dependent dilation. These findings implicate eNOS uncoupling as a mechanistic basis for the vascular toxicity of MNPs and the adverse impact of MNPs on fetal development.
37. Implications of Amplitude-Integrated Electroencephalography Monitoring for Effective Treatment of Chronic Ventilated Children During the Rehabilitation Period.
期刊: Journal of child neurology 发表日期: 2025-Dec-09 链接: PubMed
摘要
AimAmplitude-integrated electroencephalography (aEEG) is a method for continuous electrographic brain function monitoring. Despite evidence of aEEG relevancy in a range of clinical settings, its use has not yet been systematically tested in patients with chronic ventilation. We assessed the role of aEEG in the management of patients in a department of pediatric respiratory rehabilitation.MethodTwo hundred ninety aEEG readings from 116 patients over a period of 36 months were studied. aEEGs were performed on admission for all patients; 21 patients had repeated monitoring because of suspected seizures.ResultsMore than 92% of the patients had examinations that were feasible for interpretation. Seizures were noted in 29% of the aEEG readings at admission. A significant correlation was found between abnormal background activity and the presence of seizures. The aEEG obtained throughout hospitalization led to modification of treatment in 49% of patients including initiation of antiseizure medications in 20% of patients, avoidance of unnecessary treatment in 20% of patients, and transfer for advanced assessment in the primary hospital in 9% of patients.ConclusionThe results of this study reinforce the importance of using aEEG in chronically ventilated patients throughout rehabilitation. It is an important tool for accurate treatment and planning of the personal rehabilitation program.
38. Access to occupational health as a pillar of employment in Ireland.
期刊: Irish journal of medical science 发表日期: 2025-Dec-09 链接: PubMed
摘要
Occupational Health is a key pillar of employment; access to occupational health services in Ireland has been low historically and worsening in more recent years. With an ageing population beckoning, the need for Ireland to recognise its deficits and work on tackling this health inequity has never been greater. Comparisons to EU counterparts can provide a path to improvement by learning lessons from countries who have taken significant steps to tackle this health inequity. Employment is a key social determinant of health and Occupational health holds an important role therein.
39. Manual therapy with exercise for neck pain.
期刊: The Cochrane database of systematic reviews 发表日期: 2025-Dec-09 链接: PubMed
摘要
Manual therapy and exercise are supported by evidence of effectiveness as single modal interventions for neck pain; however, their combined effect remains unclear. To assess the benefits and harms of manual therapy with exercise versus placebo or no treatment for acute to chronic neck pain with or without radicular symptoms or cervicogenic headache in adults. We searched multiple databases (CENTRAL, MEDLINE, Embase, CINAHL, Index to Chiropractic Literature, trial registries) together with reference checking and handsearching up to 5 March 2025. We included parallel, cross-over, or cluster-randomised controlled trials (RCTs) in adults with neck pain, which compared manual therapy and exercise with placebo or no treatment. We excluded studies in people with myelopathy or headaches not of cervical origin. Our outcomes were pain intensity, function or disability, health-related quality of life, participant-reported treatment success, and serious or non-serious adverse events, measured at short-term and long-term follow-up. We used RoB 1 plus an additional six items to assess bias in the included studies. We synthesised results for each outcome using meta-analysis or, when not possible, SWiM methods. We used random-effects models to calculate mean differences (MD) or standardised mean differences (SMD) and 95% confidence intervals (CI) for continuous outcomes, and risk ratios (RR) with 95% CI for adverse events. We used GRADE to assess the certainty of evidence. We included nine RCTs (seven parallel, two cross-over) with a total of 694 participants. Studies were conducted in outpatient settings across North America, Europe, Central Asia, East Asia, and the Pacific. Manual therapy with exercise was compared with placebo (two studies) or no treatment (seven studies). Participants were 76% female, with a mean age of 46 years and mean pain severity of 4.75 on a 0 to 10 scale. Six studies (67%) reported receiving institutional or government funding. The disorder classification included chronic (n = 8) and subacute (n = 1) neck pain. The main biases affecting our findings were selection (44%), performance (100%), detection (100%), and reporting bias (78%). Performance bias is an inherent limitation in manual therapy and exercise RCTs, while detection bias was unavoidable due to reliance on self-reported outcomes. All data reflect short-term follow-up (closest to four weeks). Manual therapy with exercise versus placebo (short-term) Manual therapy with exercise may result in: 1) little or no difference in pain, which was a mean of 3.35 with placebo and showed little to no improvement of 0.91 points (95% CI 1.85 better to 0.04 worse) on a 0 to 10 scale, where a lower score indicates less pain (I² = 0%; 2 studies, 114 participants; low-certainty evidence due to imprecision, performance and detection bias); 2) moderate increase in function, which was a mean of 21.50 with placebo and improved by 10.20 points (95% CI 16.84 better to 3.56 better) on a 0 to 100 scale where 0 indicates best function (I² = 0%; 2 studies, 115 participants); this represents transformed data (SMD 0.77 better, 95% CI 1.15 better to 0.39 better; low-certainty evidence due to imprecision, performance and detection bias); 3) little or no improvement in health-related quality of life, which was a mean of 52.10 with placebo and slightly improved by 2.00 points (95% CI 5.78 better to 1.78 worse) on the Short Form-12 0 to 100 scale, where 0 indicates better quality of life (1 study, 64 participants; low-certainty evidence due to imprecision, performance and detection bias). Data on participant-reported treatment success and adverse effects were not available. Manual therapy with exercise versus no treatment (short-term) Manual therapy with exercise may result in: 1) large reduction in pain, which was a mean of 4.01 with no treatment and had a large reduction of 2.44 points (95% CI 3.23 better to 1.65 better) on a 0 to 10 scale where a lower score indicates less pain (I² = 66%; 7 studies, 360 participants; low-certainty evidence due to imprecision, performance and detection bias); 2) moderate improvement in function, which was a mean of 22.38 with no treatment and improved by 13.84 points (95% CI 25.24 better to 2.44 better) on a 0 to 100 scale where 0 indicates best function (I² = 92%; 5 studies, 303 participants; low-certainty evidence due to imprecision, performance and detection bias); 3) moderate improvement in health-related quality of life, which was a mean of 53.60 with no treatment and improved by 24.80 points (95% CI 31.38 better to 18.22 better) on the Short Form-36 0 to 100 scale, where 0 indicates better quality of life (1 study, 65 participants; low-certainty evidence due to imprecision, performance and detection bias); 4) very uncertain evidence for participant-reported treatment success (SMD 2.57 better, 95% CI 5.08 better to 0.05 better; I² = 97%; 2 studies, 163 participants; very low-certainty evidence due to inconsistency, imprecision, performance and detection bias); the large confidence interval spans no meaningful difference to a large effect; 5) little to no difference in non-serious adverse events; the evidence showed a 2% absolute risk increase in non-serious adverse events such as transient soreness, headache, or dizziness (RR 1.57, 95% CI 0.08 to 29.21; I² = 45%; 2 studies, 163 participants; low-certainty evidence due to imprecision, performance and detection bias). Data were not available on serious adverse events. The combination of manual therapy with exercise may result in a moderate increase in function but no reduction in pain when compared with placebo for primarily chronic neck pain. A large reduction in pain and moderate increase in function may result when comparing manual therapy with exercise with no treatment. Only non-serious adverse events were reported. Other outcomes had varied certainty. Data on participant-reported treatment success and adverse effects were unavailable for the placebo control group. Improved reporting on interventional procedures, dose, and adherence monitoring in larger trials is required. Future trials on acute and subacute neck pain are needed due to limited evidence. This Cochrane review had no dedicated funding. Protocol available via: DOI: 10.1002/14651858.CD011225.
40. Implementing evidence-based treatment for pregnant people with opioid use disorder in jail: A qualitative analysis of jail administrator and clinician perspectives.
期刊: Journal of substance use and addiction treatment 发表日期: 2025-Dec-08 链接: PubMed
摘要
Overdose is a leading cause of maternal mortality in the United States, and pregnant individuals with opioid use disorder (OUD) frequently interact with the criminal legal system. While the benefits of providing life-saving medications for opioid use disorder (MOUD) during pregnancy are well-established, access to MOUD in jail remains limited and inconsistent. Although existing literature identifies general barriers to MOUD implementation in incarcerated settings, the specific needs of pregnant individuals are often overlooked. Our study assessed the perspectives of jail custody and medical leaders to examine pregnancy-specific MOUD implementation barriers and facilitators. From September 2019 to September 2020, we conducted semi-structured qualitative interviews with jail administrators and clinicians across the United States. Interview questions were organized around domains of the Consolidated Framework of Implementation Research (CFIR) framework to explore contextual elements of jails’ provision of care to pregnant patients with OUD. We performed a CFIR-informed, directed content analysis to identify key themes and determinants for pregnancy MOUD implementation in jails. We interviewed 28 individuals from 23 jails, 18 of which offered either full or modified MOUD in pregnancy. Our pregnancy-focused, CFIR analysis identified three main themes: (1) pregnancy introduced unique challenges and opportunities for MOUD implementation in jails; (2) concerns about ensuring fetal wellbeing strongly and positively influenced jails’ decisions and approaches to providing MOUD in pregnancy, and discontinuing MOUD postpartum; and (3) stigma, judgment, and limited understanding of substance use and MOUD during pregnancy were widespread and significantly negatively shaped implementation efforts. Study findings highlight the nuances of implementing pregnancy-specific MOUD and the complex care needs of pregnant and postpartum individuals in custody. Both jail custody and medical leaders expressed varying levels of concern for this population, which influenced their treatment approaches. Leveraging their concern for fetal wellbeing could be a critical determinant in encouraging implementation of pregnancy and postpartum MOUD in jails. Successfully implementing and sustaining pregnancy MOUD in jails requires tailored strategies that improve education around maternal-fetal-newborn wellbeing, strengthen infrastructure, and reduce stigma. As jail-community partnerships work to expand MOUD in custody, they must tend to perinatal specific needs in order to optimize maternal and infant health.
41. Psychometric properties of the Turkish version of the Fear of Earthquake Scale for children and adolescents.
期刊: Journal of pediatric nursing 发表日期: 2025-Dec-08 链接: PubMed
摘要
The aim of this study was to adapt the Fear of Earthquake Scale into Turkish and to evaluate its psychometric properties in a Turkish sample of children and adolescents. This study was conducted with a methodological and cross-sectional design in a province in the Central Anatolia region of Turkey with 500 children and adolescents. Data were obtained using the Descriptive Characteristics Form and the Fear of Earthquake Scale. The Content Validity Index, explanatory and confirmatory factor analysis were used to evaluate the validity, while Cronbach’s alpha coefficients, split-half, item-total score correlation, and test-retest methods were used to assess the reliability of the scale. The Turkish version of the Fear of Earthquake Scale, comprising a one-factor, seven-item model, demonstrated a good fit similar to the original structure. The factor loadings were above 0.40 and explained 37 % of the total variance. The scale showed good internal consistency, with a Cronbach’s Alpha Coefficient of 0.80 and a test-retest Intraclass correlation coefficient of 0.88. The Turkish version of the Fear of Earthquake Scale is a valid and reliable instrument for Turkish children and adolescents. The Fear of Earthquake Scale can be easily used by nurses or other specialists to identify at-risk populations, develop psychosocial intervention programs, and evaluate post-disaster mental health services.
42. Evolving food as medicine programs to advance health equity: insights from two decades of practice.
期刊: Current opinion in pediatrics 发表日期: 2025-Dec-08 链接: PubMed
摘要
The Food as Medicine (FAM) movement has gained momentum as a strategy to address food insecurity and manage diet-related chronic conditions by integrating food prescriptions, medically tailored meals, and culinary and nutrition education into clinical care. However, few FAM programs have evaluated long-term sustainability, equity outcomes, or structural impact on systems-level change beyond food insecurity in the hospital setting alone. This case study reviews feasible, equity-centered evaluation strategies leveraged by the Nourishing Our Community Program (NoC) at Boston Medical Center (BMC), one of the country’s oldest and most comprehensive health system-based FAM initiatives. We trace the historical development of NoC, highlighting key adaptations in evaluation strategy and outlining embedded data collection methods across clinical and community settings. The evaluation approach captures both traditional metrics (e.g., food insecurity screening outcomes) and broader measures, including patient experience, cultural relevance, and local economic impact. By embedding equity into every stage of program design and assessment, this case study provides a replicable framework for health systems aiming to sustain and scale food-based interventions. It also contributes to the limited but growing body of literature on systems-level implementation of FAM programs that address both individual health outcomes and structural drivers of inequity.
43. Occupational hypersensitivity to cannabis.
期刊: Current opinion in allergy and clinical immunology 发表日期: 2025-Dec-08 链接: PubMed
摘要
The expansion of the legal cannabis market has driven rapid, exponential growth in its workforce. Emerging evidence suggests that occupational exposures during cannabis production contribute to respiratory and allergic disease in cannabis workers. There is a substantial burden of respiratory and allergic disease in cannabis production workers. Recent evaluations have demonstrated exposure to respiratory irritants and allergic sensitizers during cannabis production activities, though the cause of health symptoms among cannabis workers remains unknown. While some studies suggest that sensitization to cannabis plant allergens may drive disease, no epidemiological studies have quantitatively assessed the relationship between inhalation hazards and health outcomes in cannabis production workers. Research is critically needed on the etiology of work-related respiratory and allergic disease within the cannabis industry. Although the specific cause of reported health effects is uncertain, recent findings provide sufficient preliminary evidence to justify swift action to safeguard this rapidly growing workforce.
44. Modelling Natural History and Cost-Effectiveness of Gene-Agnostic Treatment in Retinitis Pigmentosa.
期刊: Retina (Philadelphia, Pa.) 发表日期: 2025-Dec-01 链接: PubMed
摘要
Treatment options for Retinitis pigmentosa (RP) have been limited. A new generation of innovative but potentially expensive treatments under development may halt or reverse disease progression. Using an existing database, a closed-cohort microsimulation model of all genetic subtypes of RP was conducted from a US societal perspective. A hypothetical gene-agnostic therapy was compared to standard care at age 30. Outcomes included: VF and VA progression; Incremental cost-effectiveness ratio (ICER: dollars per quality-adjusted life-year (QALY) gained); lifetime medical and productivity-related costs. Baseline cohort (age 30, N=381; mean VA logMAR, 0.26 (20/36); mean VF sum total degrees (III4e), 749). By age 45, 79% of untreated RP patients reached legal blindness or worse, compared to significantly delayed progression with treatment. ICER of gene-agnostic therapy was $158,554/QALY, yielding better outcomes compared to untreated RP (20.5 vs. 16.7 QALYs) and substantial indirect cost savings ($691,961) if a drug price of $1.5 million was assumed. A gene-agnostic treatment for RP with drug price of $1.5 million (both eyes) may be cost-effective for most types of RP, particularly with earlier initiation. These findings can inform clinical, economic, and health policy decisions, potentially supporting early intervention strategies and resource allocation for novel RP treatments.
45. Research trends and hotspots in HIV pre-exposure prophylaxis: a bibliometric analysis and visual mapping.
期刊: AIDS reviews 发表日期: 2025-Dec-01 链接: PubMed
摘要
HIV remains a major global public health challenge, and pre-exposure prophylaxis (PrEP) has established itself as a pivotal evidence-based strategy for HIV prevention. While research on PrEP has expanded rapidly, a comprehensive synthesis of the existing literature is lacking. This review systematically analyzes trends, collaborative networks, and research hotspots in PrEP through a bibliometric approach to consolidate current knowledge and inform future directions. A total of 5,273 PrEPrelated publications (1992-2025) from the Web of Science Core Collection were included, showing a 15.99% annual growth rate. The field is dominated by contributions from the United States (2,969 publications), with the University of Washington as a core institutional contributor and the Journal of Acquired Immune Deficiency Syndromes as the most prolific journal; Baeten JM emerges as a key collaborative figure. Key research hotspots include PrEP implementation, HIV prevention in men who have sex with men, adherence issues, and the development of long-acting agents (e.g., cabotegravir). Emerging trends highlight growing focus on long-acting formulations, awareness promotion, and multi-sectoral collaboration. This synthesis underscores the expanding significance of PrEP research, offering critical insights for clinicians, researchers, and policymakers. Future efforts should prioritize advancing long-acting PrEP applications, addressing barriers such as limited awareness and economic burdens, and strengthening cross-sector collaboration to maximize PrEP’s role in global HIV control.
46. Strengthening research and training on insecticide resistance in arthropod vectors in South America: The WINSA network.
期刊: PLoS neglected tropical diseases 发表日期: 2025-Dec 链接: PubMed
摘要
The “South American Research Network for the Surveillance and Control of Insecticide-Resistance in Arthropod Vectors” (WINSA), established in 2024 by the IRD and FIOCRUZ with support from the US-CDC VecNet initiative and WHO-TDR, aims to coordinate research on insecticide resistance in arthropod vectors in South America, provide a platform for regional collaboration, and develop effective mitigation strategies. WINSA brings together leading technical experts representing research institutions from 14 countries and territories located in South America, the USA, and France to promote collaboration and information exchange, identify research gaps and priorities, enhance technical capacity in insecticide resistance monitoring, and support national and regional programs on vector resistance issues. This network seeks to contribute to the reduction and elimination of vector-borne diseases in South America.
47. Consensus-Harmonized Neuropsychological Assessment for Vascular Cognitive Impairment and Dementia.
期刊: JAMA network open 发表日期: 2025-Dec-01 链接: PubMed
摘要
Harmonization of neuropsychological assessment for vascular cognitive impairment and dementia (VCID) is important for ensuring the highest standards and consistency of diagnosis. A battery proposed in 2006 by the National Institute for Neurological Disorders and Stroke and the Canadian Stroke Network (NINDS-CSN) has received much international support. Considering significant advances in the field, including the rise of computerized and remote assessment methods, a revision is needed. To develop an updated harmonized battery and associated assessment guidelines for VCID. NINDS-CSN and other relevant published harmonized neuropsychological batteries, aided by literature review of recent developments in VCID, were used as reference points for an online Delphi survey (≥3 rounds, ≥75% threshold for agreement), including questions on a core test battery based on key cognitive domains that should be assessed for VCID, consideration of computerized and remote assessment methods, and assessment of diverse populations. International experts in neuropsychological assessment from diverse international regions were invited to participate in 2023. Data were analyzed from October 11, 2023, to June 20, 2024. A total of 44 experts participated in 3 survey rounds, with 28 to 31 participants each. Consensus was reached on a core assessment battery of neuropsychological tests based on key cognitive domains, and additional guidelines for a more comprehensive test battery, cognitive screening, telehealth and computerized assessment methods, principles for normative standardization, and the assessment of diverse populations. The key cognitive domains were harmonized with the International Society for Vascular Behavioural and Cognitive Disorders version 2 World Stroke Organization (VasCog-2-WSO) diagnostic criteria for VCID. This consensus statement describes the development of a harmonized neuropsychological assessment battery and guidelines for VCID (VasCog-NP) that expands on the NINDS-CSN battery with more comprehensive and flexible assessment of VCID. Harmonized with the VasCog-2-WSO diagnostic criteria, VasCog-NP could be adopted internationally to further help more consistent neuropsychological evaluations related to VCID, facilitating global comparisons for clinicians and researchers.
48. Overview and evaluation of a nationwide hospital-based surveillance system for influenza and COVID-19 in Switzerland (CH-SUR): 2018-2023.
期刊: Swiss medical weekly 发表日期: 2025-Nov-18 链接: PubMed
摘要
In 2018, a hospital-based surveillance system for influenza (CH-SUR) was established in six tertiary care hospitals in Switzerland. From March 2020 onwards, this surveillance system was expanded to include more institutions, as well as COVID-19. To quantitatively evaluate the timeliness and completeness of CH-SUR data and to qualitatively assess stakeholder perceptions of the importance, reliability and adaptability of the surveillance system. All patients admitted to one of the participating centres for more than 24 hours and who had a laboratory-confirmed influenza virus or SARS-CoV-2 infection were included in CH-SUR. For all cases, we evaluated the timeliness and completeness of reporting to CH-SUR. A qualitative survey among CH-SUR stakeholders assessed perceived importance, understanding, reliability and adaptability of CH-SUR. Up to 20 centres participated in CH-SUR. Between December 2018 and October 2023, 7375 cases of influenza were reported and between March 2020 and October 2023, 49,235 cases of COVID-19 were reported to CH-SUR. During the COVID-19 pandemic, time to data entry and completeness improved over time; the median delay of data entry in CH-SUR was 5 days (interquartile range [IQR]: 2-23) for COVID-19 and 4 days (IQR: 2-15) for influenza during the period 2018-2023. The completeness of variables was high (99.4%), with the exception of COVID-19 or annual influenza vaccination status (respectively, 15% and 72% “Unknown” responses). Stakeholders perceived the system as important, relevant, understandable and adaptable. CH-SUR provided critical epidemiological and clinical information on hospitalised influenza and COVID-19 cases across Switzerland during the pandemic. Our evaluation highlighted the importance and relevance of this system among CH-SUR stakeholders, as well as its importance for preparedness and response to future infectious disease outbreaks.
49. Association between a mismatch of maternal/neonatal body size and obstetrical interventions in Switzerland in the 1920s: a cross-sectional study.
期刊: Swiss medical weekly 发表日期: 2025-Nov-18 链接: PubMed
摘要
Human childbirth remains a complex and risky process for both mothers and infants, even with modern advancements in medical care. This study investigated the prevalence of obstetric interventions, namely caesarean sections, episiotomies, and forceps deliveries, along with the role of maternal-foetal body size mismatch in influencing delivery outcomes. Utilising two datasets from similar archival sources in two Swiss cities (Basel and Lausanne) from the 1920s, we explored the relevance of a mismatch between the body size of the mother and the foetus as a risk factor for obstetrical interventions and the duration of the expulsion phase during delivery. Over 91% of births (1290/1407 in Basel and 1062/1145 in Lausanne) featured the foetal head in a normal position (either the right or left occiput anterior position). Episiotomies were performed in 8-17% of cases (233/1407 in Basel and 98/1145 in Lausanne) and forceps deliveries in 1-5% (17/1407 in Basel and 54/1145 in Lausanne). Caesarean sections were rare (<1%, 19/1407 in Basel and 6/1145 in Lausanne). Key findings indicated that larger foetal head diameters and narrower pelvic measurements were linked to prolonged expulsion phases and an increased likelihood of intervention. Abnormal head positions and first-time births were also associated with obstetrical interventions. Additionally, rickets was documented in 2% of mothers (23/1145) in Lausanne, correlating with increased forceps use and caesarean section rates. This research provides insights into obstetric practices and maternal health conditions over a century ago, emphasising the significant impact of maternal-foetal body size mismatches on childbirth complications in a historical context.
50. When Words Fail: Investigating Alexithymia And Coping Strategies In Adolescent Mental Health.
期刊: Prilozi (Makedonska akademija na naukite i umetnostite. Oddelenie za medicinski nauki) 发表日期: 2025-Nov-01 链接: PubMed
摘要
Introduction: Alexithymia, defined by difficulty identifying and verbalizing emotions, has emerged as a significant factor influencing emotional regulation and coping behaviors in youth. Adolescents with high levels of alexithymia may be at greater risk of psychological distress due to maladaptive coping mechanisms and reduced social support engagement. Materials and Methods: This cross-sectional study was conducted among 141 high school students aged 15-18 in Skopje, North Macedonia. Participants completed validated instruments including the Toronto Alexithymia Scale (TAS-20) and the Adolescent Coping Orientation for Problem Experiences (COPE-A). Statistical analyses included descriptive statistics, Pearson correlations, to examine associations between alexithymia and coping strategies. Results: The mean TAS-20 score suggested a high prevalence of alexithymic traits in the sample. Approximately 44% of adolescents in the sample scored above the clinical threshold for alexithymia (TAS-20 > 61), highlighting the prevalence of emotional processing difficulties in this population. Significant correlations were found between higher alexithymia and maladaptive emotion regulation strategies such as self-blame, rumination, and catastrophizing. Conversely, positive coping strategies like positive reappraisal and acceptance were negatively correlated with alexithymia levels. Participants with high alexithymia reported a greater tendency to engage in maladaptive coping behaviors. Discussion: Findings underscore alexithymia as a trait associated with emotion dysregulation and diminished coping flexibility in adolescents. The results highlight the interplay between poor emotional awareness and a tendency to adopt dysfunctional cognitive responses to stress, which may exacerbate vulnerability to psychological problems. Conclusion: Early identification of alexithymic traits and the promotion of emotional literacy and adaptive coping in adolescence are crucial. Preventive school-based programs focusing on emotional skill development and peer support may buffer the impact of alexithymia and enhance youth mental health outcomes.
51. Well-Being Among Anesthesia Providers: Results from a National Survey.
期刊: Prilozi (Makedonska akademija na naukite i umetnostite. Oddelenie za medicinski nauki) 发表日期: 2025-Nov-01 链接: PubMed
摘要
Introduction:Anesthesiology is a demanding medical specialty that requires intense focus, long working hours, and frequent exposure to high-stress situations. These factors often lead to significant occupational stress. Supporting the well-being of anesthesiologists is essential for maintaining patient safety and a stable healthcare workforce. Methods: We conducted a survey among anesthesiology residents and specialists in North Macedonia. Standardized tools were used, including the Safety Attitudes Questionnaire (SAQ), WHO-5 Well-Being Index, and custom questions related to workplace culture, mental health, and teamwork. Data were collected anonymously via Google Forms and analyzed with SPSS v29.0, focusing on work conditions, psychological well-being, and burnout levels. Results: A total of 100 participants participated-60% residents and 40% specialists. Residents reported significantly higher stress and burnout, along with lower perceived support from institutions and weaker team dynamics (p < 0.05). Specialists noted better job satisfaction and stronger organizational backing (p < 0.05). Both groups highlighted a lack of mental health support and weak safety culture, particularly in under-resourced settings; however, these differences were not statistically significant (p > 0.05). Overall, resource limitations were widely recognized as key contributors to workplace challenges in middle-income countries (p < 0.05). Conclusion: Anesthesiology residents face higher levels of stress and lower job satisfaction compared to specialists, with resource constraints worsening these disparities. To address these issues, targeted interventions are needed, including mental health support services, mentoring programs, stress management training, and policies that promote a positive work environment and psychological safety.
52. Improved global air quality health index reveals ozone and nitrogen dioxide as main drivers of air-pollution-related acute mortality.
期刊: One earth (Cambridge, Mass.) 发表日期: 2025-Oct-14 链接: PubMed
摘要
Ambient air pollutants are leading contributors to global mortality. Despite the well-established risks, most studies have relied on single-pollutant models in limited regions, leaving the combined effects and individual contributions of pollutants unclear, particularly across countries. Here, we integrate daily mortality and air pollutant (nitrogen dioxide [NO2], ozone [O3], fine particulate matter, and sulfur dioxide) data from 482 cities in 12 countries/territories from 1998 to 2021 to assess the joint mortality risks and identify the main contributing pollutant through an air quality health index of multi-pollutant constrained groupwise additive models (AQHI-Multi). AQHI-Multi outperformed commonly used air quality indices in capturing the overall mortality risks. O3 and NO2 were the leading contributors (accounting for over 70% across countries/territories), with O3’s share increasing slightly to moderately in most countries/territories. These findings highlight the need for developing air quality indices using advanced multi-pollutant models and the emerging global significance of targeted control of O3 and NO2.
53. Program implementation and evaluation of De Casa en Casa: a tailored community-based cervical cancer screening program for underserved Hispanic women.
期刊: Health education research 发表日期: 2025-Sep-29 链接: PubMed
摘要
Women on the US-Mexico border have a higher cervical cancer incidence rate, are diagnosed at later stages, and have higher mortality compared to non-Border women in the US. We identified key barriers to screening through various qualitative methods and have designed a program that addresses the needs of our community and creates a coordinated program of education, outreach, service delivery, navigation, and capacity building for the future. A multicomponent, culturally tailored, bilingual, evidence-based cervical cancer screening program was developed at Texas Tech University Health Sciences Center El Paso (TTUHSC El Paso). The program was implemented in El Paso and Hudspeth counties. Key program components were (i) theory-based and culturally tailored education delivered by bilingual community health workers; (ii) no-cost Pap and HPV screening; (iii) diagnostic and treatment colposcopy; and (iv) patient navigation and tracking. A total of 2318 women were recruited into the program and offered services. 2206 women were eligible for screening: mean age of the population was 44.8 years, 4.7% (N = 108) had never had a Pap smear, and 40.9% (N = 945) last received a Pap over 5 years previously. Screening uptake was 71.6% (N = 1 569); 7.8% (N = 114) of those tested were positive for high-risk HPV. 101 colposcopies were indicated and 98.0% (N = 99) were completed. Two cancers were diagnosed. A comprehensive cervical cancer screening program can achieve significant screening uptake rates in a high-risk population with historically low screening uptake and has the potential to significantly impact cervical cancer incidence and mortality in this border region.
54. [Climate change and its impact on human health].
期刊: Lakartidningen 发表日期: 2025-Sep-25 链接: PubMed
摘要
Climate change is already impacting our environment and health, with rising sea levels, extreme weather, and higher temperatures. Greenhouse gas levels are at their highest in three million years, making climate-related health risks increasingly urgent. Heatwaves, wildfires, and floods lead to mortality, trauma, and non-communicable diseases both in the short and long term. Climate change also alters the spread of infectious diseases in Sweden, increasing cases of Vibrio bacteria infections in brackish water and expanding the range of disease-carrying vectors like ticks and mosquitoes. Vulnerable populations, such as outdoor workers, children, elderly, and people with chronic illnesses, face higher risks. Addressing these challenges requires multidisciplinary research, proactive policy measures, and healthcare system adaptation. Additionally, the healthcare sector must reduce its own carbon footprint to mitigate climate change impacts.
55. [Healthy and sustainable eating - how do we make it happen?].
期刊: Lakartidningen 发表日期: 2025-Sep-25 链接: PubMed
摘要
Unhealthy diets are a major contributor to obesity, type 2 diabetes, cardiovascular disease and cancer, but dietary improvements can significantly reduce disease risk and premature death. The food sector is responsible for one third of global greenhouse gas emissions and significant biodiversity loss, with animal-based foods having the highest environmental impact. Climate change threatens food production and nutritional quality, while over 2.3 billion people already face food insecurity. The 2023 Nordic Nutrition Recommendations (NNR) emphasize a shift towards plant-based diets for both health and environmental benefits. Achieving sustainable food systems requires political action, education, healthcare initiatives, and increased awareness. A dietary transition can improve public health, reduce environmental impact, and contribute to a sustainable future.
56. [How can healthcare contribute to climate transition?].
期刊: Lakartidningen 发表日期: 2025-Sep-25 链接: PubMed
摘要
Climate transition has not been as prominent in healthcare as in other sectors of society. It is crucial to recognize the part and potential of healthcare in the climate transition, both as part of the problem and of the solution. Healthcare professionals globally are aware of the negative consequences of climate change for patients but have insufficient knowledge and experience to be able to act. This overview aims to provide insight into how the environmental and climate footprint footprint from clinical activity can be reduced while increasing resilience against extreme weather and other climate-related health effects that risk affecting our activities. It also highlights the unique role of healthcare professionals in the climate transition of society.
57. Potential analgesic function of the clitoris in pregnant women: A feasibility study.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
Currently, the clitoris is considered to exist solely for sexual pleasure. This prospective, single-centre pilot study focuses on and evaluates an alternative function of the clitoris; pain relief during pregnancy and childbirth. Conducted between 2020 and 2023 at Rouen University Hospital, France, this feasibility study challenges the assertion of the singular function of the clitoris. The primary aim was to assess the acceptability of an intervention focusing on the potential analgesic function of the clitoris. The secondary aim was to assess pain relief. Pregnant women were offered the option of self-external massage with a vibrating device (OVD) in the clitoral suspensory ligament area for pain relief. Data were collected via a self-schedule for precise use of the method, including pain assessment before and after the use of the OVD via a self-analytic visual scale. Acceptability was considered to have been achieved if the woman used the OVD at least twice. Comparisons before and after were performed by means of a student’s t-test. With respect to acceptability, among the 32 women included, 26 (81.25%) used an OVD at least twice. Despite concerns about sexual intimacy and the sensitive period of pregnancy, this preliminary feasibility study confirmed the suitability of this mechanical vibration for the majority of the women included. In terms of pain relief, these 26 women used the OVD to manage 304 painful episodes and the feeling of relief was reported in 86.2% of these episodes. Based on a small sample size, the numerical results are obviously highly relative to the disparity of situations and feelings. However, these few consistent reports of a positive analgesic effect encourage further studies into the potential analgesic function of the clitoris.
58. Risk factor analysis and development of a nomogram prediction model for Plasma Cell Mastitis.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
The risk factors for plasma cell mastitis (PCM) remain unclear. Understanding and mitigating these factors to prevent PCM before its onset has become a significant concern. This study identifies PCM risk factors, develops a predictive nomogram, and offers insights for targeted prevention and awareness in high-risk groups. We retrospectively analyzed the clinical data of 82 patients diagnosed with PCM at Hangzhou Women’s Hospital’s Breast Surgery Department from 01/01/2019 to 01/01/2022. A control group was randomly selected, consisting of 82 healthy women aged between 20-60 years who had undergone routine health check-ups during the same period. Using SPSS 26.0 software for univariate analysis, significant risk factors for PCM were identified. R software was used for multivariate logistic regression analysis, and a nomogram prediction model for the risk of developing PCM was established. The average age of patients in the study group was 32.37 ± 6.64 years, the control group was 29.54 ± 5.33 years, with no statistically significant difference between the groups (P = 0.176). The onset time after childbirth or miscarriage was 3.37 ± 1.91 years. Univariate analysis revealed significant differences in BMI, nipple retraction, number of pregnancies, recent trauma history, and hyperlipidemia (P < 0.05). Multivariate logistic regression analysis identified nipple retraction (OR=20.128, P = 0.000, 95% CI: 5.952-68.072), number of pregnancies (OR=0.343, P = 0.000, 95% CI: 0.189-0.624), and recent trauma history (within two weeks) (OR=11.154, P = 0.000, 95% CI: 2.936-42.382) as independent risk factors for PCM. Nipple retraction, recent trauma history, and the number of pregnancies were identified as independent risk factors for PCM. Targeted education for high-risk groups, particularly women within 3 years postpartum/post-abortion, improves disease prevention. The nomogram model had a C-index of 0.809, indicating strong discriminatory power and high prediction accuracy.