公共卫生研究摘要 (2025-12-13)
共收录 56 篇研究文章
1. Autoimmune liver diseases in Latin America: Current landscape and challenges.
期刊: Hepatology communications 发表日期: 2026-Jan-01 链接: PubMed
摘要
2. Burden of primary sclerosing cholangitis in Sweden (2002-2020): Incidence, outcomes, healthcare utilization, and costs.
期刊: Hepatology communications 发表日期: 2026-Jan-01 链接: PubMed
摘要
There is limited real-world evidence on the economic burden associated with primary sclerosing cholangitis (PSC). This study evaluated the prevalence, incidence, baseline characteristics, long-term outcomes, healthcare resource use (HRU), and healthcare costs associated with PSC in Sweden. Adults with PSC were identified in the Swedish National Patient Register from 2002 to 2020 using International Classification of Diseases, 10th revision codes for PSC (K83.0A) and/or cholangitis (K83.0) + inflammatory bowel disease (IBD) (K50/K51). The index date was defined as the date of the first (incident) PSC diagnosis. Patients were required to have a look-back period of ≥360 days (baseline) and a follow-up period of ≥30 days. Annualized mean HRU and healthcare costs (in 2021 euros) were calculated at baseline and during follow-up. Overall, 4213 incident patients with PSC were included (mean age 48.4 y; 56.8% male; 73.0% with IBD). At baseline, few patients had cirrhosis (4.2%), hepatobiliary or pancreatic cancers (4.6%), or had undergone liver transplantation (1.0%). Median duration of follow-up was 5.7 years. Outpatient visits, number of hospitalizations and filled prescriptions, and length of inpatient stay significantly increased from baseline to end of follow-up, with a 117% increase in annualized mean total healthcare costs from €9442 to €20,487 (p<0.0001), with hospitalization being a primary driver. In total, 935 patients (22.2%) died. The 10-year risk of any complication (any malignancy, cirrhosis, or liver transplantation) was 25.9% (95% CI 24.0-27.9). HRU and healthcare costs for patients with PSC in Sweden were substantial and significantly increased after diagnosis. Effective therapies are needed to reduce disease progression and economic burden.
3. Hyperbaric oxygen therapy for chronic radiotherapy-related adverse effects: A clinically focused review.
期刊: CA: a cancer journal for clinicians 发表日期: 2026 链接: PubMed
摘要
Radiotherapy is a cornerstone of modern oncologic care, yet its sequelae can significantly impair survivors’ quality of life. Chronic radiation-induced conditions-including skin fibrosis, bone necrosis, radiation cystitis, and proctitis-pose substantial challenges for both patients and caregivers, particularly in the context of improving long-term cancer survival. Hyperbaric oxygen therapy, characterized by the promotion of angiogenesis, fibroblast activation, and tissue remodeling in hypoxic environments, has emerged as a potential adjunctive treatment for mitigating these late effects. Herein, the authors critically evaluate randomized trials, cohort studies, and real-world data while highlighting gaps in knowledge, including patient selection, optimal treatment protocols, and long-term outcomes. In addition, they discuss practical considerations and health system implications of the integration of hyperbaric oxygen therapy into survivorship care. The objective of this review is to provide clinicians with an evidence-informed framework to guide decision making in the multidisciplinary management of radiation-related late effects.
4. Psychiatric Conditions and Symptoms After Toxic Environmental Exposures During Military Service: An Evidence Map.
期刊: Medical care 发表日期: 2026-Jan-01 链接: PubMed
摘要
US service members are often exposed to a range of service-related hazards. To date, there has been limited synthesis of the existing research conducted on military environmental exposures and subsequent psychiatric conditions and symptoms. To systematically review and characterize the main features of studies examining associations between military exposures and mental health outcomes. We used evidence mapping methodology to systematically search MEDLINE, Embase, PsycINFO, and PTSDpubs for studies of toxic exposure during military service and psychiatric outcomes, which included psychiatric diagnoses, psychiatric symptoms, and neurocognitive functioning. We identified 49 studies; most were comprised of predominantly White, male veteran samples. Chemical exposures, including chemical munitions from the Gulf War era and Agent Orange from the Vietnam War era, were the most frequently examined military toxic exposures. Symptoms of depression, PTSD, and anxiety were the most commonly examined psychiatric outcomes. Only 9 studies assessed neurocognitive functioning. We found extensive variation in how exposures and outcomes were defined and measured. Most exposure and symptom data were based on self-reports. Overall, available evidence suggests that veterans reporting environmental toxic exposures may report relatively high levels of mental health needs. We found broad evidence that toxic exposure was associated with poorer mental health outcomes, though the ability to draw stronger conclusions is limited by the quality of the current literature. Future research should focus on longitudinal studies of toxic exposure and mental health that include more broadly representative military populations, including diverse samples and more recent service cohorts.
5. Ask the Experts: Veterans' Perspectives on Communicating About Airborne Hazard Exposures.
期刊: Medical care 发表日期: 2026-Jan-01 链接: PubMed
摘要
We sought to identify key areas to inform the development of Veteran-facing airborne hazard exposure communication materials. Military personnel are commonly exposed to environmental and occupational hazards. Airborne hazard exposures may be particularly salient to Veterans because they are common, and the relationship to health concerns is often uncertain. VA offers a toolkit to help providers navigate caring for Veterans with airborne hazard exposure concerns. Veteran-facing materials, which address their concerns, are lacking. Five generative, qualitative focus groups with Veterans with airborne hazard exposure concerns. Focus group discussions covered information needs, how the VA should communicate about environmental exposures when the evidence is unclear, communication preferences, and how they get health information. We identified 3 areas important to communicating with Veterans about their airborne hazard exposure concerns. (1) Veterans want personalized, transparent and comprehensive communication. (2) Veterans want to be able to act on the information with tangible next steps. (3) Diverse, multimodal communication strategies are needed to reach the range of Veterans with concerns about airborne hazard exposures. In situations of uncertainty, where robust clinical guidance is limited, Veterans want Veteran-centered, transparent, respectful communication that attends to their socially and historically rooted exposure experiences. The information they receive on airborne exposures should be actionable and delivered through a variety of modalities.
6. SPNS1 is an essential cellular factor for EV-A71 by acting as a transporter of viral pocket factor.
期刊: Proceedings of the National Academy of Sciences of the United States of America 发表日期: 2025-Dec-16 链接: PubMed
摘要
Human enterovirus A71 (EV-A71) is a major cause of hand, foot and mouth disease. Cellular factors critical for EV-A71 infection remain enigmatic. Here, we performed CRISPR/Cas9 screens and identified sphingolipid transporter 1 (SPNS1) as an essential factor for EV-A71. SPNS1 deficiency inhibits infection of EV-A71 and 9 of 11 examined enteroviruses. Mechanistically, the endo/lysosomal localization of SPNS1 and the acidification of the endo/lysosomes are essential for SPNS1 to support EV-A71 infection. SPNS1 deficiency inhibits EV-A71 genomic RNA replication, but barely affects replication of EV-A71 RNA directly transfected into the cytoplasm. SPNS1 interacts with the EV-A71 capsid protein VP1 and entry receptor SCARB2 in the endo/lysosomes, where it acts as a transporter to release the viral pocket factor into the cytosol, leading to uncoating. Animal experiments show that SPNS1 deficiency results in reduced viral loads, pathological effects, and lethality following EV-A71 infection. Our findings collectively identified SPNS1 as a transporter of the EV-A71 viral pocket factor.
7. Adolescent receptiveness to dentist involvement in COVID-19 and HPV vaccination.
期刊: International journal of adolescent medicine and health 发表日期: 2025-Dec-15 链接: PubMed
摘要
Human papillomavirus (HPV) and COVID-19 can be prevented and mitigated by vaccines. Few studies have focused on dentists’ role in vaccine decision making, and even fewer have explored adolescent perspectives; a target population for both vaccinations. This study aimed to address this gap with a focus on whether opinions vary between diseases. We administered a validated cross-sectional survey to adolescent patients (11-19 years) in an orthodontic clinic in Vancouver, British Columbia from July-August 2023. The survey included questions pertaining to patient background, vaccine history and knowledge, and dentists’ roles in vaccination education, discussion, and administration. Responses were compiled and analyzed to determine differences between vaccines and across demographic groups. Adolescents surveyed (n=93) overall agreed with dentist involvement in COVID-19 and HPV vaccines, with variability according to disease and dentist role. Comfort with dentist-administered vaccines was higher for COVID-19 (60 %) than HPV (37 %, p<0.05). There was a significant knowledge difference, with 85 % aware that the COVID-19 vaccine can prevent severe illness, but only 22 % aware that the HPV vaccine can prevent oropharyngeal cancer (p<0.05). Patients showed overall willingness to discuss COVID-19/HPV vaccines with dentists (58 % and 49 %) and less agreement that dentists were qualified to educate about COVID-19/HPV vaccines (43 % and 37 %). Findings indicate mixed adolescent perception of including dentists in vaccinations, with higher comfort around COVID-19 over HPV vaccines. Openness to discussion may present an opportunity for dentists to expand scope of practice into additional education, particularly around HPV and its connection with oropharyngeal cancer.
8. Cancer incidence, stage at diagnosis, and trends across the Navajo Nation, 2014-2018.
期刊: Cancer 发表日期: 2025-Dec-15 链接: PubMed
摘要
American Indian/Alaska Native (AI/AN) people in the United States experience cancer disparities, but little is known about cancer patterns specific to each Tribal Nation. This study describes cancer incidence (2014-2018), trends (1998-2018), and stage of diagnosis across the Navajo Nation, one of the largest sovereign tribal nations worldwide. Cases from six Arizona, New Mexico, and Utah counties covering most of the Navajo Nation were identified by population-based cancer registries and linked with Indian Health Services patient registrations. Cancer incidence and stage at diagnosis were compared between Navajo and non-Hispanic White persons in the same counties. Trends from 1998 through 2018 were analyzed using Joinpoint regression. Navajo people had significantly higher incidence than non-Hispanic White people of gallbladder (incidence rate ratio [RR] = 6.25), stomach (RR = 3.19), kidney (RR = 1.89), myeloma (RR = 1.80), and liver cancers (RR = 1.79) and a lower incidence of cancers of the lung (RR = 0.16), female breast (RR = 0.49), leukemia (RR = 0.49), prostate (RR = 0.62), pancreas (RR = 0.79), and non-Hodgkin lymphoma (RR = 0.79). Diagnostic stage was not different for breast, cervical, and colorectal cancers, but two thirds of patients with cervical and colorectal cancer were diagnosed in later/unknown stages. Although all-site cancer rates did not change significantly from 1998 through 2018 among Navajo people, a significant decrease was found from 2010 through 2018 (-2.1% annual percentage change, p < .01). Navajo people experience a higher incidence of kidney, stomach, liver, myeloma, and gallbladder cancers and a lower incidence of cancers of the breast, prostate, lung, non-Hodgkin lymphoma, and leukemia. Tailored and targeted prevention efforts may help reduce cancer disparities in the Navajo Nation. This study summarized cancer rates during 2014 through 2018 among Navajo people in six counties covering the Navajo Nation, one of the largest sovereign Tribal Nations worldwide. Compared to White people in the same area, Navajo people had higher rates of liver, kidney, myeloma, gallbladder, and stomach cancers, and lower rates of lung, breast, prostate, leukemia, non‐Hodgkin lymphoma, and pancreatic cancers. Breast, cervical, and colorectal cancers were diagnosed at comparable stages among Navajo and White people, although late‐stage diagnosis was common for cervical and colorectal cancers. Although some cancers increased, overall cancer rates among the Navajo decreased from 2010 to 2018.
9. The Road from Science to Health: The Importance of Designing For, Measuring, and Communicating Impact in Public Health.
期刊: Annual review of public health 发表日期: 2025-Dec-12 链接: PubMed
摘要
Scientists are facing increasing challenges concerned with improving the health of the public. Declining trust in expertise, new diseases, widening disparities in access to care, and environmental changes all challenge population health science to lean into work that can help move societies closer to solutions. To do this work effectively, we need to nudge population health science toward research that engages with consequential health challenges, which will require a reprioritization of how we generate, measure, and articulate health impact. In this review, we provide a history of evaluating impact, along with a comprehensive framework for conceptualizing future public health research impacts. In addition, we review evaluation models and highlight best practices for measuring impact. We introduce a new framework that builds on realist evaluation principles for assessing the impact of public health research and addresses the need to communicate these impacts to diverse audiences. To achieve this reprioritization, we recognize the need for organizational and systemic changes that can incentivize, prioritize, and reward impact-driven engagement.
10. Smartwatch-Derived Digital Phenotypes Relate to Psychopathology Dimensions in Patients With Psychotic Spectrum Disorders: Longitudinal Observational Study.
期刊: JMIR mental health 发表日期: 2025-Dec-12 链接: PubMed
摘要
Digital phenotyping refers to the objective measurement of human behavior via devices such as smartphones or watches and constitutes a promising advancement in personalized medicine. Digital phenotypes derived from heart rate, mobility, or sleep schedule data have been used in psychiatry to either diagnose individuals with psychotic disorders or to predict relapse as a binary outcome. Machine learning models so far have achieved predictive accuracies that are significant but not large enough for clinical applications. This could hinge on broad clinical definitions, which encompass heterogeneous symptom and sign ensembles, thus hindering accurate classification. The 5-factor model for the Positive and Negative Syndrome Scale (PANSS), which entails 5 independently varying dimensions, is thought to better capture symptom variability. Using the specific definitions of this refined clinical taxonomy in combination with digital phenotypes could yield more precise results. This study aims to investigate potential links between digital phenotypes and each dimension of the 5-factor PANSS model. We also assess whether clinical, demographic, and medication variables confound said reactions. In the e-Prevention study, heart rate, accelerometer, gyroscope, and sleep schedule data were continuously collected via smartwatch for a maximum of 26 months in 38 patients with psychotic spectrum disorders. Obtaining the mean and SD for each patient-month resulted in a database consisting of more than 740 monthly data points. A linear mixed model analysis was used to ascertain connections between monthly aggregated heart rate and mobility features and the 5 symptom dimension scores of PANSS, obtained during monthly clinical interviews. An increase in positive symptoms was associated with a decrease in heart interpulse variation during sleep (t570.7=-3.3, P<.001, f2=0.021), while an increase in negative symptoms was associated with a decrease in accelerometer (mean: t22.1=-3.1, P=.005, f2=0.042; SD: t20=-2.4, P=.03, f2=0.019), gyroscope (mean: t22.9=-2.8, P=.01, f2=0.016), and locomotive motor activity (t17.2=-2.4, P=.03, f2=0.016) during wakefulness. An increase in accelerometer (mean: t564.4=2.8, P=.005, f2=0.017; SD: t551.6=2.5, P=.01, f2=0.015) and gyroscope (mean: t564.5=3.2, P=.001, f2=0.022; SD: t569.2=2.8, P=.005, f2=0.017) motor activity during sleep was related to an increase in depression/anxiety symptoms as well as excitement/hostility symptoms (accelerometer SD: t469.7=3.2, P=.002, f2=0.031; gyroscope mean: t497=2.3, P=.03, f2=0.013; SD: t507.7=3.2, P=.001, f2=0.029). Excitement/hostility symptoms were further associated with an increase in normalized heart rate during sleep (t368.2=3.2, P=.001, f2=0.044) and reduced sleep:wake ratio (t562=-2.7, P=.007, f2=0.013). An increase in cognitive/disorganization symptoms was related to a decrease in the SD of normalized heart rate during wakefulness (t574.5=-3.5, P<.001, f2=0.013). This study provides evidence that biological changes assessed by continuous measurement of digital phenotypes could be characteristic of specific symptom clusters rather than entire diagnostic categories of psychotic disorders. These results support the use of digital phenotypes not only as a means for remote patient monitoring but also as concrete targets for biomarker research in psychotic disorders.
11. The 5 R's of Indigenous Research as a Framework to Co-Design and Evaluate an Outdoor Play Program in Early Learning and Child Care Centers: Protocol for the Promoting Early Childhood Outside (PRO-ECO) 2.0 Wait-List Control Cluster Randomized Trial.
期刊: JMIR research protocols 发表日期: 2025-Dec-12 链接: PubMed
摘要
Outdoor play is a fundamental part of childhood. Children’s participation in outdoor play connects them to nature and the land, and supports their role in the natural world. Early learning and child care (ELCC) centers provide opportunities for outdoor play; however, barriers toward the provision of outdoor play exist, including educator attitudes, policies and procedures, outdoor space limitations, and adverse weather conditions. The Promoting Early Childhood Outside (PRO-ECO) 2.0 study is a community-based research partnership with Indigenous Knowledge Keepers and Elders, Indigenous and early childhood organizations, early childhood education faculty, ELCC centers, and families, aiming to expand outdoor play in ELCC centers. This paper provides an overview of the community-based design process, guided by the 5 R’s-Respect, Relevance, Responsibility, Reciprocity, and Relationship-and the resulting study protocol for the mixed methods waitlist control cluster randomized trial. This study considered a 5 R’s research approach from its inception, beginning with the formation of a Steering Committee and over a year of relationship building before formal study activities commenced. A key early focus was collaboratively identifying project values through an iterative process. Collectively, we worked to promote equity, disrupt power dynamics, and embed Indigenous data sovereignty principles into research agreements, marking a significant departure from traditional Western research processes. The PRO-ECO program and study protocol are implemented in partnership with 10 ELCC centers delivering licensed full-day, year-round care to children aged 2.5-6 years in rural and urban areas of British Columbia, Canada. The PRO-ECO program includes 4 components to address common barriers to outdoor play in ELCC settings. Primary outcome measures include the proportion and diversity of observed nature play behavior during dedicated outdoor times at ELCC centers as measured through observational behavior mapping. Secondary outcomes include changes in educator attitudes, quality of ELCC outdoor play space, and children’s perspectives of their experiences at ELCC centers. Outcome data are collected at baseline, and 6 months and 12 months post baseline. The community’s perspectives (educators, children, and families) on the project are assessed qualitatively to understand the acceptability of the PRO-ECO program. Mixed-effect models will test the effect of the PRO-ECO program on quantitative outcomes. Qualitative data will support the interpretation of quantitative findings and provide evidence on project acceptability. Participant recruitment for this study began in August 2023, and data collection was completed in March 2025. A total of 229 children, 91 staff and early childhood educators, and 40 family members were recruited to participate in this study. The PRO-ECO 2.0 study uses a rigorous experimental design within a community-based research project. The 5 R’s approach grounded our work in shared values, disrupting traditional academic power relations and weaving together Indigenous and Western worldviews in the context of academic research. ClinicalTrials.gov NCT05626595; https://clinicaltrials.gov/study/NCT05626595. DERR1-10.2196/77956.
12. Co-Design of a Digital Health Platform for Chronic Disease Management in Rural Settings Using a Person-Centered, Collaborative-Care Model: Protocol for a 3-Phase Mixed Methods Study.
期刊: JMIR research protocols 发表日期: 2025-Dec-12 链接: PubMed
摘要
Chronic diseases represent a significant global burden, accounting for 85% of the total disease burden in Australia. This burden is particularly pronounced in rural areas, where chronic disease rates are higher, and access to health care services is more limited. Digital technology has the potential to address these disparities by overcoming challenges such as workforce shortages and geographic isolation. Our objective is to develop a digital health platform (DHP) to support the monitoring and management of chronic disease in collaboration with rural and regional stakeholders, including researchers, health care providers, and patients. The platform is being designed to be flexible, enabling applications across a range of chronic health conditions relevant to rural contexts. Guided by implementation science methodologies, we are adopting an evidence-based approach to developing a DHP for chronic disease management. Informed by co-design frameworks and best-practice guidelines, our development plan comprises three key phases: (1) stakeholder needs analysis, (2) co-design and platform development, and (3) postdesign evaluation and testing. The Federation University Human Research Ethics Committee (HREC Ref: 2023/169) granted ethics approval for this study. Data collection is underway. The phase 1 review has been completed, and we have 84 survey responses. Phase 2 has commenced, with 9 workshops and 2 interviews conducted to date. Phase 3 will not commence until phase 2 has been completed. At this stage, project completion is anticipated by late 2026. Findings will inform the desirability, feasibility, and acceptability of co-designed DHPs for chronic disease management in rural Australia. Further, the study will contribute to the evidence base on collaborative, context-sensitive digital health innovation for resource-limited populations. DERR1-10.2196/77844.
13. Stakeholder Criteria for Trust in Artificial Intelligence-Based Computer Perception Tools in Health Care: Qualitative Interview Study.
期刊: Journal of medical Internet research 发表日期: 2025-Dec-12 链接: PubMed
摘要
Computer perception (CP) technologies hold significant promise for advancing precision mental health care systems, given their ability to leverage algorithmic analysis of continuous, passive sensing data from wearables and smartphones (eg, behavioral activity, geolocation, vocal features, and ambient environmental data) to infer clinically meaningful behavioral and physiological states. However, successful implementation critically depends on cultivating well-founded stakeholder trust. This study aims to investigate, across adolescents, caregivers, clinicians, and developers, the contingencies under which CP technologies are deemed trustworthy in health care. We conducted 80 semistructured interviews with a purposive sample of adolescents (n=20) diagnosed with autism, Tourette syndrome, anxiety, obsessive-compulsive disorder, or attention-deficit/hyperactivity disorder and their caregivers (n=20); practicing clinicians across psychiatry, psychology, and pediatrics (n=20); and CP system developers (n=20). Interview transcripts were coded by 2 independent coders and analyzed using multistage, inductive thematic content analysis to identify prominent themes. Across stakeholder groups, 5 core criteria emerged as prerequisites for trust in CP outputs: (1) epistemic alignment-consistency between system outputs, personal experience, and existing diagnostic frameworks; (2) demonstrable rigor-training on representative data and validation in real-world contexts; (3) explainability-transparent communication of input variables, thresholds, and decision logic; (4) sensitivity to complexity-the capacity to accommodate heterogeneity and comorbidity in symptom expression; and (5) a nonsubstitutive role-technologies must augment, rather than supplant, clinical judgment. A novel and cautionary finding was that epistemic alignment-whether outputs affirmed participants’ preexisting beliefs, diagnostic expectations, or internal states-was a dominant factor in determining whether the tool was perceived as trustworthy. Participants also expressed relational trust, placing confidence in CP systems based on endorsements from respected peers, academic institutions, or regulatory agencies. However, both trust strategies raise significant concerns: confirmation bias may lead users to overvalue outputs that align with their assumptions, while surrogate trust may be misapplied in the absence of robust performance validation. This study advances empirical understanding of how trust is formed and calibrated around artificial intelligence-based CP technologies. While trust is commonly framed as a function of technical performance, our findings show that it is deeply shaped by cognitive heuristics, social relationships, and alignment with entrenched epistemologies. These dynamics can facilitate intuitive verification but may also constrain the transformative potential of CP systems by reinforcing existing beliefs. To address this, we recommend a dual strategy: (1) embedding CP tools within institutional frameworks that uphold rigorous validation, ethical oversight, and transparent design; and (2) providing clinicians with training and interface designs that support critical appraisal and minimize susceptibility to cognitive bias. Recalibrating trust to reflect actual system capacities-rather than familiarity or endorsement-is essential for ethically sound and clinically meaningful integration of CP technologies.
14. Hype vs Reality in the Integration of Artificial Intelligence in Clinical Workflows.
期刊: JMIR formative research 发表日期: 2025-Dec-12 链接: PubMed
摘要
Artificial intelligence (AI) has the capacity to transform health care by improving clinical decision-making, optimizing workflows, and enhancing patient outcomes. However, this potential remains limited by a complex set of technological, human, and ethical barriers that constrain its safe and equitable implementation. This paper argues for a holistic, systems-based approach to AI integration that addresses these challenges as interconnected rather than isolated. It identifies key technological barriers, including limited explainability, algorithmic bias, integration and interoperability issues, lack of generalizability, and difficulties in validation. Human factors such as resistance to change, insufficient stakeholder engagement, and education and resource constraints further impede adoption, whereas ethical and legal challenges related to liability, privacy, informed consent, and inequity compound these obstacles. Addressing these issues requires transparent model design, diverse datasets, participatory development, and adaptive governance. Recommendations emerging from this synthesis are as follows: (1) establish standardized international regulatory and governance frameworks; (2) promote multidisciplinary co-design involving clinicians, developers, and patients; (3) invest in clinician education, AI literacy, and continuous training; (4) ensure equitable resource allocation through dedicated funding and public-private partnerships; (5) prioritize multimodal, explainable, and ethically aligned AI development; and (6) focus on long-term evaluation of AI in real-world settings to ensure adaptive, transparent, and inclusive deployment. Adopting these measures can align innovation with accountability, enabling health care systems to harness AI’s transformative potential responsibly and sustainably to advance patient care and health equity.
15. Reemergence of Yellow Fever, Magdalena Valley, Colombia, 2024-2025.
期刊: Emerging infectious diseases 发表日期: 2025-Dec-12 链接: PubMed
摘要
Yellow fever, a zoonotic arboviral disease, has reemerged in Colombia, triggering a major outbreak in the country. During 2024 through mid-2025, a total of 132 human cases and 68 infections in nonhuman primates were confirmed, primarily in the department of Tolima, historically considered a low-risk area. We analyzed the historical and current epidemiology of yellow fever in Colombia, highlighting ecologic, social, and surveillance factors that contributed to the outbreak. Low vaccination coverage, insufficient epizootic and entomological surveillance, deforestation, habitat fragmentation, and limited application of One Health approaches have all exacerbated the situation. The high mortality rate of nonhuman primate species indicated a more profound ecologic crisis. Immediate, comprehensive measures, including mass vaccination, genomic surveillance, and integrated One Health frameworks, are urgently needed. Colombia’s experience underscores the need to reevaluate risk stratification and preparedness strategies across the Americas to prevent future yellow fever outbreaks in previously unaffected regions.
16. [Immunotherapy for urological cancers in 2025].
期刊: Magyar onkologia 发表日期: 2025-Dec-12 链接: PubMed
摘要
To review the development of immunotherapy (IO) for urological cancers (urothelial carcinoma - UC, renal cell carcinoma - RCC, prostate cancer - PCa , testicular germ cell tumors - TGCT) with a focus on the latest studies, combination strategies, and the messages of the 2025 guidelines. Review of randomized phase II-III studies published in 2024-2025, international guidelines, and biomarker- guided approaches. In UC, the combination of enfortumab vedotin and pembrolizumab has been a breakthrough and has become the new first-line standard, while maintenance and adjuvant immunotherapies have also been strengthened. In RCC, IO- TKI and IO-IO combinations show long-term survival benefits, but the IO-after-IO strategy has proven questionable. In PCa, the efficacy of immunotherapy is mainly limited to biomarker-driven subgroups (MSI-H/dMMR), while in TGCT, cisplatin-based treatment remains the standard, and the role of IOs is being evaluated in further studies. By 2025, immunotherapy has become the therapeutic basis for UC and RCC, both in metastatic and curative treatments. In PCa and TGCT, immunotherapy options remain in the experimental phase, but research is ongoing with new combinations and biomarker-driven strategies.
17. [Not Available].
期刊: Magyar onkologia 发表日期: 2025-Dec-12 链接: PubMed
摘要
Gastroesophageal cancers still rank among the leading causes of cancer-related death. With the introduction of immunotherapy, the treatment strategy has evolved. In the neoadjuvant setting for gastroesophageal junction (GEJ) and gastric adenocarcinoma, the results of the MATTERHORN clinical trial, presented at this year’s ASCO meeting, are expected to shift future treatment strategies. In esophageal tumors, adjuvant nivolumab is used. In metastatic disease, depending on the histological subtype, molecular testing such as PD-L1 CPS and TPS, HER2, and MSI-H is required to determine the treatment decision. In the metastatic setting, combinations of nivolumab or pembrolizumab with fluoropyrimidine- and platinum-based chemotherapy have improved survival. Among HER2-positive patients, adding pembrolizumab to trastuzumab and chemotherapy - in PDL1 CPS ≥1 cases - has become a new standard. A special mention must be made of MSI-H tumors, in which immunotherapy is highly effective, and adjuvant chemotherapy is not recommended according to current guidelines.
18. [Modern treatment of lung cancer with immunotherapy].
期刊: Magyar onkologia 发表日期: 2025-Dec-12 链接: PubMed
摘要
In the case of non-small cell lung cancer, systemic treatment plays a key role in early, locally advanced as well as metastatic stages. The neoadjuvant approach is represented by the combination of immunotherapy+chemotherapy, while targeted therapy does not yet have an evidence-based place in this indication. Immune checkpoint inhibitor treatment has an important role in clinical practice in adjuvant setting as well. Several trials have also concluded with positive results regarding perioperative immunotherapy. Currently, the role of the multidisciplinary tumor board in the personalized decision-making process is essential. In locally advanced cases, immunotherapy after radiochemotherapy is also evidence-based. In advanced, non oncogene-addicted non-small cell lung cancer, the place of immunotherapy is well defined, both as monotherapy and in combination with chemotherapy. Progress has also been made in small cell lung cancer, both in extensive and limited stages, with immune checkpoint inhibitor treatment.
19. [Immunotherapy of cutaneous neoplasms].
期刊: Magyar onkologia 发表日期: 2025-Dec-12 链接: PubMed
摘要
Skin cancers are the most commonly diagnosed malignancies worldwide; however, effective treatment of advanced tumors was unavailable until recent years. In the past decade, the introduction of immune checkpoint inhibitors (ICIs), targeting CTLA-4, PD-1, PD-L1 and recently LAG-3, has revolutionized therapeutic strategies for advanced skin cancers and improved survival outcomes. In this review, we present the current therapeutic opportunities and future directions of immunotherapy in the management of malignant melanoma, cutaneous squamous cell carcinoma, basal cell carcinoma, and Merkel cell carcinoma, accompanied by a brief overview of their mechanisms of action. Ambrus L, Balatoni T. Immunotherapy of cutaneous neoplasms.
20. Digital Isolation and Depression Risk in Older Adults Using the National Health and Aging Trends Study Database: 8-Year Longitudinal Study.
期刊: JMIR aging 发表日期: 2025-Dec-12 链接: PubMed
摘要
The rapid advancement of digital technologies has profoundly transformed communication practices. However, this technological revolution has also led to “digital isolation,” a form of social disconnection caused by limited or absent engagement with digital communication tools, including smartphones, computers, email, and the internet. This issue is particularly concerning for older adults, as it may increase their likelihood of developing mental health disorders, with depression being a primary concern. Although digital isolation has been studied less frequently than traditional social isolation, it may be a significant contributor to both the initiation and progression of depression in this population. This investigation seeks to assess longitudinal relationships between multidimensional digital disengagement (encompassing 4 dimensions: mobile device use, computer interaction, electronic correspondence, and web-based engagement) and incident depression among older adults, using longitudinal data from the nationally representative National Health and Aging Trends Study (NHATS). The analysis was conducted based on the NHATS dataset, a nationally representative longitudinal survey using multistage sampling to represent community-dwelling Medicare beneficiaries aged 65 years and older in the United States. We analyzed data from 2011 (Round 1) to 2018 (Round 8), including 8199 participants in the discovery and validation cohorts. Digital isolation was measured using a 4-item index based on self-reported nonuse of mobile phones, computers, email, and the internet. Participants were categorized into high (aggregate score ≥3) or low (aggregate score ≤2) digital isolation groups. Weighted Cox regression models with proportional hazards assumptions were used to quantify longitudinal associations between the digital isolation index (and its individual components) and incident depression, incorporating multivariable adjustment for sociodemographic characteristics (age, sex, and race or ethnicity), socioeconomic indicators (education level, family income, and marital status), and clinical profiles (tobacco use history and multimorbidity burden). Time-to-event analyses were visualized through Kaplan-Meier estimators, complemented by prespecified subgroup analyses evaluating effect modification patterns through interaction term testing. A high level of digital isolation, as measured by the composite index, was associated with a significantly greater risk of incident depression (fully adjusted model: hazard ratio 1.35, 95% CI 1.18-1.55; P<.001). Furthermore, analysis of the individual components showed that nonuse of computers, email, and the internet was each significantly associated with a higher depression risk, whereas mobile phone isolation had a weaker, nonsignificant association. The study revealed a robust association between increased digital isolation and a higher likelihood of depression in the older population. These results underscore the importance of implementing tailored public health strategies to address digital isolation, especially for older adults. To minimize its detrimental effects on mental health, policymakers should encourage digital literacy programs and strengthen mental health services.
21. Improving Experimental Designs for Interventions to Reduce Intimate Partner Violence: Protocol for Refinements to Single-Case Experimental Design for a Safety Planning Intervention in Ontario, Canada.
期刊: JMIR research protocols 发表日期: 2025-Dec-12 链接: PubMed
摘要
Intimate partner violence (IPV) affects 2 in 5 women in Canada, leading to both physical and mental health consequences. Safety planning is a secondary prevention intervention designed to assist those experiencing IPV in taking steps to increase their safety and decrease contact with their abusive partner. Safety planning has been shown to help survivors mitigate the negative mental health effects of IPV and encourage actions to increase safety, but evaluation outside the United States remains limited. Our team plans to evaluate the use of single-case experimental design (SCED) to assess the effectiveness of a web-based safety planning app (WITHWomen Pathways) for women experiencing IPV in the Greater Toronto Area. The study also explores whether women can be safely engaged for intense follow-up. SCED evaluation will involve multiple baseline and postintervention assessments of a small number of women experiencing IPV (n=6). Participants will be recruited from IPV service organizations across the Greater Toronto Area. SCED will allow for rigorous within-subject comparison, using repeated measurements at multiple time points for 3 primary outcomes (decisional conflict, empowerment to take safety actions, and use of safety strategies) and 2 secondary outcomes (mental health and IPV recurrence). The evaluation will include 5 phases: recruitment, eligibility screening, multiple baseline interviews, intervention (web app delivery), and multiple postintervention assessments. In this paper, we also discuss the development of rigorous protocols for maintaining safety and flexible data collection methods (in person, via telephone, or online). Recruitment began on July 3, 2024. As of December 2025, a total of 4 participants have been recruited and have completed multiple baseline assessments. Data analysis has been completed for 4 participants, and results are expected to be published in spring 2026. The SCED approach may offer a novel and ethical evaluation method for IPV interventions. If effective, the WITHWomen Pathways web app could significantly improve help-seeking and safety planning among women experiencing IPV in the GTA. This study may serve as a model for future IPV intervention evaluations, demonstrating robust evaluation data and participant safety.
22. Cancer-Related Impacts on Employment and Strategies for Support Among Long-Term Young Adult Survivors of Hematologic Malignancies.
期刊: JCO oncology practice 发表日期: 2025-Dec-12 链接: PubMed
摘要
Employment is a core component of development in young adulthood and may be drastically affected by cancer. As part of a multi-institution financial navigation trial (ClinicalTrials.gov identifier: NCT05620979), we sought to explore employment-related experiences of long-term young adult (YA) survivors of cancer. We conducted a secondary qualitative analysis of YA (age 18-39 years) survivors of hematologic malignancies. Participants completed baseline questionnaires pertaining to education and work. A subset of participants completed an optional semistructured interview after trial completion, focused on financial experiences. To contextualize the cohort and supplement qualitative findings, survey data were analyzed using descriptive statistics. We analyzed interview transcripts using directed content analysis and inductive reasoning to examine employment-related themes. One hundred thirty YA participants (median 31 years; Q1-Q3, 27-35) were enrolled with median time from cancer diagnosis of 10 years (Q1-Q3, 6-16). Most (82%) were currently employed, 77% of whom worked full time; 21% were students. Almost half (46%) reported that cancer continued to affect their education and/or employment; 29% had taken extended work leave in the previous year for cancer-related reasons. Challenges expressed in interviews with 45 participants included difficulties maintaining work because of treatment and side effects, interruptions affecting employment trajectory, and choosing work primarily for insurance/health-related reasons. Recommendations from YAs included building personal financial literacy, seeking financial resources, and suggesting clinicians incorporate screening and training for vocational and financial challenges. Many long-term YA survivors of cancer reported substantial, ongoing impacts on their work-related achievement and trajectory. These findings underscore the need for universal screening and support throughout the cancer care continuum.
23. Wildland Fire as a Public Health and EMS Crisis: Evolving Threats and Imperatives for Out-of-Hospital Leadership.
期刊: Prehospital emergency care 发表日期: 2025-Dec-12 链接: PubMed
摘要
Wildland fire in the United States has evolved into a sustained public health emergency with direct and escalating implications for emergency medical services (EMS). Once viewed primarily as a forestry issue, modern wildfire is now driven by climate change, decades of fuel accumulation, expansion of the wildland-urban interface, and ecosystem degradation. Fire seasons have lengthened into year-round events, generating substantial health impacts and placing severe strain on out-of-hospital systems. The population health consequences of wildfire exposure are extensive. Acute smoke inhalation increases asthma exacerbations, chronic obstructive pulmonary disease presentations, cardiovascular events, and premature mortality. Repeated or chronic exposure contributes to long-term pulmonary dysfunction, elevated malignancy risk, and behavioral health morbidity. Children, older adults, individuals with pre-existing conditions, and socioeconomically disadvantaged communities experience disproportionate harm. Simultaneously, wildfires cause surges in EMS call volume while disrupting communications, transportation, and access to definitive care. Prehospital clinicians and responders also face significant occupational hazards, including extreme heat, prolonged particulate exposure, musculoskeletal trauma, behavioral health stressors, and an elevated risk of sudden cardiac death. As EMS agencies are increasingly tasked with austere fireground support, extended evacuations, and prolonged operations, the role of EMS physicians becomes critical. However, despite the scale of these challenges, prehospital physicians are often underrepresented in regional wildfire mitigation, preparedness, and resilience planning. National recommendations now call for a strategic shift from reactive suppression to proactive, interdisciplinary collaboration. Prehosptial physicians are uniquely positioned to integrate clinical care, disaster medicine, occupational health, and community preparedness. Their leadership is essential to ensure EMS integration into community wildfire protection plans; to strengthen occupational and mental health support for responders; to guide wildfire-specific training, triage, and protocol development; and to inform public education efforts. Prehospital physicians must also advocate for policies that incorporate out-of-hospital perspectives into resilience funding and mitigation initiatives. In summary, wildland fire is a chronic societal crisis with expanding health and EMS implications. Meeting this challenge requires prehospital physicians to broaden their roles as clinicians, educators, advocates, and policy leaders to support a more fire-adapted and resilient future.
24. Support Strategies and Interventions for eHealth Inclusion: Scoping Review.
期刊: Journal of medical Internet research 发表日期: 2025-Dec-12 链接: PubMed
摘要
Policymakers increasingly promote eHealth as a way to improve health care efficiency. However, digitalization risks excluding individuals and groups who cannot fully engage with eHealth, for example, due to limited digital literacy or restricted access to resources. Targeted support, such as skills training, personalized guidance, or system-level initiatives, may help, but evidence on how such support is organized and on their outcomes for eHealth inclusion remains limited. This scoping review aimed to map proposed strategies to promote eHealth inclusion, identify concrete support interventions, and report evidence on their outcomes. This scoping review followed the PRISMA-ScR guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews). Our search included PubMed, Scopus, Web of Science, and Embase for peer-reviewed studies published from 2014 onward, and the search was completed on January 29, 2024. We included empirical studies reporting on support to enhance eHealth inclusion. In total, 40 studies met the criteria: 19 examined support strategies and 21 evaluated targeted interventions. Strategies and interventions were categorized by actors at the microlevel (interpersonal, such as family members, friends, or peers), mesolevel (organizations, such as health care organizations or community organizations), and macrolevel (policy or system). Support strategies and interventions addressed a range of eHealth types, including video consultations, mobile health applications, and patient portals. Strategy studies often emphasized interpersonal support from family, friends, or peers, whereas interventions more often involved health care providers. Intervention outcomes, as identified during analysis, were grouped into adoption, use, skills, and attitudes. Adoption-focused interventions led by health care organizations showed limited or not statistically demonstrated effectiveness. Interventions targeting use partly demonstrated positive effects, such as increased completion of video visits, whereas outcomes related to attitudes were mixed. Nearly all multiactor interventions-combining efforts across micro-, meso-, and macrolevels-effectively improved eHealth skills, including digital and eHealth literacy. Examples include programs linking health care providers with community organizations and initiatives pairing students with older adults, both of which improved these skills. Regional differences were also observed: health care providers played a dominant role in studies from the United States, community organizations were more prominent in African contexts, and multiactor approaches were common in European studies. Overall, interventions yielded mixed results, but multiactor collaborations frequently improved eHealth skills. These findings underscore the value of combining interpersonal, organizational, and policy-level efforts when designing support structures. For health care organizations, initiatives led solely by health care actors may suffice for promoting the use of specific applications (such as video consultations), but they seem insufficient for fostering broader eHealth literacy. Future research should address the sustainability and scalability of multiactor interventions and how health system contexts and cultural factors shape their outcomes.
25. Improved Knowledge Distillation Based on Global Latent Workspace With Multimodal Knowledge Fusion for Understanding Topological Guidance on Wearable Sensor Data.
期刊: IEEE transactions on neural networks and learning systems 发表日期: 2025-Dec-12 链接: PubMed
摘要
Wearable sensors have found numerous applications in health and wellness promotion and have achieved great success leveraging advancements in deep learning. However, the development of robust continues to be hindered by issues related to sensor noise, inconsistent sampling rates, and individual differences. Topological data analysis (TDA) has emerged as a viable solution to extract robust features from such time-series data by converting them into persistence images (PIs), which capture intrinsic characteristics and demonstrate resilience to noise and signal variations. However, the computational costs of TDA pose significant challenges for small devices with limited resources. To more efficiently incorporate topological features, we utilize knowledge distillation (KD), which is a promising way to generate a smaller model using larger models. Multiple teachers can be adopted to enrich features in KD. However, this approach has presented two key challenges: 1) differences in feature dimensions from multimodal data and 2) conflicting knowledge provided by the different teachers, both of which can degrade the student model’s performance. To address these issues, we propose a novel KD framework called multimodal global latent workspace-based KD (mGLW-KD) that is motivated by global workspace theory (GTW) from cognitive neuroscience. GWT models how the brain integrates and distributes relevant information across different neural modules through a shared workspace, and it includes attentional control and working memory to prioritize and retain key information. Inspired by this theory, mGLW-KD incorporates a working memory module to unify diverse knowledge from multiple teacher models into a shared latent workspace, facilitating efficient knowledge transfer to the student model. By integrating topological insights with cognitive principles, mGLW-KD addresses the challenges posed by wearable sensor data and enables the student model to achieve superior performance using only time-series input during inference.
26. Assessment of Skeletal Muscle Quality via Intramuscular Adipose Tissue Content Predicts Surgical Morbidity and Prognosis after Pancreatoduodenectomy.
期刊: Pancreas 发表日期: 2025-Dec-12 链接: PubMed
摘要
Sarcopenia is characterized by skeletal mass reduction and is associated with surgical morbidity and poor prognosis after pancreatoduodenectomy (PD). Sarcopenia diagnosis requires a combination of motor functional tests and skeletal muscle mass measurements. Conversely, intramuscular adipose tissue content (IMAC), an indicator of skeletal muscle quality, requires only computed tomography, providing convenient diagnostic information regarding the patient’s body composition. This study aimed to clarify the impact of IMAC on surgical morbidity and prognosis in patients undergoing PD. This study included 277 patients who underwent PD between January 2013 and December 2022. The relationship between surgical morbidity (Clavien-Dindo grade ≥ 3) and clinicopathological factors, including IMAC, was examined in all patients. Predictive factors associated with overall survival (OS) and recurrence-free survival (RFS) were evaluated in 122 pancreatic cancer patients. A high IMAC independently predicted major complications (odds ratio 1.776, P=0.046) and was independently associated with poor OS (hazard ratio [HR], 1.694; P=0.038) and RFS (HR, 1.582; P=0.038). Patients with both high IMAC and CAR ≥ 0.015 had a significantly poorer OS than those with only one of the factors (5-year survival rate, 12.3% vs. 45.8%; P<0.001). IMAC, an indicator of skeletal muscle quality, provides convenient and highly valuable diagnostic information on body composition and predicts postoperative complications and prognosis in patients with malignant tumors undergoing PD.
27. Persistent gender disparities in research productivity among U.S. reproductive endocrinologists: a cross-sectional analysis.
期刊: Journal of assisted reproduction and genetics 发表日期: 2025-Dec-12 链接: PubMed
摘要
To assess gender-based differences in career trajectories among reproductive endocrinology and infertility (REI) physicians in the United States, focusing on leadership, research productivity, and professional involvement. This was a cross-sectional comparative study of demographic, professional, and research metrics stratified by gender. Practicing REI physicians were identified through the ASRM directory. Physician gender was evaluated as a variable influencing career outcomes. Main outcome measures included practice setting, geographic distribution, research productivity (h-index, publications, citations), academic leadership, journal editorial board, and society board positions. Mann-Whitney U and Chi-square tests were performed. Among 767 REI physicians, 55% were male and 45% female. Slightly more females worked in academic settings (33.3% vs. 25.1%), while more males were in private practice (70.4% vs. 66.7%). Leadership representation was comparable between genders. Female physicians had marginally greater representation on editorial (7.8% vs. 7.1%) and society boards (5.8% vs. 4.3%). Males, however, had significantly higher research productivity (mean h-index: 16.44 vs. 10.94; publications: 52.53 vs. 26.72; citations: 2216.69 vs. 1155.28; all p < 0.001). Despite near parity in leadership representation, gender disparities persist in research productivity among REI physicians. These discrepancies may reflect systemic inequities in academic support, promotion criteria, and institutional culture. Structural barriers such as inequitable research resources, gendered service loads, and family-building or domestic responsibilities may further constrain women’s ability to engage in sustained scholarly productivity and advancement. Future efforts can prioritize inclusive data practices, equitable promotion policies, and targeted interventions to support diversity within reproductive medicine.
28. Key early changes in oral squamous cell carcinogenesis are accelerated by ectopic BMI1 expression.
期刊: Cancer research communications 发表日期: 2025-Dec-12 链接: PubMed
摘要
Although five-year relative survival rates for oral squamous cell carcinoma (OSCC) have moderately increased in the last 30 years, most patients are diagnosed during the later stages of the disease. B cell-specific Moloney murine leukemia virus integration site 1 (BMI1) is a biomarker of OSCC that is increased in epithelial basal stem cells (SCs) of premalignant oral lesions. However, the molecular functions of BMI1 in early-stage OSCC have not been fully elucidated. Here we used a transgenic mouse line (KrTB) that overexpresses BMI1 in the tongue epithelial SCs to delineate BMI1 actions during these early stages. We observed more oncogenic changes in mice with ectopic BMI1 expression after only a short, 4-week treatment with the carcinogen 4-nitroquinoline 1-oxide (4-NQO). For example, we detected increased proliferation, oxidative stress, and expression of multiple transcripts and proteins linked to human OSCCs in murine tongue epithelia with high, ectopic BMI1 expression. Furthermore, increases in mRNAs encoding multiple metabolic targets, such as SLC16A3, PKM, and GPI1, were greater upon BMI1 overexpression with 4 weeks of 4-NQO treatment. In a human OSCC model (SCC-25 cell line) in which we deleted the BMI1 gene we observed decreases in proliferation, oxidative stress, and expression of the glycolysis-associated protein GLUT1. Thus, BMI1 expression leads to increases in key features of early-stage, carcinogen-induced tumorigenesis, including metabolic reprogramming. Consequently, limiting BMI1 could be a potential target for cancer prevention approaches that merits further consideration and additional functional studies.
29. Biological Reset Protocol for the Regenerative Treatment of Advanced Peri-implantitis Defects: A Proof of Concept.
期刊: The International journal of periodontics & restorative dentistry 发表日期: 2025-Dec-12 链接: PubMed
摘要
This study presents the Biologic Reset Protocol (BRP), a reproducible workflow that integrates prosthetic and surgical phases to improve the predictability of regenerative treatment in intrabony peri-implantitis lesions. The protocol is designed to re-establish peri-implant conditions favorable to long-term tissue stability and proper implant function. The BRP is structured into three sequential phases: (1) a pre-surgical phase, involving the removal of the existing prosthesis to improve diagnostic accuracy, facilitate non-surgical decontamination, and promote soft tissue healing; (2) a regenerative surgical phase based on principles of guided bone and tissue regeneration, favoring a submerged healing approach. This phase involves meticulous implant surface decontamination using air-polishing to preserve the fixture’s original biocompatibility, followed by the placement of particulate bone grafting combined, when necessary, with a stabilized membrane; and (3) a final prosthetic phase which may include prosthetic refinement or replacement to ensure biologically favorable design and prevent disease recurrence. By integrating current evidence with comprehensive biological, surgical, and prosthetic principles, the BRP offers a structured and predictable framework for the treatment of complex peri-implantitis cases, promoting both regenerative success and the long-term preservation of implant health.
30. Environmental and Microbial Drivers of Global Rhizosphere Resistome Assembly.
期刊: Journal of agricultural and food chemistry 发表日期: 2025-Dec-12 链接: PubMed
摘要
Soil serves as a critical reservoir for antibiotic resistance genes (ARGs); however, the ecological mechanisms driving ARG assembly at the plant-soil interface remain poorly understood. In this study, we analyzed 383 metagenomic samples and identified 4803 predicted ARGs, which were classified into two distinct clusters. The ARG-abundant cluster exhibited higher rhizospheric ARG abundance and diversity but posed a relatively lower health risk compared to the ARG-scarce cluster. Warm and nutrient-rich soils promote diverse resistomes shaped by complex microbial interactions, whereas humid environments promote more homogeneously predicted ARG compositions. Environmental variables such as the temperature and nitrogen were found to indirectly influence resistome composition by modulating microbial diversity. Notably, relatively high proportions of high-risk predicted ARGs were detected in grains and raw-eat vegetables, highlighting a potential threat to public health. Our findings underscore the importance of incorporating both environmental and microbial perspectives into agricultural practices to mitigate ARG dissemination in soil.
31. Human alterations to global riverine phosphorus fluxes to the ocean.
期刊: Science advances 发表日期: 2025-Dec-12 链接: PubMed
摘要
Rivers regulate land-ocean total phosphorus (TP) fluxes critical to ecosystem health and food security, yet global dynamics remain poorly understood due to limited observations. Here, we develop a machine learning framework integrating multimodal data and 280,000 TP measurements to reconstruct TP flux patterns over 1980-2019 across 420 major rivers. Results reveal a deceptive global equilibrium. While TP flux declines in the Northern Hemisphere, driven by dam trapping, particularly in Western Europe (-16.2%) and Eastern Asia (-8.7%), it rises in the Southern Hemisphere due to increased fertilizer use and deforestation, especially in Southern Africa (+15%) and the Malay Archipelago (+20.3%). Notably, the number of small rivers with rising TP flux is nearly double that of large rivers. This growing TP export from small rivers and Southern Hemisphere basins may intensify eutrophication, expand hypoxic zones, and threaten fishery yields. Our findings highlight a shifting global phosphorus landscape and underscore the need for more targeted, sustainable phosphorus management strategies.
32. Single nucleotide variants in VDR and GC genes associated with osteoporosis in Mexican women.
期刊: Climacteric : the journal of the International Menopause Society 发表日期: 2025-Dec-12 链接: PubMed
摘要
Osteoporosis is a prevalent multifactorial disease. Single nucleotide variants (SNVs) have been studied as a potential tool for estimating disease risk. These findings suggest that the GG genotype of rs2282679 in the vitamin D-binding protein (GC) gene may confer a protective effect against osteoporosis in postmenopausal Mexican women, whereas no significant association was found for rs4516035 in the vitamin D receptor (VDR). This highlights the potential of integrating genetic screening, particularly of GC-related variants, into osteoporosis risk assessment and prevention strategies. A total of 535 women were included. Genotyping was performed through TaqMan assays, and association analyses, including the chi-squared test and logistic regression, were conducted considering different inheritance models. The allelic frequencies from both SNVs did not show a statistically significant difference between the groups of cases and controls. However, through logistic regression analyses for rs2282679, the GG genotype of the rs2282679 was associated with a protective effect under both recessive and additive inheritance models in unadjusted (odds ratio [OR] 0.27, confidence interval [CI] 0.11-0.63, p = 0.003; OR 0.26, CI 0.11-0.63, p = 0.003, respectively) and adjusted (OR 0.13, CI 0.03-0.55, p = 0.006; OR 0.13, CI 0.03-0.57, p = 0.007, respectively) models. The GG genotype of rs2282679 seems to confer protection against osteoporosis. Further research, including functional validation and studies in larger and diverse cohorts, is warranted to elucidate the underlying biological mechanisms and confirm these results. Osteoporosis is a worldwide public health issue, with affected individuals susceptible to suffering fragility fractures. A main goal of health systems is to develop a tool able to detect the population at major risk and early diagnosis, for designing proper medical management strategies. Osteoporosis occurrence relies on environmental and genetic factors. Genetic factors consist of variants in the human genome, which can be specific for each population; in other words, they can be different in people from different countries or continents. Genetic variants can be used for identifying the population at major risk, and therefore the aim of this study was to determine whether two genetic variants could be associated with the risk for developing osteoporosis in postmenopausal Mexican women. The results showed that a genetic variant in the main protein carrying the vitamin D gene can be associated with a reduced risk for developing osteoporosis. These results need to be corroborated in other populations to establish whether this genetic variant can be implemented as a medical tool for improving the medical management of individuals at risk for suffering osteoporosis.
33. Effectiveness and User Experience of Immersive Virtual Reality in Cognitive Rehabilitation for Attention-Deficit/Hyperactivity Disorder: Systematic Review.
期刊: JMIR mental health 发表日期: 2025-Dec-12 链接: PubMed
摘要
Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by difficulties in attention, impulsivity, and hyperactivity. These difficulties can result in pervasive and longstanding psychological distress and social, academic, and occupational impairments. This systematic review aims to investigate the effectiveness and user experience (ie, safety, usability, acceptability, and attrition) outcomes of immersive virtual reality (VR) interventions for cognitive rehabilitation in people with ADHD and identify research gaps and avenues for future research in this domain. Peer-reviewed journal articles that appraised the treatment impact of any immersive VR-based intervention on cognitive abilities in people of all ages with ADHD were eligible for inclusion. The following databases were searched up until November 2024: Cochrane Library, IEEE Explore Digital Library, PsycINFO, PubMed, Scopus, and Web of Science. Records were screened on title and abstract information after deduplication, leading to full-text appraisal of the remaining records. Findings from eligible articles were extracted into a standardized coding sheet before being tabulated and reported with a narrative synthesis. Out of 1046 records identified, 15 articles met the inclusion criteria. Immersive VR-based interventions for people with ADHD were generally effective in improving cognitive abilities, such as attention, memory, and executive functioning. User experience outcomes were also generally positive, with low levels of simulator sickness and minimal attrition reported during VR-based treatment. Immersive VR-based interventions hold promise for effectively, safely, and rapidly treating cognitive deficits in children and adults with ADHD. However, more studies are required to examine their longitudinal impact beyond treatment cessation.
34. Cobalt Mediates Stage-Specific Toxicity of Metal Mixtures in Cardiovascular-Kidney-Metabolic Syndrome.
期刊: Toxicological sciences : an official journal of the Society of Toxicology 发表日期: 2025-Dec-12 链接: PubMed
摘要
Cardiovascular-Kidney-Metabolic (CKM) syndrome imposes a rising global health burden, yet the link between environmental metal mixtures and CKM progression remains unclear. To assess the joint effects of metal mixtures on CKM syndrome staging and identify critical toxic drivers through advanced mixture analysis. NHANES data (2011-2016) from 1,816 participants were analyzed via Weighted Quantile Sum (WQS) regression, generalized linear models (GLMs), ridge regression, Shapley Additive exPlanations (SHAP) analysis, and polynomial regression. An Adverse Outcome Pathway (AOP) framework was utilized to characterize the mechanisms of metal-mediated CKM. The WQS model revealed an association between mixed metal exposure and CKM (β = 0.502, p = 0.013). Subsequently, GLMs and ridge regression further identified the associative characteristics of individual metals, with all three models pointing to cobalt as the key driver. The SHAP model validated cobalt’s dominant contribution from the perspective of marginal feature importance. Additionally, a polynomial equation analysis showed that cobalt exhibited a linear dose-response relationship with CKM syndrome. Based on these findings, the AOP framework furtherly identified that early CKM stages are linked with cobalt-related metabolic and immune dysregulation. In contrast, late stages involve disruptions in calcium homeostasis, lipid metabolism, and cell apoptosis-survival balance. Our findings highlight the impact of metal exposure on the progression of CKM syndrome, the AOP framework has deciphered stage-specific mechanisms of cobalt, revealing distinct toxicological pathways in early versus late CKM.
35. Empowering patients: qualitative insights into decisional needs in shared decision-making for post-operative rehabilitation after distal radius fracture.
期刊: Disability and rehabilitation 发表日期: 2025-Dec-12 链接: PubMed
摘要
Post-surgical rehabilitation may benefit patients after distal radius fractures, yet evidence guiding referral to supervised versus home-based rehabilitation remains unclear. Shared decision-making may facilitate a patient-centered decision about the most appropriate rehabilitation option. This study explores patients’ decisional needs before shared decision-making regarding post-operative rehabilitation options following distal radius fracture surgery. A qualitative study using focus group interviews informed by observations of consultations. Focus group interviews with patients (n = 17) and clinicians (n = 15) were analyzed deductively using the Ottawa Decision Support Framework, followed by an inductive analysis. Personal and clinical needs were linked to the International Classification of Functioning, Health, and Disability domains. Observations indicated that decisions about the most appropriate rehabilitation option were mainly made by clinicians based on clinical assessments. In focus group interviews, a wish was expressed for decision-making to be shared, emphasizing that adequate patient information was a prerequisite. Decisional needs were related to decision timing, the possibility of expressing preferences, and rehabilitation options. Participants emphasized empowering patients in identifying their individual rehabilitation needs and becoming aware of their own preferences. Multiple factors were considered essential for making a patient-centered decision about the most appropriate rehabilitation option. Both patients and clinicians were in favor of shared decision-making regarding rehabilitation options, but patients need information to empower their involvement in the decision-making process. Information—including decision timing, patients’ rights to express preferences and values, and post-surgical rehabilitation options—may support patients’ readiness to participate in shared decision-making.Empowering patients to identify their individual rehabilitation needs, express their personal preferences, and assess whether their rehabilitation progress aligns with expected trajectories is essential for their active participation in shared decision-making.Active listening, patient-centered communication—including consideration of multiple factors related to patients’ capacity to manage everyday life—and shared decision-making may enhance patient engagement, motivate adherence to rehabilitation, and potentially improve health outcomes.Providing patient information materials prior to decision-making may facilitate patient involvement in shared decision-making, and foster partnership with clinicians in making individualized and person-centered rehabilitation decisions.
36. Cost-effectiveness analyses of catch-up vaccination against human papillomavirus (HPV) related cancers of boys and young men in Sweden.
期刊: Vaccine 发表日期: 2025-Dec-11 链接: PubMed
摘要
The aim of the study was to assess the cost-effectiveness of a catch-up vaccination against HPV of unvaccinated adolescent boys and young men in Sweden. Costs and health effects of HPV related cancer in such situation was compared to no vaccination of the same cohort. We used a dynamic Markov multi-state model to simulate the burden of HPV related cancer in Sweden and the effects of a catch-up vaccination in adolescent boys and young men compared to no vaccination. The model accounted for direct effects of preventing cancer in vaccinated individuals and indirect effects of vaccination through herd-immunity. The main epidemilogical outcome was the number of HPV related cancers in men and women. Costs included resource use for HPV related cancer, production loss when sick, and the cost of the vaccine and administration. Health effects were measured as quality-adjusted life years (QALY). Costs and QALYs were accumulated over the simulated time-horizon to calculate the cost per gained QALY. A HPV catch-up vaccination strategy for adolescents boys and young men would lead to a reduction in the number of HPV related cancers, both through direct and indirect effects. Vaccinating a birth cohort of boys aged 17-19 would lead to a reduction of about 510 cases of HPV related cancer over the simulated time-horizon. The corresponding figures for ages 17-26 and 17-30 were 1450 and 2080 respectively. The cost per gained QALY was EUR 50,100 for 17-19, EUR 42,800 for 17-26, and EUR 32,800 for 17-30 years old. Providing catch up vaccination to adolescent boys and young men aged 17-26 years old can be considered good value for money in a Swedish setting. The results are sensitive to changes in the vaccine effectiveness, which is greater before being exposed to the virus, and to the price of the vaccine.
37. Problem representation of the Risk Mitigation Guidance (RMG) within the context of dual public health emergencies of COVID-19 and toxic drug deaths in British Columbia, Canada.
期刊: The International journal on drug policy 发表日期: 2025-Dec-11 链接: PubMed
摘要
Risk Mitigation Guidance (RMG) was released in response to the dual public health emergencies of COVID-19 and overdose in British Columbia (BC), Canada. RMG enabled the provision of prescribed alternatives to the unregulated drug supply for people at risk of COVID-19 and overdose. Our objective was to gain insight into how health planners in BC problematized the dual health emergencies and the impacts of such on the design and implementation of RMG. Qualitative interviews (n = 28) were conducted with health planners across BC about their understanding of RMG, the implementation process, and context. Carol Bacchi’s “What’s the Problem Represented to be?” framework was used to interrogate the data and guide analysis. From the perspectives of health planners, RMG was a solution to the primary problem of COVID-19 and to reduce spread of the virus. We identified four problem representations related to the problematization of safer supply as a COVID-19 response: 1) COVID-19 opened a window of opportunity; 2) dual public health emergency, but COVID-19 as the priority ‘problem’; 3) the effects of making COVID-19 problem priority; 4) expanding understandings of safer supply beyond COVID-19. Our study builds on the importance of evaluating problem representations in the process of policymaking. The RMG illustrates how crisis-driven policymaking shapes problem representations, enabling rapid intervention through the COVID-19 response while constraining responses to the toxic drug emergency. As a medicalized emergency response, the RMG addressed contagion but failed to confront the structural drivers of toxic drug deaths. Our study highlights the needs for prescribed safer supply models to directly address the unregulated toxic drug supply.
38. Hidden costs of diagnostic mistakes: A descriptive study of guilt, shame, and scapegoating among sonographers practising in the United Kingdom.
期刊: Radiography (London, England : 1995) 发表日期: 2025-Dec-11 链接: PubMed
摘要
Mistakes are part of ultrasound practice, but the emotional impact of mistakes on sonographers remains poorly understood. This study explored the emotional consequences of mistakes among UK sonographers and identified strategies to mitigate their effects. A cross-sectional online survey was conducted in the UK from December 2024 to February 2025. Fifty-three sonographers were recruited through professional networks and member platforms. The survey, hosted on the JISC platform, included quantitative items and open-ended questions. Quantitative data were analysed using descriptive statistics and non-parametric tests in SPSS 28, while qualitative data were coded thematically using Braun and Clarke’s framework in NVivo 12. Thirty-nine respondents reported at least one diagnostic-type error at some point in the past year. Mistakes occurred across all settings (p = 0.107) and experience levels (p = 0.624). Guilt (45.3 %), shame (25 %), and perceptions of scapegoating (33.3 %) were common. Most participants (69 %) reported receiving emotional support after making mistakes (N = 52; no response = 1). Coping strategies varied, though none were significantly associated with setting or experience (p > 0.05). Four themes emerged from qualitative analysis: workplace culture and interpersonal dynamics, emotional and psychological impact, reporting and learning from Mistakes, and recommended support and mitigation strategies. Diagnostic mistakes are common and emotionally challenging for sonographers. Existing institutional responses are perceived as insufficient. A just culture that prioritises psychological safety, non-punitive reporting, prompt debriefing, and access to counselling supports staff wellbeing, retention, and patient safety. Organisations must move beyond policy statements and provide confidential, non-punitive reporting pathways, easily accessible psychological support, and managers trained in empathetic communication to ensure responses to mistakes prioritise learning rather than fault.
39. A composite and synthetic index of potentially avoidable hospitalization in adults to assess primary care quality: an application across Italian geopolitical areas.
期刊: Health policy (Amsterdam, Netherlands) 发表日期: 2025-Dec-05 链接: PubMed
摘要
Avoidable hospitalizations for Ambulatory Care Sensitive Conditions (ACSC) are key proxy indicators of Primary Care (PC) services quality. Challenges in Italy’s National Health Service, worsened by COVID-19, have spurred outpatient care reforms to ultimately reduce avoidable hospitalizations. To provide a synthetic, composite and cross-national index of avoidable hospitalizations in adults, for evaluating PC services performance. Nine avoidable hospitalization indicators for 2017-2019 and 2020-2022 were calculated from discharge data of Italian hospitals. Their standardized z-scores, grouped into five nosological areas, were equally weighted to ensure balanced representation. A final synthetic index for each area was classified into one of five Jenks clusters. The national hospitalization rate decreased from 148.17 per 1,000 residents in 2017-2019 to 125.98 in 2020-2022. Before COVID-19, the “low” clusters were 11, whereas the “high” clusters were 14. In 2020-2022, the “low” and “high” clusters changed to 13 and 10, showing a mild improvement. The “medium-low” and “medium-high” clusters reported significant changes, from 29 to 39 and from 29 to 20, respectively. The “medium” clusters have remained essentially unchanged (from 36 to 37). The index distribution offers three main insights: consistently low values suggest efficient PC services; high values may indicate weak strategies or ineffective PC policies; heterogeneous distribution shows fragmented policies, implying better integration and evaluation. Despite potential biases involving patient behaviors and healthcare system factors, the synthetic index offers an evaluation tool for PC performance, reducing access inequalities, and guiding targeted improvements.
40. Improving person-centred maternity care in Sri Lanka through co-creation: Utilising women's perceptions and stakeholder opinions.
期刊: Midwifery 发表日期: 2025-Dec-04 链接: PubMed
摘要
There is a lack of studies documenting the utilisation of different views of person-centred maternity care (PCMC), such as maternal perceptions, views of health professionals, and women’s advocates, to co-create interventions to improve the quality of care (QoC) in Sri Lanka. The study was conducted at a referral maternity care centre in Colombo. It involved 87 stakeholders in four phases. We conducted the study in phases to optimize logistics and feasibility. Therefore, it was conducted in a phase wise manner. Perceptions of PCMC among 39 mothers who delivered vaginally were explored through focus group discussions (FGDs). Delphi rounds with 25 healthcare providers were conducted to identify and prioritise interventions. Phase III: Intervention priorities were revised based on feedback from a group of 23 women’s advocacy group (WAG), using the Nominal Group Technique. Phase IV: the Nominal Group Technique was utilised to obtain the views and consensus of the women included in Phase I. Phase I revealed five key topics:1) care and attention; 2) companions in labour; 3) respect, dignity, privacy, and communication; 4) awareness of autonomy; and 5) general safety and cleanliness. In Phase II, ten possible interventions to improve PCMC were identified, with improving staff communication skills and empowering women on their rights being the highest priorities. In Phase III, the WAG revised the priority list, with the top priorities being improving infrastructure and the organisation of care and appointing more staff. In Phase IV, the majority (94 %) of the women agreed that the proposed prioritised interventions would improve maternal healthcare services. This study revealed gaps in PCMC but demonstrated that in a setting like Sri Lanka, views of service users, healthcare providers, and advocacy groups can be successfully used to co-create context-specific interventions for improving QoC. We recommend further implementation research to obtain data on the feasibility, sustainability, and challenges of the identified interventions. There is limited evidence documenting the utilisation of different views in improving person-centred maternity care in LMIC. A participatory approach involving care seekers, WAG representing the public, and healthcare providers was useful in co-creating a list of prioritised interventions to improve the quality of maternity care services in a low-resource setting. The findings highlight the importance of further exploration and engagement with local stakeholders, including healthcare users, providers, and advocacy groups, to co-create context-specific interventions to improve PCMC. This study’s methods can serve as a model for identifying and prioritising such interventions in similar settings.
41. 'Pela Saúde de Portugal' - data from a screening on blood pressure.
期刊: Blood pressure 发表日期: 2025-Dec 链接: PubMed
摘要
The Portuguese Society of Hypertension is responsible for the Mission 70/26 Project, a movement that aims to achieve 70% control of hypertensive patients aged 18-65 years old, under Primary Healthcare by 2026. To reach the general population, different activities were done, in this article we will describe one in particular, the campaign called ‘Pela Saúde de Portugal’. From December 2023 to July 2024, there were nine screenings for hypertension done in eight cities in Portugal. Volunteers were asked about medical history, their weight and blood pressure were assessed and they were informed about Hypertension (HTN) and target organ damage. 479 screenings were performed. Of the participants, 243 (51%) were female. History of hypertension was reported in 34,7% of them and 32,4% of these were taking medication. There was a significant blood pressure (BP) reduction from the first to the third measurement and both systolic and diastolic BP (mean of the second and third measurements) were higher in hypertensive patients. There were significant BP differences between the cities. ‘Pela Saúde de Portugal’ was not a study of the prevalence of hypertension but merely an awareness campaign with HTN screening done all around the country. This type of campaign is important to draw attention to HTN and other risk factors, improving health literacy in this field. The analysis of the volunteer’s characteristics is important to design future interventions. Mission 70/26 project was designed by the Portuguese Society of Hypertension with the purpose of achieving 70% control of hypertensive patients aged 18–65 years old under Primary Healthcare by 2026.‘Pela Saúde de Portugal’ was a campaign aimed at the general population;Nine screenings in eight cities were performed during eight months;People were asked about their medical history and weight and blood pressure were assessed.Each contact was an opportunity to enhance literacy in the field.
42. A metabolic atlas of the Klebsiella pneumoniae species complex reveals lineage-specific metabolism and capacity for intra-species co-operation.
期刊: PLoS biology 发表日期: 2025-Dec 链接: PubMed
摘要
The Klebsiella pneumoniae species complex inhabits a wide variety of hosts and environments, and is a major cause of antimicrobial resistant infections. Genomics has revealed the population comprises multiple species/sub-species and hundreds of distinct co-circulating sub-lineage (SLs) that are associated with distinct gene complements. A substantial fraction of the pan-genome is predicted to be involved in metabolic functions and hence these data are consistent with metabolic differentiation at the SL level. However, this has so far remained unsubstantiated because in the past it was not possible to explore metabolic variation at scale. Here, we used a combination of comparative genomics and high-throughput genome-scale metabolic modeling to systematically explore metabolic diversity across the K. pneumoniae species complex (n = 7,835 genomes). We simulated growth outcomes for each isolate using carbon, nitrogen, phosphorus, and sulfur sources under aerobic and anaerobic conditions (n = 1,278 conditions per isolate). We showed that the distributions of metabolic genes and growth capabilities are structured in the population, and confirmed that SLs exhibit unique metabolic profiles. In vitro co-culture experiments demonstrated reciprocal commensalistic cross-feeding between SLs, effectively extending the range of conditions supporting individual growth. We propose that these substrate specializations may promote the existence and persistence of co-circulating SLs by reducing nutrient competition and facilitating commensal interactions. Our findings have implications for understanding the eco-evolutionary dynamics of K. pneumoniae and for the design of novel strategies to prevent opportunistic infections caused by this World Health Organization priority antimicrobial resistant pathogen.
43. METTL3 and METTL14 determine human neural fate specifications.
期刊: Nucleic acids research 发表日期: 2025-Nov-26 链接: PubMed
摘要
METTL3/METTL14, the canonical methyltransferase complex modifying N6-methyladenosine (m6A) on mRNAs, plays critical roles in development and various diseases. However, its precise functions in specifying neural fate from human embryonic stem cells (hESCs) remain poorly understood. Here, we demonstrate, using an inducible knockout system, that METTL3/METTL14 deletion impairs the generation of neural progenitor cells (NPCs) from hESCs. Furthermore, inducible METTL3/METTL14-deficient NPCs exhibit compromised long-term proliferation and fail to differentiate into neurons. Mechanistically, METTL3 is enriched in gene loci essential for neurogenesis and chromatin remodeling in human NPCs, thereby promoting chromatin accessibility at these sites. Importantly, forced expression of BRM, a catalytic component of the chromatin-remodeling BAF complex, in METTL3-deficient hESCs rescues the defects in neural fate specifications caused by METTL3 loss. Our study systematically defines the essential requirement of METTL3 and METTL14 in ensuring the fidelity and neuronal specification of human NPCs, and underscores the coordination among distinct epigenetic regulators in neural development.
44. Metabolomic profiling, antioxidant activity, and skin cell viability of citrus peel flavonoids extracted via ultrasonic-assisted aqueous two-phase system.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
Citrus peels, often considered agricultural waste, are rich in flavonoids with potent antioxidant properties. This study utilized ultrasonic-assisted aqueous two-phase extraction (UA-ATPE) to obtain flavonoid-rich upper phase extracts (UPEs) from the peels of four citrus varieties sourced from different cultivars and regions. Targeted metabolomics was used to analyze the flavonoid compositions in the UPEs, revealing distinct metabolic profiles among the varieties. The antioxidant activities of the UPEs were evaluated through hydroxyl, superoxide, and ABTS radical scavenging assays, while their effects on skin cell viability were assessed using HaCaT and BJ cells. Multivariate statistical analyses, including principal component analysis (PCA) and hierarchical clustering analysis (HCA), identified six key differential metabolites (naringenin, p-coumaric acid, luteolin, butin, vitexin/isovitexin, and ferulic acid) that effectively distinguished the citrus varieties. Among the UPEs, Guangxi mandarin orange exhibited the highest total flavonoid content and the most potent superoxide anion and ABTS radical scavenging activities. However, Meizhou shatian pomelo demonstrated the strongest overall antioxidant capacity, as indicated by the lowest IC50 values for the antioxidant potential composite (APC). Cell viability assays confirmed that none of the UPEs exhibited cytotoxicity at concentrations of 0.06–1.00% (v/v). These findings highlight significant varietal differences in flavonoid content and antioxidant activity, providing a scientific basis for the utilization of citrus peels in functional cosmetics and other industries.
45. 'Obstetricians' perceptions of midwifery-led care in Bangladesh - A qualitative study.
期刊: PLOS global public health 发表日期: 2025 链接: PubMed
摘要
The midwife as a separate and autonomous profession is a relatively new concept in Bangladesh; as a result, its integration into the maternal healthcare system is yet to be determined. Obstetricians are key stakeholders in maternal health, and understanding how they perceive midwifery-led care can provide valuable insight into the acceptance of the model, and the profession itself. Data was collected from 13 semi-structured interviews conducted with obstetricians working in the Dhaka division, Bangladesh, in July 2023. Thematic analysis was then carried out on the transcripts. Four main themes were identified. 1. Diverse understanding of the role of a midwife; There was a general lack of understanding of the role of a midwife, and confusion surrounding their scope of practice. 2. Perceived benefits of midwifery; Obstetricians felt as though midwives can help decrease their workload, and that they are specialised practitioners who can help improve access and equity of healthcare. 3. Factors restricting midwives’ professional autonomy; There was an evident lack of trust from obstetricians of midwives’ competency and their education, and their acceptance and integration into the healthcare system are weak. 4. Strengthening future midwifery; Obstetricians suggested a need for improvements in midwifery education, as well as government promotion of midwives. The lack of awareness of the role and potential of midwives limits their professional autonomy. There is a need to increase awareness of other healthcare professionals, as well as the public, of the benefits of midwives and the midwifery-led model of care. Improved regulation is also needed, particularly in the private health sector and in the implementation of midwifery education.
46. "This needs to be told to everyone": Content analysis of written immediate responses from an online experiment examining health warning messages about alcohol consumption and breast cancer risk.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
Alcohol consumption increases breast cancer risk. We evaluated the responses of 748 United States female participants ages 21-29 to health warning messages addressing the relationship between alcohol consumption and increased breast cancer risk. In an online experiment, participants were randomly assigned to view standalone health warning messages about alcohol, breast cancer, and breast cancer health effects with varying picture and text attributes. Participants then completed post-message exposure assessments that included an immediate open-ended response to the message prompt. We conducted a qualitative content analysis of the responses and coded deductively based on constructs from the Message Impact Framework including message reactions, attitudes and beliefs, and behavioral intentions. These constructs and corresponding variables were present in participants’ responses. Response type did not vary by participants’ demographics or the attributes of the health warning message they viewed. The code new information was applied to 20% of the responses, indicating that those participants had no prior knowledge of alcohol and breast cancer risk. Alcohol and breast cancer messaging could impact drinking behaviors. Given the frequency of responses indicating a lack of awareness, more work in cancer prevention and population health messaging is warranted.
47. Cross-national disparities in healthcare workers' perceptions: Examining fear of infection and confidence in the received COVID-19 vaccines amid emerging variants.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
Variants of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can influence transmissibility, virulence, vaccine efficacy, the effectiveness of therapeutic agents, diagnostic accuracy, and the overall success of public health interventions. This study aimed to assess the impact of emerging variants on healthcare workers’ (HCWs) fear related to SARS-CoV-2 new variant infection and to evaluate their confidence in the received vaccines. A globally distributed cross-sectional study was performed using an online anonymous survey and face-to-face interviews between 1st November and 5th December 2023. The fear level was assessed by the Fear of Coronavirus Disease 19 (COVID-19) Scale (FCS), and the confidence level in the received COVID-19 vaccines was measured using the Arabic Tool for Assessment of Post-vaccination Confidence in COVID-19 vaccines (ARAB-VAX-CONF). A total of 5843 eligible HCWs completed the survey with a mean age of 32.1 ± 10.8 years. Of them, 42.5% were from the Eastern Mediterranean region, 24.2% were from the African region, 14.4% were from the Western region, and 18.9% were from other regions (Eastern Asia and Latin America). Nearly three-fourths (72.7%) were vaccinated, primarily with Pfizer (40.0%), AstraZeneca (36.8%), and Sinopharm (14.3%). Nearly two-fifths (40.5%) were in extreme fear of catching infection from the COVID-19 emerging variants. Among the HCWs who received COVID-19 vaccines, 41.0% showed good confidence in the received vaccine. Predictors of lower fear included being married [adjusted odds ratio (AOR): 0.8; 95% CI (0.7-0.9)], having a small family of two members [AOR: 0.63; 95% CI (0.5-0.78)] or three members [AOR: 0.62; 95% CI (0.51-0.72)], and being a pharmacist [AOR: 0.75; 95% CI (0.55-0.92)]. Conversely, predictors of increased fear included being divorced or widowed [AOR: 1.3; 95% CI (1.0-1.8)], residing in rural areas [AOR: 1.6; 95% CI (1.4-1.8)] or desert/mountain areas [AOR: 2.5; 95% CI (1.6-4.0)], having insufficient income and in debt [AOR: 2.5; 95% CI (2.2-3.1)], having insufficient income [AOR: 2.4; 95% CI (2.0-2.8)], and having chronic diseases [AOR: 1.2; 95% CI (1.1-1.4)]. Predictors of good confidence in the received vaccine were middle age (30-39 years) [AOR: 1.4; 95% CI (1.1-1.8)], age group 40 years and more [AOR: 1.8; 95% CI (1.4-2.3), rural/other residence [AOR: 1.3; 95% CI (1.1-1.5)], male sex [AOR: 1.3; 95% CI (1.1-1.4)], and small family members of one [AOR: 5.5; 95% CI (4.2-7.2)], two [AOR: 1.5; 95% CI (1.2-1.9)], and three [AOR: 1.3; 95% CI (1.1-1.6)]. On the other hand, having chronic diseases [AOR: 0.82; 95% CI (0.71-0.95)], having mental disorders [AOR: 0.59; 95% CI (0.51-0.69)], high family number of four [AOR: 0.78; 95% CI (0.69-0.89)], personal history of COVID-19 infection [AOR: 0.61; 95% CI (0.53-0.71)], and experiencing side effects of vaccination [AOR: 0.63; 95% CI (0.55-0.72)] were associated with low confidence regarding the received vaccine. In conclusion, HCWs exhibited notable fear of infection with SARS-CoV-2 new variants, along with low confidence in the vaccine. The study suggests realistic approaches, such as targeted interventional programs to address the fear, resolve uncertainties, and promote widespread vaccine confidence among HCWs.
48. The protective influence of Astragalus on rat models of preeclampsia.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
Preeclampsia (PE) is a high-risk hypertensive syndrome of pregnancy that occurs in the middle to late stages of pregnancy (after 20 weeks) and has become a major risk factor for maternal and fetal health and safety. Studies have shown that some components of Astragalus possess antioxidant and anti-apoptotic properties, which are beneficial in various diseases. The objective of this study was to investigate the effects of Astragalus on preeclampsia-like symptoms in a rat model that was induced using NG-nitro-L-arginine methyl ester (L-NAME). Pregnant rats were evaluated for blood pressure, 24-hour urinary protein excretion, the number of surviving and resorbed fetuses, placental diameter and weight, as well as fetal body length and weight. Placental growth factor (PLGF) and soluble fms-like tyrosine kinase-1 (sFlt-1) in serum were measured by enzyme-linked immunosorbent assay (ELISA). Placental and serum malondialdehyde (MDA) and nitrite, as well as serum glutathione peroxidase (GSH-Px) and superoxide dismutase (SOD) activities, were measured. The expression of mRNA B-cell lymphoma-2 (Bcl-2), Bcl-2-associated X protein (Bax), and caspase-3 were examined using real-time quantitative PCR (RT-qPCR), and proteins expression were assessed using Western blot analysis. The results showed that Astragalus treatment can effectively improve the symptoms and adverse pregnancy outcomes in a PE rat model. Meanwhile, it has no adverse effects on normal pregnant rats and fetuses. Furthermore, the observed effects of Astragalus were associated with a reduction in oxidative damage, improved vascular endothelial function, and inhibition of the Bcl-2/Bax/caspase-3 apoptosis pathway. This research indicate that Astragalus could serve as a promising candidate for treating PE.
49. Prevalence of sexually transmitted infections and immunization status among registered sex workers: A pilot study in lower Bavaria, Germany.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
Sex workers are often considered at elevated risk for sexually transmitted infections (STIs). This pilot study describes the socio‑epidemiological characteristics of registered sex workers in a rural German setting, estimates the prevalence of four STIs (HIV, hepatitis B [HBV], hepatitis C [HCV], and syphilis [lues]), compares these with the local population, and assesses HBV immunization coverage. Under §10 of the Prostitute Protection Act (ProstSchG), annual health consultations are mandatory; voluntary serologic testing is permitted under §19 of the Infection Protection Act. We conducted a retrospective observational monocentric pilot study using routine consultation records and voluntary serologic results from the Public Health Service (PHS) of Landshut (2017-2021). In total, 523 consultations were documented; 99 blood samples from 48 registered sex workers (2019-2021) were analyzed. Primary screening assays were followed by confirmatory tests when indicated. Crude point/period prevalences and 95% confidence intervals (95% CI) were calculated. HBV immunization was defined according to Standing Committee on Vaccination (STIKO) recommendations. The cohort was predominantly female (n = 47; 97.9%), mean age 34.8 ± 11.2 years; 85.3% (n = 41) had a migration background (n = 27; 56.3% from Eastern EU countries). No acute HIV, HBV, or HCV infection was detected. Evidence of past HBV infection (anti‑HBc) was found in n = 7 (14.6%; 95% CI: 6.8-26.5), past HCV in n = 1 (2.1%; 95% CI: 0.2-9.3). Syphilis serology was reactive in 12.5% (n = 6), with n = 2 (4.2%; 95% CI: 0.9-12.7) meeting criteria for treatment‑requiring infection. HBV vaccine‑induced immunity was documented in 43.8%; only 29.2% achieved titers ≥100 mIU/ml. Compared with regional surveillance data, the prevalence of acute notifiable STIs among sex workers was not increased. In this rural setting, acute notifiable STIs were uncommon among registered sex workers, while past HBV infection and suboptimal HBV immunization were frequent. Public health efforts should prioritize HBV vaccination and syphilis prevention or treatment, and expand low‑threshold, trusted services tailored to this workforce.
50. Framework to prioritize health outcomes of particulate matter exposure using national claims data.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
Although particulate matter (PM) exposure poses significant public health risks, previous research has focused on limited clinical areas. However, emerging evidence and pathological mechanisms of PM suggest that PM may exert broader systemic effects across a wide range of diseases. Therefore, we aim to identify and prioritize research questions to evaluate health impacts of PM exposure across various clinical specialties. A structured collaborative process was conducted between April and November 2024 in South Korea, incorporating systematic literature reviews, multidisciplinary expert discussions, and knowledge-sharing seminars. The primary outcomes were the identification of diseases potentially influenced by PM exposure and the development of corresponding research questions. The literature review synthesized more than 417 publications, including the U.S. Environmental Protection Agency’s integrated science assessment materials, a government-issued abstract compendium on PM covering 2010-2019, and studies published from 2020 to 2024 identified via a structured search. These were categorized by exposure duration (short- or long-term) and diseases outcome (incidence or progression). Prioritization was based on three criteria: pathological causality, clinical impact (public health burden), and feasibility using the Korea National Health Insurance Service (K-NHIS). A total of 99 experts from epidemiology, data science, and 14 clinical specialties participated. The experts panel (mean age: 46.1 years; mean professional experience: 20.5 years) identified 211 research questions across 80 diseases. These were classified by disease outcome: disease incidence (short-term, 54; long-term, 64) and progression (short-term, 47; long-term, 46). Notably, several clinical areas such as ophthalmology, dermatology, and otolaryngology were underrepresented. This structured, multidisciplinary approach broadened the scope of PM-related clinical research beyond commonly studied clinical area. This scalable framework can be adapted in other regions with similar claims data systems to guide evidence-based research agendas and inform public health policies.
51. Core outcome sets for spinal and associated limb, trunk, abdomen or pelvic pain: A systematic review.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
Spinal pain is a significant global health issue, affecting millions and ranking as one of the leading causes of disability worldwide. Despite the wide scope of research conducted on spinal and associated pain, the lack of standardised core outcome measures poses challenges for comparing and synthesising research data. Core Outcome Sets (COSs) are intended to harmonise assessment and facilitate comparison across studies. This review aimed to identify, map, and examine published core outcome sets (COSs) designed for the assessment of spinal pain-including cervical, thoracic, lumbar-and spinal-related limb, trunk, abdomen, or pelvic pain. It also sought to synthesise consistent outcome domains across these COSs, categorising them by anatomical region and measurement type, including patient-reported, physical, biological, psychological, social, and environmental measures. This systematic review followed PRISMA guidelines and was registered with PROSPERO. A comprehensive literature search of 13 electronic databases and grey literature sources was conducted from 2000 to April 2025. Two independent reviewers assessed study eligibility and quality using predefined criteria. Data extraction was performed to identify core outcome domains, and a thematic analysis was conducted to categorise domains based on anatomical regions, patient-reported outcomes, performance measures, and biopsychosocial factors. Thirteen studies met inclusion criteria, addressing core outcome sets for cervical (n = 4), thoracolumbar (n = 1), and lumbar (n = 8) spinal regions. Patient-reported outcome measures were the most frequently recommended outcome type. The most commonly endorsed domains were physical function n = 9 (100%), pain intensity n = 8 (88.9%), participation in work or daily activities n = 7 (77.8%), and disability n = 6 (66.7%). However, few studies incorporated psychological, social, environmental, or physiological domains, highlighting critical gaps in the multidimensional assessment of spinal pain. This systematic review identified key domains in current use and significant gaps in biopsychosocial and biological measurement. Findings will support researchers, clinicians, and policymakers in selecting appropriate outcomes for spinal pain research and practice. A Delphi study to develop an internationally agreed “Essential Universal Set” for spinal pain, inclusive of multidimensional biopsychosocial domains, is a sound next step.
52. DeltaBreed: A BrAPI-centric breeding data information system.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
DeltaBreed is a unified breeding data management system designed by Breeding Insight (BI, Cornell University) to serve the wide diversity of USDA-ARS specialty crop and livestock breeding programs. DeltaBreed has a RESTful microservice architecture that utilizes the BrAPI v2.1 Java Test Server as its primary database. The system is interoperable with many BrAPI-compliant applications (BrApps), including Field Book v6.1.0, and is continually aligned with the most recent BrAPI specifications (BrAPI v2.1). Here we describe the features of DeltaBreed v1.0, a minimum viable product, and how we aligned data capture and validation with community standards. We highlight the modules for management of germplasm, observation variables, experiments and observations, genotypic sample submission, and a prototype genomic database that supports polyploid and multiallelic genomic data, as well as SNP data. Several test cases are illustrated to demonstrate the successes and challenges of interoperability with other open-source BrAPI-enabled software packages. We also discuss expansion and enhancement plans for future DeltaBreed versions, as well as outline possible solutions to known limitations. To our knowledge, DeltaBreed is the first species-agnostic, fully BrAPI-compliant breeding data management system built for transactional use.
53. Psychometric performance of the WHOQOL-HIV BREF among people living with HIV on antiretroviral therapy in Bauchi State, Nigeria.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
The well-being of people living with HIV (PLHIV) remains a significant public health concern. Despite advancements in ART, PLHIV face various challenges impacting their quality of life (QOL). Measuring the QOL of PLHIV is essential for improving care, shaping policy, and evaluating intervention. However, the extent to which the measurement properties of the World Health Organization Quality of Life HIV BREF (WHOQOL-HIV BREF) tool, in the Nigeria context is limited. This study evaluated the psychometric performance of the WHOQOL-HIV BREF in a Nigerian population, with the aim of examining its construct validity, reliability, and sensitivity when used to assess the well-being of PLHIV. This was a cross-sectional quantitative study involving of 790 PLHIV aged 18 years and older in Bauchi State, Nigeria. Data was collected between May and October 2023. Quality of life was assessed using the 31-item WHOQOL-HIV BREF which assesses QOL based on the 6 domains, including Physical, Psychological, Level of Independence, Social Relationships, Environmental, and Spirituality/Religion/Personal Beliefs. The general quality of life and general health perception was also assessed. The psychometric evaluation of the instrument in this population included analyses of internal consistency reliability, confirmatory factor analysis (CFA) to assess construct validity, and sensitivity analysis to examine measurement responsiveness. Confirmatory factor analysis of the WHOQOL-HIV BREF in the sample indicated poor model fit (CFI = 0.807, TLI = 0.767, RMSEA = 0.110, SRMR = 0.136), indicating that the original six-domain structure was not well supported in the study population and context. Internal consistency (Cronbach’s alpha) varied widely across domains, ranging from very low to acceptable: Physical Health (α = 0.386), Psychological Health (α = 0.722), Level of Independence (α = 0.531), Social Relationships (α = 0.693), Environment (α = 0.775), and Spirituality (α = 0.304). The Global Quality of Life score demonstrated high reliability (α = 0.884). Nonetheless, high scores were observed for general quality of life (Mean = 3.86) and health perception (Mean = 3.65), as well as for independence (Mean = 14.84) and social relationships (Mean = 14.93). Moderate scores were found in physical health (Mean = 13.99), psychological health (Mean = 13.95), environmental (Mean = 12.74), and spiritual well-being (Mean = 13.77). This study revealed limited structural validity and varied internal consistency in this sample, with some domains of the WHOQOL-HIV BREF performing poorly. These findings reinforce concerns raised by researchers about the use of the tool without proper contextual adaptation. Further research is needed to better understand QOL in the Nigeria population, by refining and validating the QOL assessment tools for the country, to ensure adequate monitoring of the health of PLHIV.
54. A small-scale study on dancing for people living with Parkinson's disease.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
People with Parkinson’s disease (PD) need life-long rehabilitative interventions to slow disease progression and reduce impact of the disease on daily life activities. To be sustainable for the individual, activities should have a positive impact on physical, cognitive and mental health, and should be appealing and meaningful. To quantitatively evaluate the health-related effects of a 10-week dance program for patients with PD. A cross-over design with two groups. Group 1 undertook 10 weeks of dance classes; after that, group 2 began their 10 weeks of dance classes. Assessments of both groups at four timepoints (baseline, 10, 20 and 30 weeks) included physical tests and self-reported questionnaires to assess cognition, self-efficacy, well-being, fatigue, and health-related quality of life. The analysis involved comparisons of results after the dance and non-dance periods, for all instruments. The analyses could not show any significant differences between the assessments after the dance period compared to after the no dance period. Despite the lack of quantitative evidence of the positive experiences earlier described from focus groups, the study provided insights into how future research could be organised to better capture the multifaceted benefits. Furthermore, the study provides additional evidence that dance as a health-promoting activity in Parkinson’s disease should be viewed in a longer-term perspective.
55. Redirecting patients from the pediatric emergency department to community locations for care: A qualitative study of healthcare professional and leader perspectives.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
Emergency department (ED) to community (ED2C) programs, which redirect patients from the pediatric ED to community healthcare professionals represent a promising strategy to reduce the impact of non-urgent visits on the pediatric ED. Given an ED2C program’s potential impact on various care professionals, we completed a qualitative study to explore key informants’ attitudes and perceptions of pediatric ED2C programs. We conducted one-on-one semi-structured interviews with key informants in British Columbia, Canada. Participants included: pediatric ED staff - triage nurses and physicians; community professionals - pediatricians and family physicians; and health system leaders responsible for pediatric and emergency care in British Columbia. Interviews were recorded, transcribed verbatim, de-identified, and analyzed using reflexive thematic analysis within an interpretive description framework. A visual model was developed to depict key themes in attitudes and perceptions towards pediatric ED2C programs. We interviewed 24 participants: 6 community professionals, 11 pediatric ED professionals, and 7 healthcare leaders. Participants viewed the ED2C program as a valuable solution to address pediatric system strain provided that systemic barriers are addressed, and both emergency and community settings are equipped with adequate training and resources. Participants emphasized the need for clear guidelines on eligibility and operations to build confidence and enhance program effectiveness. Our findings suggest there is support for ED2C programs as a means to reduce the impact of non-urgent pediatric ED visits and strengthen community-based care. Successful implementation will require coordinated planning, resource investment, and clear operational frameworks.
56. Roma 2 Local Health Authority and Fondazione Baroni for the safety and accessibility of care: aninnovative telerehabilitation project for patients withspinal cord injuries.
期刊: Igiene e sanita pubblica 发表日期: 2025 链接: PubMed
摘要
The COVID-19 emergency has forced a rapid reorganization of healthcare services, suspending many non-urgent outpatient services and redefining the offering based on companies’ potential for process and resource optimization and adapting it to the new context. In this period, therefore, it became necessary to use digital media and to verify the possibility of ensuring remote services for chronic patients. In light of this experience, ASL ROMA 2 has implemented a research project to ensure the remote rehabilitation of chronic patients with motor impairments, in particular with spinal cord injury. The project was funded by the Baroni Foundation Objectives: Since 2023, ROMA 2 local health authority (ASL ROMA 2) has launched a project for the use of a platform dedicated to telerehabilitation, funded by the Baroni Foundation, with the following objectives: Objectives: Since 2023, ROMA 2 local health authority (ASL ROMA 2) has launched a project for the use of a platform dedicated to telerehabilitation, funded by the Baroni Foundation, with the following objectives: ensure access and continuity of care, including continued rehabilitation at home. improve rehabilitation interventions through the appropriate use of remote services and capabilities; these allow for better tailoring of treatment frequency and intensity to the needs and preferences of The platform can be integrated with other healthcare systems and supports protocol and plan definition, wearable device integration, telerehabilitation, schedule management, clinical monitoring, and more. The technology architecture is based on open-source software solutions such as Kafka, Kubernetes, Java, Typescript, PostgreSQL, MongoDB, TimescaleDB, AWS, KeyCloak, Drools, DSL, Strapi, and Workflow Engine. increase the efficiency of home rehabilitation services, allowing for the provision of care to a greater number of patients requiring assistance. promote monitoring, health education, and/or the adoption of appropriate self-care practices. These objectives are consistent with the objectives outlined in the National Recovery and Resilience Plan (PNRR) Mission 6 - Health Component 1 (M6C1) Proximity networks, facilities, and telemedicine for community care. This paper describes the results of the research project “Fleexi-Rehab-Care-Tech (FRCT)” by ASL ROMA 2, focusing on tele-assistance and the provision of physiotherapy and occupational therapy for patients with motor and neuromotor injuries.