公共卫生研究摘要 (2025-12-16)
共收录 58 篇研究文章
1. Correlates of physical activity and sedentary behavior among Latino persons with spine pain.
期刊: Health psychology : official journal of the Division of Health Psychology, American Psychological Association 发表日期: 2026-Jan 链接: PubMed
摘要
Latino persons with chronic spine pain (CSP) face challenges engaging in physical activity (PA) and minimizing sedentary behavior (SB). This study aimed to objectively characterize PA and identify correlates of PA and SB in Latino persons with CSP. Cross-sectional baseline data from Latino participants who were enrolled in a clinical trial for CSP near the U.S.-Mexico border were utilized. Blockwise regression assessed the association between sociodemographic, clinical, interpersonal, and environmental factors with light PA (LPA), moderate-to-vigorous PA (MVPA), and SB. Participants (N = 154, Mage = 47.5 ± 12.1 years) spent 342.8 ± 111.6 min/day in LPA, 56.1 ± 71.1 min/day in MVPA, and 550.3 ± 140.9 min/day in SB. Seventy-five percent of participants met national PA guidelines. Lower income and higher pain interference were associated with lower LPA (R2 = 9%, p < .05). Younger age and lower income were associated with higher MVPA (R2 = 13%, p < .05). Lower income was associated with lower SB (R2 = 5%, p < .05). Younger age (OR 95% confidence interval [CI] [0.87, 0.98]) and higher exercise self-efficacy (OR 95% CI [1.06, 8.09]) increased the odds of meeting PA guidelines. Participants with CSP exhibited greater levels of LPA, MVPA, and SB compared with prior studies of Latino persons without pain. Sociodemographic variables including age and income were most consistently associated with PA and SB outcomes. Future research is needed to identify other relevant intrapersonal, interpersonal, and environmental determinants of PA and SB in this clinical population. (PsycInfo Database Record (c) 2025 APA, all rights reserved).
2. Long-term exposure to wildfire smoke and mortality: Heterogeneous effects by exposure metric and across subpopulations.
期刊: Proceedings of the National Academy of Sciences of the United States of America 发表日期: 2025-Dec-23 链接: PubMed
摘要
Wildfire smoke, once rare, is a hazard that populations across the globe are increasingly exposed to repeatedly. Evidence of acute health effects of wildfire particulate matter (PM2.5) is growing, but less is known about long-term effects related to repeated exposures. Using a cohort of 1,250,083 Kaiser Permanente Southern California members aged ≥60, we estimated the association between all-cause mortality and 3-y exposure to five different census tract-level wildfire smoke metrics (mean daily wildfire-specific PM2.5, mean daily wildfire-specific PM2.5 during the peak wildfire week, number of days with daily wildfire-specific PM2.5 > 0 μg/m3, number of weeks with average wildfire-specific PM2.5 > 5 μg/m3, and number of smoke waves). We applied a discrete-time approach with pooled logistic regressions, adjusting for sex, age, race and ethnicity, marital status, smoking status, requiring an interpreter, calendar year, and census tract-level poverty and population density. When comparing those highly exposed (95th percentile) to those minimally exposed (5th percentile), we found an increased odds of mortality across all five wildfire smoke metrics. Mean daily wildfire PM2.5 was the metric most strongly associated with mortality (odds ratio: 1.07; 95% CI: 1.05, 1.09). We observed greater vulnerability to the long-term effects of smoke for individuals under age 75, or with Black or Other racial/ethnic identity, or living in a census tract with higher poverty. Identifying the most harmful long-term wildfire smoke metric and most-at-risk populations can help focus attention for developing effective adaptation strategies in a changing climate.
3. Effect of Interventions Aimed at Reducing or Modifying Saturated Fat Intake on Cholesterol, Mortality, and Major Cardiovascular Events : A Risk Stratified Systematic Review of Randomized Trials.
期刊: Annals of internal medicine 发表日期: 2025-Dec-16 链接: PubMed
摘要
Debates about optimal saturated fat advice continue. To systematically summarize randomized trial data on reducing or modifying saturated fat intake on cholesterol, mortality, and major cardiovascular events. MEDLINE, Embase, and Cochrane Central Register of Controlled Trials from inception to July 2025. Eligible trials enrolled adults with or without cardiovascular disease and studied the effect of reducing or modifying saturated fat intake. Standard Cochrane methods. There were 17 eligible trials (66 337 participants). Risk stratified evidence provides low to moderate certainty that reducing saturated fat intake may result in a reduction in all-cause mortality (risk ratio [RR], 0.96 [95% CI, 0.88 to 1.06]), cardiovascular mortality (RR, 0.93 [CI, 0.77 to 1.11]), nonfatal myocardial infarction (MI) (RR, 0.86 [CI, 0.70 to 1.06]), and fatal and nonfatal stroke (RR, 0.83 [CI, 0.58 to 1.19]). For persons at low baseline cardiovascular risk, absolute reductions were below our thresholds of importance (5 and 10 per 1000 persons followed over 5 years for fatal and nonfatal outcomes, respectively); for those at high risk, the benefits were above our thresholds, suggesting there may be important absolute reductions. The effects were more pronounced when replacing saturated fat with polyunsaturated fat for nonfatal MI (RR, 0.75 [CI, 0.58 to 0.99]; P for interaction = 0.05; moderate credibility of subgroup effect based on Instrument to assess the Credibility of Effect Modification Analyses assessments). Data were limited on the replacement of saturated fat with monounsaturated fat or protein. Trials varied considerably in their efficacy in reducing saturated fat intake and in their replacement macronutrients and concomitant dietary interventions, and new trials are needed to clarify uncertainty. For persons at low cardiovascular risk, reducing or modifying saturated fat intake has little or no benefit over a period of 5 years. Among persons at high cardiovascular risk, low- to moderate-certainty evidence was found for important reductions in mortality and major cardiovascular events, particularly for MI, with respect to replacing saturated fat with polyunsaturated fat. None. (PROSPERO: CRD42023387377).
4. Eligibility and Prognostic Performance of Smoking Duration-Based Versus Pack-Year-Based U.S. National Lung Cancer Screening Criteria Across Racial and Ethnic Groups.
期刊: Annals of internal medicine 发表日期: 2025-Dec-16 链接: PubMed
摘要
The U.S. Preventive Services Task Force expanded lung cancer (LC) screening eligibility in 2021 (USPSTF-2021) by decreasing the minimum number of smoking pack-years from 30 to 20. Underrepresented minorities still experience disparities in screening eligibility. To evaluate screening eligibility and prognostic performance of alternative smoking duration-based criteria versus USPSTF-2021 (primary outcome) and risk-based screening using the recalibrated Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial 2012 (PLCOm2012update) model (secondary outcome) across diverse racial and ethnic groups. Prospective, population-based Multiethnic Cohort linked to SEER (Surveillance, Epidemiology, and End Results) registries. California and Hawai’i, with recruitment from 1993 to 1996. 105 261 adults aged 45 to 75 years with a history of smoking. Hypothetical eligibility and prognostic performance (sensitivity and specificity) in detecting 6-year LC. Under USPSTF-2021, 24.0% of the cohort would be eligible for screening; a 30-year smoking duration yielded the closest eligibility rate (27.5%). Compared with USPSTF-2021, the 30-year duration criteria would reduce eligibility gaps across all races relative to Whites, most notably in African Americans (30.4% vs. 28.8% for Whites under duration-based; 21.4% vs. 30.2% for Whites under USPSTF-2021) and Latinos (25.1% vs. 28.8% for Whites under duration-based; 15.7% vs. 30.2% for Whites under USPSTF-2021). Prognostic sensitivity to identify LC within 6 years increased across all races under the 30-year duration criteria, although specificity decreased commensurately. At matched overall eligibility (27.5%), a risk-based PLCOm2012update 6-year threshold of 1.1% improved both sensitivity and specificity in the overall cohort. However, it widened the eligibility gap between Latinos and Whites (14.4% vs. 31.3%) and demonstrated lower sensitivity in Latinos than duration-based criteria (59.7% vs. 69.8%). Cohort geography and enrollment period may limit generalizability. Overdiagnosis was not measured. Compared with USPSTF-2021, the 30-year duration-based criteria could reduce the eligibility gaps among African Americans and Latinos relative to Whites while improving 6-year LC detection sensitivity across all races. National Institutes of Health.
5. Multimodal Data-Driven Explainable Prognostic Model for Major Adverse Cardiovascular Events Prediction in Patients With Unstable Angina and Heart Failure With Preserved Ejection Fraction: Multicenter, Cross-Regional Cohort Study.
期刊: Journal of medical Internet research 发表日期: 2025-Dec-15 链接: PubMed
摘要
Heart failure with preserved ejection fraction (HFpEF) and unstable angina (UA) often coexist in clinical practice, constituting a high-risk cardiovascular phenotype with a markedly increased incidence of major adverse cardiovascular events (MACEs). The identification of high-risk patients within this population is crucial for reducing complications, improving outcomes, and guiding clinical decision-making. This study aimed to develop and externally validate predictive models based on machine learning algorithms to estimate the risk of MACEs in patients with coexisting UA and HFpEF, and to construct an online risk calculator to support individualized prevention strategies. This multicenter cohort study included 4459 patients with both HFpEF and UA admitted to 7 hospitals across eastern, central, and western China between January 1, 2015, and December 31, 2021. Patients were divided into the derivation cohort (n=2923) and external validation cohort (n=1536) based on geographic regions. Clinical, laboratory, and imaging data were extracted from electronic medical records. Key predictors were identified using a hybrid feature selection method combining least absolute shrinkage and selection operator and Boruta algorithms. A total of 33 survival models were developed, including a variety of machine learning algorithms and survival analysis models. The model with the best concordance index (C-index) performance was deployed as a web-based risk calculator. Additionally, we assessed other performance indicators of the best-performing model, including the area under the receiver operating characteristic curve, accuracy, sensitivity, specificity, recall, F1-score, Brier scores, calibration curves, and decision curve analysis. Using a combination of the least absolute shrinkage and selection operator regression and the Boruta algorithm, 7 key predictors were identified: diabetes mellitus, blood platelet count, triglyceride, systemic inflammatory response index, triglyceride-glucose-BMI, N-terminal pro-brain natriuretic peptide, and atherogenic index of plasma. The surv.xgboost.cox model was used to predict MACEs in patients with UA and HFpEF due to its superior C-index. The model demonstrated the following performance metrics in the external validation cohort: a C-index of 0.788; cumulative/dynamic area under the curve of 0.81; and area under the curve values at 20, 30, and 40 months of 0.809 (95% CI 0.745-0.873), 0.784 (95% CI 0.745-0.824), and 0.807 (95% CI 0.776-0.838), respectively. The model exhibited satisfactory calibration and clinical utility in predicting 40-month MACEs. Model interpretability was enhanced using Shapley Additive Explanations for survival analysis to provide global and individual explanations. Furthermore, we converted the surv.xgboost.cox-based model into a publicly available tool for predicting 40-month MACEs, providing estimated probabilities based on the predictive indicators entered. We developed a surv.xgboost.cox-based predictive model for MACEs in patients with the dual phenotype of HFpEF and UA. We implemented this model as a web-based calculator to facilitate clinical application.
6. Low-Carbohydrate Nutrition Counseling With Continuous Glucose Monitoring to Improve Metabolic Health Among Veterans With Type 2 Diabetes: Pilot Quality Improvement Initiative Study.
期刊: JMIR diabetes 发表日期: 2025-Dec-15 链接: PubMed
摘要
One in 4 Veterans who receive care through the Veterans Health Administration has type 2 diabetes (T2D). Dietary carbohydrate restriction can promote weight loss and improve blood glucose control, but Veterans taking certain medications (eg, insulin) may experience serious complications (eg, hypoglycemia) without adequate support and monitoring. This study aims to develop and evaluate the feasibility, acceptability, and clinical effectiveness of a pilot low-carbohydrate (LC) nutrition counseling program guided by continuous glucose monitoring (CGM) for Veterans with T2D receiving insulin (ie, LC-CGM). This is a pragmatic, nonrandomized, pre-post quality improvement pilot program. Eligible patients were Veterans with T2D who were prescribed ≥3 daily injections of insulin. The 24-week LC-CGM program consisted of virtual visits with a registered dietitian (RD) and clinical pharmacy practitioner (CPP); CGM data were used to guide tailored nutrition counseling and de-escalation or cessation of glucose-lowering medications. To evaluate changes from baseline, intention-to-treat analyses were conducted for all enrollees, with separate analyses for program completers. Primary outcomes were program feasibility and acceptability (ie, program enrollment and completion rates and mean number of RD and CPP visits). Secondary outcomes included mean weight change, percent weight loss, achievement of ≥5% and ≥10% weight loss, change in glucose-lowering medication use, and change in laboratory measures (eg, hemoglobin A1c [HbA1c]). Program evaluation occurred from March 19, 2021, to May 3, 2024. Among 43 Veterans referred to the LC-CGM program, 38 (88%) enrolled. Most were men (37/38, 97%), white (29/38, 76%), with an average age of 63.7 (SD 9.6) years. Mean BMI and HbA1c were 38.1 (SD 5.8) kg/m2 and 7.8% (SD 1.3). Of 38 enrollees, 27 (71%) completed the program. Enrollees averaged 9.5 (SD 3.3) RD visits and 12.8 (SD 4.7) CPP visits. In intention-to-treat analyses, mean weight change was -11.5 kilograms (SD 8.7; 95% CI -14.4 to -8.6), corresponding to 9.5% weight loss (SD 7.2; 95% CI -14.9 to -4.2), with 58% (22/38) achieving ≥5% weight loss and 32% (12/38) achieving ≥10% weight loss. Overall, use of glucose-lowering medications decreased from 3.5 (SD 0.8) per patient at baseline to 2.4 (SD 0.9) per patient at 24 weeks (P<.001), with 72% (26/36) of Veterans discontinuing short-acting insulin and 50% (18/36; P<.001) discontinuing long-acting insulin. Use of glucagon-like peptide-1 receptor agonists increased from 39% (15/38) at baseline to 61% (23/38) at 24 weeks (P=.02). Among program completers (n=27), mean percent weight loss was -11.8% (SD 6.5) and median HbA1c decreased by 0.7% (95% CI -0.9 to -0.3; P=.001). This pilot program provides preliminary evidence that supports feasibility, acceptability, and clinical effectiveness among Veterans with T2D. Additional research is needed to rigorously test longer-term clinical and cost-effectiveness among a larger cohort of eligible Veterans.
7. Smartphone App-Based Eating Behavior Monitoring and Feedback Intervention for Glucocorticoid-Induced Appetite Increase in Patients With Systemic Lupus Erythematosus: Protocol for a Pilot Randomized Controlled Trial.
期刊: JMIR research protocols 发表日期: 2025-Dec-15 链接: PubMed
摘要
Increased appetite and weight gain are common adverse effects of glucocorticoid therapy in patients with systemic lupus erythematosus (SLE). Concerns about appearance-related changes due to weight gain can reduce medication adherence. Moreover, the complex interplay among glucocorticoids, mood changes, sleep disturbances, and appetite can influence eating behaviors. Daily data collection using ecological momentary assessment and analysis of interrelations may help clarify these dynamics. Furthermore, real-time feedback based on daily eating behavior may help patients regulate appetite and eating patterns. Accordingly, we developed Mogu!☆Log, a smartphone-based app that enables daily self-reporting of eating behaviors, appetite, and mood and provides graphical feedback on meal frequency and perceived control over eating. This paper presents a protocol for a pilot randomized controlled trial designed to evaluate the effects of real-time feedback on eating behaviors using the Mogu!☆Log app among patients with newly diagnosed SLE who had started glucocorticoid therapy. This multicenter study recruited Japanese patients with newly diagnosed SLE who had started glucocorticoid therapy across 15 hospitals with rheumatology services. Participants were randomly assigned in a 1:1 ratio to two groups: (1) the immediate feedback group, which receives graphical feedback on meal frequency and perceived control over eating starting from day 1, and (2) the delayed feedback group, which uses the same app without feedback for the first 14 days and begins receiving identical feedback from day 15. Participants enter data daily from day 1 to day 21 after randomization. The primary outcome is the mean number of meals on day 14 after glucocorticoid initiation. Secondary outcomes include the loss-of-control-over-eating score and a 5-item visual analog scale-based appetite score, both recorded on day 14. Between-group mean differences will be analyzed using 2-tailed t tests. The target sample size is 60. In an embedded observational “study within a trial,” linear mixed models will examine whether glucocorticoid dose influences appetite scores through mood and sleep changes. We hypothesized that participants receiving immediate feedback will have fewer meals on day 14, reduced loss of control over eating, and better appetite scores. The study received funding in April 2019, April 2022, and April 2024. Recruitment began in October 2024, and 17 participants had been enrolled as of May 2025. Data collection is expected to be completed by March 2027; data analysis has yet to begin. Results will be submitted for publication and reported to the University Hospital Medical Information Network (UMIN) registry in the summer of 2027. This pilot trial will provide foundational data on the feasibility and efficacy of smartphone-based real-time feedback in managing glucocorticoid-induced appetite increase in patients with SLE. These findings may contribute to the growing body of literature on app-based interventions for medication-related adverse effects.
8. Using Patient-Held Devices to Measure Variations in Resting Heart Rate and Step Count Prior to Presentation With an Acute Illness: International, Multicenter Flash Mob Feasibility Study.
期刊: JMIR cardio 发表日期: 2025-Dec-15 链接: PubMed
摘要
Many patients experience a gradual decline in health before seeking hospital care, with subtle changes in vital signs such as increased heart rate or decreased mobility. Recognizing deviations from baseline vital signs can support clinical decision-making, especially admission decisions. Smart devices (ie, smartphones, smartwatches, and activity trackers) track health metrics like heart rate and step count, offering new opportunities to estimate illness severity and track deterioration early. This study aimed to assess the feasibility of using heart rate and step count measurements from smart devices (ie, smartphones, smartwatches, and activity trackers) to enhance the evaluation of patients presenting with acute illness in emergency settings. We conducted an international multicenter prospective observational study using the flash mob study design in 34 hospitals in the Netherlands (n=17), the United Kingdom (n=7), Denmark (n=9), and Switzerland (n=1) in May 2024. Researchers collaborated with patients to complete questionnaires upon an acute care (ie, emergency department, acute medical unit, same day emergency care) visit and extracted physiological data from their smart devices. Among patients with an acute care visit (n=1137), 40% (n=452) had a smart device with health data. These patients tended to be from a higher educational level and in relatively good health. Only half had retrievable heart rate or step count data, resulting in a usable data set for 20% (n=209) of the total study population. Analysis showed a significant increase in heart rate (P<.001) and a decrease in step count (P<.001) in the days preceding their hospital visit. Both heart rate (P=.04) and step count (P=.04) on the day before presentation were significantly associated with disposition. Our study demonstrates the feasibility of using a patient’s personal smart device to monitor vital signs in the days leading up to an acute care visit. In a selected patient group, significant changes in heart rate and step count were observed prior to hospital presentation, suggesting that disposition may be predicted using data collected from the patient’s own device. High-risk patient groups, who might benefit the most from digital health monitoring, are currently underrepresented among device users.
9. Driving under the influence of alcohol and cannabis: Associations with substance use and behavioral health characteristics.
期刊: Traffic injury prevention 发表日期: 2025-Dec-15 链接: PubMed
摘要
Driving under the influence of alcohol (DUIA) and cannabis (DUIC) continues to increase. Given the increased number of states with cannabis legalization in recent years, updates on driving under the influence (DUI) prevalence and risk factors are needed to inform targeted prevention and intervention efforts aimed at reducing substance-impaired driving. We used data from the 2021-2023 U.S. National Survey on Drug Use and Health (N = 139,524 individuals age 18 years and older) for self-reported DUI. After presenting the prevalence of alcohol, cannabis, and other substance use and DUI, we used binary logistic regression models to examine sociodemographic and clinical correlates of DUIA and DUIC, and a multinomial logistic regression model to examine DUIC but no DUIA (DUIC-NA) and both DUIA and DUIC (DUIA&C), compared to DUIA but no DUIC (DUIA-NC). Among those who used alcohol in the past year, 8.6% had DUIA; among those who used cannabis, 20.6% had DUIC. Among those who reported DUIA and/or DUIC, 47.9% had DUIA-NC, 34.0% had DUIC-NA, and 18.1% had DUIA&C. Any severity of alcohol and cannabis use disorder, initiation of substance use during adolescence, mental health problems, risk propensity, self-recognition of substance use problem, and criminal justice involvement were associated with DUIA and DUIC. Age 65+, relative to age 18-25, was also a risk factor for DUIC among those who used cannabis. Compared to DUIA-NC, DUIC-NA was higher among residents of medical cannabis legal states. Substance use treatment, including mental health screening and treatment, is the most important DUI prevention approach. As cannabis use rises among older adults, prevention strategies must increasingly include this group. States with legalized medical cannabis suggest a need for complementary public safety measures.
10. Maternal Micronutrient Status During Pregnancy and Its Neurodevelopmental Implications for Infants in South Asia: Protocol for a Scoping Review.
期刊: JMIR research protocols 发表日期: 2025-Dec-15 链接: PubMed
摘要
Pregnancy is a crucial stage characterized by an increased demand for various nutrients. The role of micronutrients becomes especially important during pregnancy and infancy to support neurodevelopment. Micronutrient deficiencies are prevalent in low- and middle-income countries due to socioeconomic disparities, limited dietary diversity, and barriers to quality antenatal care. This results in women of reproductive age and developing offspring being disproportionately affected. Despite extensive research, evidence remains fragmented, leading to a lack of comprehensive synthesis. This scoping review aims to explore the existing evidence on the role of maternal micronutrient status during pregnancy influencing neurodevelopmental outcomes in infants. Additionally, it will assess the prevalence and distribution of specific micronutrient deficiencies and identify their sociodemographic determinants within South Asian countries. This scoping review uses an iterative, three-step search strategy to identify both published and gray literature. Initially, a targeted search using relevant keywords was developed for PubMed to locate studies investigating maternal micronutrient status or supplementation during pregnancy (women aged 15-49 y) and associated neurodevelopmental outcomes in offspring up to two years of age. The search was sequentially narrowed by geographic region (South Asian countries), study design, human studies, English-language publications, and clinical trials. In the second stage, this search strategy will be adapted and implemented across additional electronic databases, including MEDLINE, Embase, Google Scholar, Cochrane Library, OpenGrey, JSTOR, and Wiley, as well as trial registries such as ClinicalTrials.gov and PROSPERO. Further, supplementary hand-searching of relevant journals will be conducted. The third step involves applying a snowballing technique to review the bibliographies of initially identified papers. Two reviewers will independently conduct study selection and data extraction using standardized forms. Quality assessment will use Joanna Briggs Institute critical appraisal checklists. Quantitative findings (study characteristics, exposure definitions, outcome measures) will be summarized with descriptive statistics and visualized in structured tables and charts, and qualitative findings will be coded inductively to develop themes pertinent to the review questions. We will integrate evidence through a convergent narrative synthesis to contextualize how maternal micronutrient deficiencies are influenced by sociodemographic factors and how these relate to infant neurodevelopment. The review will adhere to PRISMA-ScR reporting guidelines. The initial database search was completed on July 3, 2025. Title and abstract screening is in progress, and final synthesis and reporting are anticipated by January 2026. This review aims to summarize the available evidence on maternal micronutrients and infant neurodevelopment in South Asia, identify major gaps and inconsistencies in the data, and highlight opportunities for focused research and multisectoral action. The findings will help guide the next phases of the South Asia Collaborative for Maternal Micronutrients and Infant Neurodevelopment (SACMIND) collaborative project, which will include qualitative studies, biomarker assessments, and designing interventions.
11. Development and Validation of a Revised Multidimensional Digital Health Literacy Scale: Secondary Analysis Using Cross-Sectional Data From the 2022 GetCheckedOnline Community Survey In British Columbia, Canada.
期刊: Journal of medical Internet research 发表日期: 2025-Dec-15 链接: PubMed
摘要
Digital technologies are reshaping health care, making digital health literacy (DHL) a critical competency for navigating online health information. Although widely conceived and measured as a unidimensional measure of DHL, the literature increasingly supports a multidimensional framing of the eHealth Literacy Scale (eHEALS). Studies propose alternative factor structures that can better inform population-level interventions, but these studies have not accounted for the ordinal nature of eHEALS response data. This study aimed to identify and validate an alternate multidimensional structure of eHEALS accounting for its ordinal response scale. Data were drawn from the 2022 GetCheckedOnline community survey of consenting English-speaking British Columbia residents aged ≥16 years who reported sexual activity in the past 12 months. Participants were recruited through geo-targeted digital advertisements, community outreach, and in-person recruitment at public events, and community locations. DHL was measured using eHEALS, with responses collected on a 5-point Likert scale. Descriptive statistics summarized eHEALS responses using means, medians, and IQRs. Exploratory and confirmatory factor analyses were used to assess the scale’s structure using polychoric correlations and standard model fit indices. Reliability and validity were evaluated using polychoric ordinal alpha, average variance extracted, and composite reliability, with missing data addressed via multiple imputation. Overall, 1657 participants met inclusion criteria with a mean age of 33.0 (SD 11.77, 95% CI 32.4-33.6) years. Among these 47.3% (95% CI 44.9%-49.7%) identified as women, 30.4% (95% CI 28.1%-32.6%) identified as racialized minorities, 80.5% (95% CI 78.5%-82.3%) reported easy internet access, and 32.2% (95% CI 30.0%-34.5%) had a bachelor’s degree or higher. Across eHEALS items, median scores were 4.0 (IQR 1.0-2.0) with excellent internal consistency (polychoric ordinal α=.92). Exploratory factor analysis supported a 3-factor solution explaining 65.7% of the variance, demonstrated through confirmatory factor analysis (χ²17=71.7, P<.001, root-mean-square error of approximation=0.059, standardized root-mean-square residual=0.026, comparative fit index=0.969, Tucker-Lewis Index=0.948). The final model included Information Navigation (standardized loadings=0.765-0.917), Resource Appraisal (0.825-0.892), and Confidence in Use (0.803 for both items), with composite reliability (0.784-0.900), and average variance extracted (0.503-0.738) supporting construct validity. This study confirms a multidimensional structure of eHEALS, identifying Information Navigation, Resource Appraisal, and Confidence in Use as key dimensions of DHL. This revised model enhances measurement precision, enabling more accurate identification of populations with limited DHL and informing the development of targeted, equity-oriented interventions. Future research should aim to confirm this multidimensional structure in more diverse populations and explore how distinct DHL domains influence access to digital health services in various contexts. Additionally, ongoing scale development must adapt to account for the role of emerging technologies, including artificial intelligence and social media algorithms in health care.
12. Effective Narratives and Strategies from Successful Social Change Movements to Inform Public Health.
期刊: Annual review of public health 发表日期: 2025-Dec-15 链接: PubMed
摘要
Racism is an underlying cause of health inequities and is entrenched in health systems, disproportionately affecting marginalized groups. Advancing health equity requires reimagining health systems to uproot racism from health-related policymaking. Racism, in its systemic, cultural, and interpersonal forms, remains a significant threat to health equity, a barrier to reform, and a public health crisis. This review draws lessons from US social movements-including tobacco control, sexual and gender minority rights, criminal justice reform, civil rights, and reproductive justice-to identify effective strategies for change. Drawing on key theories, typologies, and insights from the literature, we examine how organizing, messaging, and mobilization have shaped narratives, have fostered public will, and have driven policy reform. Prior movements can serve as a guide for the development and implementation of a social change movement aimed at addressing racism in public health.
13. Facilitators and Barriers to Patient Enrollment in the AV Access Trial of Vascular Access Outcomes: A Qualitative Study.
期刊: Kidney360 发表日期: 2025-Dec-15 链接: PubMed
摘要
People with kidney failure on chronic hemodialysis (HD) require sustainable vascular access. The AV Access trial is a randomized controlled trial comparing clinical and patient-reported outcomes in adults ≥ 60 years old on HD with a central venous catheter, randomized to receive either a surgical arteriovenous (AV) fistula or graft. Patient enrollment in the trial initially progressed slower than anticipated. We designed a cross-sectional qualitative substudy to identify facilitators and barriers to patient enrollment in the AV Access trial. We conducted qualitative focus groups and semi-structured interviews of site investigators and providers, and semi-structured interviews of patients who had been approached for enrollment in the AV Access trial. We performed hybrid inductive-deductive thematic analysis of transcripts. We analyzed transcripts from two focus groups (one with four vascular surgery physician investigators and one with four nephrology physician investigators) and 44 individual interviews with vascular surgery physician investigators (n=2), nephrology physician investigators (n=2), vascular surgery providers (n=9), nephrology providers (n=10), and patients (n=21). Participants identified themes related to clinical site selection, buy-in from clinical teams, patient referral processes to vascular surgery, and processes to recruit patients to enroll in the trial. Subthemes included barriers related to patients receiving care from providers external to the study team, pervasive biases from the “Fistula First” initiative, limited patient knowledge of the importance of AV access, and a need for additional information provided to patients to support informed decision-making about trial participation. Enrollment in the AV Access trial was hindered by multi-level barriers. Some of these may be mitigated through collaborative patient education surrounding the importance of access placement, as well as provider-directed education to increase buy-in and enhance engagement. These findings can inform the design and implementation of future randomized controlled trials concerning surgical AV access outcomes.
14. Leveling the playing field: Transgender inclusion in athletics.
期刊: The American journal of orthopsychiatry 发表日期: 2025-Dec-15 链接: PubMed
摘要
More than half of the states in the United States have implemented laws or policies requiring transgender athletes to participate in athletics aligned with their sex assigned at birth. President Trump signed Executive Order 14201, Keeping Men Out of Women’s Sports, on February 5, 2025, expanding these restrictions to recipients of federal education funding. The order also made it official policy to oppose transgender women athletes participating in women’s sports “as a matter of safety, fairness, dignity, and truth.” Restricting trans adolescents’ physical activity may exacerbate health disparities within this marginalized population. Allowing participation in categories aligned with gender identity could alleviate these disparities. The trans athlete debate primarily focuses on testosterone’s effects on performance. This article argues against exclusion based on testosterone, emphasizing sex and gender as social constructs and the complexity of determining eligibility in binary gender categories. It reviews racial/ethnic and age changes in the size of the trans population since 2014. It provides foundational knowledge on sex differences in physical performance and reviews testosterone’s role in superior male performance. The article critiques research on performance differences between trans and nontrans athletes, highlighting limitations in generalizing findings from adult studies to youth. Health care professionals must advocate for trans athletes by confronting restrictive policies and promoting inclusive sports participation. Policy recommendations are provided to implement these conclusions. (PsycInfo Database Record (c) 2025 APA, all rights reserved).
15. A Refined Mobile Health Intervention (SMARTFAMILY2.0) to Promote Physical Activity and Healthy Eating in a Family Setting: Randomized Controlled Trial.
期刊: JMIR mHealth and uHealth 发表日期: 2025-Dec-15 链接: PubMed
摘要
Many mobile health (mHealth) apps focus on promoting physical activity (PA) and healthy eating (HE). However, there is limited empirical evidence regarding their effectiveness in initiating and sustaining behavior change, particularly among children and adolescents. Considering that behavior is influenced by social contexts, it is essential to take core settings like family dynamics into account when designing mHealth apps. The purpose of this study was to further develop and refine the SMARTFAMILY (SF) app targeting PA and HE in a collective family-based setting by enhancing design and usability, as well as by adding gamification aspects, health literacy, and just-in-time adaptive interventions to the first version of the app. The SF2.0 app, based on behavior change theories and techniques, was developed, implemented, and evaluated. The app was used in a collective family setting, with family members using it individually and cooperatively. In a cluster-randomized controlled trial, the intervention group (IG) used the app for 3 consecutive weeks, while the control group (CG) received no treatment. Primary outcomes included PA measured through self-reports and accelerometry, as well as self-reported fruit and vegetable intake (FVI) for HE. Secondary outcomes included intrinsic motivation, behavior-specific self-efficacy, and the Family Health Climate. A follow-up assessment (T2) was conducted 4 weeks after the postmeasurement (T1) to assess intervention effects. Multilevel analyses were performed in R (R Foundation for Statistical Computing), considering the hierarchical structure of individuals (level 1) within families (level 2). Overall, 55 families (28 CG, 105/209; 27 IG, 104/209 participants) were recruited for the study. In total, 3 families (3 CG, n=12) chose to drop out of the study due to personal reasons before T0. Overall, no evidence for meaningful and statistically significant increases in PA was observed in favor of the IG of our physically active sample. However, the app elucidated positive effects in favor of the IG for FVI diary (T0-T1; P=.03), joint PA (T0-T1; P=.02 and T0-T2; P<.001), and joint family meals (T0-T1; P=.004). The SF2.0 trial evaluated an mHealth intervention designed to promote PA and HE within families. Despite incorporating a theoretical foundation, several behavior change techniques based on family life, and gamification and just-in-time adaptive intervention features, the intervention did not significantly increase PA levels among physically active participants. FVI, joint PA, and joint meals were improved within the IG. Previous studies on digital health interventions have produced mixed results, and family-based mHealth interventions remain rare, with limited focus on whole-family behavior and randomized controlled trials. To enhance intervention effectiveness, future app development could consider incorporating even more advanced features and should focus on inactive participants. Further research is needed to better understand intervention engagement and tailor mHealth approaches for primary prevention efforts. German Clinical Trials Register DRKS00010415; https://www.drks.de/search/en/trial/DRKS00010415. RR2-10.2196/20534.
16. Effect of office strain level on mental workload and musculoskeletal disorders in employees of the design department: A case-control study.
期刊: Work (Reading, Mass.) 发表日期: 2025-Dec-15 链接: PubMed
摘要
BackgroundCAD (Computer Aided Design) designers spend long hours in front of visual displays, using specialized automotive design software. In addition to musculoskeletal disorders that may result from prolonged static activities, these individuals are also exposed to high mental workloads.ObjectiveThis study aims to assess the effect of office strain levels on the mental workload and musculoskeletal disorders of the design department.MethodsThis descriptive-analytical study included 48 cases, consisting of the occupation of CAD designing from the computer design department, and 48 control participants, comprised of non-computer users. It assessed musculoskeletal disorders using the CMDQ (Cornell Musculoskeletal Discomfort Questionnaire), ergonomic risk with the ROSA (Rapid Office Strain Assessment), and mental workload with the NASA-TLX (NASA Task Load Index). Data were analyzed using SPSS version 22.ResultsIn the case group, 37.5% were categorized as high risk for strain, compared to 31.25% in the control group. 27.08% of participants experienced an unacceptable level of mental workload according to NASA-TLX criteria, while only 17.71% were within the acceptable level. Significant relationships were found between office strain, musculoskeletal disorders, and mental workload, with a direct correlation between ROSA, NASA-TLX, and CMDQ scores (<0.011).ConclusionsThe most significant factors influencing office strain and mental workload among the occupation of CAD designing include ergonomic conditions in the workplace, duration of computer use, temporal demand, and the nature of job tasks. Factors such as health status, physical characteristics, and work experience are crucial in determining the intensity of mental workload and office strain.
17. Strengthening interprofessional collaboration by working with cross-sectoral boundaries: Introducing mental health teams in Denmark.
期刊: European journal of public health 发表日期: 2025-Dec-15 链接: PubMed
摘要
Interprofessional collaboration across sectors is a major challenge for the health and care workforce. Collaboration often remains weak, as fragmented services cannot match complex needs. Working with the underlying professional, organisational, and administrative boundaries may help to address the challenge, but we know little about how managers and professionals do this. This study examines how boundary work can strengthen interprofessional collaboration, based on the introduction of mental health teams in three Danish municipalities. A qualitative case study was conducted involving three intersectoral teams consisting of health and social care professionals in Central Denmark Region. Data collection included observations of interactions, 27 semi-structured interviews with users, professionals, and middle managers, and three focus group interviews. Key themes and dynamics in boundary work were identified using thematic network analysis. Findings indicate that boundary work by management established shared frameworks for interprofessional collaboration, such as weekly board meetings and risk categorization systems. In two municipalities, these frameworks fostered collaborative boundary work among professionals, agreeing on how to share information and adjust care plans collectively. However, in the third municipality, professionals competed to defend existing boundaries, hindering the introduction of new collaborative practices. Working with boundaries can help to address the challenge of interprofessional collaboration across sectors by combining top-down and bottom-up strategies by managers and professionals. However, implementation needs fine-tuning to existing professional hierarchies and local organisational contexts. Managers also need to acknowledge the limits of steering boundary work, which thrives on autonomy in daily interactions among professionals.
18. Management of Patients with Arterial Hypertension in Italy: A Consensus Document of the Italian Society of Hypertension (SIIA) and the Italian Society for Cardiovascular Prevention (SIPREC) About the Recommended Care Pathway and Areas for Improvement.
期刊: High blood pressure & cardiovascular prevention : the official journal of the Italian Society of Hypertension 发表日期: 2025-Dec-15 链接: PubMed
摘要
Chronic diseases represent one of the most significant challenges for Public Health in Italy, involving approximately 24 million people and generating an annual cost of more than 66.7 billion euros. Among these, arterial hypertension affects 31% of the population, and it is the leading risk factor for cardiovascular diseases. However, the management of arterial hypertension presents several challenges, including inconsistencies in care pathways, poor integration between healthcare settings, and low therapeutic adherence. This document aims to share the findings of a national-level project that defined the recommended care pathway for managing hypertensive patients, identified potential areas for improvement, and proposed supporting solutions, including a list of indicators for evaluation and monitoring. The key areas for improvement, particularly the promotion of therapeutic adherence and the strengthening of communication between community-based and hospital services, serve as a foundation for optimizing the management of this condition and fostering more effective collaboration among the various stakeholders and levels of care within the healthcare system.
19. Comparative analysis of toxicokinetic profiles of methamphetamine and its metabolites at toxic and therapeutic doses in mice.
期刊: Forensic toxicology 发表日期: 2025-Dec-15 链接: PubMed
摘要
Methamphetamine (MA) is widely abused worldwide and has long been a major social concern. To provide basic information for comparing MA toxicokinetics in humans, we analyzed changes in the serum and urinary concentrations of MA and its metabolites in mice and compared the toxicokinetic profiles at the toxic dose with those at the therapeutic dose. Mice were administered therapeutic (1.5 mg/kg) or toxic (15 mg/kg) doses and blood and urine samples were collected. The serum concentrations of MA and its metabolite amphetamine (AMP), as well as the urinary concentrations of MA and its metabolites-AMP, p-hydroxymethamphetamine (OHMA), p-hydroxyamphetamine (OHAMP), and norephedrine (NEP) -were measured using liquid chromatography-tandem mass spectrometry (LC-MS/MS). The serum AUC0-24 values for MA and AMP were approximately 16 and 41 times higher, respectively, in the toxic dose group than those in the therapeutic dose group. The urinary AMP and OHAMP excretion levels were approximately 3.6 and 2.2 times higher, respectively, in the toxic dose group. The urinary [AMP] / [MA] ratio at all collected points and [AMP] / [OHMA] ratio in the 0-24 h sample were significantly higher in the toxic than in the therapeutic dose group. The results obtained from this study suggest that the metabolism of AMP to OHAMP and NEP was saturated during intoxication. Furthermore, the determination of whether a toxic dose had been administered within 24 h or after 24 h would be possible through a joint evaluation of the urinary [AMP] / [MA] and [AMP] / [OHMA] ratios.
20. Th-1 cytokine-primed small extracellular vesicles from limbal mesenchymal stem cells modulate immune and inflammatory responses in Hashimoto's Thyroiditis: an ex vivo proof-of-concept study.
期刊: Molecular biomedicine 发表日期: 2025-Dec-15 链接: PubMed
摘要
21. Disparities in sleep medicine in Japan: association between CPAP prescriptions and the number of certified sleep medicine providers.
期刊: Sleep & breathing = Schlaf & Atmung 发表日期: 2025-Dec-15 链接: PubMed
摘要
Health disparities in sleep medicine are associated with underdiagnosis and undertreatment of sleep disorders, despite their well-established impact on health. This study aims to clarify regional disparities in continuous positive airway pressure (CPAP) therapy prescriptions across prefectures in Japan and to examine the association between the number of sleep specialists and CPAP prescription rates. This is an ecological study, investigating the association between the number of sleep specialists and CPAP insurance claims across 47 Japanese prefectures, using publicly available open data. Multiple linear regression was used to assess the impact of sleep specialists on CPAP prescriptions, adjusting for covariates such as proportion of population aged 65 and over, obesity rates, and heart disease prevalence. The number of CPAP insurance claims per 1,000 population ranged from 35.0 to 65.3, with a 1.87-fold variation. The number of sleep specialists per million population varied substantially, from 0 to 35.8. Multivariable regression analysis revealed that the number of CPAP prescriptions was significantly associated with the number of sleep specialists (β = 0.32, B = 0.37, 95% CI: 0.04-0.71, p = 0.03), and the prevalence of heart disease (β = 0.39, B = 561.9, 95% CI: 55.7-1068.2, p = 0.03). The present study showed regional disparities in sleep medicine in Japan and a positive association between the number of sleep specialists and CPAP prescriptions, which highlighted the importance of enhancing the certification systems for sleep specialists to address regional health inequities in sleep medicine.
22. Population-Level Circadian Rhythm of eGFR and the Effect of Chronodisruption.
期刊: American journal of physiology. Renal physiology 发表日期: 2025-Dec-15 链接: PubMed
摘要
Chronic kidney disease (CKD) is one of the leading causes of global morbidity, and early diagnosis is essential to prevent complications. Estimated glomerular filtration rate (eGFR) is a key biomarker for assessing renal function. However, its value is influenced by various factors, including circadian variations. Previous studies have documented a circadian rhythm in eGFR, but population-level investigations using the cosinor method have not been conducted. We conducted a retrospective study in two hospitals in Spain (Toledo and Lorca) between 2017 and 2019. The circadian rhythm of eGFR was studied by fitting it to a cosine function, analyzing the effects of age and CKD stage. The results showed a statistically significant circadian rhythm in both populations, with the acrophase occurring at the beginning of the active phase of the day. The amplitude of the rhythm decreased in older patients (70-85 years) while patients with advanced CKD had lost their circadian rhythm entirely. This study, for the first time, uses the cosinor method to demonstrate the existence of a population-level circadian rhythm of eGFR. The cosinor analysis was performed on different CKD stages and ages, revealing the existence of significant rhythms, although none at advanced ages or post G1 CKD stage. The loss of circadian variability in advanced CKD emphasizes the importance of considering these rhythms in clinical practice to improve the diagnosis and management of kidney disease.
23. Ppid is Necessary for Overnutrition-Induced β-cell Loss.
期刊: American journal of physiology. Endocrinology and metabolism 发表日期: 2025-Dec-15 链接: PubMed
摘要
Type 2 diabetes (T2D) involves progressive loss of functional β-cell mass. In a zebrafish insulin-resistant model (zMIR), overnutrition triggers islet inflammation and nocturnal β-cell death. The cell death is prevented by the cyclophilin D (Ppid) inhibitor, cyclosporin A (CsA). Reducing mitochondrial ROS with mito-TEMPO or mitochondrial calcium with Ru360 protects β cells, further implicating the mitochondrial permeability transition pore (mPTP) in β-cell loss. The timing of β-cell death coincides with lower mitochondrial antioxidant gene expression, indicating diurnal mitochondrial vulnerability. Global ppid-/- preserves β-cell mass without altering islet inflammation or macrophage recruitment. Conversely, β-cell-specific PPID re-expression restores-and exacerbates-β-cell loss, which remains CsA-sensitive. These findings identify Ppid as a β-cell-intrinsic mediator of overnutrition-induced β-cell loss.
24. Approach to the Patient with Cushing's Syndrome: Use of Anticoagulation Therapy.
期刊: The Journal of clinical endocrinology and metabolism 发表日期: 2025-Dec-15 链接: PubMed
摘要
There is an increased awareness on the higher hypecoagulability risks in patients with Cushing’s syndrome (CS) but management remains controversial. Here, we present four illustrative cases of CS that exemplify some “grey areas” on venous thromboembolism (VTE) prevention-when to start, how long to continue, what to use, and when to stop. The cases span: initiation of prophylaxis at diagnosis of active CS; periprocedural management around inferior petrosal sinus sampling; peri-operative prophylaxis after transsphenoidal surgery (TSS); and discontinuation decisions in medically controlled disease. We synthesise current evidence and expert practice and recommend considering low-molecular-weight heparin at diagnosis of active CS, continuing through surgery, and extending for approximately three months after biochemical remission in selected patients to address the highest-events risk window. Based on recent data, we discourage routine use of graduated compression stockings for VTE prevention. Though bleeding complications appear uncommon, they need to be carefully considered on an individualized basis. Finally, scenarios where prophylaxis can be safely discontinued once eucortisolaemia is achieved are outlined. This case-anchored framework translates heterogeneous data into actionable guidance and highlights priorities for prospective evaluation.
25. The US EPA's National Nutrient Inventory: Critical Shifts in US Nutrient Pollution Sources from 1987 to 2017.
期刊: Environmental science & technology 发表日期: 2025-Dec-15 链接: PubMed
摘要
Efforts to constrain the negative environmental impacts of excess nitrogen (N) and phosphorus (P) are costly and challenging, due in part to inconsistent reporting of nutrient sources at temporal and spatial scales relevant for local decision making. To meet this challenge, the U.S. Environmental Protection Agency’s National Nutrient Inventory provides estimates of major agricultural, urban, atmospheric, and natural nutrient fluxes for the contiguous United States at county and HUC12 scales annually from 1987 (from 1950 for agriculture) to 2017. Since the late 1980s, total N emissions and atmospheric N deposition have declined 22% and 15%, respectively, despite increased agricultural emissions. Over the same period, municipal wastewater N and P loads remained largely stable, despite population increases, through wastewater treatment upgrades and the phaseout of phosphorus-containing detergents. Improved agricultural efficiency allowed for dramatic increases in agricultural production and crop harvest since 1987 (∼25% for N and P), with little change in surplus nutrients left on fields. Overall, a combination of innovative technologies and management has stemmed or even decreased major sources of nutrient pollution to the environment over the last several decades, representing an important shift that, if continued, may contribute to improved air, land, and water quality and human health.
26. Cell-Surface Inter-Cytochrome Electron Transfer Limits Biofilm Electron Conduction Kinetics in Shewanella oneidensis.
期刊: Journal of the American Chemical Society 发表日期: 2025-Dec-15 链接: PubMed
摘要
The electrical conductivity of biofilms plays a critical role in advancing bioelectronics for energy and environmental applications, yet the underlying mechanisms remain poorly understood. Previous studies proposed interheme electron transfer between hemes 5 and 10 in the outer-membrane deca-heme cytochrome (OMC) MtrC as the rate-limiting step in the biofilm electron conduction of Shewanella oneidensis MR-1. However, the strong interheme electron coupling in MtrC suggests that interprotein interactions may represent the primary barrier to biofilm electron conduction. Here, we investigated the biofilm electron conduction mechanism with a focus on interprotein electron transfer in S. oneidensis MR-1. Conductive currents and their temperature dependence were measured for estimating the thermal activation energy (Ea) by using indium tin-doped oxide (ITO) interdigitated electrodes in wild-type and mutant biofilms. While deletion of periplasmic cytochromes had a negligible impact on Ea, the deletion of OmcA or MtrC increased Ea 3-fold, revealing that interprotein interactions, particularly between OmcA and MtrC, dominate biofilm electron transfer over clonal OMC interactions. Furthermore, suppressing outer-membrane fluidity dramatically increased Ea, while interheme exciton coupling negligibly changed in the OMCs, confirming the critical role of protein diffusion and collision on the outer membrane. Flavin binding to OmcA or MtrC reduced conduction currents attributable to heme centers but enhanced those assignable to noncovalently bound flavins, suggesting that flavin occupancy blocks hemes 2 and 7, which serve as key interprotein electron transfer sites. These findings provide a mechanistic foundation for engineering highly conductive biofilms through targeted protein interface optimization, offering new avenues for the development of bioelectronic technologies.
27. Occurrence of fluoride in various infant and toddler formulas in Saudi Arabia: probabilistic dental fluorosis risk assessment by the Monte Carlo simulation method.
期刊: Food additives & contaminants. Part A, Chemistry, analysis, control, exposure & risk assessment 发表日期: 2025-Dec-15 链接: PubMed
摘要
The main objective of the present study was to determine fluorine (F) in different types of infant and toddler formulas (ITFs) and to assess the dental fluorosis risk (DFR) using the Monte Carlo simulation method and Crystal Ball software. Three types of ITFs-including SFL, FOFL, and TFL-from ten well-known and widely consumed brands of each type (a total of 30 brands) were selected. For each brand, three samples were collected (90 samples in total), and the F content was measured using the fluoride ion-selective electrode (ISE) method. DFR assessment was performed both for raw ITFs and for the scenario of simultaneous consumption with reconstitution water (RW). The findings indicated that, regardless of F levels in RW, the estimated daily intake (EDI) of F for all brands and all three types of ITFs was below the permissible levels established by the U.S. Environmental Protection Agency (EPA), the European Food Safety Authority (EFSA), and the American Dental Association (ADA), set at 60, 100, and 120 µg/kg bw/day, respectively. Based on EPA guidelines, the hazard quotient for dental fluorosis risk (HQ-DFR) for all brands and ITF types was lower than the threshold level (HQ = 1). When RW containing 0-1.5 mg/L F was assumed for formula preparation, HQ-DFR values increased significantly with higher F concentrations in RW, exceeding the permissible level in some scenarios. However, considering the higher EDI values recommended by EFSA and ADA, and acknowledging that the acceptable standard range for F concentration in drinking water used as RW is 0.5-1.5 mg/L, it can be concluded that the consumption of ITFs available in the Saudi market, together with drinking water within the standard F range, results in an acceptable DFR level for the health of infants and young children.
28. Bioinspired Face Mask for Exhaled Breath Condensate Collection and Multiplexed Biomarkers Analysis.
期刊: ACS nano 发表日期: 2025-Dec-15 链接: PubMed
摘要
The respiratory disease pandemic has heightened interest in breathomics. Exhaled breath condensate (EBC), which is a noninvasive and information-rich biofluid, holds great promise for personalized health management. However, insufficient collection and limited analytical versatility remain major challenges for wearable EBC analysis. Here, the bioinspired design and performance of a wearable face mask for efficient sampling (0.86 μL min-1 per well) and in situ electrochemical monitoring of four biomarkers (alcohol, NO2-, NH4+, and pH) in EBC are reported. The face mask sensor platform consists of a multistage thermoelectric cooling module, a bionic superhydrophobic self-cleaning cover, an expandable 4 × 4 electrode array, and an electrochemical microsystem readout circuit. The surface temperature rapidly decreases to 12.5 °C within 1 min, reaching the exhaled vapor dew point to ensure rapid condensation. A wettability-gradient interface, constructed by a patterned superhydrophobic micro/nanostructured PDMS cover and hydrophilic electrode regions, effectively guides the biofluid into the sensor regions and stably fixes it even under 180° rotation. The usability of this system is demonstrated by tracking metabolic responses in healthy participants following alcohol and high-protein food intake, as well as by enabling continuous dynamic monitoring of four biomarkers in EBC. This wearable EBC analysis system offers a versatile strategy for real-time breath analysis and may help personalized respiratory healthcare, metabolism tracking, and environmental exposure analysis.
29. Response to letter to the editor on: "the use of canonical dose-response models for benchmark dose analysis of continuous toxicological data".
期刊: Critical reviews in toxicology 发表日期: 2025-Dec-15 链接: PubMed
摘要
30. The impact of cooling vests on restaurant workers: A study.
期刊: Work (Reading, Mass.) 发表日期: 2025-Dec-15 链接: PubMed
摘要
BackgroundWith the increasing workforce, especially in unfavorable working environments, for example, indoor working in kitchens, thermal stress has been a major problem. The effects of thermal stress are that it can reduce the efficiency of workers, thereby raising their body temperature and causing irritability, restlessness, and negligence to safety instructions.ObjectiveCooling vests (CV) are used to mitigate these effects. This study aimed to assess the effect of CVs on performance, thermal strain, and physiological responses of personnel in an industrial company restaurant.MethodsThe current cross-sectional, descriptive-analytical study recruited 60 staff working in restaurants exposed to heat above the permissible level. Initial measurements of heat stress indices, physiological parameters, and performance were taken before starting work. The same measurements were repeated during and after an 8-h work shift. Secondly, ice gel cooling vests were provided to the staff, and the same indices were re-measured.ResultsThe results demonstrated that restaurant workers were subjected to thermal stress higher than the allowable limit. Cooling with ice gel vests significantly improved the Wet Bulb Globe Temperature (WBGT) - Heat Stress Index (HSI) thermal stress index, physiological indicators (heart rate, respiratory rate, deep ear temperature), and performance. This study suggests using CVs to improve physiological indicators and reduce thermal stress and ameliorate performance in restaurant settings.ConclusionsThermal stress in restaurant workers imposes a high thermal load, leading to increased cognitive demands. The study showed that the use of CVs would considerably alleviate physiological indicators of thermal discomfort and thus improve workers’ productivity. CVs are recommended as an intervention to reduce thermal stress and to ameliorate the working environment for restaurant workers.
31. Examination of occupational and physical therapists' exposure to physical risk factors in outpatient rehabilitation settings using the workplace ergonomics risk assessment and pain scale.
期刊: Work (Reading, Mass.) 发表日期: 2025-Dec-15 链接: PubMed
摘要
BackgroundHealthcare providers experience a significant rate of nonfatal occupational injuries associated with their occupational duties and characteristics.ObjectiveThis study aimed to gauge occupational and physical therapists’ exposure to physical risk factors and pain levels related to patient handling in outpatient rehabilitation settings.MethodsFor this observational, descriptive, and cross-sectional study design, the Workplace Ergonomics Risk Assessment (WERA) tool was used to collect real-time data, and a self-administered numeric pain intensity scale was utilized to rate pain levels.ResultsThe study included ninety-eight participants. The WERA overall final score showed that participants were exposed to moderate physical risk factors associated with Work-Related Musculoskeletal Disorders (WMSDs). Postures and repetitions of the anatomical areas were positively correlated with the use of force, vibration tools, contact stress tools, and task duration. Pain ratings showed that most of the participants experienced moderate to severe physical pain immediately after therapy sessions. A Kruskal-Wallis H test revealed a statistically significant difference in the exposure to physical risk factors in outpatient rehabilitation settings.ConclusionParticipants were exposed to moderate levels of physical risk factors and moderate to severe pain that may lead to WMSDs. Participants working in pediatric settings experienced the most significant exposure to physical risk factors. Results from this observational study were consistent with those from self-reported studies involving WMSDs from different geographical regions worldwide.
32. Perceptions of and experiences with trauma-informed care principles among pediatric occupational therapists.
期刊: Psychological trauma : theory, research, practice and policy 发表日期: 2025-Dec-15 链接: PubMed
摘要
Trauma has a profound and lasting impact on individuals. Trauma prevalence continues to rise nationally, yet few health care providers are trained to intervene and address trauma appropriately. Occupational therapy practitioners (OTPs) have a unique role in addressing trauma due to our profession’s ability to intervene across the lifespan. This study investigated the education and training OTPs received in trauma-informed care (TIC) practices and their perceptions and confidence levels in utilizing these approaches in practice. Three hundred twenty-one participants were recruited online using convenience, purposeful, and snowball sampling methods. Participants completed an anonymous 14-question online survey. The study indicated that over half the participants (51%) felt only moderately confident in applying TIC methods. A substantial percentage (46%) did not learn these practices during their occupational therapy education. For those who did, the training was typically limited to a single chapter or unit, suggesting a need for more in-depth curriculum integration. The findings of this study highlight the critical need for TIC education and training early in OTPs’ careers. While therapists recognize the importance of TIC approaches in their practice, they require additional education and support to integrate these approaches confidently. Addressing this gap through comprehensive TIC education in occupational therapy training programs is essential to enhancing the capacity of OTPs to provide TIC effectively. (PsycInfo Database Record (c) 2025 APA, all rights reserved).
33. Loneliness in spinal cord injury: A systematic review and comparison with the general population.
期刊: The journal of spinal cord medicine 发表日期: 2025-Dec-15 链接: PubMed
摘要
The psychosocial consequences of a Spinal Cord Injury or Disorder (SCI/D) can include increased loneliness. However, differences in the measurement of loneliness confound the available evidence. To compare levels of loneliness between adults with a SCI/D and the general population (Touch Test data) using the UCLA Loneliness Scale (any version). A secondary aim was to explore potential subgroups vulnerable to loneliness. Observational studies examining loneliness in SCI/D were identified via CINAHL, PubMed, PsycINFO, MEDLINE, Embase, Web of Science (up until 9th Sept 2025), Google Scholar (first 100 results), and targeted citation searching. Standardized mean group differences (Hedges’ g) were pooled using random effects modelling and the methodological quality of included studies evaluated (QualSyst tool). Study characteristics and bivariate correlations of loneliness in SCI/D were additionally examined. Thirteen observational studies (N = 3029 adults with SCI/D) were included in the analysis. Average UCLA scores (revised Version 3, 20-item and 3-item) for the pooled SCI/D sample and the general population were comparable, with both groups reporting moderate levels of loneliness (gw = .01; CI: -.43 to .46, P = .951). Individual effect estimates among the SCI/D studies were, however, characterized by imprecision and heterogeneity. Associations between loneliness, demographic and SCI/D characteristics were inconsistent although those who were lonely did report adverse health and social outcomes. The underlying personal, social and environmental factors which contribute to loneliness in SCI/D should be monitored and addressed. Ongoing research is also needed to develop a more culturally nuanced understanding of loneliness in disability. Protocol registration: https://osf.io/s6723/.
34. Participation-Based Intervention Using the Management Tool for Daily Life Performance (MTDLP): A One-Year Case Report Following Acute Stroke.
期刊: Occupational therapy in health care 发表日期: 2025-Dec-15 链接: PubMed
摘要
This case report highlights the effectiveness of the early application of the Management Tool for Daily Life Performance (MTDLP) in acute-phase stroke occupational therapy, with coordination of occupational therapy services across the continuum of care. A male patient in his 70s with left hemiparesis received interdisciplinary goal-oriented, personalized activities of daily life training. Care transitions were actively managed via transfer sheets and follow-up communication to ensure seamless occupational therapy delivery between facilities. On follow up, one year later, the client regained full ADL independence and meaningful participation suggesting early MTDLP application and coordinated occupational therapy across care settings can improve long-term outcomes.
35. A comparative analysis of CXCR4 gene expression from published datasets and cell surface protein levels in breast and prostate cancer models.
期刊: Biochemical and biophysical research communications 发表日期: 2025-Dec-13 链接: PubMed
摘要
The CXCL12/CXCR4 signaling axis is a critical mediator of cancer metastasis, particularly in the homing of breast and prostate cancer cells to the bone. Consequently, characterizing the CXCR4 status of preclinical cancer models is essential for designing meaningful experiments. However, prior reports show conflicting CXCR4 status in these models, with reported positivity rates varying from <5 % to >90 % across studies, highlighting the urgent need for systematic comparison. This study provides a systematic comparison of CXCR4 expression patterns by analyzing gene expression data from breast cancer cell lines (MDA-MB-231, MDA-MB-468) and prostate cancer cells (PC3) across multiple published datasets using batch effect correction. Additionally, flow cytometry experiments were conducted to directly quantify CXCR4 surface protein levels in these same cell lines, integrating transcriptomic analyses with proteomic evidence. The comparative analysis revealed a marked divergence between transcript abundance and surface protein expression. The highly metastatic MDA-MB-231 cells exhibited the highest levels of CXCR4 mRNA, which correlated with a strong enrichment of metastasis-related signaling pathways. Conversely, MDA-MB-468 and PC3 cells displayed relatively lower CXCR4 transcript levels but contained a significantly higher proportion of CXCR4-positive cells at the protein level. These findings indicate that high transcriptional activity does not necessarily translate to high surface protein availability, likely due to active post-translational regulation, such as rapid receptor internalization. Overall, these results emphasize the importance of validating both gene and protein expression in specific cell line models prior to conducting CXCR4-focused mechanistic or therapeutic studies. Such validation is crucial, as expression patterns may vary considerably between laboratories due to differences in passage number, culture conditions, and genetic drift.
36. Cutaneous manifestations associated with HIV preexposure prophylaxis: what to expect and when to worry.
期刊: Current opinion in infectious diseases 发表日期: 2025-Dec-11 链接: PubMed
摘要
Preexposure prophylaxis (PrEP) represents a cornerstone in HIV prevention, yet its broader clinical implications are less frequently explored. This review summarises current evidence on dermatological manifestations associated with PrEP use, including drug-induced reactions, sexually transmitted and contact-acquired infections, and cutaneous effects related to recreational substance use and chemsex practices. Antiretroviral agents approved for PrEP exhibit excellent dermatologic tolerability, with cutaneous adverse drug reactions rarely reported in clinical trials. When present, these typically manifest as mild maculopapular or urticarial rashes, though rare hypersensitivity syndromes have also been described. Doxycycline, increasingly used as postexposure prophylaxis against bacterial sexually transmitted infections, can induce photosensitivity and fixed drug eruptions. In parallel, the expansion of chemsex practices - commonly involving methamphetamine, mephedrone, and cocaine - has introduced a new spectrum of dermatological conditions, including infectious complications, traumatic lesions, vasculitic or necrotic reactions, and severe toxic-allergic responses. Cutaneous findings in PrEP users often arise from a complex interplay of pharmacologic exposure, infectious risk, and behavioural factors. Recognizing these dermatologic clues during PrEP follow-up offers an opportunity for early diagnosis, appropriate management, and targeted harm-reduction interventions in populations at a high risk for both HIV and other sexually transmitted or contact-transmitted diseases.
37. Recent advances in fluorescent metal organic framework based detection of heavy metal contaminants in water.
期刊: Talanta 发表日期: 2025-Dec-11 链接: PubMed
摘要
Heavy metal contamination of the water sphere poses a grave threat to environmental safety as well as wellbeing of human and other species. Heavy metal ions (HMI) such as Pb2+, Hg2+, Cd2+, Cr6+, As3+, Ni2+, Cu2+, regularly form potentially damaging industrial waste constituents that severely affect marine and human life. Excess Fe3+ ions in water can also pose a risk to human health. Detection methodologies are essential before taking action. The design and development of highly selective, sensitive methods for detecting such harmful ions would be a crucial step toward resolving water pollution. Due to their high surface area, porosity and functionalized structures metal organic frameworks (MOFs) turned into a versatile platform for the detection of HMIs. This review provides an overview of various MOF based detection mechanisms, including fluorescence sensing and quenching, along with their sensitivity, selectivity, and applicability in real world scenarios. Important developments in the design, structure, and functionalization of MOFs will also be included. The aims of this work are twofold: first, to provide a firm understanding of luminescent MOFs and their mechanisms for detecting HMIs; and second, to serve as a launch-pad for future innovations in this important area.
38. Theobromine is associated with slower epigenetic ageing.
期刊: Aging 发表日期: 2025-Dec-10 链接: PubMed
摘要
Theobromine, a commonly consumed dietary alkaloid derived from cocoa, has been linked to extended lifespan in model organisms and to health benefits in humans. We examined associations between circulating levels of theobromine intake, measured using serum metabolomics, and blood-based epigenetic markers of biological ageing in two European human population-based cohorts. Serum theobromine levels were significantly associated with reduced epigenetic age acceleration, as measured by GrimAge (p < 2e-7) and DNAmTL (p < 0.001) in 509 individuals from the TwinsUK cohort, and both signals replicated in 1,160 individuals from the KORA cohort (p = 7.2e-08 and p = 0.007, respectively). Sensitivity analyses including covariates of other cocoa and coffee metabolites suggest that the effect is specific to theobromine. Our findings indicate that the reported beneficial links between theobromine intake on health and ageing extend to the molecular epigenetic level in humans.
39. Historical neighborhood redlining and fertility in a cohort of U.S. Black women.
期刊: Epidemiology (Cambridge, Mass.) 发表日期: 2025-Dec-05 链接: PubMed
摘要
Structural racism can manifest in contemporary neighborhoods via historical policies or programs. For example, the Home Owners’ Loan Corporation (HOLC), a government-backed program from the 1930s, systematically diverted wealth away from Black neighborhoods. The reproductive health consequences of this racist program remain understudied. We evaluated associations between residence in a historically redlined neighborhood and fecundability, the per-cycle probability of conception. We used data from the Black Women’s Health Study (BWHS), a U.S. cohort of Black women who were aged 21-69 years in 1995 at ages 21-69 years with biannual follow up questionnaires. Experiences of infertility (i.e., tried for ≥12 months to conceive without success) were captured on several questionnaires. A 2011 supplemental module collected pregnancy histories between 1995 and 2011, including planning status and time to conception. We linked geocoded addresses to historical HOLC grades (A [“best”] to D [“hazardous”, i.e., redlined]). Using proportional probabilities regression models with generalized estimating equations, we estimated fecundability ratios and 95% confidence intervals (CI). Our analysis included 818 planned pregnancy attempts from 674 participants (mean age = 33.9 years). Relative to participants residing in neighborhoods with the highest grades (A or B), adjusted models showed reduced fecundability among participants who resided in lower graded neighborhoods (C: 0.91, 95% CI: 0.77, 1.09; D: 0.82, 95% CI: 0.68, 0.99). In this cohort of U.S. Black women, contemporary residence in a historically redlined neighborhood was associated with reduced fecundability. Our findings highlight the importance of exploring how historical neighborhood disinvestment affects reproductive health.
40. Neighborhood-level Measures of Structural Racism and Severe Maternal Morbidity among Black Mothers in California.
期刊: Epidemiology (Cambridge, Mass.) 发表日期: 2025-Dec-05 链接: PubMed
摘要
Drivers of persistent racial-ethnic inequities in severe maternal morbidity are poorly understood. This study examined how neighborhood-level structural racism measures shape risk of severe maternal morbidity among Black mothers. Data are from live hospital births in California between 1997-2019 at ≥20 weeks’ gestation (N=555,511). We leveraged information from the U.S. Census Bureau and the American Community Survey to determine neighborhood (census-tract) measures of structural racism across six domains (homeownership, unemployment, poverty, educational attainment, racialized economic deprivation, and racial residential segregation). We used 1) an additive composite index (Quartile 1 (low)- Quartile 4 (high)) and 2) latent class analysis to characterize four structural racism typologies. We examined associations across both measurement approaches using mixed-effects logistic regression models with neighborhood random intercepts adjusting for maternal age, education, and hospital payer information. Black mothers living in neighborhoods scoring high (Quartile 4) on the additive composite index had 13% higher risk of severe maternal morbidity than those in neighborhoods scoring low (Quartile 1) (95% Confidence Interval (CI): 1.04-1.24). Models evaluating latent class typologies also revealed that Black mothers living in neighborhoods characterized by consistently high racial inequity in unemployment, racialized economic deprivation, and racial residential segregation across the study period had 12% higher risk of severe maternal morbidity compared to those in neighborhoods consistently scoring low in the domains examined (95% CI: 1.03-1.23). Our findings support the hypothesis that neighborhood-level measures of structural racism influence risk of severe maternal morbidity among Black mothers.
41. A framework for thinking about the potential public health impact of epidemiologic research.
期刊: Epidemiology (Cambridge, Mass.) 发表日期: 2025-Dec-05 链接: PubMed
摘要
An impactful epidemiologic question is one that, if answered, could inform meaningful action to reduce the burden of disease in the population it concerns. We propose a set of factors that could be used for discussing, evaluating, and communicating the public health impact of epidemiologic studies. These factors pertain to the burden and distribution of disease, the potential for an intervention to alter the disease burden, and the context in which the study is conducted. The disease burden is characterized by the number of cases, severity or cost of disease, and distribution of disease across the population. The potential for intervention is characterized by the mutability of the exposure itself, the prevalence and distribution of other causes of the disease in the population, the prevalence of the exposure and risk of the outcome under the natural course (prior to any intervention),1 and the feasibility of intervening. An epidemiologic question need not be impactful along all these factors to make answering it worthwhile. However, answering epidemiologic questions with more of these factors present will likely have greater public health impact than answering questions for which these factors are absent. We hope that collecting these factors into a single framework may aid students and senior epidemiologists alike when organizing arguments for the value of their own work or attempting to evaluate the impact of others’ work.
42. Longer-term survival of UK people with bleeding disorders infected by Human Immunodeficiency Virus and/or Hepatitis C Virus through contaminated blood transfusions.
期刊: Epidemiology (Cambridge, Mass.) 发表日期: 2025-Dec-05 链接: PubMed
摘要
Between 1970-1991 when viral inhibition reduced the risk, people with a bleeding disorder in the UK had their missing clotting factors replaced with plasma products derived from donated plasma at-risk of infection. We analyzed longer-term survival of people with bleeding disorders exposed to plasma products. The National Haemophilia Database documents people with bleeding disorders registered, treated before, and alive on 1 January 1992. We estimated all-cause mortality proportional hazard ratios (HR) for exposure groups (Human Immunodeficiency Virus (HIV)/ Hepatitis C Virus (HCV) co-infected, HCV-diagnosed, and HCV-status unknown) vs HCV antibody negative, within distinct epochs: 1992-1999; 2000-2009; 2010-2019. We estimated years of life lost (YLL) by epoch and exposure group versus UK general population lifetables or via parametric survival models compared to people with bleeding disorders negative or unknown for HCV antibodies. Models were adjusted for sex, age-band at 1 January 1992, bleeding disorder, and severity. Of 6,282 people with bleeding disorders who met inclusion criteria, 15% were HIV/HCV co-infected, 32% HCV antibody positive, and 28% HCV antibody negative. Compared with HCV-negative, those HIV/HCV co-infected had an all-cause mortality HR of 4.2 (95% CI 2.9,6.0) and HCV+ of 2.2(1.7,2.8) in 2010-19. YLL for 2014-19 were 740(95% CI 440,1030) for HCV+ persons and 270(130,400) for HIV/HCV coinfected persons, compared with HCV unknown or negative persons. People with bleeding disorders in the UK infected prior to, but alive at, 1 January 1992, were still at increased risk of death 3 decades post implementation of HCV screening of blood supplies.
43. Comparing area-level patient density and physician prescribing preference instruments for the effect of antidiabetics on adverse cardiovascular events among Medicare beneficiaries.
期刊: Epidemiology (Cambridge, Mass.) 发表日期: 2025-Dec-05 链接: PubMed
摘要
Randomized trials (RCT) of major adverse cardiovascular events found no effect of dipeptidyl-peptidase-4 inhibitors (DPP-4i) medications compared to second-generation sulfonylureas while non-randomized studies estimated a benefit of DPP-4i. Socioeconomic residual confounding was thought to be implicated. We compared area-level prescribing density and physician prescribing preference as candidate instrumental variables for the effect of DPP-4i medications on major adverse cardiovascular events. Using Medicare claims data, we built two cohorts emulating RCTs of sitagliptin or saxagliptin starters, each compared to sulfonylurea starters. The proportion of DPP-4i prescribing in a ZIP Code tabulation area defined the area-level prescribing density instrumental variable at various cutoffs (0% vs. 100% to <50% vs. ≥50%). Patients’ physician prescribing history using the same proportion cutoffs was the physician prescribing preference candidate instrumental variable. An instantaneous physician preference instrumental variable used a physician’s most recent prescription. We adjusted two-stage instrumental variable regression models for propensity score quintiles. Unadjusted analyses for sitagliptin and saxagliptin, each compared to sulfonylurea, estimated a reduced risk of major adverse cardiovascular events (sitagliptin hazard ratio (HR)=0.86; 95% confidence interval 0.83 to 0.88); saxagliptin HR=0.68; 0.64 to 0.73). All instrumental variables were strong and reduced covariate imbalance. Analyses of area-level prescribing density found no meaningful difference for sitagliptin (0% vs. 100% HR=1.1; 0.79 to 1.6). Analyses of physician prescribing preference estimated reduced risk for sitagliptin (<50% vs. ≥50% HR=0.69; 0.48 to 0.98). Instantaneous physician prescribing preference analyses showed little to no difference for sitagliptin (HR=0.86; 0.60 to 1.1) and saxagliptin (HR=0.98; 0.56 to 1.7). Candidate instrumental variables focusing on short-term prescribing preference hold promise over area-based variables but remain inefficient.
44. The Perceived Role and Contributions of Physical Therapists in Health Promotion Practices Within School-Based Settings.
期刊: Pediatric physical therapy : the official publication of the Section on Pediatrics of the American Physical Therapy Association 发表日期: 2025-Dec-05 链接: PubMed
摘要
The purpose of this study was to examine the perceived role and contributions of physical therapists in health promotion (HP) practices within school-based settings. A survey was sent to US pediatric physical therapists through a variety of means. Related to HP in their educational program, 71% indicated content was provided across the curriculum, with 55% reporting gaps in content; 53% reported they are minimally involved in HP efforts, while 41% were not involved at all. Participants perceived role in HP included supporting participation, encouraging an active lifestyle, and providing resources to families. Barriers included time, administrative support, and role as a contract employee. Results suggest that SBPTs are minimally involved in HP largely due to time. Status as contract employees appears to limit engagement. Participants viewed their role in HP as related to improving participation.
45. Sibling comparison designs to assess social exposures and empirical tools to guide interpretation: an illustrative study of childhood income and subsequent mental disorders.
期刊: Epidemiology (Cambridge, Mass.) 发表日期: 2025-Dec-02 链接: PubMed
摘要
Sibling comparison designs are increasingly used to strengthen causal claims about social exposures and health outcomes, yet methodologic challenges in interpreting their results remain insufficiently addressed. This study develops empirical approaches to help assess whether sibling comparison estimates provide reliable evidence for causal relationships. We used childhood family income and severe mental disorders in a Danish nationwide cohort (n=643,623; 403,963 siblings born 1986-1996) as an example. We applied three complementary approaches: negative control analyses using pseudo-siblings (unrelated individuals with similar income differences as real siblings) to isolate exposure variability effects from shared familial confounding effects; assessment of sibling age structure, exposure correlation, and variation patterns to establish whether meaningful contrasts exist between siblings; and critical period assumption evaluation through age-specific income measurement. Family income at age 14 was associated with decreased mental disorder risk in the population-wide analysis (adjusted hazard ratio [aHR]=0.78; 95% CI:0.76-0.81) but showed no association using a sibling comparison design (aHR=1.02; 95% CI:0.94-1.11). The pseudo-sibling cohort matched on income also showed substantial attenuation (aHR=0.93; 95% CI:0.85-1.01), while pseudo-siblings not matched on income showed no attenuation. Income associations were similar across childhood measurement ages 0-14 (aHR range = 0.67-0.82). In this example, estimates from the sibling comparison design may reflect limited exposure variability within families and unmet life course model assumptions, rather than or in addition to the removal of shared familial confounding. The empirical approaches we developed help researchers distinguish methodologic factors from genuine null findings, and are available with R code for implementation.
46. Antibodies to combat melioidosis: bridging immune mechanisms with diagnostics and therapeutic potential.
期刊: Current opinion in infectious diseases 发表日期: 2025-Dec-02 链接: PubMed
摘要
Melioidosis, caused by the Gram-negative soil bacterium Burkholderia pseudomallei, is a frequently fatal (sub)tropical infection with a substantial global burden. This review summarizes current insights into antibody-mediated immunity in melioidosis and its clinical potential. Antibodies against B. pseudomallei polysaccharides and protein antigens promote bacterial clearance through opsonophagocytosis and complement activation, reducing intracellular spread. People who survive melioidosis develop broader and more durable antibody repertoires than nonsurvivors. Protective antibody responses vary by antigen class and are influenced by host factors, notably diabetes, a main risk factor for melioidosis. Diagnostic serology has advanced from low-performing indirect hemagglutination to single-antigen tests and multiplex platforms. Performance, however, is specimen-dependent, limited by cross-reactivity with related Burkholderia spp., and by cost and resource constraints in endemic settings. In preclinical models of melioidosis, monoclonal antibodies against B. pseudomallei confer passive protection and are being developed for prophylaxis, adjunctive therapy, and as platforms for antibody-antibiotic conjugates or vaccine design. Antibody responses to key virulence factors correlate with disease course and are increasingly studied for diagnostic and therapeutic applications. This review aids in informing novel diagnostics and guide antibody-based therapies offering new directions for clinical management and prevention of this high-burden but underrecognized infection.
47. National Public Health Policy Blueprint to Expand Equitable Radiation Therapy Access in India: A Scalable Model.
期刊: JCO global oncology 发表日期: 2025-Dec 链接: PubMed
摘要
To propose a comprehensive national policy blueprint to expand equitable radiation therapy (RT) access in India, addressing persistent rural-urban disparities and aligning with global cancer control priorities. This expert viewpoint was informed by consultations with oncology practitioners from government and private centers, medical physicists, policy planners, and patient advocates. Drawing on Indian and global precedents, best practices were synthesized to develop a 10-point framework addressing infrastructure, financing, workforce, quality assurance, and governance. RT services in India remain highly centralized, with only 120 of 740 districts offering access, disproportionately affecting the 934 million rural population. Key strategies in the proposed blueprint include import duty reform to incentivize rural investment, quality-linked reimbursements under public insurance schemes, bundled workforce incentives, and regionally focused public-private partnerships. Additional measures include phased deployment of indigenous linear accelerators (LINACs), pooled brachytherapy services, mandatory cancer notification, and digital integration through the Ayushman Bharat Digital Mission. Use of artificial intelligence (AI) and remote planning is highlighted as a means to address workforce shortages. The framework is modular and designed for adaptation by other low- and middle-income countries (LMICs). This 10-point National RT Policy Blueprint provides a scalable pathway to strengthen oncology infrastructure and improve treatment equity in India, with direct relevance for LMICs pursuing universal health coverage and Sustainable Development Goal 3.4. Although promising, some elements such as indigenous LINAC deployment and AI-enabled remote planning are aspirational and contingent on phased implementation, infrastructure readiness, and sustained political commitment.
48. Hematologic Malignancies Among Adults in Southeast Asia: Incidence, Mortality, and Regional Contexts.
期刊: JCO global oncology 发表日期: 2025-Dec 链接: PubMed
摘要
Southeast Asia (SEA), home to over 690 million people across 11 countries-Brunei, Cambodia, Indonesia, Lao PDR, Malaysia, Myanmar, the Philippines, Singapore, Thailand, Timor-Leste, and Vietnam-features diverse socioeconomic contexts and cancer care landscapes. We report and interpret incidence and mortality statistics for hematologic malignancies (HMs) in SEA. We analyzed 2022 Global Cancer Observatory data from the International Agency for Research on Cancer to report age-standardized incidence rate (ASIR) and age-standardized mortality rates (ASMR) per 100,000 individuals age 20 years and older. We focused on non-Hodgkin lymphoma (NHL), leukemia, multiple myeloma (MM), and Hodgkin lymphoma (HL), standardized using Segi-Doll world population estimates. Across 11 Southeast Asian countries, age-standardized incidence and mortality rates (ASIRs and ASMRs) for HMs vary widely, highlighting significant regional disparities. Singapore consistently reports the highest ASIRs for NHL, leukemia, MM, and HL, yet its ASMRs are much lower, reflecting strong health care infrastructure. Thailand, Brunei, and Malaysia mirror these associations, which are particularly pronounced in NHL and HL. In contrast, for leukemia and MM, Brunei, Cambodia, Indonesia, Lao PDR, Malaysia, Myanmar, the Philippines, Timor-Leste, and Vietnam demonstrated lower ASIR and ASMR that approaches ASIR, suggesting barriers to diagnosis and survivorship. Time trends suggest increasing mortality from MM and NHL, particularly in Thailand and the Philippines. Overall, survival outcomes correlate strongly with national health care capacity. Higher reported incidence in wealthier SEA countries may reflect greater diagnostic capacity, whereas similar incidence and mortality in low-income countries likely indicates limited access to timely diagnosis and treatment. Mortality patterns underscore the region’s broad disparities in cancer care infrastructure and outcomes, shaped by socioeconomic and systemic health inequities.
49. Telemedicine in adult intensive care: A systematic review of patient-relevant outcomes and methodological considerations.
期刊: PLOS digital health 发表日期: 2025-Dec 链接: PubMed
摘要
Given the growing challenges of healthcare, including an aging population and increasing shortages of specialized intensive care staff, this systematic review investigates the efficacy of telemedicine in intensive care compared to standard of care (SoC) or any other type or mode of telemedicine on patient-relevant outcomes for adult intensive care unit (ICU) patients. This systematic review follows Cochrane’s methodological standards. Comprehensive searches for any controlled clinical studies were conducted in MEDLINE, Scopus, CINAHL, and CENTRAL (up to 18 April 2024, and an updated search for randomized controlled trials (RCTs) up to 29 September 2025). Twenty-six studies comparing telemedicine in intensive care to SoC with approximately 2,164,508 analysed patients were identified, including data from one cluster RCT (cRCT), two stepped-wedge cluster RCTs (sw-cRCTs), and 23 non-randomized studies of interventions (NRSIs). No other comparisons were identified. Due to high clinical and methodological heterogeneity among studies, no meta-analysis was conducted. For ICU mortality, one cRCT (15,230 patients) and two sw-cRCTs (5,915 patients) showed heterogeneous results: two found no evidence for a difference, while one favoured SoC (very low-certainty). One sw-cRCT (1,462 patients) reporting overall mortality at 180 days suggested no evidence for a difference between groups (very low-certainty). Data from one cRCT (15,230 patients) and one sw-cRCT (1,462 patients) on ICU length of stay (LOS) showed no evidence for a difference between groups (moderate- and very low-certainty). Quality of life from one sw-cRCT (786 patients) indicated no evidence for a difference (very low-certainty). Six NRSIs reported adjusted data on ICU mortality, two on overall mortality, and three on ICU LOS, with heterogeneous results. High risk of bias and substantial heterogeneity limited the certainty, emphasizing the need for robust, patient-centered research in clinical studies to define telemedicine’s role in intensive care and optimize its implementation. Future studies should particularly ensure transparent and comprehensive reporting.
50. Patient-Centered Prioritization of Health Care Processes for Multimorbidity.
期刊: JAMA network open 发表日期: 2025-Dec-01 链接: PubMed
摘要
Primary care provides a broad service range, including preventive screenings and chronic disease care. Busy clinicians frequently select which health care processes to address per visit based on time or perceived disease impact, especially for patients with multimorbidity. Little evidence exists for how to prioritize processes by patient-centered health goals. To identify criteria for prioritizing health care processes for patients with multimorbidity and using these criteria, develop recommended priority rankings of health care processes aligned with patient-centered health goals. This consensus statement was developed using multicriteria decision analysis, a group consensus method. Using purposeful sampling, 21 national subject matter experts were recruited across 10 sites, with input from patient and health system partners. Experts completed 2 electronic survey rounds. The first round was conducted February 26 to April 2, 2024, with experts weighting 12 criteria for health care processes by importance (0-100 scale, with higher score indicating more importance) for addressing 3 common domains of patient-centered health goals (mortality, symptom relief, physical function) for hypothetical patients with multimorbidity. The second round was conducted June 3 to July 26, 2024, with experts scoring 53 health care processes by criteria (1-9 scale, with higher scores indicating greater priority). Experts received an evidence summary (publications through January 19, 2023) underlying health care processes. Weights and scores were combined as weighted sums, converted to process rankings per goal. Monte Carlo simulation (5000 randomizations) was used to evaluate confidence in findings (described as percentage of iterations at rank). A total of 20 experts participated (95% response rate). Survey 1 determined attributes important for decision-making. Seven criteria were selected: actionability, safety impact, completion ease, impact on high-prevalence health issues, evidence quality, long-term health outcome impact, and validity. The second survey used these criteria to rank health care processes by patient goals. Tobacco use screening was the highest priority health care process for all goals (function: total score, 6.9 [49% of iterations ranked as No. 1]; mortality: total score, 7.4 [27% of iterations ranked as No. 1]; symptoms: total score, 7.1 [44% of participants ranked as No. 1]). Rankings for remaining health care processes varied by goal. In this consensus statement, consideration of patient-centered health goals led to varied recommended decision-making criteria and prioritization of health care processes by subject matter experts. For patients with multimorbidity, these findings could inform systems evaluating health care process applications (eg, selection of screenings for patient-centered quality initiatives) or clinicians personalizing care delivery for patients (eg, catalyzing conversation about goals or efficiently addressing processes if goals are known).
51. Not here yet, but one bite away: Risk for vector-borne zoonotic diseases.
期刊: PLoS neglected tropical diseases 发表日期: 2025-Dec 链接: PubMed
摘要
Recent data demonstrate that vector-borne diseases (VBDs) are expanding into new regions across the globe. This trend is intensified by the interconnected world characterized by rapid urbanization, environmental changes, and increased human mobility, all of which create favorable conditions for the spread of both vectors and pathogens. Despite this growing threat, many countries still rely on reactive surveillance strategies, responding only after outbreaks occur. This approach focuses mainly on well-known vector species, while other potentially important or emerging vectors remain overlooked. Proactive vector surveillance is essential to anticipate and potentially prevent future outbreaks and monitor the importation of pathogens. The authors call on relevant authorities, researchers, and stakeholders to expand and strengthen vector surveillance systems, with particular emphasis on the inclusion of lesser-known vector species.
52. Music therapy for autistic people: summary of a Cochrane review.
期刊: Explore (New York, N.Y.) 发表日期: 2025-Nov-19 链接: PubMed
摘要
53. Is price associated with the quality of medicines? Evidence from active pharmaceutical ingredient testing in Nigeria.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
Determining the quality of medicines remains a challenge, particularly in low- and middle-income countries, where regulatory oversight and enforcement vary, and resources and infrastructure for quality testing are often constrained. In these settings, price is often used as a proxy for higher-quality medicines, yet empirical evidence supporting this assumption remains scarce. We conducted a mystery shopper survey in over 1,200 retail pharmacies across urban and rural areas in the six geopolitical zones of Nigeria, purchasing one drug sample from a list of twenty branded medicines, including analgesics, antimalarials, antibiotics, antihypertensives, and multivitamins. A sub-sample of the purchased medicines (N = 246) was tested for quality, defined as passing a laboratory test using High-Performance Liquid Chromatography (HPLC) to measure the Active Pharmaceutical Ingredient (API) content of each medicine. Using probit regressions, we examined the extent to which price is associated with quality, controlling for observable pharmacy and drug sample characteristics. A 1% increase in price is associated with a 16.7 percentage point increase in the probability of passing the laboratory test, conditional on other factors. Receiver Operating Characteristic (ROC) analysis shows strong out-of-sample classification performance, with an Area Under the Curve (AUC) of 0.82 for the price-only model, indicating that price alone explains much of the variation in quality. Other results show that medicines organized by brand and displaying visible expiration dates may signal higher quality, while the presence of other observable characteristics (e.g., packaging, storage, display) shows more counterintuitive associations with drug quality in this context. Stratified analyses show that the association between price and quality is particularly strong for analgesics and antibiotics. These findings suggest that price appears to be a reliable signal of medicine quality, whereas other characteristics of pharmacies and drug samples provide weaker and less consistent indicators. This underscores the need for stronger regulatory oversight, greater market transparency, and targeted consumer education to promote safer access to quality medicines.
54. Prevention of Infections in Cardiac Surgery (PICS)-Prevena Study - A pilot/vanguard factorial cluster cross-over RCT.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
Sternal surgical site infections after cardiac surgery can lead to significant morbidity, mortality, and cost. The effects of negative pressure wound management and adding vancomycin as perioperative antimicrobial prophylaxis are unknown. The PICS-PREVENA pilot/vanguard trial, a 2x2 factorial, open label, cluster-randomized crossover trial with 4 periods, was conducted at two major cardiac surgery hospitals in Ontario, Canada. Sites were randomized to one of eight sequences of the four study arms (Cefazolin or Cefazolin + Vancomycin (not analyzed) and standard wound dressing or a negative pressure 3M Prevena incision management system (Prevena). Only diabetic or obese patients were eligible for the latter comparison. This trial investigated feasability including adherence to protocol of each intervention (goal: > 90% each) and loss to follow-up (goal: < 10%). Among the 4107 included patients, 2230 were obese/diabetic (1208 standard wound dressing period, 1022 during Prevena period). Compliance to wound management and antimicrobial prophylaxis was 68.1% and 98.7%, respectively. Loss to follow-up was 3.6%. Deep/organ-space sternal surgical site infections occurred in 16 (1.6%) patients in the Prevena allocated periods and in 17 (1.4%) patients in the standard wound dressing allocated periods (OR= 1.11, 95% CI: 0.56-2.20). Other clinical outcomes did not suggest a difference and a post-hoc as-treated analysis showed similar results. This study showed challenges with introducing a novel technology as standard of care, with non-compliance mostly driven by one of the sites. No firm conclusions should be drawn regarding the effectiveness of Prevena, as this vanguard trial was not powered for clinical outcomes.
55. "You just forget about preeclampsia and move on" -awareness of chronic disease risks and follow-up preferences after preeclampsia in Ireland: a national qualitative study.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
Preeclampsia is associated with increased long-term risks of cardiovascular disease, kidney disease, and stroke. International guidelines recommend structured follow-up care to prevent chronic disease, but limited research has explored women’s knowledge of these risks, and their preferences regarding long-term follow-up care. This may impede how obstetric information is used for chronic disease prevention in practice. This qualitative study used purposive and snowball sampling to recruit women in Ireland diagnosed with preeclampsia at least one year prior. Semi-structured interviews were conducted online, exploring awareness of chronic disease risks and provision of follow-up care. Thematic analysis was performed using an inductive approach. Twelve women aged 28-64 years were interviewed, at median six years since preeclampsia diagnosis. Participants’ antenatal and postnatal care experiences varied widely, but most described follow-up care after preeclampsia as being inconsistent or absent. Three key themes were generated: (1) Preeclampsia in the ‘rear-view mirror’-women often viewed preeclampsia as an acute, resolved event, and had limited awareness of any long-term risks. However, they regarded chronic disease risk information as valuable and empowering; (2) Changing priorities as ‘life takes over’- women often prioritised other family members’ health needs above their own, particularly in the newborn phase. They favoured delaying discussions about chronic disease risks, ideally to 6-12 months after pregnancy, preferably provided through primary care; (3) Desire for proactive, ‘blameless’ follow-up care-women favoured systematic, non-judgmental follow-up programmes underpinned by clear communication between obstetric and primary care services, continuity of healthcare providers, and free access. Some described residual anxiety relating to their preeclampsia experience, and emphasised the importance of sensitive, person-centred follow-up care. Women affected by preeclampsia in Ireland typically have limited awareness of its links with long-term chronic disease risks, and frequently experience a lack of structured follow-up care. They expressed strong support for receiving personalised information about opportunities for secondary prevention, and advocated for systematic, proactive follow-up. Participants emphasised that future models of care should be pragmatic, person-centred, and include default enrolment for all women.
56. Investigating risk factors of hemorrhagic fever of renal syndrome (HFRS) in Qingdao, Shandong province, China.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
Qingdao, a historically high-risk area for hemorrhagic fever with renal syndrome (HFRS) in China, is undergoing agricultural mechanization and urbanization. However, the specific risk factors for HFRS in this context remain unclear. This study sought to determine the risk factors for HFRS in Qingdao. Community-based, 1:2 case-control study. Each case was matched with two healthy neighborhood controls based on biological sex, age, and the same neighborhood or village. Univariate and multivariate conditional logistic regression analyses were performed. Furthermore, stratified analyses were performed to explore risk factor heterogeneity between the peak season for Hantaan virus (HTNV) type HFRS (October-January) and other months. 93 cases (73.2%, 93/127) reported from January 2022 to September 2023 and 186 controls completed this questionnaire. Farmers accounted for the highest proportion (68.8%, 64/93). In multivariate logistic regression analysis, there were three significant risk factors for HFRS: piles of firewood and/or grain in residential yards (odds ratio [OR]=3.75, 95% CI: 2.14-6.55), mite and/or flea bites (OR=1.83, 95% CI: 1.06-3.18) and contacting with rats and/or their excreta (OR=1.73, 95% CI: 1.09-2.74); three variables represented significant protective factors for HFRS: frequency of sun exposure for quilts and bedding (OR=0.41, 95% CI: 0.19-0.90), rodent control measures at home (OR=0.50, 95% CI: 0.30-0.81) and knowing the main sources of HFRS transmission (OR=0.58, 95% CI: 0.36-0.90). Stratified analysis revealed that the influence of these factors varied by season, with rodent contact and control measures being particularly salient during the HTNV peak season. This study provides the first comprehensive evidence of risk and protective factors for HFRS in Qingdao, highlighting the role of rodent control, promoting comprehensive health education, environmental management, and personal protection. However, the results should be interpreted considering the study’s limitations, including a 73.2% response rate and the potential for recall bias.
57. Reduction of noise pollution in CNC wood milling through multi-parameter optimization using response surface methodology.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
CNC (Computer Numerical Control) wood milling machines offer significant productivity advantages but are associated with excessive noise pollution, posing health risks to workers. This study investigates the influence of machining parameters on Noise Pollution Level (NPL) in CNC wood milling and aims to optimize these parameters to minimize noise emissions. A Response Surface Methodology (RSM) based on Box-Behnken Design (BBD) was employed to model the effects of cutting speed, feed rate, depth of cut, and step over on NPL. A total of 27 experimental runs were conducted. Statistical analysis, including ANOVA and regression modeling, was performed to determine the significance of each parameter. The model was further optimized using a Genetic Algorithm (GA). The NPL observed across experiments ranged from 97.4 dB to 103.8 dB, with all values exceeding the NIOSH recommended limit of 85 dB. ANOVA results revealed that cutting speed, cutting speed squared, feed rate, and depth of cut had a statistically significant effect on NPL (p < 0.05). The regression model showed a high degree of fit (R² = 0.945). Optimal parameters-cutting speed of 12,730 rpm, feed rate of 58 mm/s, depth of cut of 3.2 mm, and step over of 6.4 mm-were identified using GA, resulting in a predicted NPL of 96.2 dB, which closely matched the experimentally validated value of 95.8 dB. The study confirms that NPL in CNC wood milling can be significantly reduced by optimizing machining parameters. The integration of RSM and GA provides a reliable framework for minimizing occupational noise exposure, thereby enhancing worker safety in woodworking environments.
58. Role and mechanism of the CBX4-HDAC5-CERS6 axis in disrupting sphingomyelin metabolism in acute myeloid leukemia.
期刊: American journal of cancer research 发表日期: 2025 链接: PubMed
摘要
To investigate the mechanism by which the CBX4-HDAC5-CERS6 axis regulates sphingolipid metabolism in acute myeloid leukemia (AML), with the goal of providing new theoretical foundations for the targeted therapy of AML. This prospective study involved 50 AML patients and 50 healthy controls. The expression levels of CBX4, CERS6, and free ceramide were detected. RNA sequencing, proteomics, and lipidomics were employed to analyze CBX4’s regulatory effects on sphingolipid metabolism-related genes and pathways. Using THP-1 and KG-1 cell lines, we validated the molecular mechanisms of the CBX4-HDAC5-CERS6 axis through techniques including gene knockdown (siRNA), overexpression, chromatin immunoprecipitation (ChIP), and dual-luciferase reporter assays. CCK-8 assay, flow cytometry, and Western blot were used to analyze the effects of CBX4 on cell proliferation, cell cycle, and key signaling pathways. CBX4 was significantly overexpressed in AML cells, with its expression levels markedly higher in THP-1 and KG-1 cell lines compared with CD34+ normal hematopoietic stem cells (P<0.05). Analysis of clinical samples revealed that the mRNA expression levels of CBX4 and CERS6 as well as free ceramide content were significantly lower in the AML group than the control group (all P<0.05). Mechanistic studies demonstrated that CBX4 knockdown significantly downregulated both mRNA and protein expression of CERS6 (P<0.05) and activated the PI3K/AKT and MAPK signaling pathways. Furthermore, CBX4 indirectly regulated CERS6 transcription by suppressing HDAC5 expression, and dual-luciferase reporter assays confirmed that HDAC5 directly targets the CERS6 promoter region (P<0.05). Combined use of ceramide synthesis inhibitors synergistically enhanced the activation of p-AKT/p-PI3K and p-MEK1/2/p-Raf1 signaling pathway associated proteins induced by CBX4 knockdown. The CBX4-HDAC5-CERS6 axis influences AML malignant progression by regulating sphingolipid metabolism, and targeted intervention of this axis may represent a novel therapeutic strategy for AML.