公共卫生研究摘要 (2025-12-11)
共收录 58 篇研究文章
1. Association Between GLP-1 Receptor Agonist Use and Epilepsy Risk in Type 2 Diabetes.
期刊: Neurology 发表日期: 2026-Jan-13 链接: PubMed
摘要
Individuals with type 2 diabetes mellitus (T2DM) are at an increased risk of developing epilepsy, particularly in later life. While preclinical studies suggest neuroprotective properties of glucagon-like peptide-1 receptor agonists (GLP-1 RAs), real-world comparative effectiveness data remain limited. We aimed to evaluate whether GLP-1 RA use is associated with a lower risk of incident epilepsy compared with dipeptidyl peptidase-4 inhibitor (DPP-4i) use in adults with T2DM. We conducted a retrospective cohort study using the TriNetX network from 2015 to 2023, including adults aged 18 years or older with T2DM who were new users of either GLP-1 RAs or DPP-4is. Patients with a previous diagnosis of epilepsy or seizure, or those using antiepileptic drugs, were excluded. The primary outcome was incident epilepsy, identified using ICD-10-CM codes. Propensity score matching (1:1) was performed based on demographics, socioeconomic status, body mass index, comorbidities, and baseline medications. Cox proportional hazard models estimated hazard ratios (HRs) with 95% CIs. We also conducted prespecified subgroup and sensitivity analyses to assess the robustness of the findings. After matching, 452,766 patients were included (226,383 in each group; mean age 60.5 years; 47.1% female). During follow-up, 1,670 individuals in the GLP-1 RA group and 1,886 in the DPP-4i group developed epilepsy, corresponding to cumulative incidences of 2.35% vs 2.41%. GLP-1 RA use was associated with a significantly lower risk of epilepsy (HR 0.84, 95% CI 0.78-0.90), with protective associations evident at 1 year (HR 0.71, 95% CI 0.62-0.80), 3 years (HR 0.81, 95% CI 0.74-0.88), and 5 years (HR 0.82, 95% CI 0.76-0.88). Among individual agents, semaglutide showed the strongest association (HR 0.68, 95% CI 0.60-0.77). The results were consistent across major subgroups, including both age and sex. Sensitivity analyses excluding patients with overlapping or switching exposure yielded similar findings (HR 0.71, 95% CI 0.64-0.78). GLP-1 RA therapy was associated with a significantly lower epilepsy risk compared with DPP-4i use in adults with T2DM. These results support the hypothesis that GLP-1 RAs may exert neurologic benefits beyond glycemic control. Limitations include the observational design and potential residual confounding. This study provides Class III evidence that the use of GLP-1 RAs in people with T2DM results in a lower risk of developing epilepsy compared with those treated with DPP-4i.
2. Prenatal Exposure to Antiseizure Medications and the Risk of Congenital Anomalies: A Nationwide Population-Based Study in South Korea.
期刊: Neurology 发表日期: 2026-Jan-13 链接: PubMed
摘要
Valproate has a well-documented teratogenic risk, whereas lamotrigine and levetiracetam seem relatively safe. However, evidence for other antiseizure medications (ASMs) and specific congenital anomalies remains limited and inconsistent. We aimed to assess the risk of overall and specific congenital anomalies associated with prenatal exposure to individual ASMs. We conducted a retrospective cohort study using the Korean National Health Insurance Service mother-child linkage database from 2013 to 2021. Pregnant women aged 20-45 years with live births were included. Exposure was defined as the prescription of any ASM during the first trimester. The primary outcome was congenital anomalies in offspring identified by diagnostic codes within 1 year of birth. We estimated the odds ratios (ORs) for overall congenital anomalies, organ system anomalies, and specific congenital anomalies associated with prenatal exposure to ASMs compared with those in the unexposed group. Propensity score fine stratification was used to adjust for potential confounders. Among 2,494,958 pregnancies, 5,880 (0.24%) were exposed to ASMs during the first trimester. The mean maternal age at delivery was 32.9 years in the exposed group and 32.4 years in the unexposed group. ASM exposure was associated with an increased risk of overall congenital anomalies (OR 1.26, 95% CI 1.11-1.43). Among monotherapies, valproate had the highest risk (OR 1.46, 95% CI 1.11-1.91), showing a dose-dependent relationship (OR 1.57, 95% CI 1.12-2.19 at ≥500 mg/d). Polytherapy, including valproate, had a higher risk (OR 2.06, 95% CI 1.32-3.20), whereas polytherapy without valproate was not significantly associated with an increased risk (OR 1.26, 95% CI 0.92-1.71). Specific congenital anomalies associated with individual ASMs included congenital hydrocephalus (carbamazepine), atrial septal defects (oxcarbazepine), cleft palate (valproate), hypospadias (levetiracetam), and tetralogy of Fallot and talipes equinovarus (topiramate). This study revealed that prenatal exposure to valproate increased the risk of congenital anomalies. Although other ASMs, even in polytherapy, did not significantly increase the overall risk of congenital anomalies, carbamazepine, levetiracetam, oxcarbazepine, and topiramate were associated with specific types of congenital anomalies. Given the limited number of cases, these findings warrant further investigation in other populations. This study provides Class III evidence that prenatal exposure to valproic acid increases the risk of overall congenital anomalies while other ASMs, including carbamazepine, levetiracetam, oxcarbazepine, and topiramate, do not increase the risk of overall congenital anomalies.
3. Extreme Polarization Is a Threat to US Health.
期刊: American journal of public health 发表日期: 2026-Jan 链接: PubMed
摘要
4. Lessons Learned From the COVID-19 Pandemic: "Those Who Cannot Remember the Past Are Condemned to Repeat It".
期刊: American journal of public health 发表日期: 2026-Jan 链接: PubMed
摘要
5. The Need to Invest in Infrastructure and Partnerships to Achieve Complete Public Health Data.
期刊: American journal of public health 发表日期: 2026-Jan 链接: PubMed
摘要
6. To Demonstrate Trustworthiness, Public Health Must Listen, Reflect, Act, and Revisit.
期刊: American journal of public health 发表日期: 2026-Jan 链接: PubMed
摘要
7. Geochemical tales of individual lives in the industrial revolution: Untangling the impact of pollutant exposure in two English towns.
期刊: Science advances 发表日期: 2025-Dec-12 链接: PubMed
摘要
England’s Industrial Revolution transformed natural environments. However, studies of this period are often limited to broad generalizations that neglect individuals’ lived experiences. Here, we explore industrialization’s impact at the individual scale by analyzing skeletal concentrations of pollutants (arsenic, barium, and lead) and evaluating biogenic versus diagenetic contributions. Analysis of the skeletal remains of 94 individuals from two 18th/19th century English towns, South Shields and Barton-upon-Humber, showed biogenic exposure to contaminants and variation in exposure by environment and biosocial identity. South Shields individuals showed higher concentrations of arsenic (P < 0.001) and barium (P = 0.013), while Barton-upon-Humber individuals showed higher concentrations of lead (P = 0.020). Skeletal lead isotope ratios match geologic samples from throughout the United Kingdom, suggesting a wide network of anthropogenic lead consistent with widespread industrial activities. These findings reveal a spectrum of realities and lived experiences hidden between the dichotomy of rural versus urban industrial England.
8. Residual Breast Cancer Cells Co-opt SOX5-driven Endochondral Ossification to Maintain Dormancy.
期刊: Cancer discovery 发表日期: 2025-Dec-11 链接: PubMed
摘要
Recurrent breast cancer accounts for most disease-associated mortality and can develop decades after primary tumor therapy. Recurrences arise from residual tumor cells (RTCs) that can evade therapy in a dormant state, however the mechanisms enforcing dormancy in RTCs are poorly understood. CRISPR-Cas9 screening identified the transcription factors SOX5/6 as functional regulators of tumor recurrence. Loss of SOX5 accelerated recurrence at both local and metastatic sites and promoted dormancy escape in both therapy-associated and microenvironment-induced contexts. Remarkably, SOX5 drove dormant RTCs to adopt a cartilage-dependent bone development program, termed endochondral ossification, that was confirmed by [18F]NaF-PET imaging and reversed in recurrent tumors escaping dormancy. Consistent with findings in mice, osteochondrogenic expression signatures in patients were enriched in residual disease following neoadjuvant therapy, and their enrichment in primary breast cancers predicted improved recurrence-free survival. These findings identify SOX5-dependent mesodermal transdifferentiation as an adaptive mechanism that prevents recurrence by reinforcing tumor cell dormancy.
9. Development and Validation of an Electronic Health Record-Based Algorithm for Identifying Patients With Long-Term Opioid Therapy: Cross-Sectional Study.
期刊: Journal of medical Internet research 发表日期: 2025-Dec-10 链接: PubMed
摘要
Health care providers must carefully monitor patients receiving long-term opioid therapy (LTOT) to minimize risks and maximize benefits. Yet, algorithms to support intervention during patient encounters are lacking, with accurate LTOT identification in routine care being the essential first step. This study aims to develop and validate an LTOT identification algorithm using electronic health record (EHR) data. In this cross-sectional study, we used 2016-2021 OneFlorida+ EHR data linked with Florida Medicaid claims to identify patients aged ≥18 years who received opioid prescriptions. The main outcome was the first LTOT episode in the algorithm development (2016-2018) and validation (2019-2021) periods. A Medicaid claims-based LTOT algorithm served as the reference standard, defined as ≥90 days of continuous opioid use with ≤15-day gaps. Given strong correlations among covariates, an elastic net regression model was applied to identify LTOT episodes in EHR data using patient characteristics, clinically relevant features, and medication use, and to evaluate the model’s classification performance. We randomly split the 2016-2018 cohort into development and internal validation datasets (2:1 ratio), stratified by LTOT incidence. External validation was performed using 2019-2021 data. Among 64,206 eligible patients identified in 2016-2018 (mean age 35.7, SD 12.3 years; 51,421/64,206, 80.1% female), a total of 8899 (13.9%) had LTOT. Among 50,009 eligible patients identified in 2019-2021 (mean age 37.3, SD 12.5 years; 39,866/50,009, 79.7% female), a total of 6000 (12%) had LTOT. The model selected 29 out of 131 candidate features. Among 2967 individuals with LTOT in the 2016-2018 OneFlorida+ internal validation dataset, a total of 2176 (73.3%) individuals were identified in the top 3 deciles of risk scores. The model achieved a C-statistic of 0.83 (95% CI 0.82-0.84), with 73.4% (95% CI 71.8%-75%) sensitivity, 76.8% (95% CI 76.2%-77.4%) specificity, 33.8% (95% CI 33.1%-34.6%) precision, 76.3% (95% CI 75.8%-76.9%) accuracy, and an F1-score of 0.46. In the 2019-2021 OneFlorida+ external validation dataset, a total of 75.5% (4527/6000) individuals were correctly captured in the top 3 risk subgroups. The model achieved a C-statistic of 0.83 (95% CI 0.83-0.84), with 78.8% (95% CI 77.8%-79.9%) sensitivity, 73.3% (95% CI 72.9%-73.7%) specificity, 28.7% (95% CI 28.3%-29.1%) precision, 73.9% (73.6%-74.3%) accuracy, and an F1-score of 0.42. The EHR-based LTOT algorithm showed comparable accuracy to the claims-based reference and may support risk stratification and inform decision-making during clinical encounters.
10. Smartphone-Based Physical Activity Program to Reduce "Chemo-Brain" Symptoms and Improve Health in Cancer Survivors With and Without Type 2 Diabetes: Protocol for a Single-Arm Pre-Post Pilot Trial.
期刊: JMIR research protocols 发表日期: 2025-Dec-10 链接: PubMed
摘要
The US cancer survivor population is projected to hit 26M by 2040. Chemotherapy is an effective cancer treatment, but can diminish cancer survivors’ quality of life-particularly cognitive function-through select pathophysiological processes, including immune system and antioxidant dysregulation. The resulting cytokine release can impair cerebrovascular function-likely contributing to chemotherapy-induced cognitive impairment (CICI; “chemo-brain”). Type 2 diabetes mellitus (T2DM)-a common cancer survivor comorbidity-shares underlying pathophysiology with CICI. Cancer survivors with T2DM might thus have a higher CICI risk than those without T2DM. Physical activity (PA) counteracts CICI’s and T2DM’s pathophysiology, but little to no research has been conducted assessing the impact of PA on this joint pathophysiology. To compare cerebrovascular and cognitive function as well as proinflammatory, cardiometabolic, epigenetic, and psychosocial outcomes between ancer survivors with and without T2DM pre- to postengagement in a 12-week technology-based PA program grounded in the Social Cognitive Theory. We hypothesize that cancer survivors with and without T2DM will demonstrate similar pre to poststudy improvements in psychosocial outcomes, but that changes in cerebrovascular and cardiometabolic outcomes, as well as PA engagement, will be greater for cancer survivors with T2DM. We also believe that each group will have distinct epigenetic profiles that will change pre to poststudy. We are conducting a 30-participant pilot study in cancer survivors with (n=15) and without (n=15) T2DM-all of whom report currently experiencing “chemo-brain.” To account for attrition, we are recruiting 38 cancer survivors from Oklahoma City, OK, and the surrounding area. Among the most important eligibility criteria are the self-report of cognitive difficulties following primary cancer treatment, being ≥18 years old, being within 3 years of primary cancer treatment, and not meeting nationally recommended PA guidelines. Participants receive 2 smartphone apps. One smartphone app provides health education and the ability to set goals and journal about their wellness journey. The other provides a workout program continually tailored to each participant via their communication with the study exercise physiologist, with resistance bands and a wearable device provided to support the program. At Baseline and Poststudy, we assess cerebrovascular function (transcranial doppler [TCD]), cognition (National Institutes of Health Toolbox), cardiometabolic outcomes (venipuncture), and epigenetics (saliva collection). Participants also wear accelerometers at Baseline and Poststudy to objectively assess PA, with Baseline, Midpoint, and Poststudy surveys assessing psychosocial outcomes. We will use t tests and chi-square tests to assess baseline differences and repeated-measures ANCOVA to assess changes over time. Participant recruitment started in March 2025, and we expect to recruit until late 2026. We will begin analyzing baseline data in 2026. Successful study completion will provide valuable insights into the remote delivery of PA-oriented supportive care for cancer survivors experiencing chemo-brain, as well as how T2DM and PA contribute to the mechanistic underpinnings of chemo-brain. ClinicalTrials.gov NCT06725953; https://clinicaltrials.gov/study/NCT06725953. DERR1-10.2196/79739.
11. Effects of a Walking-Based Physical Activity Intervention on Health Indicators in University Students: Protocol for a Randomized Controlled Trial.
期刊: JMIR research protocols 发表日期: 2025-Dec-10 链接: PubMed
摘要
Regular participation in some type of physical activity brings improvements in health indicators such as cardiorespiratory fitness, muscle strength, and body composition. However, despite evidence indicating health benefits, 1 in 4 adults is physically inactive, a situation that also occurs in the university population. Walking is a physical activity modality that can be easily incorporated into daily activities; therefore, using a walking-based physical activity intervention could improve some health indicators. This protocol aims to analyze the impact of a walking-based physical activity intervention on health indicators in university students. An intervention group (n=99) and a control group (n=99) will be randomly selected. All participants will be assessed at the beginning and end of the intervention for indicators of health, cardiorespiratory fitness, muscle strength, and body composition. The intervention group will participate in a 14-week walking program with individualized daily goals, self-monitoring, personalized feedback, and weekly educational material, while the control group will only record their steps without receiving personalized goals or feedback. The recruitment process will begin in March 2026. Initial assessments are scheduled to take place from March 2, 2026, to March 13, 2026. The intervention will be performed from March 16, 2026, to June 19, 2026 (14 weeks). From June 22, 2026, to July 6, 2026, the final evaluations will be performed. The final results of this study are expected to be published by October 2026. This protocol proposes a novel and feasible approach to overcome common barriers to physical activity in university students, with the potential for large-scale application in similar contexts. ClinicalTrials.gov NCT06580769; https://clinicaltrials.gov/study/NCT06580769. PRR1-10.2196/83983.
12. Short-Term Effects of Nonnutritive Sweetener (Sucralose and Saccharin) Consumption on Glycemic Control and Gut Microbiota in Patients With Type 2 Diabetes: Protocol for a Double-Blind, Randomized, Placebo-Controlled, Crossover Trial.
期刊: JMIR research protocols 发表日期: 2025-Dec-10 链接: PubMed
摘要
Nonnutritive sweeteners (NNSs) are widely used as sugar substitutes to help individuals with diabetes manage glycemic control. However, emerging evidence suggests that even low doses of NNSs, such as saccharin and sucralose, may adversely affect metabolic health by impairing glycemic regulation, potentially through alterations in the gut microbiota. In Malaysia, where gut microbiome research is still limited, particularly among individuals with type 2 diabetes mellitus (T2DM), further investigation is warranted to inform safe and evidence-based use of NNSs. This study aims to evaluate the short-term effects of saccharin and sucralose consumption on glycemic control and gut microbiota composition in adults with T2DM. This is a double-blind, randomized, placebo-controlled, crossover trial. A total of 33 adults with T2DM will consume sucralose (5 mg/kg body weight), saccharin (2 mg/kg body weight), or a placebo (calcium carbonate) in capsule form daily for 7 days per intervention arm, with a 4-week washout period. Data collection will include anthropometric measurements, biochemical assessments for glycemic control, dietary records, physical activity levels, and stool samples. The homeostatic model assessment for insulin resistance will be used to assess insulin sensitivity, while 16S rRNA V3-V4 region sequencing will be conducted to profile gut microbiota composition. Recruitment is planned to begin in January 2026 and is expected to conclude by September 2026, with study completion anticipated by March 2027. As of December 2025, no participants have been enrolled. This trial will contribute novel insights into the effects of short-term NNS consumption on glycemic control and gut microbiota composition in individuals with T2DM. These findings may support evidence-based recommendations for NNS use in diabetes management and enhance understanding of microbiome-diet interactions in an ethnically diverse Asian population. ClinicalTrials.gov NCT07124585; https://clinicaltrials.gov/study/NCT07124585. PRR1-10.2196/82695.
13. Changes in the Neighborhood Built Environment and Chronic Health Conditions in Washington, DC, in 2014-2019: Longitudinal Analysis.
期刊: JMIR formative research 发表日期: 2025-Dec-10 链接: PubMed
摘要
Google Street View (GSV) images offer a unique and scalable alternative to in-person audits for examining neighborhood built environment characteristics. Additionally, most prior neighborhood studies have relied on cross-sectional designs. This study aimed to use GSV images and computer vision to examine longitudinal changes in the built environment, demographic shifts, and health outcomes in Washington, DC, from 2014 to 2019. In total, 434,115 GSV images were systematically sampled at 100 m intervals along primary and secondary road segments. Convolutional neural networks, a type of deep learning algorithm, were used to extract built environment features from images. Census tract summaries of the neighborhood built environment were created. Multilevel mixed-effects linear models with random intercepts for years and census tracts were used to assess associations between built environment changes and health outcomes, adjusting for covariates, including median age, percentage male, percentage Hispanic, percentage African American, percentage college educated, percentage owner-occupied housing, and median household income. Washington, DC, experienced a shift toward higher-density housing, with non-single-family homes rising from 66% to 72% of the housing stock. Single-lane roads increased from 37% to 42%, suggesting a shift toward more sustainable and compact urban forms. Gentrification trends were reflected in a rise in college-educated residents (16%-41%), a US $17,490 increase in the median household income, and a US $159,600 increase in property values. Longitudinal analyses revealed that increased construction activity was associated with lower rates of obesity, diabetes, high cholesterol, and cancer, while growth in non-single-family housing was correlated with reductions in the prevalence of obesity and diabetes. However, neighborhoods with higher proportions of African American residents experienced reduced construction activity. Washington, DC, has experienced significant urban transformation, marked by substantial changes in neighborhood built environments and demographic shifts. Urban development is associated with reduced prevalence of chronic conditions. These findings highlight the complex interplay between urban development, demographic changes, and health, underscoring the need for future research to explore the broader impacts of neighborhood built environment changes on community composition and health outcomes. GSV imagery, along with advances in computer vision, can aid in the acceleration of neighborhood studies.
14. Using Social Media Marketing to Improve Retention of Children in the Special Supplemental Nutrition Program for Women, Infants, and Children: Implementation Study.
期刊: JMIR public health and surveillance 发表日期: 2025-Dec-10 链接: PubMed
摘要
Many eligible infants and children do not participate in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC); coverage declines throughout the preschool period of eligibility. National and state-level social marketing campaigns promote the value of WIC and increase enrollment and participation. Local contextualization and targeting of materials may increase effectiveness, considering the diversity of families eligible for the program. However, there are few examples of such approaches and their impact. This study evaluated the impact on child retention of a locally contextualized and targeted social media marketing campaign directed to WIC-eligible families living in the minority-majority population of Miami-Dade County, Florida. The digital marketing campaign geographically targeted low-income families with young children with customized static image and video advertisements on Facebook and Instagram, and a bilingual Google Ads campaign. It was implemented in 2 of 15 clinics operated by the Miami-Dade WIC local agency from May 2020 through April 2021. A before and after evaluation used program administrative data to compare the outcomes for infants and children in 2 innovation clinics (n=6162) with 11 comparison clinics (n=41,074) during a baseline period (2019 calendar year) and the implementation period (n=5636 and n=38,241, respectively). Outcome measures included recertification (re-enrollment during a period), retention (active in the program at the end of a period), and participation (household continuous benefit issuance defined as 11 out of 12 mo). Impact was assessed following cluster-adjusted propensity score weighting and difference-in-difference modeling. Household continuous benefit issuance was estimated in households with only an infant or a child. Overall, 1,994,170 people were exposed to the campaign advertisements; 16.68% engaged with an advertisement. There were 22,983 unique visits to the local program website, 69.6% of which were acquired directly from the campaign. Four of the 5 top-performing advertisements were locally tailored messages and in Spanish. The change in recertification over time was 5.2% points (95% CI 3.4%-7.1%), greater for those in the innovation group than those in the comparison group. For retention and continuous benefit issuance, the absolute difference in change was 5.5% points (95% CI 3.7%-7.3%), and 6.6% points (95% CI 3.5%-9.7%), respectively. Differences in change over time associated with the innovation were qualitatively stronger for infants than for children; the difference in change for recertification was 7.6% points (95% CI 5.1%-10.1%) for infants and 4.0% points (95% CI 2.2%-5.9%) for children. Engaging low-income families with young children through a locally contextualized targeted media marketing campaign can improve retention of children in WIC.
15. Evaluating a Clinical Decision Support Tool for Cancer Risk Assessment in Primary Care: Simulation Study of Unintended Weight Loss.
期刊: JMIR formative research 发表日期: 2025-Dec-10 链接: PubMed
摘要
Early cancer detection is crucial, but recognizing the significance of associated symptoms such as unintended weight loss in primary care remains challenging. Clinical decision support systems (CDSSs) can aid cancer detection but face implementation barriers and low uptake in real-world settings. To address these issues, simulation environments offer a controlled setting to study CDSS usage and improve their design for better adoption in clinical practice. This study aimed to evaluate a CDSS integrated within general practice electronic health records aimed at identifying patients at risk of undiagnosed cancer. The evaluation of a CDSS to identify patients with unintended weight loss was conducted in a simulated primary care environment where general practitioners (GPs) interacted with the CDSS in simulated clinical consultations. There were four possible clinical scenarios based on patient gender and risk of cancer. Data collection included interviews with GPs, cancer survivors (lived-experience community advocates), and patient actors, as well as video analysis of GP-CDSS interactions. Two theoretical frameworks were employed for thematic interpretation of the data. We recruited 10 GPs and 6 community advocates, conducting 20 simulated consultations with 2 patient actors (2 consultations per GP: 1 high-risk consultation and 1 low-risk consultation). All participants found the CDSS acceptable and unobtrusive. GPs utilized CDSS recommendations in three distinct ways: as a communication aid when discussing follow-up with the patient, as a reminder for differential diagnoses and recommended investigations, and as an aid to diagnostic decision-making without sharing with patients. The CDSS’s impact on patient-doctor communication varied, facilitating and hindering interactions depending on the GP’s communication style. We developed and evaluated a CDSS for identifying cancer risk in patients with unintended weight loss in a simulated environment, revealing its potential to aid clinical decision-making and communication while highlighting implementation challenges and the need for context-sensitive application.
16. Insurance Coverage and Pricing of Weight-Loss Drugs in the United States.
期刊: The New England journal of medicine 发表日期: 2025-Dec-10 链接: PubMed
摘要
17. Everyday Digital Support to Promote Health and Literacy Among Older Adults: 14-Week Randomized Digital Pilot Trial by Engagement Level.
期刊: JMIR formative research 发表日期: 2025-Dec-10 链接: PubMed
摘要
While digital health solutions are becoming increasingly sophisticated, simple forms of everyday digital support may offer underexplored opportunities to promote health among older adults. However, evidence remains scarce on whether such teleassistance-based approaches can effectively enhance health literacy and daily self-care, particularly among populations facing socioeconomic and educational disparities. This study examined whether a 14-week mobile teleassistance intervention could support daily health promotion and improve health literacy and quality of life among older adults, and whether different levels of user engagement were associated with differences in outcomes. This randomized digital pilot study involved 21 older adults (aged ≥60 years) from Ribeirão Preto, Brazil. All participants were assigned to the intervention arm and subsequently categorized into high-engagement (n=11) and low-engagement (n=10) subgroups according to platform-use metrics. The intervention combined weekly teleconsultations, gamified educational quizzes, and guided health-related activities delivered through a mobile app. Outcomes included health literacy (Health Literacy Questionnaire), quality of life (36-Item Short-Form Health Survey), physical activity, and sedentary behavior, assessed at baseline and postintervention. Analyses appropriate for small samples were applied, including frequentist and Bayesian models. Participants in the high-engagement subgroup showed greater improvements in health literacy compared with those in the low-engagement subgroup (mean change +9.5 vs +9.1 points; time × group: P<.001; Bayes Factors [BF₁₀]=15). Significant interactions also favored higher engagement for selected quality-of-life domains: vitality (P≤.001), functional capacity (P=.02), and general health (P=.02). A group effect was observed for the mental component (P<.001). Physical activity (F2,38=0.95; P=.39; BF_incl=0.68) and sedentary behavior (F1,19=1.12; P=.32; BF_incl=0.53) did not differ significantly between subgroups. Engagement analytics confirmed higher overall platform use in the high-engagement subgroup (mean 6483.8, SD 807.0 vs mean 3345.3, SD 742.7; t19=6.238; P<.001; d=2.73) and more weekly health-activity minutes (mean 5124.3, SD 757.9 vs mean 3120.7, SD 704.3; t19=6.256; P<.001; d=2.73). This 14-week randomized digital pilot trial suggests that everyday digital teleassistance may enhance health literacy and specific quality-of-life domains among older adults when engagement is high. However, such support alone appears insufficient to modify physical activity or sedentary behavior in the short term. Larger and longer trials are needed to assess sustainability, scalability, and strategies to address structural inequalities in digital health adoption.
18. The effects of community-based green exercise on health, wellbeing, and physical activity participation: a systematic review and meta-analysis of the quantitative and qualitative literature.
期刊: Health psychology review 发表日期: 2025-Dec-10 链接: PubMed
摘要
The aim of the study was to systematically retrieve and analyse current published literature and grey literature regarding the impact of community-based outdoor physical activity (PA) interventions on quantitative and qualitative measures of health and wellbeing in adults and children. A systematic review of seven databases was undertaken in February-April 2022 and September 2024. Overall, 57 outdoor community-based PA intervention studies were included. Meta-analysis results revealed a small-to-moderate positive effect for green exercise (GE) on measures of general health and mental health from pre-to-post intervention, with some evidence of greater benefits on overall health and PA compared to no exercise engagement. Quantitative and qualitative data synthesis indicated positive effects on mental wellbeing and PA engagement when interventions lasted 45 -90 minutes over 6 -13 weeks, with the greatest benefits displayed after walking and multi-activity interventions. A content analysis of qualitative findings emphasises the importance of social opportunities for GE uptake and adherence, and recommended developing low-cost, accessible, fun, and varied exercise opportunities in collaboration with community stakeholders. This comprehensive and robust evidence synthesis demonstrates the positive impact of GE engagement on mental wellbeing and PA, offering novel guidance for the creation, application, and promotion of community-based GE projects.
19. Advanced strategies in organoid/organ-on-a-chip for female reproductive diseases.
期刊: Biofabrication 发表日期: 2025-Dec-10 链接: PubMed
摘要
A comprehensive understanding of the female reproductive system is essential for safeguarding fertility and preventing diseases related to women’s health. Organoid/organ-on-a-chip, as a promising platform, could simulate complex physiological and pathological conditions, has revolutionized our understanding and management of female reproductive health. This technology is anticipated to advance the development of more effective assisted reproductive techniques, treatments and drug screening methods. This review focuses on various organoid/organ-on-a-chip models designed to mimic the ovary, uterus, mammary gland, and vagina. Then, we introduce the current state of organoid/organ-on-a-chip in female reproductive health and highlight how these models contribute to the study of female reproductive diseases. Additionally, we discuss the limitations of organoid/organ-on-a-chip technology as well as its challenges and perspectives. Collectively, we believe that as organoid/organ-on-a-chip technology continues to evolve, it holds great potential for transforming the diagnosis and treatment of female reproductive disorders, thereby enhancing women’s overall health and well-being worldwide.
20. Development of a Hospital-at-Home Digital Twin for Patients With Frailty: Scoping Review.
期刊: Journal of medical Internet research 发表日期: 2025-Dec-10 链接: PubMed
摘要
Increasing demand on health care systems requires innovative, transformative solutions for efficient, high-quality care. One promising approach is digital twin (DT) technology, which leverages real-time data to create dynamic, virtual representations of a physical entity (individuals or space) to anticipate future scenarios and support care decisions. Although DTs have been explored in various sectors, their application in hospital at home (HaH), which delivers acute-level care in home environments, remains unexplored. This review bridges a critical knowledge gap, examining existing evidence on DT-enabling tools to manage patients with frailty in home settings. This will identify the underpinning architectural components required to inform an HaH-DT system supporting clinical decision-making. We searched 6 electronic databases and gray literature for primary English-language studies published between January 2019 and September 2025. Included studies reported on the monitoring or management of patients with frailty within their own home. Information was charted on a predefined data collection form to answer the research objectives. Review articles, protocols, and conference abstracts were excluded. We included 69 reports: 54% (37/69) used quantitative approaches, and 36% (25/69) were pilot or feasibility studies. Reports were analyzed for DT-enabling tools and systematically mapped across the proposed 5-layered DT architecture: sensing, communication, storage, analytics, and visualization. DT layer taxonomies, interconnections, and classifications of data types collected (eg, about the patient, home environment, use of medical equipment) are presented. This evidence identifies DT-enabling tools for a variety of functions and a range of sensing technologies (eg, wearable-based passive sensing, active physiological sensors, ambient sensors detecting motion or environmental changes). The most prevalent communication modes were wireless and network-based (36/112, 32.1%), the majority (12/36, 33%) using Bluetooth. Better understanding of data management, particularly secure storage, is required within local health care systems. The emerging potential of predictive and prescriptive analytics for risk prediction, clinical decision-making, or activation of alert-triggered health interventions by clinicians was mapped. Analytics methods are currently largely descriptive. Advanced methods such as prescriptive analytics for recommendations of an optimal course of action and diagnostic analytics that highlight why a situation has occurred are lacking. DT-enabling tools demonstrate patient-centered benefits, including enhanced motivation, reassurance, and personalized care. Concerns include device accuracy, user acceptability, and implications for carers and organizational workflows. This review is among the first to systematically map DT-enabling tools to inform a potential HaH DT for patients with frailty, organized by a 5-layered conceptual model. Understanding these architectural layers provides the foundations for stakeholders to advance research and development in areas where there are knowledge gaps and consider how an HaH DT can effectively operate within current health care systems. Leveraging technology-enabled care in complex home-based settings provides great potential to deliver safer, personalized, timely care.
21. Supplements for bone health.
期刊: Archives of endocrinology and metabolism 发表日期: 2025-Dec-10 链接: PubMed
摘要
Bonehealth is influenced by a dynamic interplay of genetic, hormonal, and environmental factors, with nutrition playing a vital role throughout life. This review consolidates the current evidence on the roles of essential micronutrients, specifically calcium, vitamin D, vitamin K, magnesium, and phosphorus, in skeletal metabolism and integrity. Calcium and vitamin D, the most extensively studied, have been shown to reduce bone loss and fracture risk, particularly in institutionalized individuals or those with deficiencies, while evidence is less consistent in the general population. Although vitamin K, magnesium, and phosphorus are important for bone physiology, the clinical evidence supporting their supplementation is either limited or context dependent. Additionally, this review explores the current status of micronutrient intake in Brazil and discusses potential risks associated with excessive or inappropriate supplementation, such as cardiovascular issues and mineral metabolism disturbances. An individualized, evidence-informed approach may be beneficial in optimizing bone health while minimizing adverse effects.
22. Lead exposure is associated with increased lead bioaccumulation and a decline in semen quality: a systematic review and meta-analysis.
期刊: JBRA assisted reproduction 发表日期: 2025-Dec-10 链接: PubMed
摘要
This systematic review and meta-analysis aimed to assess the impact and associated mechanisms of lead on human semen quality. A systematic search was conducted from March 18th to April 30th, 2024, utilizing Google Scholar, PubMed, and Scopus, and applying the PECOS model to identify relevant studies. A total of seventeen studies fulfilled the inclusion criteria. The results of our analysis indicated that blood lead levels were markedly elevated in men exposed to lead compared to control subjects (SMD -7.06 [95% CI: -9.03, -5.08], p<0.00001), with analogous results observed for semen lead levels (SMD -3.42 [95% CI: -5.22, -1.62], p=0.0002). Lead exposure was linked to significant decreases in ejaculate volume (SMD 0.81 [95% CI: 0.16, 1.45], p=0.02), sperm count (SMD 2.10 [95% CI: 1.11, 3.09], p<0.0001), sperm concentration (SMD 0.77 [95% CI: 0.09, 1.44], p=0.03), and total motility (SMD 2.20 [95% CI: 1.28, 3.11], p<0.00001), as well as an increase in abnormal sperm morphology (SMD -3.29 [95% CI: -4.87, -1.71], p<0.0001). While reductions in testosterone levels and elevations in semen malondialdehyde were noted, these changes did not reach statistical significance. This study demonstrates that lead exposure is associated with reduced sperm quality. The present findings highlight the urgent need for strategies to reduce lead exposure and emphasize the importance of further research into potential mitigating interventions.
23. Inhibition of CXCL10 and IFN-γ ameliorates myocarditis in preclinical models of SARS-CoV-2 mRNA vaccination.
期刊: Science translational medicine 发表日期: 2025-Dec-10 链接: PubMed
摘要
Messenger RNA (mRNA) vaccines against SARS-CoV-2 are highly effective and were instrumental in curbing the COVID-19 pandemic. However, rare cases of noninfective myocarditis, particularly in young males and typically after the second dose, have been observed. Here, we explore the mediators of this myocarditis to better understand and to enhance the safety of future mRNA vaccines. Through analysis of human plasma data and in vitro experiments with human macrophages and T cells, we identified increased C-X-C motif chemokine ligand 10 (CXCL10) and interferon-γ (IFN-γ) after exposure to BNT162b2 (Pfizer) or mRNA-1273 (Moderna). Neutralization of CXCL10 and IFN-γ during the second dose (21 days after the first dose) reduced vaccine-induced cardiac injury in mice. Neutralization also reduced cardiac stress markers such as the release of N-terminal pro-B-type natriuretic peptide (NT-proBNP) and expression of inflammatory genes in human induced pluripotent stem cell (iPSC)-derived cardiac spheroids. When exposed to these cytokines in vitro, human iPSC-derived cardiomyocytes (iPSC-CMs) exhibited impaired contractility, arrhythmogenicity, and proinflammatory gene expression patterns. Genistein, a phytoestrogen implicated in reducing cardiovascular inflammation, mitigated these effects in iPSC-CMs. In mice exposed to these cytokines or receiving BNT162b2 vaccination, genistein treatment reduced cardiac injury markers and attenuated infiltration of neutrophils and macrophages into the heart. These findings implicate CXCL10-IFN-γ signaling as a contributor to myocardial injury in experimental models of mRNA vaccination and indicate that pharmacologic modulation, such as with genistein, may mitigate cytokine-driven injury.
24. Aggravated Risks of Emergency Hospitalizations Associated with Temperature amid Elevated Ambient Air Pollution: Evidence from a 20-Year Time-Series Study in Hong Kong.
期刊: Environmental science & technology 发表日期: 2025-Dec-10 链接: PubMed
摘要
The combined impact of nonoptimal temperatures and air pollution on hospitalizations remains understudied. This study investigated how major criterion air pollutants (PM2.5, NO2, and O3) modified the short-term temperature-hospitalization associations and quantified the excess attributable burden. Daily time-series data of emergency hospitalizations and environmental exposures (2000-19) in Hong Kong were analyzed using two comparative models with product terms (1) between temperature and lower and higher strata for pollutants, and (2) between temperature and the count of elevated pollutants. Over 10 million noncancer nonexternal (NCNE) admissions occurred, including ∼14% circulatory and ∼20% respiratory admissions. PM2.5 consistently amplified temperature effects, leading to 1.5-2.6% significantly higher NCNE risks with low and high temperatures and 2.8-3.7% higher circulatory risks with low temperatures. NO2 also intensified circulatory risks. Temperature effects were 1.4-2.6% higher on polluted days (≥1 elevated pollutants) than on unpolluted days (0 elevated pollutants), with positive linear trends as pollutant counts increased (p-trend <0.05). The observed temperature-attributable numbers (fraction, %) without considering pollution modification were 68,032 (0.7%), 44,290 (3.2%), and 39,995 (2.0%) for NCNE, circulatory, and respiratory admissions, respectively. These could be reduced by 0.5-0.8% in counterfactual low-pollution scenarios. Combined air pollution exposure exacerbates temperature-related hospitalization risks in Hong Kong, particularly for NCNE and circulatory admissions.
25. Cognitive reserve: The role of occupational experience.
期刊: The Clinical neuropsychologist 发表日期: 2025-Dec-10 链接: PubMed
摘要
Objective: This study aimed to assess the relationship between occupational skillsets and neuropsychological performance in older adults to explore the use of life-long occupational demands as a possible biopsychosocial contributor to cognitive reserve. We hypothesized that individuals’ whose careers emphasized verbal skillsets would predict higher cognitive performance as compared to other occupations that emphasized visuospatial, learning and memory, or executive functioning/processing speed abilities. Method: A sample of 182 participants (79 male, 103 female; Mage = 75.75, SD = 10.72) completed full neuropsychological evaluations, with cognitive performance broken down into four domains: verbal, learning and memory, visuospatial, and executive functioning/processing speed. Their reported careers were coded based on variables provided by O*NET (U.S. Department of Labor). A series of hierarchical linear regressions were used to examine if participants with higher verbal occupational skills performed better on neuropsychological testing, above and beyond well-established predictors of age, education, and gender. Results: Those who had careers with higher verbal skillsets showed better performance in verbal (r = .15) and executive functioning/processing speed (r = .18) domains over and above the robust effect of education. Other job skills (e.g. visuospatial skills, learning, and memory) did not relate. Conclusion: Our results support the potential contribution of specific occupational skillsets to cognitive reserve, especially occupations high in verbal demands. Discussion focuses on limits of the study to investigate directionality of verbal job skills and cognitive functioning, and the potentially confounding role of IQ-a critical agenda for future research requiring a longitudinal design-as well as potential implications for preservation of cognitive functioning.
26. Botulinum Toxin for Refractory Digital Ischemia and Ulcers in Systemic Sclerosis: A Systematic Review and Meta-Analysis.
期刊: JAMA dermatology 发表日期: 2025-Dec-10 链接: PubMed
摘要
Acute digital ischemia, digital ulcers, and gangrene are debilitating complications of systemic sclerosis and other vasculopathies and are often refractory to standard vasodilator and immunosuppressive therapies. Botulinum toxin (BTX) has emerged as a potential rescue therapy, but its clinical effectiveness and safety remain unclear. To evaluate the effectiveness and safety of BTX injections for ischemic digital complications and identify predictors of treatment response using individual participant data (IPD). MEDLINE (PubMed), Embase (Ovid), and Scopus were searched from inception through April 20, 2024. Eligible studies included patients who presented with acute digital ischemia, ischemic digital ulcers, or gangrene. Studies were limited to Raynaud disease without digital ulcers or gangrene were excluded. Two reviewers independently screened articles using Covidence, with discrepancies resolved by consensus with the senior author. Of 116 studies screened, 31 (27%) met inclusion criteria. Data were extracted in duplicate and study quality was assessed using the Joanna Briggs Institute checklist. Descriptive statistics were used to summarize baseline characteristics, treatment regimens, and outcomes. The primary outcome was complete response (CR), which was defined as resolution of ischemia or ulcer healing. Secondary outcomes included adverse events and time to response. Cox regression was used to identify factors associated with CR. This systematic review and IPD meta-analysis included 119 patients (72 female individuals [75.0%]; mean [SD] age, 49.0 [15.1] years). BTX was associated with high CR rates for ischemia (93.1%), ulcers (90.1%), and gangrene (87.5%). Adverse events were infrequent, with transient muscle weakness (7.6%) and injection site pain (5.9%) being most common. No associated factors reached statistical significance in multivariable models, but autoimmune etiology and younger age were associated with faster response in Kaplan-Meier analyses. The results of this systematic review and IPD meta-analysis suggest that BTX injections appear to be a safe and effective adjunct for refractory digital ischemia in systemic sclerosis. Prospective trials are needed to confirm long-term effectiveness and standardize administration protocols.
27. Fracture incidence and osteoporosis treatment in Parkinson's disease: a population-based cohort study.
期刊: Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA 发表日期: 2025-Dec-10 链接: PubMed
摘要
Individuals with Parkinson’s disease have an increased fracture risk. We found approximately 3% of individuals newly diagnosed with Parkinson’s disease have a fragility fracture in the year following diagnosis, with low rates of screening and treatment for osteoporosis. Education is required to minimize this gap for an at-risk population. Individuals with Parkinson’s disease (PD) have an increased risk of fractures due to increased rates of falls and osteoporosis, yet bone health in PD is often overlooked. This study described fracture rates, use of osteoporosis medications, and bone mineral density (BMD) screening in individuals newly diagnosed with PD. Administrative data were used to conduct a population-based cohort study in individuals over 65 years of age, with newly diagnosed PD in Ontario, Canada between January 2008 and December 2023. Descriptive statistics on rates of fracture, use of osteoporosis medication, and BMD testing within the year following diagnosis were reported overall and stratified by sex. Cox proportional hazard models were adjusted for age, sex, Charlson comorbidity score, previous diagnosis of osteoporosis, history of fragility fracture, and use of corticosteroids. After exclusions, 28,119 individuals were included in our cohort, of whom 39.9% were female. Within 1 year of PD diagnosis, 3.1% experienced a fragility fracture (3.4 per 100 person-years), 17.6% received a prescription for an osteoporosis medication, and 9.8% received a BMD test. Rates for all outcomes were greater among females than males. In the adjusted analysis, higher fracture rates were observed in females, those aged ≥ 80 years, with prior fragility fractures, and higher comorbidity scores. Despite elevated fracture risk, fewer than one in five individuals with PD received osteoporosis screening or treatment within a year of diagnosis. These findings highlight the need for proactive bone health strategies to prevent fragility fractures in this high-risk population.
28. Budget Impact and Investment Case for HEARTS Hypertension Control Programs in 4 Low- and Middle-Income Countries.
期刊: JACC. Advances 发表日期: 2025-Dec-09 链接: PubMed
摘要
Hypertension (HTN) is a leading modifiable risk factor for cardiovascular disease, yet diagnosis, treatment, and control are suboptimal in many low- and middle-income countries. The World Health Organization HEARTS program is a standardized approach to improve HTN management in primary care. The purpose of this study was to model the program costs and health benefits of scaling up the HEARTS program over 2025-2040 in 4 low- and middle-income countries with HEARTS programs: Bangladesh, Ethiopia, Nigeria, and the Philippines. A cardiovascular disease simulation model estimated health benefits-averted deaths and disability-of increasing HEARTS HTN treatment coverage by 15 percentage points from 2025 to 2040 in the 4 countries. Program costs were obtained from the HEARTS programs including staff salaries, medications, diagnostics, and infrastructure in 2023 international dollars ($). Base and alternative cost scenarios projected HEARTS program budget impact, health benefits, cost-effectiveness over 2025 to 2040. By 2040, cost of scaling up HEARTS treatment coverage is projected to be $2.9 billion in Bangladesh, $1.7 billion in Nigeria, $0.9 billion in the Philippines, and $0.5 billion in Ethiopia. Across the 4 countries, cost per primary care user ranged from $3 to 16 and cost per patient treated ranged from $27 to 67. HEARTS scale-up can prevent more than 300,000 deaths by 2040: 120,000 in Bangladesh, 77,500 in Nigeria, 47,200 in Ethiopia, and 82,000 in the Philippines. Alternative scenarios assuming lower-cost components identified ways to improve HEARTS affordability and economic returns. Scale-up of HEARTS HTN control package may provide increased health gains and economic benefits over time.
29. Parental and peer influences on adolescent alcohol use in China: Findings from a national study.
期刊: Chinese medical journal 发表日期: 2025-Dec-05 链接: PubMed
摘要
30. Patient Portal Engagement in Oncology: Results From the NU IMPACT Study in a Large Health Care System.
期刊: JCO clinical cancer informatics 发表日期: 2025-Dec 链接: PubMed
摘要
Electronic patient portals can promote patient-centered care, but determinants of engagement remain underexplored in oncology. This study examines sociodemographic and clinical factors associated with engagement with four portal features, including invitations to complete patient-reported outcome (PRO) measures before appointments. Secondary analysis of the Northwestern University IMproving the Management of symPtoms during and following Cancer Treatment study, a stepped-wedge cluster randomized trial to promote symptom management using PROs in adult oncology care was performed. For each enrolled participant, we examined portal usage across 1 year. A total of 3,457 patients were enrolled between April 2020 and April 2023 from 30 Northwestern Medicine ambulatory oncology clinics. Patients were 65% female, 85% White, and 85% non-Hispanic/Latino, with a mean age of 60.8 years. Cancer diagnoses were 30% breast, 12% lymphoma, and all other types accounted for <10% of the sample. Patients accessed laboratory results most frequently (median 23 days in the year), followed by messaging (median 11 days) and physician notes (median 2 days). A total of 62.6% of patients completed at least one invited PRO. Controlling for sociodemographic factors, patient characteristics that were associated with greater engagement across three or more features included more oncology appointments, high health literacy, high anxiety, one or more severe physical symptoms, and high shared decision making with their health care team. Black race, Hispanic/Latino ethnicity, and Medicaid insurance were associated with lower portal engagement. Patients who used any other portal features were more likely to complete PROs. In contrast to other portal features, patients with at least one severe physical symptom were less likely to complete PROs (incidence rate ratio, 0.87 [95% CI, 0.81 to 0.93]; P < .001). Portal use among patients with cancer varies by sociodemographic and clinical characteristics. Findings suggest a need for targeted interventions to promote equitable use among under-represented groups and promote portal-based PRO completion for patients with higher symptom burden.
31. Building Pediatric Cancer Cohorts and Accessing Data Using Childhood Cancer Data Initiative Tools.
期刊: JCO clinical cancer informatics 发表日期: 2025-Dec 链接: PubMed
摘要
Data sharing is necessary to advance understanding of the etiology and biology of cancer in children, adolescents, and young adults; drive therapeutic discoveries; and improve treatment outcomes. To meet this critical need, the National Cancer Institute’s Childhood Cancer Data Initiative (CCDI) provides innovative, user-friendly tools and resources that enable researchers and pediatric oncologists to access and analyze the large volume of diverse childhood cancer data (over 1 million files) that has been collected and harmonized from multiple studies, including CCDI’s Molecular Characterization Initiative, Pediatric MATCH, Childhood Cancer Survivor Study, etc. This article outlines how to find, request, access, download, and analyze data indexed in the CCDI Hub Explore Dashboard and Childhood Cancer Clinical Data Commons (C3DC), key components of the CCDI Data Ecosystem, to accelerate progress in pediatric cancer research. Both CCDI resources support cohort-based analysis and use data models that include study, participant, sample, diagnosis, and treatment data. These models are updated in collaboration with field experts. Additionally, CCDI drafted a Pediatric Cancer Core common data elements list, which serves as a standard reference for researchers. The CCDI Hub is the primary access point for finding data, tools, and applications managed by CCDI. The C3DC provides harmonized, participant-level clinical data and the CCDI Hub Explore Dashboard catalogs data at the file level. These resources enable users to search for and download manifests of harmonized, de-identified participant data and build cohorts. CCDI prioritizes data accessibility and interoperability and, with its resources and data, continues to aid in pediatric cancer research discovery, data-driven insights, and collaboration across the pediatric cancer community.
32. Clinical Outcomes of Adult Patients With Newly Diagnosed Mixed Phenotype Acute Leukemia.
期刊: JCO precision oncology 发表日期: 2025-Dec 链接: PubMed
摘要
Mixed phenotype acute leukemia (MPAL) is a rare clinical entity with historically poor outcomes. We conducted a retrospective analysis of adults 18 years and older with newly diagnosed B-cell (B/M) or T-cell/myeloid (T/M) MPAL treated at our institution between 2017 and 2024. We identified 42 patients (median age 70 years); 20 (48%) had B/M MPAL, and 22 (52%) had T/M MPAL; 57% of patients had adverse risk cytogenetics, and 41% had a TP53 mutation. Sixty-two percent of patients were treated with a hybrid regimen, and 45% of patients received intensive therapy. A composite complete remission (CRc; CR + CRi) was achieved in 57% of patients (86% measurable residual disease [MRD]-negative). After a median follow-up of 27.9 months, the median relapse-free survival in patients achieving an overall response (CRc + morphological leukemia-free state) was 10.1 months, 17.8 months in those who achieved a CRc, and not reached (NR) in patients with MRD-negative CRc. The median overall survival (OS) for all patients was 9.5 months and NR for patients achieving a CRc. Although patients with T/M MPAL had a trend toward improved survival compared with those with B/M MPAL (median OS of 9.1 v 25 months P = .28), this difference abrogated when comparison was stratified by treatment intensity. Twelve patients (29%) underwent allogeneic hematopoietic stem-cell transplantation (HSCT); on landmark analysis, HSCT trended to improve OS (NR v 22.8, P = .12). Multivariate Cox analysis demonstrated that TP53 mutation was associated with increased hazards for death (hazard ratio [HR], 3.5, P = .01), whereas the use of intensive chemotherapy trended to be favorable (HR, 0.45, P = .11). Overall, these data demonstrate the need for treatment intensification in MPAL with HSCT in first remission for best outcomes.
33. Development and Validation of an Intratumor Heterogeneity-Based Prognostic Model for Clear Cell Renal Cell Carcinoma.
期刊: JCO precision oncology 发表日期: 2025-Dec 链接: PubMed
摘要
Clear cell renal cell carcinoma (ccRCC) is characterized by marked intratumor heterogeneity (ITH), which contributes to therapeutic resistance and poor clinical outcomes. We aimed to develop a robust prognostic model for stratifying patients with ccRCC on the basis of ITH. RNA-seq data from 522 patients with ccRCC in TCGA-KIRC were analyzed using the DEPTH algorithm to quantify ITH, with external validation in the E-MTAB-1980 cohort (N = 101). Differentially expressed genes between high and low DEPTH tumors were identified, and a machine learning framework was applied to develop the ITHscore. The ITHscore was compared with other published signatures in literature for ccRCC. The random survival forest model on the basis of three genes (UBE2C, MOCOS, and MELTF) was selected to compose the ITHscore, showing high accuracy in the development (5-year AUC = 0.957) and in the validation cohorts (5-year AUC = 0.82). The ITHscore had the best performance across all 45 retrieved signatures in both development and validation data sets. High-ITHscore tumors exhibited immunosuppressive microenvironments and were associated with immune checkpoint blockade (ICB) resistance signatures. The ITHscore was significantly associated with poor overall survival in five distinct tumor types across a meta-analysis of 104 independent data sets comprising 18,004 patients. We developed and validated the ITHscore, a three-gene expression-based model with superior prognostic performance in ccRCC. The ITHscore reflects key features of aggressiveness in tumor biology, including immune evasion and ICB resistance. Its minimal gene set and consistent performance across data sets support its potential for clinical implementation in ccRCC stratification.
34. Post-traumatic headache phenotypes and clinical characteristics.
期刊: Cephalalgia : an international journal of headache 发表日期: 2025-Dec 链接: PubMed
摘要
Background/AimPost-traumatic headache often resembles migraine or tension-type headache, but distinct phenotype and clinical characteristics necessitate further delineation. We aimed to characterize the clinical phenotype, headache patterns, associated features and comorbidities, medication patterns and functional impact of post-traumatic headache in an adult population following mild traumatic brain injury.MethodsThis is a cross-sectional analysis of a cohort of adults with post-traumatic headache after mild traumatic brain injury, by any mechanism, evaluated by a neurologist at an outpatient specialized concussion and headache center in Ontario, Canada between February 2021 and October 2023. Data were collected through standardized pre- and during-visit questionnaires. Descriptive statistics are presented.ResultsAmong 405 patients assessed by a neurologist for post-traumatic headache, median time since injury was 37 days (IQR: 13-126). Most patients reported headache 26 + days per month (292, 72.1%). Headache was continuous in 114 (28.1%), whereas in 215 (53.1%) it lasted hours to days. Headache location was unilateral in 174 (43.0%) and bilateral in 159 (39.3%). Headache quality was described as pulsating/throbbing in 260 (64.2%). The median severity was 7/10 (IQR 5-8). Aggravation by routine physical activity was reported in 287 (70.9%), nausea/vomiting in 279 (69.0%), photophobia in 358 (88.4%) and phonophobia in 337 (83.2%). There was no positional preference for 147 patients (36.3%), while 216 (53.3%) preferred lying down/reclined. Acute medication use frequency was reported as 3 + days per week in 218 (53.8%) and daily in 143 (35.3%). Within this cohort, 201 (49.6%) endorsed one or more psychiatric comorbidities. Only 66 (16.3%) had returned to full work/school attendance, while 169 (41.7%) were completely off usual occupational activities post-injury. One hundred seventy-eight (44.0%) reported pending litigation or insurance claims related to their injury, and/or having a work-related injury. Among the 183 (45.2%) who had undergone neuroimaging, 160 (87.9%) studies were reportedly normal, while there were 13 (7.1%) incidental findings and eight (4.3%) injury-related.DiscussionWhile select migraine features such as photophobia, phonophobia and worsening with routine physical activity are common in post-traumatic headache, there are also distinct features, including daily or near daily headache of long duration. The latter may suggest early sensitization in post-traumatic headache. There is an associated high risk of medication overuse headache, given frequent administration of acute medications, as well as high rates of psychiatric comorbidities and functional impairment. Future studies should aim to further delineate the longitudinal clinical, pathophysiological, and treatment response differences between post-traumatic headache and primary migraine.
35. Identifying multi-dimensional health clusters associated with high hospitalization burden among middle-aged and older adults in China: A 10-Year cohort study.
期刊: Archives of gerontology and geriatrics 发表日期: 2025-Nov-29 链接: PubMed
摘要
To identify and characterize health subtypes among middle-aged and older adults in China, and test if individuals in high-burden subtypes experience greater hospitalization over time. This cohort study utilized data from the China Health and Retirement Longitudinal Study (CHARLS), a nationally representative survey of adults aged ≥45 years, covering five waves (2011-2020). K-means clustering was applied to seven baseline indicators-functional disability, chronic conditions, neuropsychological vulnerability composite (NVC), unhealthy behaviors, social resources composite (SRC), and prior-year hospitalization-to identify distinct health subtypes. The optimal number of clusters was determined using the elbow method and average silhouette width, and cluster stability was assessed via bootstrap resampling with the adjusted Rand index. Associations between the identified subtypes and subsequent hospitalization burden were examined using generalized estimating equation (GEE) models. The analysis included 16,710 participants (mean age, 59.4 years; 51.2 % female). Two health subtypes were identified: high-burden (27.1 %) and low-burden (72.9 %). The high-burden group showed worse health across all indicators and had significantly higher hospitalization rates. GEE models showed that the low-burden group had fewer hospitalization days (β = -0.34; P < .001) and lower costs (β = -2,336; P < .001). Age and education were significant factors (P < .001). Greater functional disability, more chronic diseases, higher NVC, unhealthy behaviors, and lower SRC were significantly associated with a higher hospitalization burden. These findings underscore the importance of subtype-based stratification for designing targeted interventions in older adults.
36. One- and two-year overall survival following stereotactic body radiotherapy versus conventional radiotherapy for pancreatic cancer: a systematic review and meta-analysis.
期刊: International journal of surgery (London, England) 发表日期: 2025-Nov-24 链接: PubMed
摘要
Pancreatic cancer remains one of the most aggressive malignancies with a dismal prognosis. Both stereotactic body radiotherapy (SBRT) and conventional radiotherapy (CRT) are used in pancreatic cancer treatment, however, there is a lack of robust evidence comparing their efficacy, particularly in terms of 1-year and 2-year overall survival (OS). We systematically searched PubMed, Embase, Web of Science, and the Cochrane Library (up to March 2025) for head-to-head comparative studies evaluating SBRT versus CRT in pancreatic cancer under the PRISMA 2020 guideline. Random-effects meta-analyses were used to pool 1- and 2-year OS rates, with heterogeneity test assessed. Prespecified subgroup and sensitivity analyses examined the influence of study design, treatment intent, chemotherapy use, and outlier impact. Publication bias was evaluated using funnel plots and Egger’s test. Study quality was assessed using the Newcastle-Ottawa Scale, and the overall review process was appraised using the AMSTAR 2 tool. Twelve retrospective studies comprising 6,566 patients were included. SBRT significantly improved 1-year OS compared to CRT (logit OR = 0.43, 95% CI: 0.26-0.60; I2 = 22.5%), corresponding to an OR of 1.54. Subgroup analyses stratified by disease stage, chemotherapy regimen, and study design consistently favored SBRT. The prediction interval (OR: 1.14-13.50) supported the robustness of the pooled effect. Cumulative meta-analysis demonstrated a progressively increasing survival advantage of SBRT over CRT from 2015 to 2023. For 2-year OS, SBRT also showed a significant benefit over CRT (logit OR = 0.33, 95% CI: 0.02-0.64; p = 0.039), equivalent to an OR of 1.39. No evidence of publication bias was found (Egger’s test p = 0.811). SBRT is associated with superior 1- and 2-year OS versus CRT in pancreatic cancer. These findings warrant further prospective validation to optimize integration in contemporary treatment algorithms.
37. OX40 Ligand Inhibitors for Moderate-to-Severe Atopic Dermatitis: A Review of Phase II Clinical Trial Data.
期刊: Skin therapy letter 发表日期: 2025-Nov 链接: PubMed
摘要
Atopic dermatitis (AD) is a common, chronic immune-mediated inflammatory skin disease. The OX40-OX40 ligand (OX40L) pathway has emerged as a novel therapeutic target. On this basis, three phase II clinical trials have been conducted to evaluate the efficacy and safety of three different OX40-OX40L inhibitors (amlitelimab, rocatinlimab, and telazorlimab) in moderate-to-severe AD. Herein, we review the published data from these studies.
38. THE ASSOCIATION BETWEEN LABOR PARTICIPATION AND THE MENTAL HEALTH OF OLDER ADULTS IN THE CONTEXT OF THE SILVER ECONOMY.
期刊: Georgian medical news 发表日期: 2025-Oct 链接: PubMed
摘要
This research aims to examine the association between labor participation and mental health of older adults, particularly depressive symptoms, and to investigate the extent to which this relationship varies across gender and socioeconomic backgrounds. Based on data from the China Longitudinal Aging Social Survey (CLASS), the research examined the mechanisms through which labor participation influenced the mental health of older adults and provided theoretical support and practical guidance for policymakers. This research utilized data from the 2023 China Longitudinal Aging Social Survey (CLASS), involving 10,366 older adults aged 60 and above. Employing a cross-sectional design, the research assessed depressive symptoms using the Center for Epidemiologic Studies Depression Scale (CES-D). Labor participation was measured through the questionnaire item, “whether engaged in paid work.” Descriptive statistics, univariable analysis, and multiple linear regression analysis explored the relationship between labor participation and mental health of older adults. Gender-stratified analyses were conducted to examine potential heterogeneity, and further heterogeneity analysis based on job types was performed to examine employment quality. Labor participation showed a significant association with depressive symptoms among older adults, with those engaged in labor exhibiting lower levels of depressive symptoms than their non-working counterparts. Gender analysis revealed that labor participation exerted a significantly greater association with depressive symptom among women than men. Heterogeneity analysis further revealed that a significant negative association with depressive symptoms was strongest only for work characterized by high autonomy and low physical demands. Additionally, factors such as educational attainment, health status, and marital status significantly influenced depressive symptoms. Labor participation interacted with these factors, jointly influencing the mental health of older adults. A significant association was found between labor participation and reduced depressive symptoms, particularly among women. Furthermore, this relationship varied by job type, showing the strongest association in high-autonomy, low-physical-demand positions. Policy interventions should not only encourage labor participation-particularly among women-but also prioritize job quality by creating positions with greater autonomy and manageable physical demands. Enhancing these job characteristics can strengthen social participation and self-efficacy, thereby maximizing the mental health benefits of working in later life.
39. ETHICAL AND LEGAL ASPECTS OF USING ARTIFICIAL INTELLIGENCE IN THE DIAGNOSIS OF CARDIOVASCULAR DISEASES IN PRIMARY HEALTH CARE.
期刊: Georgian medical news 发表日期: 2025-Oct 链接: PubMed
摘要
This review aims to analyse and systematise the ethical and legal aspects of implementing artificial intelligence (AI) in the diagnosis of cardiovascular diseases within the framework of primary health care. The review was conducted in accordance with established scientific standards for writing review articles. A comprehensive literature search was performed using databases such as PubMed, Scopus, Web of Science, and Google Scholar. Key search terms included: «artificial intelligence», «primary health care», «cardiovascular diseases», «ethics», «legal aspects», «data protection», and «medical AI». The review included publications from 2005 to 2025, with a focus on peer-reviewed articles and reports addressing the ethical and/or legal application of AI in healthcare. The findings of the review indicate that despite the high potential of artificial intelligence (AI) to improve diagnostic accuracy, expand access to medical care, and reduce the burden on healthcare professionals, its implementation in primary health care is accompanied by a range of ethical and legal challenges. These include ensuring data privacy, obtaining informed consent, promoting equitable access to AI technologies, addressing legal uncertainty, and clarifying liability in cases of AI-related errors. Particular attention must be paid to vulnerable and rural populations to prevent digital inequality. Although AI holds promising applications-such as remote monitoring of cardiovascular health and intelligent decision support-the level of trust among healthcare providers in these algorithms remains limited. This highlights the need for a comprehensive regulatory and educational framework to ensure the safe and ethical integration of AI into clinical practice. Artificial intelligence (AI) holds significant potential for improving the quality of cardiovascular disease diagnosis in primary health care. However, its effective and safe implementation is possible only when supported by a well-defined ethical and legal framework. To minimise risks related to data privacy, algorithmic bias, legal liability, and unequal access, collaboration is essential among physicians, developers, legal experts, ethicists, and patient representatives. This collaboration should focus on developing unified regulatory policies, patient-centred technologies, and practical ethical guidelines. Future research should prioritise empirical evaluation of AI integration outcomes in cardiovascular diagnostics, as well as cross-cultural analyses. Such efforts will help shape a sustainable and adaptable global policy for the ethical use of AI in primary cardiology practice.
40. ACCESSIBILITY OF DENTAL CARE TO PREGNANT WOMEN IN ALMATY: AN ANALYSIS OF AWARENESS, ROUTING AND TARIFF POLICY.
期刊: Georgian medical news 发表日期: 2025-Oct 链接: PubMed
摘要
Despite the inclusion of dental examination in the screening package of the guaranteed volume of free medical care (GVFMC), the coverage of pregnant women with dental care in Kazakhstan remains extremely low. Untimely treatment, lack of awareness and financial barriers contribute to the deterioration of the oral cavity and the increased risk of pregnancy complications. As part of the doctoral thesis, a survey of 455 pregnant women was conducted from September to December 2024 on the basis of voluntary informed consent. The author’s questionnaire was used with questions about seeking dental care. The analysis included descriptive characteristics, medians and interquartile range, and comparison of index of caries according to the Kruskal-Wallis test. Additionally, a retrospective analysis of CSHI tariffs for 2020-2024 for key types of dental services was conducted, taking into account their importance for pregnant women and comparing them with clinical results. Only 17.6% of women went to the dentist during pregnancy, only 4.8% of them - for preventive purposes. The median index of caries was 6.0 (IQR: 5.0-7.0) for those who did not apply, and 2.0 (IQR: 2.0-3.0) - for those referred by an obstetrician-gynecologist, p<0.001. Despite the fact that 81.3% were registered before the 10th week, few people received preventive care, which indicates routing problems. Only 14% patients were fully informed, and 65% patients paid extra for treatment. Complaints were related to inattentive attitude (28%), insufficient qualifications (22%) and inconvenient schedule. The analysis of CSHI tariffs showed a slowdown in growth in 2024 after a jump in 2021-2023, which worsens the gap between real costs and service coverage. The study revealed low coverage, insufficient information and economic barriers. Interdisciplinary collaboration needs to be strengthened, routing needs to be improved, and tariff policies need to be reviewed.
41. ENDOMETRIOSIS IN WOMEN OF REPRODUCTIVE AGE IN KAZAKHSTAN: DIAGNOSTIC AND THERAPEUTIC DIFFICULTIES.
期刊: Georgian medical news 发表日期: 2025-Oct 链接: PubMed
摘要
This review aims to examine the current diagnostic and therapeutic challenges associated with endometriosis in women of reproductive age in Kazakhstan and globally. The goal is to identify existing gaps in care and propose improvements in diagnosis, treatment, and health policy. A comprehensive literature review was conducted using English-language studies published up to July 2025. Databases such as PubMed, Scopus, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials were searched using keywords: «infertility», «epidemiology», «prevalence», «Kazakhstan», and «endometriosis». Only peer-reviewed studies were included. The global prevalence of endometriosis is estimated at approximately 10%, yet data from Kazakhstan’s national electronic health system shows a significantly lower rate of 0.12%, indicating underdiagnosis. Delays in diagnosis, often reaching several years, are linked to insufficient awareness, lack of non-invasive diagnostic tools, and limited access to specialised care, especially in rural regions. Diagnostic laparoscopy remains the gold standard, but its invasive nature restricts widespread use. Recurrence rates of up to 67% are reported, often due to incomplete lesion removal. Hormonal therapy remains the mainstay of treatment, although it does not offer a definitive cure. Promising innovations, including cytokine biomarker panels, nanotechnology, and stem cell therapy, are being explored. A multidisciplinary, patient-centered approach is essential for long-term disease management. Endometriosis in Kazakhstan remains underdiagnosed and undertreated. Systemic healthcare reforms, improved awareness among both healthcare professionals and the public, and investment in research and technology are critical. Early diagnosis and personalised, multidisciplinary care can significantly improve outcomes and quality of life for affected women.
42. BIBLIOMETRIC ANALYSIS OF RESEARCH ON THE MANAGEMENT OF IATROGENIC VASCULAR INJURIES DURING GENERAL SURGICAL PROCEDURES (2000-2025).
期刊: Georgian medical news 发表日期: 2025-Oct 链接: PubMed
摘要
Iatrogenic vascular injuries (IVIs) are rare but severe complications of general surgical procedures, often leading to hemorrhage, ischemia, and increased healthcare costs. Despite technological advances in imaging and endovascular management, IVIs remain a critical challenge. Current research is fragmented, and no comprehensive bibliometric analysis has mapped global trends in this field. This study aimed to analyze global research output on the management of IVIs during general surgical procedures between 2000 and 2025, focusing on publication trends, authorship, institutional collaborations, and thematic evolution. A bibliometric analysis was conducted using PubMed, Medline, and Embase databases. Publications from 2000-2025 were retrieved using predefined search terms related to IVIs and general surgery. Only original research, reviews, and case reports were included. Data were screened following PRISMA guidelines, duplicates removed, and metadata analyzed with VOSviewer and Bibliometrix to assess publication trends, co-authorship, institutional networks, and keyword clusters. Bradford’s and Lotka’s Laws were applied to examine journal and author productivity. A total of 716 publications met inclusion criteria. Annual output increased from fewer than 20 papers per year in the early 2000s to peaks in 2015 (57 publications) and 2020 (61 publications). Annals of Vascular Surgery (48 articles), Vascular and Endovascular Surgery (33), and Catheterization and Cardiovascular Interventions (25) were the most productive journals, confirming strong adherence to Bradford’s Law. Authorship analysis revealed that 96.4% of authors contributed only a single paper, consistent with Lotka’s Law, while a small number of researchers, such as Bergqvist, Agarwal, and Kumar, demonstrated sustained contributions. The United States led global output (340 articles), followed by Italy (234) and China (161), although multinational collaboration rates remained below 11%. Keyword mapping identified three phases of research: early focus on open surgical complications (2000-2009), transitional adoption of endovascular and imaging techniques (2010-2013), and recent emphasis on long-term outcomes and minimally invasive strategies (2014-2025). Research on IVIs during general surgery has expanded significantly over the past two decades, driven by advances in endovascular repair and imaging. However, output remains highly concentrated in specialized journals and dominated by single-country contributions, with limited global collaboration and underrepresentation of preventive strategies. Future research should prioritize multinational registries, standardized reporting, and comparative studies of prevention and long-term outcomes. Emerging technologies such as artificial intelligence and simulation-based training offer promising directions for reducing IVI risk and improving patient safety.
43. US Views on New Vaccine Development and False Information After COVID-19.
期刊: Health security 发表日期: 2025 链接: PubMed
摘要
Vaccine innovations offer key tools to protect health, yet public views about vaccine development in the wake of COVID-19 are not well understood. We conducted a nationally representative survey of 1,632 US adults to examine public perceptions of vaccine development and false vaccine information that may shape views after the pandemic. The vast majority (81%) of adults thought vaccine development is “mostly a good thing,” largely because vaccines protect the vulnerable and protect against severe illness (81% and 78%, respectively, among those who thought it was mostly a good thing). Most (78%) adults thought the spread of false vaccine information is a major problem, though few (26%) believed it is spread predominantly by people with bad intentions. Two-thirds (67%) said they had personally heard false information, but among those who gave examples, 31% provided statements that were about vaccines being beneficial, implying they believe vaccines are actually harmful. Findings suggest that public health leaders can build on largely positive public views of vaccine development, but should use caution when communicating about new vaccines and false information. It will be essential for leaders to acknowledge risks of new vaccines and avoid messages that seemingly denigrate people who might share false information.
44. Regulatory Approval of CBRN Medical Countermeasures: Current Scenario and Way Ahead.
期刊: Health security 发表日期: 2025 链接: PubMed
摘要
This review is focused on chemical, biological, radiological and nuclear (CBRN) medical countermeasures (MCMs) regulations in the United States between 2014 and 2024. Primary agencies involved in this process include the Food and Drug Administration (FDA), National Institutes of Health, Department of Homeland Security, and Centers for Disease Control and Prevention. Upon emergency declaration by the Secretary of Health and Human Services Emergency Use Authorization (EUA) goes into effect. Current regulation encompasses section 564 of Federal Food, Drug, and Cosmetic Act of 1938) governing EUA and authorizes the FDA to permit the use of unapproved medical products or unapproved uses of approved medical products to diagnose, prevent, or treat serious or life-threatening conditions caused by CBRN threat agents when no adequate, approved, and available alternatives exist. The regulation also includes Animal Rule, which allows pharmaceuticals or biologics licensing based on animal studies when conducting human efficacy studies is unethical. While expedited pathways exist for CBRN EUA, balancing speed and safety considerations is crucial. Priority Review Vouchers can be issued by the FDA to manufacturers for developing medical products during public health emergencies. While these policies and practices have worked well enough, there is room for improvement in the current regulatory framework regarding ongoing innovations, anticipated changes in regulatory policies, and global collaboration efforts. In this article, we discuss various regulatory challenges, including ethical and safety issues to be considered during the approval of MCMs for CBRN threats. Overcoming these challenges necessitates safety and efficacy demonstration of MCMs, maintaining public trust, and striking a balance between speed and safety considerations.
45. Leveraging Systems-of-Systems Analysis to Strengthen Epidemic Intelligence for Preparedness and Response.
期刊: Health security 发表日期: 2025 链接: PubMed
摘要
The COVID-19 pandemic exposed significant gaps in the coordination and integration of efforts required to effectively manage large-scale infectious disease outbreaks. A successful response to such crises demands the swift and ongoing synthesis of information and activities across multiple sectors, including government, healthcare, and private industry. However, these systems are often managed in isolation, leading to misaligned policies, fragmented communications, and inefficiencies that hinder pandemic response efforts. To address these challenges, we propose adopting a systems-of-systems (SOS) paradigm to enhance epidemic intelligence and improve preparedness and response during infectious disease emergencies. The SOS approach, widely used in engineering, offers a framework for integrating diverse fields such as virology, ecology, psychology, and policy. We illustrate the potential of this approach using highly pathogenic avian influenza (HPAI) as a case study and discuss key considerations for implementing SOS thinking in the context of global epidemic intelligence systems.
46. Nursing and the essential public health functions framework in the Americas: reflections and perspectives.
期刊: Revista brasileira de enfermagem 发表日期: 2025 链接: PubMed
摘要
to reflect on nursing’s role in essential public health functions in the Americas, highlighting contributions, challenges, and perspectives for strengthening public health actions. this theoretical-reflective study was conducted between March and April 2025, based on Pan American Health Organization official documents, especially the 2002 and 2021 versions of the essential functions. The materials were identified by searching the Pan American Health Organization’s institutional repository, including normative and descriptive documents. The analysis was structured in four stages: historical evolution; conceptual update of the functions; impact on the Brazilian reality; and nursing contributions. the updated essential functions incorporated social determinants. Nursing stands out for its strategic role in surveillance, health promotion, and public policy formulation. the updated essential functions expand opportunities for nursing to reduce inequalities and strengthen resilient and inclusive health systems.
47. Factors associated with common mental disorders, suicidal risk, and stimulant use in college students.
期刊: Revista brasileira de enfermagem 发表日期: 2025 链接: PubMed
摘要
to identify factors associated with common mental disorders, suicide risk, and stimulant use among undergraduate students. a quantitative, cross-sectional, correlational, and analytical study was conducted with a sample of 190 students from a public university. Validated instruments were used for data collection, and logistic regression models were used for analysis. 71.6% of participants tested positive for common mental disorders. Suffering losses during the pandemic was a risk factor for common mental disorders, and feeling satisfied with their life when accessing social media was a protective factor. It was found that 23.9% were at high risk for suicide, with a higher risk for those without religion, using non-prescription medications, diagnosed with a mental disorder, and consuming alcohol. Furthermore, 73.7% of participants used stimulants. Stimulant use showed no significant relationship with the variables analyzed. this research contributes evidence for promotion and prevention actions in academic mental health.
48. The INGENIA project and "Healthy Future": a multidisciplinary innovative impulse within the SDGs.
期刊: Revista brasileira de enfermagem 发表日期: 2025 链接: PubMed
摘要
to evaluate the educational actions proposed in the field of healthy lifestyles developed by the Canary Islands Health Service and by the teaching staff of the educational centres, with the help of students of the Nursing degree using Service-Learning. intervention project with a pretest-posttest that was developed from the II Edition of ‘INGENIA. Agents of change for the SDGs’, between February and July 2021. We proceeded to measure the impact of the intervention and the satisfaction of those involved. The programme was a success, increasing both the knowledge of healthy habits of primary school pupils and the satisfaction of the agents implementing the programme. the considerable increase in the satisfaction of both pupils and teachers who use this teaching methodology stands out, as well as the benefits it generates for the society in which they are involved.
49. Intervention characteristics and speech therapy strategies in care for autistic children in health services: a scoping review.
期刊: CoDAS 发表日期: 2025 链接: PubMed
摘要
to identify and systematize speech therapy practices with autistic children in healthcare services reported as an evaluative and therapeutic strategy in Brazil. a scoping review following the guidelines of the Joanna Briggs Institute and PRISMA-ScR. Articles, essays, reviews, and gray literature available until July 4, 2024, were retrieved from databases such as PubMed, Scielo, Scopus, Web of Science, ProQuest Central, Embase, EBSCOhost, BVS, BDTD, and Google Scholar. Reference lists and relevant systematic reviews were also checked for additional documents. based on the PCC format (Participants: autistic children aged 2 to 12 years; Concept: speech therapy assessment and treatment strategies; Context: Brazil). data were extracted using a pre-designed matrix considering author, type/year of publication, objective, sample, autism concept, type/strategy of intervention, setting, and conclusion. Descriptive quantitative and qualitative analyses were performed. a total of 49 studies were included in the review, allowing the identification that speech therapy practices targeting autistic children in Brazilian healthcare services predominantly involve therapeutic and evaluative approaches, mainly carried out in university clinics. although speech therapy has advanced in the personalization of care and adaptation of therapeutic strategies, there is still a predominance of interventions focused on diagnosis and rehabilitation, with a limited number of studies addressing health promotion and social inclusion actions. Identificar e sistematizar a prática fonoaudiológica com crianças autistas em serviços de saúde relatadas enquanto estratégia avaliativa e terapêutica no Brasil. Revisão do tipo escopo seguindo as diretrizes do Joanna Briggs Institute e PRISMA-ScR. Artigos, ensaios, revisões e literatura cinzenta disponíveis até 4 de julho de 2024 foram recuperados em bases como PubMed, Scielo, Scopus, Web of Science, ProQuest Central, Embase, EBSCOhost, BVS, BDTD e Google Acadêmico. Listas de referências e revisões sistemáticas relevantes também foram verificadas para documentos adicionais. Baseados no formato PCC (Participantes: crianças autistas de 2 a 12 anos; Conceito: estratégias de avaliação e terapia fonoaudiológica; Contexto: Brasil). Os dados foram extraídos com matriz previamente elaborada considerando autor, tipo/ano de publicação, objetivo, amostra, conceito de autismo, tipo/estratégia de intervenção, local e conclusão. Foram realizadas análises quantitativas descritivas e qualitativas. Foram incluídos 49 estudos na revisão, sendo possível identificar que as práticas fonoaudiológicas direcionadas a crianças autistas em serviços de saúde brasileiros têm predominância de abordagens terapêuticas e avaliativas realizadas principalmente em clínicas-escola. Embora a fonoaudiologia tenha avançado na personalização do atendimento e na adaptação das estratégias terapêuticas, ainda há um predomínio de intervenções centradas no diagnóstico e reabilitação, com número reduzido de estudos sobre ações de promoção da saúde e inclusão social.
50. Risk communication, respiratory health risks, and air pollution forecasting in the city of Rio de Janeiro, Brazil.
期刊: Jornal brasileiro de pneumologia : publicacao oficial da Sociedade Brasileira de Pneumologia e Tisilogia 发表日期: 2025 链接: PubMed
摘要
Although communicating air pollution risks is critical for protecting public health, particularly in low- and middle-income countries (LMICs), its effectiveness remains underexplored. This study evaluated current risk communication practices in the city of Rio de Janeiro, Brazil, by assessing the associations between short-term exposure to pollutants and respiratory-related hospital admissions; the ability of the Brazilian national índice de qualidade do ar (IQAr, air quality index) to reflect health risks; and the accuracy of pollutant forecasts in comparison with monitored concentrations. Exposure and health data for the 2014-2019 period were obtained through a research partnership with local government officials. Poisson generalized linear models were employed to determine whether IQAr values and short-term exposure to air pollutants, including nitrogen dioxide (NO2) and particulate matter (PM), were associated with daily hospital admissions for respiratory disease. Bias-corrected, forecasted daily concentrations of individual air pollutants from the Goddard Earth Observing System Composition Forecast Composition Forecast (GEOS-CF) model were employed to assess the performance of existing forecasting tools for use in risk communication. Significant associations were consistently observed between hospital admissions for respiratory disease and short-term exposures to NO2 and coarse PM, with excess risks of 5.1% (95% CI: 1.3-8.9%) and 5.6% (95% CI: 1.5-9.9%), respectively, per interquartile range increases in lag day 0-1 exposures. Values of IQAr were not significantly associated with respiratory health events, likely due to their failure to capture the health risks associated with NO2. Bias-corrected forecasts from the GEOS-CF model showed strong correlations with observed pollutant concentrations. These findings indicate that adopting a health-based, multi-pollutant index, combined with improved forecasting tools, could substantially strengthen risk communication in the city of Rio de Janeiro and other LMIC settings.
51. Smartphone-based retrospective analysis for malaria hotspot detection.
期刊: Einstein (Sao Paulo, Brazil) 发表日期: 2025 链接: PubMed
摘要
To leverage passively collected retrospective smartphone location data to accurately identify malaria transmission hotspots through the development of a novel tool, the Sickness Positioning System. We collected anonymized location history data from over 200 malaria-infected individuals using Google Takeout. Sickness Positioning System applies density-based clustering techniques to this passively collected data to identify areas of elevated infection risk. The identified hotspots were subsequently validated through field investigations. Sickness Positioning System successfully pinpointed multiple areas of increased malaria transmission risk. Field validation confirmed two previously unrecognized mosquito breeding sites as active sources of transmission. When compared to Brazil’s federal surveillance system - which updates data annually - Sickness Positioning System provided a more precise and timely spatial assessment of malaria spread. Sickness Positioning System demonstrates a cost-effective, objective, and timely method for identifying malaria transmission hotspots. This approach has the potential to significantly enhance disease surveillance and facilitate more targeted public health interventions.
52. A Late Pleistocene archaic human tooth from Gua Dagang (Trader's Cave), Niah national park, Sarawak (Malaysia).
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
The rarity of Late Pleistocene hominin remains from Insular Southeast Asia (ISEA) has hampered our ability to understand a crucial episode of human evolutionary history, namely, the global dispersal of Homo sapiens from Africa. Moreover, recent discoveries indicate a surprising level of taxic diversity during this time with at least two species-H. floresiensis and H. luzonensis-endemic to the region when H. sapiens first arrived. A third hominin dubbed the ‘Denisovans’ is shown from DNA evidence to have interbred with the ancestors of contemporary Indigenous populations across ISEA, New Guinea and Australia. Yet, the Denisovans have not been identified from the fossil record of the area despite recent breakthroughs in this regard on mainland East Asia. New excavations by our team at the Trader’s Cave in the Niah National Park (‘Niah Caves’), northern Borneo, have yielded an isolated hominin upper central permanent incisor dated with Optically Stimulated Luminescence dating of sediments to about 52 - 55 thousand years ago. Specimen SMD-TC-AA210 has a massive crown absolutely and relative to its root size, the crown is wide (mesiodistally) and relatively short (labiolingually). Morphologically, it exhibits a very strong degree of labial convexity, pronounced shovelling, and the bulging basal eminence exhibits several upward finger-like projections. Labial enamel wrinking on the enamel-dentine junction is expressed as two large ridges exhibiting numerous spine-like projections, and the lingual extensions on the enamel surface of the basal eminence are expressed as six extensions. This combination of crown size and morphological traits is not normally found in H. sapiens and instead characterises archaic members of Homo such as H. erectus, H. neanderthalensis and Middle Pleistocene hominins sharing a clade with H. heidelbergensis. The Trader’s Cave tooth suggests that an archaic hominin population inhabited northern Borneo just prior to or coincident with the arrival of H. sapiens as documented at the nearby West Mouth of the Niah Great Cave.
53. Overweight/obesity among health professionals and associated factors.
期刊: Revista brasileira de enfermagem 发表日期: 2025 链接: PubMed
摘要
to estimate the prevalence of overweight/obesity and identify associated factors among health professionals. this cross-sectional study included professionals who had worked for at least six months in critical units of nine hospitals in northern Minas Gerais, Brazil. Sociodemographic, occupational, anthropometric, and health condition data were collected. Poisson regression with robust variance was applied to estimate prevalence ratios (PR) using SPSS 20.0. a total of 490 health professionals participated, 65.9% were women, and 49.7% were aged 30-39 years. The prevalence of overweight/obesity was 61.8%. Associated factors included age ≥ 30 years, ≥ 5 years working in healthcare, elevated triglycerides, and elevated blood pressure. the prevalence of overweight/obesity among health professionals was high and associated with sociodemographic, occupational, and health factors, underscoring the need for support to promote lifestyle changes in this workforce.
54. Association of cognitive reserve with 9-year domain-specific cognitive trajectories and risk of cognitive impairment in Mexican older adults.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
Cognitive reserve (CR) refers to the adaptation of cognitive performance to endure brain pathology or the aging process. CR can be categorized into static (education and occupation) or dynamic (leisure and physical activities) proxies. Typically, longitudinal studies assess CR as a composite score at baseline and cognitive performance as a global score. This study aimed to compare the relationship between different CR proxies (static and dynamic) with 9-year domain-specific cognitive trajectories, and the risk of cognitive impairment in older adults. Data from the latest four waves of the Mexican Health and Aging Study (MHAS; n = 3102, baseline mean age = 66.62 years) were used. Mixed effects models were performed with CR as independent variables and cognitive trajectories (verbal memory encoding and retrieval, verbal fluency, constructional praxis, visual attention, and memory) as outcomes. Education and leisure activities were significant positive predictors of all cognitive domains. Physical activities were a positive predictor of verbal fluency and verbal memory encoding only. Occupation was a positive predictor of verbal fluency and visual attention. Logistic regression analysis was performed to assess the relationship between CR and the risk of cognitive impairment, where education (OR: 0.79, 95% CI: 0.76, 0.83), occupational complexity (OR: 0.85, 95% CI: 0.77, 0.95), and leisure activities (OR: 0.96, 95% CI: 0.95, 0.97) were significant protective factors. Increasing the years of education can serve as a preventive strategy to delay the clinical manifestation of cognitive impairment while implementing leisure activities can act as an intervention to promote cognition even in later years.
55. Increased inflammation and oxidative stress caused by accumulated metal particle exposure among metro station staff.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
Metro is a significant part of world transport, delivering over 58 billion passengers annually. Train operation processes generated PM rich in heavy metals in the station, but the natural ventilation underground is poor leading to a high PM exposure indoors. Though PM pollution in metro stations was reported widely, there is limited evidence of the adverse health effect of metro station PM. This study collected urinary samples from 74 metro station staff from three different metro stations in Tianjin for 8-OHdG, IL-6, MDA, GSH and T-AOC tests using commercial kits. PM samples were collected for metal composition tests using ICP-MS and oxidative potential test using DTT method. The average PM2.5 concentration was 31.5 ± 12.4 μg/m3, meeting the Standard for indoor air quality in China. However, the indoor concentrations of Zn, Cu, Mn, and Fe were ten times higher than those in the ambient air, inferring a higher exposure level of metal particles. Urinary 8-OHdG, MDA, and IL-6 of senior employees (length of service in the metro station > 5 years) were significantly higher than new employees but not related to age, suggesting a significant influence on individual’s inflammation and oxidative stress led by PM exposure. Identified as characteristic elements in the metro stations, Mo and Ni, were also found significantly correlated with urinary IL-6 and GSH. The findings indicates that chronic metal PM exposure in the metro station may induce oxidative stress and inflammation. However, the accumulated PM2.5 concentration showed a poor relation with biomarkers except for IL-6. Accumulated oxidative potential of PM was significantly correlated with urinary IL-6, 8-OHdG, GSH, and T-AOC. This result suggested the accumulated oxidative potential of PM as a better evaluation method of health influence led by PM rather than mass concentration.
56. Investigation on the knowledge-attitude-practice of medical students in controlling emerging infectious diseases: A case study of COVID-19.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
Investigate the Knowledge-Attitude-Practice (KAP) of students from Medical College towards emerging infectious diseases, and assess their impact, can provide a scientific basis and practical guidance for enhancing medico’s prevention and control capabilities. A total of 2,395 participants from various grades and majors at Medical University were randomly selected using a stratified cluster sampling method. This cross-sectional study was conducted between April 25 and May 31, 2020, using a self-administered questionnaire developed on the Wenjuanxing platform to assess COVID-19-related knowledge, attitudes, and practices (KAP) among medical students. A total of 2,245 participants (aged 16-28 years) were included in the study, coming from five medical disciplines: Clinical Medicine, Preventive Medicine, Nursing, Clinical Pharmacy, Health Inspection and Quarantine. The average scores for the COVID-19 epidemiological knowledge and the control measures for the epidemic were 4.92 ± 1.03 and 4.50 ± 0.78, respectively. Among them, the scores of epidemiological knowledge exhibited significant differences in sex, nation, type of dwelling place, major, grade, annual per capita household income, and age. The scores of preventive knowledge significantly differed by sex, major, grade, physical condition, and age. Further, behavioral data indicated that 96.0% of the students thought the pandemic had severely affected their daily life, while >90% maintained consistent mask usage and >80% insisted on health-protective practices. Practice scores finally varied significantly by sex, family structure, and ethnicity. Altogether, medical students possess certain basic knowledge in controlling emerging infectious diseases, but some still generally suffer from insufficient cognitive depth and anxiety. Colleges can systematically enhance students’ rational cognitive level which include offering specialized courses as well as promoting cutting-edge research achievements, and through standardized operations stabilize their psychological states.
57. Can nighttime lights serve as a proxy for economic inequality at the local administrative unit scale? Evidence from Spain.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
Economic inequality remains a pressing issue, with localized disparities becoming increasingly visible. Monitoring these subnational dynamics is often constrained by the availability of timely, reliable data. This study evaluates the potential of nighttime light (NTL) data to proxy economic inequality at the scale of local administrative units (municipalities), using Spain as a case study. Spain is among the most unequal EU countries by the Gini index and has published municipal income distribution records since 2015. Its geographic and demographic diversity provides a robust setting for testing NTL-based measures with broader applicability. We combine two remote-sensing products (VIIRS and Harmonized NTL) with WorldPop gridded population data to compute lights-per-capita for each pixel. Within each municipality, Gini coefficients are calculated using pixels as the unit of analysis, enabling fine-grained spatial estimation of inequality. We derive Gini values for over 8,000 municipalities for 2015-2020 and compare them with official income-based Gini coefficients from Spain’s tax administration. Relationships between light- and income-derived measures are assessed using cross-sectional regressions and multilevel panel models. Results show statistically significant associations between NTL- and income-derived Gini coefficients, particularly in smaller settlements and rural areas. Panel models outperform cross-sectional models, indicating that NTL data capture temporal changes in inequality even when contemporaneous correlations are modest. Some regions exhibit elevated NTL-derived inequality despite low official estimates-often where unemployment or informal economic activity is prevalent-suggesting that light-based metrics detect disparities not fully reflected in formal income statistics. These findings demonstrate the promise of NTL-derived indicators as scalable, low-cost, and globally replicable tools for monitoring inequality in both data-rich and data-poor settings. As subnational disparities gain importance, this framework offers a practical avenue for fine-grained and inclusive socioeconomic monitoring. Future work should integrate additional spatial layers-such as urban form, infrastructure, and demographics-to refine accuracy and interpretation.
58. The relationship between lay beliefs about the world and pandemic-related beliefs, attitudes, and behaviors.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
The Covid-19 pandemic created a strong need to understand how people can be motivated to engage in protective health behaviors (such as vaccination). Past research suggests that perceiving a health threat as serious and protective behaviors as beneficial increases people’s motivation to engage in protective behavior. However, perceptions of the seriousness of the threat and the effectiveness of protective behavior can be ambiguous in the context of a novel, global pandemic. Research on climate change suggests that people’s core understanding of the world (as either stable and unchangeable or dynamic and influenced by humans) influence whether people perceive such abstract threats to be serious and protective behaviors to be effective on a large scale. Across five online studies (N = 1663), we investigated the correlational relationship and causal effect of these lay beliefs about the world on beliefs, attitudes, and behavioral inclinations regarding both Covid-19 and a hypothetical pandemic scenario. The results did not support a causal effect of lay beliefs about the world, but consistently showed correlational relationships. A sixth online study (N = 410) tested a possible reversed causal effect of pandemic-related behavior inclinations being justified by shifting one’s lay beliefs about the world accordingly. However, we did not find evidence for this effect either. These results indicate that lay beliefs about the world are associated with perceptions of pandemic health threats, but their causal role is unclear.