公共卫生研究摘要 (2025-12-26)
共收录 64 篇研究文章
1. Closing the gender gap in Pakistan's pharmaceutical workforce: evidence, insights, and a policy agenda.
期刊: Journal of pharmaceutical policy and practice 发表日期: 2026 链接: PubMed
摘要
2. TTG-U-Net: An Interpretable and Efficient Framework for Multi-Modal Brain Tumor Segmentation Enabling Clinically-Aligned Decision Support.
期刊: IEEE journal of biomedical and health informatics 发表日期: 2025-Dec-25 链接: PubMed
摘要
Accurate, automated analysis of multi-modal MRI is foundational to neuro-oncology informatics. However, the integration of Artificial Intelligence (AI) into clinical workflows is critically hampered by the “black box” nature of many deep learning models, which erodes clinical trust and complicates validation. This challenge is compounded by the difficulty of developing integrative approaches that can transparently and efficiently fuse heterogeneous information from multiple MRI sequences. To address this critical gap in Explainable AI (XAI) for healthcare, we propose TTG-U-Net, a novel segmentation framework designed to bridge performance with clinical interpretability and efficiency. Our framework provides an integrative solution through three synergistic components: (1) a cross-modal Transformer that explicitly models inter-modality dependencies, yielding attention maps that serve as a transparent visual audit trail for the model’s reasoning, directly addressing the need for XAI; (2) a dynamic low-rank tensor decomposition that adaptively regularizes the model and reduces its computational footprint, facilitating deployment in standard hospital information systems; and (3) a modality-adaptive gating mechanism that learns a transparent information routing policy, mimicking established radiological principles. Validated on the BraTS 2021 benchmark, a single TTG-U-Net achieves state-of-the-art performance (Dice: WT 91.7%, TC 88.8%, ET 84.5%), competitive with computationally-intensive ensembles. The dynamic low-rank design reduces the parameter count by approximately 41%, enhancing efficiency for practical deployment. Crucially, interpretability studies confirm the model’s learned fusion strategy aligns with clinical knowledge, bolstering its trustworthiness. TTG-U-Net offers a compelling framework that moves beyond pure segmentation accuracy, providing a robust, efficient, and trustworthy tool poised for meaningful integration into clinical decision support systems and informatics workflows, demonstrating a viable path for responsible AI in healthcare decision-making.
3. Patterns of tick infestation and tick-borne pathogen prevalence in sika deer and brown bears in Hokkaido, Japan.
期刊: Experimental & applied acarology 发表日期: 2025-Dec-25 链接: PubMed
摘要
Understanding the interactions among hosts, vectors, and pathogens is essential for elucidating the ecology of tick-borne diseases. However, studies on tick fauna and pathogenic infections in large mammals in Hokkaido, Japan remain limited. We examined the spatial and temporal (region and season) and host factors (sex and age) affecting pathogen prevalence and tick infestation in sika deer (Cervus nippon yesoensis) and brown bears (Ursus arctos yesoensis) in Hokkaido. We selected Anaplasma and Hepatozoon, two prevalent pathogens in sika deer and brown bears, respectively, to analyze host-vector-pathogen relationships. Between 2021 and 2024, we tested samples from 223 deer and 437 bears for these pathogens and examined tick infestation patterns in 157 deer and 255 bears across four regions. Anaplasma infection prevalence was high in deer from South and East Hokkaido but low in those from North Hokkaido. Hepatozoon infection in bears was high in South and Central Hokkaido, and low in the East and North. Generalized linear mixed models (GLMMs) indicated that Anaplasma prevalence was determined by regional factors, whereas Hepatozoon infection was influenced by region and host age, with adults showing lower infection rates. Six tick species were identified: Ixodes ovatus, Ixodes persulcatus, Haemaphysalis japonica, Haemaphysalis megaspinosa, Haemaphysalis flava, and Haemaphysalis longicornis. The GLMMs revealed that I. ovatus was more prevalent on male deer than females. Conversely, I. persulcatus nymphs were less prevalent male bears than females. Older hosts showed higher levels of infestation across multiple tick species. These findings reveal the complex interplay shaping tick-borne disease ecology in wildlife.
4. Just-In-Time Adaptive Interventions for Weight Management Among Adults With Excess Body Weight: Scoping Review.
期刊: Journal of medical Internet research 发表日期: 2025-Dec-25 链接: PubMed
摘要
Just-in-time adaptive interventions (JITAIs) use real-time monitoring to deliver personalized support at optimal moments, demonstrating potential for improving lifestyle behaviors in weight management. This study provides an overview of how JITAIs have been used or developed for weight management in adults with excess body weight. This scoping review followed Arksey and O’Malley’s 5-step framework and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist to ensure methodological rigor. Eight electronic databases (PubMed, Cochrane Library, Embase, CINAHL, PsycINFO, IEEE Xplore, Scopus, and Web of Science) were searched from journal inception to November 13, 2024, along with gray literature and hand-searched references. Two independent reviewers conducted data extraction for all included studies. Descriptive statistics were used to summarize study characteristics, followed by a nonlinear, inductive qualitative content analysis of the extracted data to identify and synthesize recurring concepts and characteristics of JITAI-based weight management interventions. Thirty-five studies on JITAIs for weight management were included, focusing on dietary behavior (25/35, 71.4%), physical activity (20/35, 57.1%), and self-weighing (17/35, 48.6%). Types of support included prompts (n=33), feedback (n=24), recommendations of coping strategies (n=7), and educational information (n=5). A total of 31.4% of studies used machine learning for decision-making, while the rest used rule-based algorithms. Retention rates varied from 74% to 100%, and compliance from 15.1% to 94.6%. Greater user engagement was associated with improved weight loss outcomes. Across interventions, significant improvements were observed in weight, waist circumference, BMI, and blood pressure, alongside increased physical activity, healthier dietary behaviors, and reductions in sedentary time. While JITAIs show potential for improving lifestyle habits by providing the right intervention at the right time and in the right setting, most studies lacked theoretical grounding and were not conceptualized as JITAIs. Furthermore, terminology and reporting were inconsistent, which hindered evaluation and comparison across studies. Nevertheless, most studies incorporated varied distal and proximal outcomes, behavioral theories, intervention delivery methods, and data acquisition methods, and demonstrated positive outcomes in weight, physical activity, and dietary behaviors. This review demonstrates JITAIs’ potential in weight management but highlights the field’s early stage of development. Future research should focus on improving reporting standards, optimizing JITAI components such as the integration of behavioral theories and machine learning, and enhancing user engagement and long-term effectiveness by incorporating passive sensing, personalization, and adaptive feedback mechanisms.
5. Early aggressive treatment with DMARDs vs. step-up therapy in rheumatoid arthritis: a traditional review of joint damage and functional outcomes.
期刊: Journal of basic and clinical physiology and pharmacology 发表日期: 2025-Dec-25 链接: PubMed
摘要
Rheumatoid arthritis (RA) is a chronic autoimmune disease characterized by progressive joint inflammation and structural damage. Two primary treatment strategies - step-up therapy and early aggressive DMARD therapy have been widely debated in clinical practice. The step-up approach begins with NSAIDs or corticosteroids, progressing to DMARDs based on disease severity, whereas early aggressive therapy prioritizes immediate DMARD initiation to prevent irreversible joint damage. This comprehensive review evaluates the effectiveness of these strategies by analyzing randomized controlled trials (RCTs), meta-analyses, and cohort studies assessing treatment outcomes, remission rates, and radiographic progression. A literature search was conducted across PubMed, Scopus, and Web of Science, including studies published between 2010 and 2024. Key clinical trials, including TICORA, COBRA, BeSt, and CAMERA, were critically analyzed to assess the comparative benefits and limitations of both treatment approaches. Evidence suggests that early aggressive therapy is associated with higher remission rates, reduced radiographic progression, and improved long-term physical function, whereas the step-up approach often leads to delayed disease control and cumulative joint damage. However, concerns related to treatment adherence, cost-effectiveness, and safety profiles necessitate further investigation. Future research should focus on biomarker-driven personalized treatment strategies, optimizing drug sequencing, and long-term comparative effectiveness studies to refine RA management.
6. Assessing Lead Exposure by Biological Matrices Analysis and Links to Breast Cancer: A Critical Review of Experimental and Epidemiological Findings.
期刊: European journal of breast health 发表日期: 2025-Dec-25 链接: PubMed
摘要
Lead (Pb), a ubiquitous environmental contaminant, is a toxic heavy metal known to interfere with enzymatic and hormonal processes. Its classification as a probable human carcinogen by international agencies has raised concerns about its potential role in cancer, including breast cancer (BC). This review critically examines epidemiological and experimental evidence linking Pb exposure to BC, emphasizing the impact of biological matrices used for Pb measurement on the consistency of findings. A systematic review following PRISMA guidelines was conducted. Eligible studies quantified Pb in breast tissues, blood, urine, hair, or toenails and assessed its association with BC risk. Animal studies and non-English publications were excluded. Twenty-seven studies (described in 23 publications) quantified Pb in human biological matrices: breast tissue (n = 6), urine (n = 6), blood (n = 9), hair (n = 4), and toenail (n = 2). Among them, 16 reported a positive association between Pb and BC risk (breast tissues: 4; urine: 3; blood: 6; hair: 3; toenails: 0). By contrast, 11 studies found no significant correlation (breast tissues: 2; urine: 3; blood: 3; hair: 1; toenail: 2). Four studies quantified Pb in different matrices, and the same results were obtained from analyses of breast tissue, blood, and hair. Discrepancies across studies included small sample sizes, heterogeneous demographic characteristics, insufficient follow-up, and different Pb assessment methods. While the majority of studies suggest a potential link between Pb exposure and BC, significant heterogeneity in study design and population selection limits definitive conclusions. Future research should standardize Pb measurement protocols in selected populations and explore mechanistic pathways to clarify this potential association and improve prevention strategies.
7. CRISPR-Cas9 editing of agricultural crops and medicinal plants: toward a cornucopia of natural products.
期刊: Critical reviews in biochemistry and molecular biology 发表日期: 2025-Dec-25 链接: PubMed
摘要
Plants have been a part of human health since our very beginnings, and many of our modern pharmaceuticals claim their origins from medicinal plants. The range of specialized metabolites synthesized by plants is highly diverse, and metabolic functions have developed over the millennia to cover roles such as defense, adaptation to environmental stress, and even reproduction. These metabolites subsequently play roles in human health and diseases that are both significant and profound. The importance of plant natural products for the pharmaceutical, cosmetic and nutraceutical industries cannot be overstated. However, the fact that these specialized metabolites may be available only in low quantities from plants that are slow growing, endangered, or from fragile environments due to certain biotic and abiotic stresses makes their commercial use challenging despite the scenario that some stresses can enhance the production of secondary metabolites. Genome editing is a technique or technology that comprises of tools like CRISPR/Cas9, TALEN, ZFN. The following review describes the successful use of CRISPR/Cas9 genome editing in engineering medicinal plants, food crops and commercial crops to modulate metabolic pathways involved in the biosynthesis of valuable compounds to improve natural product identification, development and ultimately, commercial viability.
8. Finely Tuned CRISPRi Module for Upgrading the Performance of Constitutive Promoters in the Bacillus subtilis Protein Expression System.
期刊: Journal of agricultural and food chemistry 发表日期: 2025-Dec-25 链接: PubMed
摘要
Bacillus subtilis is a critical host for protein production, with many industrial strains relying on strong constitutive promoters. However, this kind of promoter typically imposes a heavy burden on the host from the early stage of fermentation, leading to reduced growth rate and biomass. To overcome the drawbacks of these promoters, we developed a xylose-inducible CRISPRi module to dynamically control the activity of these promoters. The strength of this module was finely tuned via promoter engineering and the xylose concentration. The addition of xylose inhibited the target promoter and favored cell growth at an early stage, while the consumption of xylose recovered the strength of the promoter and facilitated protein expression, resulting in better balance between cell growth and protein production. The yield of a target protein was increased by 38% using this module. Our work provides a simple and effective method to upgrade industrial strains driven by strong constitutive promoters.
9. A Mobile App (MyPeer) Co-Designed With Immigrant Adolescents for Better Sexual and Reproductive Health: Usability Study.
期刊: JMIR formative research 发表日期: 2025-Dec-25 链接: PubMed
摘要
Adolescents require comprehensive sexual and reproductive health (SRH) education to successfully transition from puberty into adulthood. However, they often experience barriers and challenges while trying to promote their SRH or access SRH services. Such challenges are amplified among youth from migrant backgrounds, who may further be constrained by societal stigmas and cultural taboos regarding SRH. Mobile health interventions have the potential to provide culturally relevant, accessible, and evidence-based SRH educational resources; however, few SRH mobile apps in Canada are co-designed with immigrant youth or meaningfully integrate their voices and lived experiences. We aimed to co-design a culturally relevant and evidence-based mobile app with immigrant adolescents to provide accurate SRH resources. In this paper, we present the findings of the usability testing of our SRH mobile app-MyPeer. Throughout our study, we used a community-based participatory research approach and implemented the principles of human-centered design to co-design our mobile app. For our usability study, we recruited immigrant adolescents and interest holders working with the target population. Adolescents participated in moderated focus group discussions (FGDs) and interest holders evaluated the app’s quality using the standardized Mobile App Rating Scale (rating components on a scale of 1-5). All FGDs were audio-recorded and later analyzed to implement changes in the app. Mobile App Rating Scale (MARS) scores and responses were analyzed descriptively to evaluate the app’s engagement, functionality, aesthetics, quality of information, and subjective app quality. Overall, 25 adolescents and 17 interest holders participated in this usability study. We analyzed the findings from the FGDs and categorized them into four categories: (1) navigation and interface, (2) SRH information quality and learning, (3) technical performance, and (4) accessibility and multimedia usability. Adolescents found the app visually appealing and the interface easy to navigate. They appreciated interactive features, such as quizzes, and the presentation of information through various media (eg, videos and infographics). However, they also identified technical issues, such as map glitches and navigation inconsistencies, and requested deeper content on SRH topics. The data from the MARS checklist completed by interest holders were analyzed descriptively. The app received the highest scores in the domains of functionality, with mean scores of 4.3 (performance and navigation); engagement, with mean scores of 3.7 (interest); and aesthetics, with mean scores of 4.1 (graphics) and 3.9 (visual appeal). The lowest rated items were customization, with a mean score of 2.5, and interactivity, with a mean score of 3.1. Our app-MyPeer-has promising usability and appeal for adolescents looking for SRH information. Incorporating feedback from youth and content experts helped identify both technical refinements and content requirements. Our findings support the app’s potential as a scalable, youth-centered SRH digital tool and emphasize the value of participatory design in youth digital interventions.
10. Genomic characterization and comparative analysis of multidrug-resistant uropathogenic Escherichia coli strain U1 from Pakistan revealed ST131 as dominant clade.
期刊: Antonie van Leeuwenhoek 发表日期: 2025-Dec-25 链接: PubMed
摘要
Uropathogenic Escherichia coli (UPEC) is a primary etiological agent of urinary tract infections (UTIs) worldwide. The emergence of multidrug-resistant (MDR) UPEC strains, especially the globally disseminated ST131 clone, poses a critical health threat in regions like Pakistan, where comprehensive genomic data is limited. This study performed an in-depth genomic characterization of a newly isolated MDR UPEC strain (U1) and conducted a comparative pangenome analysis of 73 UPEC genomes from Pakistan. The overall cohort exhibited an average genome size of 5.2 Mb, an average GC content of 50.6%, and an average of 5180 coding sequences. In silico genomic analysis identified U1 as a high-risk ST131 lineage member (O25:H4, phylogroup B2). The strain exhibited an MDR profile, supported by the prediction of key antibiotic resistance genes (ARGs), including blaCTX-M-15 and dfrA17, as well as several putative virulence factors (VFs) and four plasmid replicon types. The comparative analysis revealed a highly diverse and open pangenome (3280 core and 10,977 unique genes). The U1 genome’s total coding sequences (5273 genes) contribute ~ 30% share of the total pangenome gene families, indicating its status as a well-equipped strain with essential genes (core) and a substantial number of fitness and adaptability genes (accessory/unique). Core-genome phylogeny confirmed the prevalence of the ST131 lineage, with U1 clustering closely with other local isolates. Widespread VFs and ARGs highlight their critical role in UPEC adaptability. These findings demand urgent antimicrobial stewardship and enhanced genomic surveillance to control the spread of MDR UPEC, particularly the ST131 clone, in Pakistan.
11. Melatonin supplementation alleviates stocking-density stress and enhances growth, immune, and physiological performance of Sparus aurata cultured in groundwater-based systems.
期刊: Veterinary research communications 发表日期: 2025-Dec-25 链接: PubMed
摘要
The intensive mariculture of S. aurata can promote aquaculture development, although it can also pose challenges because of predatory behavior and environmental stressors caused by intensification. The objective of this study is to alleviate stress and prevent cannibalism, thereby improving the fish’s performance and welfare. A 90-day growth experiment investigated the dietary inclusion of melatonin (ML) on Sparus aurata performance, physiology, immunity, histopathology, and welfare when grown in saline groundwater (36 ppt) at stocking densities (SD) of 50 fish/500 L‒tank (SD50) and 100 fish/500 L‒tank (SD100). Six fish groups in triplicate were fed three increasing levels of ML (0, 25, and 50 mg/kg- 1 diet) expressed as T1, T2 and T3 under SD50, and T4, T5, and T6 under SD100. Fish (n = 1350) weighing 16.46 ± 0.18 g/fish were grown using a flow-through system and a daily feeding rate of 4%. The results revealed significant declines in nitrogen by-product (NH3 and NO2) levels of fish fed ML in a dose density-dependent manner. Fish fed ML under both densities showed significantly improved growth indices, FCR, growth hormone, and crude protein content compared with those fed the control diet, with T2 and T6 groups achieving the highest values. ML augmentation enhanced serum lipase, protease, immunoglobulin, albumin, globulin, antioxidants, and proinflammatory cytokine interleukin-1β and lowered serum cortisol, glucose, ALT, AST, and ALP. Under both densities, the ML-fish presented healthier livers and intestines than those fed the control diet, which showed marked liver vacuoles and steatotic changes. The ML-SD interaction showed superior fish performance, particularly in groups T2 and T6; thus, it is recommended to administer dietary melatonin at 25 mg/kg for seabream reared at 50 fish per 500-liter tank and 50 mg/kg for those cultivated at 100 fish per 500-liter tank using groundwater.
12. Deep Learning-Powered Dark-Field Microscopy for Simultaneous Size and Concentration Analysis of Nanoplastics in Water.
期刊: Analytical chemistry 发表日期: 2025-Dec-25 链接: PubMed
摘要
Nanoplastics have become a significant environmental and health concern due to their widespread presence. Accurately analyzing both size and concentration of nanoplastics is essential for assessing their environmental behavior and potential toxicity; however, this remains a significant challenge. In this study, we developed a novel approach of convolutional neural networks (CNNs) powered dark-field microscopy (DFM) to achieve concurrent size and concentration analysis of nanoplastics. DFM images of polystyrene nanoplastics (PSNPs) down to 150 nm were facilely acquired based on their scattering characteristics, which were subsequently extracted and studied by combining contour recognition algorithms with a streamlined VGGNet. The established approach achieves high accuracy (over 0.99 on test sets) and sensitivity (limit of detection: 1.7 ng mL-1) in identifying PSNPs ranging from 150 to 600 nm. Spiked recovery results yield 93.55-103.8% recovery rates across 200 to 400 nm PSNPs, demonstrating the ability of the developed method to simultaneously determine size and concentration of nanoplastics. Therefore, the proposed strategy can offer a reliable and visual alternative for nanoplastics analysis with potential applications in environmental and biological monitoring.
13. Gender differences in psychosomatic symptoms associated with problematic Internet use among adolescents in Saudi Arabia.
期刊: Psychology, health & medicine 发表日期: 2025-Dec-25 链接: PubMed
摘要
Excessive Internet usage may lead to problematic Internet use (PIU) with significant functional, social, or occupational consequences. We investigated whether the association between PIU and psychosomatic symptoms varied between genders among adolescents in Saudi Arabia. School students (grades 7-12; n = 1599) from two major cities in Saudi Arabia participated in this cross-sectional study. PIU was assessed with Young’s Internet Addiction Test (YIAT), and psychosomatic symptoms were evaluated using the Health Behavior in School-aged Children Symptom Checklist (HBSC SCL). Univariate and multivariate logistic regression models examined the associations between PIU and psychosomatic symptoms and their variance between genders. The mean (SD) age of the participants was 16 (2) years, and more than half (52.2%) were girls. The prevalence of PIU in this sample was 35.6%. Irritability or bad temper (14.3%) was the highest reported daily psychosomatic symptom, while 12.6% of participants suffered from daily sleep difficulty, and 11.8% reported nervousness. Stomachache was the least common health complaint (5.6%). Collectively, 12.8% of participants experienced ≥3 psychosomatic symptoms daily, and 26% of girls with PIU suffered from them. Girls with PIU were significantly more likely (OR = 6.2, 95% CI = 3.95-9.60) to have ≥3 daily symptoms than boys without PIU after adjusting for other covariates. Overall, psychosomatic symptoms are more common among adolescent girls with PIU than girls without PIU and more than boys with or without PIU. Measures to decrease PIU in this group are necessary to reduce the odds of developing these psychosomatic symptoms.
14. Tropospheric ozone in Tehran: integrated assessment of inhalation health risk over the last decade.
期刊: International journal of environmental health research 发表日期: 2025-Dec-25 链接: PubMed
摘要
This study assessed long-term trends of tropospheric ozone (O3) concentrations in Tehran, Iran, over the time period 2015-2024, and quantified the non-carcinogenic health risks across different age groups by applying the United States Environmental Protection Agency (U.S. EPA) human health risk assessment methodology. The O3 data from 22 air-quality monitoring stations and satellite-retrieved columnar from Copernicus Sentinel-5P were analyzed. Annual O3 mean concentrations exhibited a slight non-statistically significant decreasing trend (-0.11% year-1). Peak concentrations were recorded in 2021, corresponding to post-COVID-19 socio-economic recovery and rising precursor emissions. Age-specific Hazard Quotients (HQ) remained <1.0 in all years, indicating acceptable non-carcinogenic risk for any single life stage. However, the cumulative lifetime Hazard Index (HI), obtained by summing age-specific HQs, ranged from 5.48 to 8.10 and consistently exceeded the U.S. EPA safe threshold of 1.0, showing potential adverse non-carcinogenic health effects from chronic O3 exposure over a full lifetime. These results underline the importance of controlling O3 precursors in densely populated cities and demonstrate the value of combining ground and satellite observations with lifetime exposure modeling for urban air-quality management.
15. Cost-Utility and Budget Impact Analysis of Pharmacogenetic-Guided Antiplatelet Therapy for Acute Coronary Syndrome in Thailand.
期刊: Value in health regional issues 发表日期: 2025-Dec-24 链接: PubMed
摘要
Pharmacogenetic (PGx) testing for CYP2C19 genotypes offers a precision medicine approach to dual antiplatelet therapy in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI). PGx testing is limited in Thailand because of policy constraints. This study evaluated the cost-utility and budget impact of PGx-guided dual antiplatelet therapy compared with universal clopidogrel in Thailand. A hybrid decision tree and Markov model were developed to estimate lifetime costs and health outcomes for patients with post-PCI ACS from a societal perspective. The model compared universal clopidogrel with 2 PGx-guided strategies for CYP2C19 loss-of-function allele carriers. Key outcomes included life-years and quality-adjusted life-years (QALYs) gained. One-way and probabilistic sensitivity analyses were conducted to assess model uncertainty. A 5-year budget impact analysis was performed from a payer perspective. Compared with universal clopidogrel, the PGx-guided ticagrelor strategy was dominant with lower costs and higher QALYs. The PGx-guided prasugrel strategy exceeded the willingness-to-pay threshold, with an incremental cost-effectiveness ratio of 247 604 Thai Baht (THB)/QALY. Probabilistic sensitivity analyses indicated a 99.9% probability that the ticagrelor strategy would be a cost-effective strategy at the Thai willingness-to-pay threshold. The 5-year budget impact analysis, assuming 100% access to PGx testing, estimated a budget saving of 240.54 million THB for ticagrelor. In contrast, prasugrel was associated with an additional requirement of 1520.89 million THB. In Thailand’s healthcare setting, PGx-guided ticagrelor is a dominant strategy for patients with post-PCI ACS. These findings support revising the National List of Essential Medicines to incorporate genotype-guided prescribing and enable broader access to precision medicine.
16. Medication incidents and informal caregiver burden: A cross-sectional study.
期刊: Journal of healthcare quality research 发表日期: 2025-Dec-24 链接: PubMed
摘要
The aim of this study was to evaluate the potential association between medication-related safety incidents in home care settings reported by informal caregivers and their emotional burden levels. A cross-sectional study was conducted among informal caregivers of senior patients aged over 65 years requiring daily care. Participants completed the 7-item Zarit Caregiver Burden Scale and self-reported medication safety incidents. In total, 176 participants responded. Medication safety incidents were reported by 25.6% of them. Caregiver burden was independently associated with a higher likelihood of self-reported medication safety incidents, with an odds ratio of 2.16 (95% CI: 1.03-4.50), after adjusting for caregiving hours. In addition, male sex was also independently associated with increased risk, with an odds ratio of 2.29 (95% CI: 1.06-4.98). This study shows that caregiver burden is associated with self-reported medication-related incidents in home care. Targeted interventions that promote informal caregiver well-being may reduce safety incidents and enhance the sustainability of informal care. This study suggests that training programs should address medication safety using gender-sensitive strategies and incorporate tools to alleviate caregiver burden. Trial registration NCT05885334 (date 2023-06-01).
17. Reprogramming offspring liver health: maternal indole supplementation as a preventive strategy against MASLD.
期刊: EBioMedicine 发表日期: 2025-Dec-24 链接: PubMed
摘要
Disruptions in early-life gut microbiota and metabolites associated with maternal Western-style diet (WD) during critical windows of development are linked to metabolic and inflammatory diseases in offspring, including metabolic dysfunction-associated steatotic liver disease (MASLD) in later life. These disturbances can alter microbial metabolite production, such as tryptophan derivatives, which are crucial for immune and metabolic regulation. However, the specific effects of maternal supplementation with tryptophan metabolites on offspring gut microbiome maturation and MASLD risk remain unexplored. WD-fed mouse dams were supplemented with microbial metabolites indole (Ind) or indole-3-acetic acid (I3A) during gestation and lactation; male offspring were weaned to chow diet for 9 weeks, followed by a 4-week WD challenge. Fecal microbiota transfer (FMT) was performed from offspring to naïve recipients, followed by a 4-week WD challenge. Human LX-2 stellate cells were used to study mechanisms for indole and very long-chain (VLC) ceramide effects on TGF-β-induced fibrosis. Maternal supplementation with Ind or I3A had long-term protective effects in adult WD-challenged offspring against excess weight gain, steatosis, stellate cell activation, and fibrosis. Perinatal exposure to Ind or I3A activated offspring aryl hydrocarbon receptor (AHR) signalling in gut and liver, which trans-repressed known and new target genes, including ceramidases Asah2 and Acer3, leading to increased VLC ceramides. FMT from offspring with perinatal exposure to Ind protected recipients from WD-induced fibrogenesis and increased beneficial VLC ceramides in recipient livers. In vitro, LX-2 stellate cells cultured with Ind or VLC ceramides demonstrated an anti-fibrotic effect, which was abolished by AHR inhibition. Maternal indole supplementation, through sustained activation of AHR in offspring gut and liver and an increase in hepatic VLC ceramides, prevents diet-induced MASLD and fibrosis in offspring, offering a novel therapeutic pathway for prevention of paediatric MASLD. See Acknowledgements.
18. Age assessment using the second molar maturation index (I2M): A systematic review.
期刊: Forensic science international 发表日期: 2025-Dec-23 链接: PubMed
摘要
Age estimation plays a crucial role in forensic sciences, being necessary for deceased and living individuals. In adolescents, it is often used to estimate whether an individual is above or below legal age thresholds, which vary across countries. In 2018, Cameriere et al. introduced the Second Molar Maturation Index (I2M), a method based on measuring apical openings and tooth height of the second molar to estimate whether an individual is older or younger than 14 or 16 years. Since then, some studies have sought to validate this method, with varying outcomes. This systematic review aimed to assess the applicability of the I2M method for estimating age thresholds of 12, 14, 15, and 16 years in forensic contexts. A systematic search was conducted in six databases (PubMed/MEDLINE, Embase, Scopus, Web of Science, LILACS, and SciELO), using keywords in Portuguese, Spanish, and English. Studies were selected based on predefined inclusion and exclusion criteria. The methodological quality and risk of bias were assessed. Seven eligible studies were identified, all using orthopantomographs of individuals aged 7-22 years. Validations were performed in seven countries: Brazil, Chile, China, Croatia, India, Portugal, and Turkey. All included studies showed a low risk of bias. The findings indicate that the I2M method is applicable for estimating age thresholds of 12, 14, 15, and 16 years in forensic practice, with satisfactory results across diverse populations. However, further primary research is necessary to strengthen the evidence base and improve the method’s reliability.
19. Individualized disability support schemes and their impact on autism diagnoses.
期刊: Journal of health economics 发表日期: 2025-Dec-20 链接: PubMed
摘要
This paper examines the impact of individualized funding for disability supports on autism diagnoses. We identify these effects using the staggered roll out of the National Disability Insurance Scheme (NDIS), which provides individualized funding for non-medical disability interventions. We find compelling evidence that the introduction of the NDIS has led to a 32 % increase in reported autism prevalence and accounts for 47 % of new diagnoses since the introduction of the scheme. We find a significant reduction in diagnoses from government subsided healthcare professionals, accompanied by an increase in diagnoses from disability service providers. A lower threshold for autism recognition appears more consistent with our results than catch-up in historically underdiagnosed groups.
20. Prevalence of psychoactive drugs in injured drivers over 10 years in Victoria, Australia.
期刊: Forensic science international 发表日期: 2025-Dec-20 链接: PubMed
摘要
One thousand of the mandatory blood specimens taken from injured drivers attending a hospital over a decade were analyzed for a full range of legal and illegal drugs in an accredited forensic toxicology laboratory with confirmation by a validated LC-MS/MS procedure. Ethanol ( ≥0.05 g/100 mL), methamphetamine (≥0.01 mg/L), THC (≥1 ng/mL) were present in 13.6 %, 12.7 % and 11.5 %, respectively with only minor variations over the decade. In contrast, the prevalence of ketamine, cocaine, fentanyl and new psychoactive substances (NPS) increased substantially over this period reaching 7.0 %, 1.8 %, 2.0 % and 3.0 % in the last 5 years of the study. A substantial proportion of drivers were also positive for opioids, antidepressants, and benzodiazepines, although some of these may have been given post-crash as part of their medical treatment. Overall, about 38 % of drivers had a potentially impairing drug detected in their blood on presentation to hospital and at least one common illicit drug with or without ethanol were present in almost 23 % of drivers. The presence of more than one common illicit drug (THC, methamphetamine, MDMA, cocaine, heroin), with or without ethanol, increased from 4.3 % in the first 5 years to 5.8 % in the last five years, which may reflect a higher crash risk for those drivers.
21. Combined concentrations and genetic variability of fibroblast growth factors predict cardiovascular risk in renal patients.
期刊: iScience 发表日期: 2025-Dec-19 链接: PubMed
摘要
Chronic kidney disease (CKD) is a major risk factor for cardiovascular events (CVE). We assessed whether circulating levels and genetic variability of endocrine fibroblast growth factors (FGF19, FGF21, and FGF23) could predict CV risk in these patients. In 1,182 participants (815 CKD patients and 367 controls), plasma FGF concentrations and 46 gene variants were analyzed, with participants followed-up for a mean of 37.6 ± 25.7 months for CVE. Clustering based on combined scores for all three FGF concentrations correlated strongly with CKD severity (p < 0.001) and predicted CVE after adjusting for other risk factors [hazard ratio (HR) = 2.03 (1.02-4.05), p = 0.044]. Four SNPs, notably FGF19 rs1307968 [odds ratio OR = 5.14 (1.53,17.27), p = 0.008], were also independently associated with CVE. Incorporating both combined FGF concentration scores and the relevant genetic variants into traditional risk models significantly improved prediction accuracy (AUC increased from 0.713 to 0.779; p < 0.0001). These findings suggest that combining FGF biomarkers with genetic information may enhance CV risk stratification in CKD patients.
22. Research progress and applications of reverse genetics systems for infectious bronchitis virus.
期刊: Poultry science 发表日期: 2025-Dec-19 链接: PubMed
摘要
Infectious bronchitis virus (IBV) poses a persistent threat to global poultry health, driving the need for advanced molecular tools to study and combat this pathogen. Reverse genetics has emerged as a pivotal technology in IBV research, enabling precise manipulation of the viral genome to investigate pathogenesis, design novel vaccines, and identify potential antiviral targets. This review systematically examines the development, applications, and challenges of reverse genetics platforms for IBV. Established methods, including vaccinia virus supported systems, in vitro ligation and transcription, targeted RNA recombination, bacterial artificial chromosome cloning, transformation associated recombination, and circular polymerase extension reaction are detailed, with their principles, advantages, and limitations highlighted. Furthermore, contributions of these platforms to elucidating gene function, rational vaccine design, and the development of IBV as a viral vector for multipathogen vaccines are discussed. Current technical hurdles, safety considerations, and knowledge gaps are addressed, along with future perspectives integrating CRISPR/Cas9, synthetic biology, and computational approaches. This comprehensive overview aims to guide researchers in selecting appropriate reverse genetics strategies and to inspire innovative solutions for IBV control.
23. Clinical Manifestations.
期刊: Alzheimer’s & dementia : the journal of the Alzheimer’s Association 发表日期: 2025-Dec 链接: PubMed
摘要
Even among cognitively unimpaired (CU) older adults, specific patterns of neuropsychological performance impart differential risk for progression to Alzheimer’s disease and related dementias (ADRD). Early identification in the prodromal phase may inform early intervention efforts. We used a data-driven approach to classify neuropsychological phenotypes within CU older adults from the Atherosclerosis Risk in Communities (ARIC) study and tested for differences in ADRD and cerebrovascular outcomes. Participants included 4737 CU (via a previously published algorithm plus consensus diagnosis protocol) older adults (mean age=75.1 years, 60.8% female, 23.1% Black) with neuropsychological data from Visit 5 (2011-2013) of the ARIC study. Latent profile analysis was leveraged to identify unique cognitive phenotypes using 10 demographically adjusted (age, sex/gender, education, race-center, WRAT Reading) neuropsychological z-scores. Cognitive phenotypes were then compared on demographics, depressive symptoms, and vascular risk factors (VRFs). In a subset with available neuroimaging and biofluid data (n range=1102-1678), white matter hyperintensity (WMH) and bilateral hippocampal (HV) volumes normalized for intracranial volume and plasma biomarkers (i.e., Aβ42/40, ptau181, NfL, and GFAP) were examined by phenotype. Phenotype comparisons adjusted for demographic variables, VRFs, and an indicator of kidney function (i.e., eGFR-creatinine) for plasma biomarkers. We applied Tukey adjustment for pairwise comparisons. A 6-class solution of cognitive phenotypes emerged as the best fitting model: Average Overall (28%), Low Overall/Very Low Memory (7%), Average Overall/Super Memory (11%), Subtle Low Overall/Low Executive (22%), Subtle Low Executive/High Memory (13%), and Average Overall/Low Memory (19%; Figure 1). Phenotypes differed on education, race, and word reading, despite prior adjustments for these variables when creating the neuropsychological z-scores (Table 1). Additionally, phenotypes differed on depressive symptoms, VRFs, WMH, HV, Aβ42/40, and ptau181 (all ps < .05). The Subtle Low Overall/Low Executive group had the highest WMH volumes, the Subtle Low Executive/High Memory group had the lowest Aβ42/40, and the Low Overall/Very Low Memory group had the lowest HV and highest levels of plasma ptau181 (Table 2). Cognitive heterogeneity is observed even among CU older adults, with lower executive performance associated with cerebrovascular changes and lower memory associated with certain AD-related changes, possibly indicating risk for cognitive progression through distinct pathways.
24. Biomarkers.
期刊: Alzheimer’s & dementia : the journal of the Alzheimer’s Association 发表日期: 2025-Dec 链接: PubMed
摘要
Organs may age at different rates. We used a plasma protein-based algorithm that captures organ age to investigate how older age in different organs compared to chronological age (henceforth, organ age gaps) and greater longitudinal increase in organ age gaps (henceforth, pace of organ aging) influence dementia risk and brain structures. Using the Atherosclerosis Risk in Communities (ARIC) study, we generated 11 organ age gaps in midlife (N = 11,595, mean age 57±6 years) and in late life (N = 4,287, mean age 75±5 years). Paces of organ aging were standardized by decades between midlife and late life (N = 3,725). We used Cox proportional hazard models to relate (i) midlife organ age gaps to 20-year dementia risk, (ii) late-life organ age gaps to 7-year dementia risk, and (iii) paces of organ aging to 7-year dementia risk. Linear regression models were used to relate late-life organ age gaps and paces of organ aging to concurrent MRI-defined brain volume and cortical thickness (standardized by SD). All models were adjusted for demographic factors, BMI, eGFR, smoking status, APOE, diabetes, and hypertension. Larger midlife age gaps in artery, brain, heart, immune, intestine, and liver (HR=1.02-1.07, q<0.05) and larger late-life age gaps in all organs except kidney (HR=1.03-1.09, q<0.05) were associated with higher dementia risk (Figure 1). Late-life brain, heart, and liver age gaps remained significant after further adjustment of Aß42:Aß40 ratio, GFAP, NfL, and p-tau181. Faster paces of aging in brain, heart, intestine, muscle, and pancreas were associated with higher dementia risk independent of their respective late-life organ age gaps (HR=1.04-1.05, q<0.05, Figure 2). Larger late-life age gaps in all organs except kidney were also associated with reduced cortical thickness and/or volumes (ß=-0.01 to -0.04 SD, q<0.05, Figure 3A). Independent of their respective late-life age gaps, faster pace of immune and pancreas aging was associated with lower total cortical thickness (ß=-0.02 SD, q<0.05) and temporal-parietal volume (ß=-0.02, q<0.05, Figure 3B), respectively. Older age gaps and faster pace of aging in organs other than the brain, e.g., heart, immune system, and pancreas, may play an important role in dementia risk and structural brain changes.
25. Biomarkers.
期刊: Alzheimer’s & dementia : the journal of the Alzheimer’s Association 发表日期: 2025-Dec 链接: PubMed
摘要
Research has found that high levels of serum myocardial necrosis markers, specifically Troponin I (TnI), can affect heart pumping, leading to an increased risk of vascular disease and cognitive impairment. TnI can also be affected by hypoxia and exerrese. Our study investigates the correlation between TnI levels and multiple cognitive domains in patients with mild cognitive impairment(MCI) and Alzheimer’s disease(AD) in hypoxic environment. Using a cross-sectional approach, we selected 535 middle-aged and elderly individuals(age 64.18 ±10.42 years) from the Qinghai region (average altitude < 3,000 meters). Participants were categorized into three groups based on their Montreal Cognitive Assessment (MoCA) scores: 318 with normal cognition, 135 with MCI, and 82 with AD. Collect demographic and general clinical data, assess with multidimensional cognitive scales, and measure blood biomarkers such as serum troponin I (TnI) levels. There were statistically significant differences among the three groups in terms of age, gender, education level, occupation, height, weight, smoking, drinking, marital status, and living conditions (p <0.05). Compared with the cognitively normal group, the MCI group showed significantly lower Pulse Oximetry Saturation (SpO2) levers (p <0.05); serum TnI values increased in both the MCI and AD groups (p <0.05, p <0.01). The ordered logistic regression results indicate that weight (p = 0.012), instrumental activities of daily living ability (IADL) (p = 0.004), albumin (ALB) (p = 0.001), C-reactive protein (p = 0.033), and TNI (p = 0.026) were risk factors for the MCI and AD. Male (p = 0.006), stop drinking (p = 0.013) and good basic activities of daily living (BADL) (p = 0.031) are protective factors. Correlation analysis showed that SpO₂ was positively correlated with Symbol-Digit Modalities Test (SDMT) (rs=0.103), Verbal Fluency Test (VFT) (rs=0.111), and negatively correlated with Digit Span Test (DST) (rs=-0.125), IADL (rs=-0.185), and Geriatric Depression Scale (GDS) (rs=-0.125) (p <0.05). TnI is positively correlated with Stroop color-word test (Stroop-C) (rs=0.208) and IADL (rs=0.185) (p = 0.01), while it is negatively correlated with the Auditory Verbal Learning Test - Delayed Recall (AVLT) (rs=-0.240), SDMT (rs=-0.256), and VFT (rs=-0.191) (p <0.01). Elevated TnI is a risk factor for MCI and AD patients in hypoxic environments. There is a correlation between TnI and SpO₂ levels were associated with memory, executive function, attention, and language skills.
26. Biomarkers.
期刊: Alzheimer’s & dementia : the journal of the Alzheimer’s Association 发表日期: 2025-Dec 链接: PubMed
摘要
Cerebrospinal fluid (CSF) platelet-derived growth factor receptor-β (PDGFRβ) concentration, as well as CSF/plasma albumin ratio (Qalb), have been regarded as the biomarkers reflecting blood-brain barrier (BBB) damage. However, it is still unclear whether plasma PDGFRβ levels relate to BBB damage as well as how it correlates with Alzheimer’s disease (AD). We tested Qalb and plasma PDGFRβ concentrations among 93 participants with concurrent CSF and plasma samples from the Greater-Bay-Area Healthy Aging Brain Study (GHABS) Chinese aging cohort. We investigated the association between Qalb and plasma PDGFRβ in the whole cohort, females and males. Additionally, we measured plasma PDGFRβ in 592 GHABS participants who only had plasma samples, including 122 normal control (NC), 277 subjective cognitive decline (SCD), 110 mild cognitive impairment (MCI), and 83 dementia. Among 592 participants, 277, 143, 469, and 542 had Aβ PET, tau PET, structural MRI, and MoCA scores, respectively. We investigated the association of plasma PDGFRβ with Aβ-PET, tau-PET, residual hippocampal volume (rHCV), temporal-MeraROI cortical thickness, and MoCA. Plasma PDGFRβ concentrations were negatively associated with Qalb in the whole cohort (standardized β (βstd) = -0.225 [95% confidence interval (ci), -0.426 - -0.025], p = 0.028) and males (βstd = -0.347 [95% ci, -0.641 - -0.053], p = 0.021) but not in females (Figure 1). MCI and dementia patients showed lower plasma PDGFRβ than NC individuals in the whole cohort and males (Figure 2). Additionally, lower plasma PDGFRβ levels were related to higher Aβ PET and tau PET and lower MoCA scores in the whole cohort and males (Figure 3). These findings demonstrated that decreased plasma PDGFRβ levels are related to BBB damage, providing a potential plasma biomarker to detect and monitor BBB leakage in AD, particularly in males.
27. Clinical Manifestations.
期刊: Alzheimer’s & dementia : the journal of the Alzheimer’s Association 发表日期: 2025-Dec 链接: PubMed
摘要
Recent research suggests that, relative to controls, adults with attention-deficit/hyperactivity disorder (ADHD) are more often diagnosed with Lewy Body Disease (LBD) in old age and people with LBD are more likely to report features of ADHD earlier in life. We examined the prevalence of childhood ADHD symptoms in older adults with Parkinson’s disease (PD) and known early LBD markers in older adults with ADHD. Participants aged 40+ were recruited from the local community in Calgary, Alberta and the Calgary Parkinson Research Initiative Registry. The following measures were administered: Montreal Cognitive Assessment, Barkley Adult ADHD Rating Scale-IV Childhood symptoms, Beck Depression Inventory (BDI), a 5-item self-report questionnaire for autonomic dysfunction, Innsbruck REM Sleep Behavior Disorder (RBD) Inventory, and University of Pennsylvania Smell Identification Test. Kruskal-Wallis H or Chi-square tests analyzed group differences. The sample consisted of ADHD (n = 40), PD (n = 35), and control (n = 37) participants and was largely female (61.6%). Mean age of the sample was 64.34 years (SD=11.03). There was no difference in cognition between groups, H(2,108)=4.42, p = .11. The ADHD group had significantly worse childhood ADHD symptoms than PD and control groups on inattention, hyperactive-impulsive, and total ADHD symptom percentiles, H(2,111)>38.28, all p < 0.001). The ADHD group also had significantly more depressive symptoms than control participants (F(3,103)=8.34, p = .001). People with PD (44.1%) reported more problems with salivation than ADHD (30.8%) and control (10.8%) groups (χ2(2,110)=9.91, p = .007), and more issues with constipation (67.6%) than ADHD (46.2%) and control (13.5%) groups (χ2(2,110)=21.81, p < .001). Based on the RBD inventory cut-off (≥0.25), 22.9% of ADHD, 53.1% of PD, and 12.5% of controls were classified as having probable RBD (χ2(2,112)=13.82, p < .001). Participants with PD had worse olfaction than ADHD and control groups (H(2,112)=25.44, p < .001); 86% of participants with PD had moderate microsmia or worse, compared to 7.5% and 30% in the ADHD and control groups, respectively. Our data did not show a higher prevalence of childhood ADHD symptoms in people with PD, or that people with ADHD had increased LB markers. Our findings do not suggest that ADHD is an early stage or risk factor for LBD and there is no evidence that they are pathophysiologically linked.
28. Drug Development.
期刊: Alzheimer’s & dementia : the journal of the Alzheimer’s Association 发表日期: 2025-Dec 链接: PubMed
摘要
The Dominantly Inherited Alzheimer Network Trials Unit (DIAN-TU) adaptive platform trial has launched the first of three tau drugs in the tau Next Generation Prevention Trial (tau NexGen), starting with the combination of anti-tau monoclonal antibody etalanetug (E2814) and anti-amyloid-beta antibody lecanemab. Herein, we provide the first results of lecanemab (open-label) on amyloid PET in a symptomatic DIAD population (the asymptomatic cohort will be evaluated later). The DIAN-TU-001 Tau NexGen Trial (NCT05269394) is a phase II/III randomized, double blinded, placebo-controlled trial in participants with DIAD. Eligible mutation-positive participants were enrolled in 2 cohorts (Cohort 1: Symptomatic Population (CDR=0.5-1), n=97; Cohort 2: Asymptomatic Population (CDR=0), n=100). The symptomatic Cohort 1 received open-label lecanemab at Week 0 for 6 months and were then randomized to receive concurrent E2814 or placebo; meanwhile, asymptomatic Cohort 2 was randomized to E2814 or placebo at Week 0 and then received open-label lecanemab at Week 52. For Cohort 1, amyloid PET ([11C]PiB-PET) was performed at baseline (Week 0) and Week 24, and then at the weeks 52, 104, and 208 visits. Change on amyloid PET from Week 0 to Week 24 is a secondary endpoint for Cohort 1. Preliminary Week 24 amyloid PET data was available from 62 symptomatic participants receiving lecanemab (avg EYO=1.51 and avg age= 47.4). Baseline mean amyloid PET SUVr was 2.06 (SD=0.38) (equivalent to 99.9 (SD=39.5) Centiloids (CL)) and SUVr=3.63 (SD=0.99) with partial volume correction (PVC). The change from baseline in amyloid PET SUVr at 24 weeks was -0.18 (SD=0.17) (equivalent to -18.6 CL (SD=17.3)) and SUVR=-0.43 (SD=0.49) with PVC. The six-month amyloid clearance results in participants with DIAD are consistent with pharmacokinetic (PK)/pharmacodynamic (PD) modeling in sporadic Alzheimer’s disease, with faster rate of amyloid clearance in older patients and those with lower baseline amyloid. Lecanemab reduced amyloid PET in symptomatic participants with DIAD at Week 24. The reduction in amyloid PET was in line with predictions based on PK/PD modeling developed from sporadic AD.
29. Clinical Manifestations.
期刊: Alzheimer’s & dementia : the journal of the Alzheimer’s Association 发表日期: 2025-Dec 链接: PubMed
摘要
The Cognitive Function Index (CFI) was developed to identify individuals with Subjective Cognitive Decline (SCD), which is defined by the self-perception of cognitive impairment, not detected in neuropsychological tests. Limited research has been done with this tool in Latin America (LA). We aimed to investigate the association between CFI and global cognition and to investigate whether CFI scores can identify participants with cognitive performance below 1.0 standard deviation (SD) of the sample mean. The LatAm-FINGERS study is a dementia prevention feasibility study in 12 LA countries. For the present analysis, 815 participants with complete cognitive data (604 women, 74.1%; 436 mestizo 53.5%; mean age=67.5, SD=4.8; mean education = 13.0, SD=3.6; mean GDS=2.7, SD=2.8) were included. The CFI is a 14-item self-report measure of cognitive change; higher scores indicate higher concerns. CFI total score was normalized into a z-score, as some questions were not applicable to all participants and total score differed among them. Cognition was assessed with the Preclinical Alzheimer Cognitive Composite (PACC-5) - Mini-Mental State Examination; Logical Memory Delayed Recall; Free and Cued Selective Reminding Test; Digit Symbol Substitution Test; and Animal Category Fluency. Participants were classified into those with PACC-5 at or above 1 SD from the mean (n = 764) and those below (n = 51). Bivariate and partial correlations (controlling for sex, age, education and GDS score) were used to assess the association between the CFI and PACC-5 scores. Receiver operating characteristic (ROC) analyses were used to assess CFI accuracy to identify participants with PACC-5 scores below 1 SD. CFI and PACC-5 scores were negatively associated with each other (r = -0.27; p <0.001; partial r = -0.12; p <0.001). ROC analyses indicated an area under the curve (AUC) of 0.71 (sensitivity=0.64; specificity=0.70) with an optimal threshold of 0.36 (Youden Index=0.35) as a suggested cutoff score for the normalized CFI score. The CFI may be added to cognitive screening protocols to identify individuals who may need further assessment. Integrating the CFI into screening strategies in LA could play a pivotal role in reducing cognitive health disparities and advancing tailored dementia prevention initiatives that address the region’s specific sociocultural and healthcare challenges.
30. Clinical Manifestations.
期刊: Alzheimer’s & dementia : the journal of the Alzheimer’s Association 发表日期: 2025-Dec 链接: PubMed
摘要
Peripheral inflammation damages endothelia throughout the body, and increases Alzheimer’s disease (AD) pathogenesis in the brain. Since brachial artery flow-mediated dilation (FMD) evaluates conduit artery endothelial function, this study aimed to examine if FMD can be used to predict AD risk. Data from 2844 individuals of the Framingham Heart Study (FHS) offspring cohort (Gen 2, Exam 7, 1998 -2024) includes baseline data on different variables of FMD, and incident dementia/AD, the measurements of plasma AD biomarkers and brain volumes. The average age at FMD measurements was 60.6 ± 9.4 (mean ± SD) years old, and 1512 (53.2%) of them were women. The FMD measurements were collected at baseline and the main outcomes were AD dementia during the 17 years of follow-up. Compared to those who remained normal cognitive function (n = 2325, 81.8%) had the highest levels of FMD and Hyperemic mean flow velocity followed by those who developed mild cognitive impairment (MCI) (n = 241, 8.5%), and those who developed dementia (n = 278, 9.8%) including 241 AD had the lowest levels of FMD (p <0.001) and Hyperemic mean flow velocity (p <0.001). After adjusting for age, sex, education, ApoE4 and different cardiovascular diseases, baseline endothelial function status including Flow-mediated vasodilation (%) (HR, 95%CI: 0.83, 0.76-0.91, p <0.001) as well as Hyperemic mean flow velocity (cm/s) (HR, 95%CI: 0.89, 0.79-1.00, p = 0.049) were negatively associated with AD risk. Based on these endothelial statuses, we further divided the participants into three tertiles and found that the highest tertiles of all three variables (indicating healthy endothelia) had lower levels of plasma AD biomarkers and higher brain volumes than the lowest tertiles (indicating poor endothelial function). This is the first study to show the relationship between endothelial dysfunction and AD dementia risk in a community cohort study. The data further supports that healthy brain endothelia is a resilience mechanism during the aging process to protect from cognitive decline and AD dementia development.
31. Biomarkers.
期刊: Alzheimer’s & dementia : the journal of the Alzheimer’s Association 发表日期: 2025-Dec 链接: PubMed
摘要
Dyslipidemia as a risk factor for cognitive impairments has been known widely, however the effects of serum lipids levels on cognitive decline (CD) had not been determined. This cohort initiated in 2014, and two follow-up visits were conducted in 2016 and 2018. The Mini-Mental State Examination (MMSE) was used to assess cognitive function and a drop of ≥2 points in MMSE score was defined as CD in 4-years follow-up. Baseline lipid levels [total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-c), low-density lipoprotein cholesterol (low-density lipoprotein cholesterol (LDL⁃c)] were converted into 3 classifications based on 25% and 75% quantile [level Q1 (≤25%), level Q2-Q3 (25%-75%) (reference group), level Q4 (≥75%)]. The relationship between serum lipid and CD was analyzed by multivariate logistic regression. Interaction effect (IE) and subgroup analysis (< 65 years vs ≥65 years) has also been used. There were 1,349 participants in the analysis, with 230 cases (17.05%) of CD. In the subgroup < 65 years, incidence rate has no differences among the 3 classifications within each lipid index. No associations between serum lipid and CD were found. In the subgroup ≥65 years, incidence rate of CD was increased in TC and LDL-c level Q4 and was decreased in TG level Q1 (Figure 1). Compared with reference group, TC level Q4 (≥5.61 mmol/L) was associated with an increased risk of CD (OR =2.519, 95%CI 1.217-5.214, P = 0.013) (Tab 1). Age had an IE (ORTC level Q4× age = 2.202, 95%CI 1.111-4.363, P = 0.024) (Tab 2); TG level Q1 (≤ 1.03 mmol /L) was associated with a lower risk of CD (OR = 0.318, 95%CI 0.120-0.838, P = 0.020). Age had an IE (ORTG level Q1× age = 0.344, 95%CI 0.132-0.896, P = 0.029); LDL-c level Q4 (≥3.81 mmol/L) was associated with an increased risk of CD (OR = 2.367, 95%CI 1.143-4.900, P = 0.020). Age had an IE (ORLDL-c level Q4× age=2.237, 95%CI 1.134-4.415, P = 0.020). In participants over 65 years old, high baseline levels of TC and LDL-c, low baseline levels of TG was associated with CD. These suggested that dyslipidemia patients may accelerate CD in older people.
32. Biomarkers.
期刊: Alzheimer’s & dementia : the journal of the Alzheimer’s Association 发表日期: 2025-Dec 链接: PubMed
摘要
We examined and compared the associations of Alzheimer’s disease (AD) blood-based biomarkers to clinical and cognitive functioning in Hispanic (n = 214) (an understudied group) and White-non-Hispanic (WNH) (n = 169) older adults. Neuropsychological and Functional assessments were completed and AD blood biomarkers were obtained in cognitively normal (n = 62), PreMCI (n = 36), MCI (n = 217), or dementia (n = 68) subjects. Functional limitations were measured by the modified Clinical Dementia Rating (mCDR). Ordinary least squares models were conducted using unit-weighted composites for the dependent blood biomarker variables ptau217, abeta40, abeta42, GFAP, and NFL concentrations, controlling for age, sex, education, ethnicity, and cognitive diagnosis. After inclusion of covariates, we examined unstandardized (b) and standardized regression weights (stb) for all three biomarkers among both ethnic groups (Hispanic and WNH). In the Hispanic group, higher levels of ptau217 concentration predicted lower memory scores (b=-4.24, stb=-0.26, p = 0.002), and lower word fluency scores (b=-3.48, stb=-0.22, p = 0.016). Higher NFL concentration significantly predicted lower word fluency scores (b=-0.15, stb=-0.2, p = 0.047) and higher functional limitation scores (b= 0.27, stb = 0.36, p = 0.00). Education predicted Trails, letter fluency, and word fluency. In the WNH group higher Abeta40 (b=-0.05, stb= -0.36, p = 0.048) and GFAP (b =-0.03, stb=-0.35, p = 0.024) concentrations predicted lower letter fluency scores, and higher ptau217 (b=5.79, stb=0.30, p = 0.029) and lower abeta42 concentrations (b=1.05, stb=0.35, p = 0.043) were predictors of higher letter fluency scores. Significant standardized regression weights (-0.36 to 0.35) of biomarkers had small to moderate unique effect sizes. Blood-based biomarker levels were found to be associated with cognitive functioning among Hispanic and WNH older adults and associations to functional limitations were present only in the Hispanic group. Associations of Ptau217 with memory, word fluency, and associations of NFL with functional limitations appeared to have a larger effect among Hispanics. While Abeta 40, abeta42, GFAP, and NFL were associated with letter fluency only among WNH. Our results indicate that the use of blood-based biomarkers may be predictors of cognitive status and functional impairment among Hispanic ADRD populations. This may enhance diagnostic accuracy and address health disparities among this population.
33. Clinical Manifestations.
期刊: Alzheimer’s & dementia : the journal of the Alzheimer’s Association 发表日期: 2025-Dec 链接: PubMed
摘要
Aging is associated with changes in sleep and cognitive function. While disrupted sleep is linked to cognitive decline, little is known about how subjective sleep characteristics relate to cognitive impairment across different age groups, particularly in the oldest old. We harmonized data on self-reported sleep, cognitive outcomes, and covariates across four U.S. cohorts: the Memory and Aging Project (MAP), Minority Aging Research Study (MARS), Osteoporotic Fractures in Men Study (MrOS), and Study of Osteoporotic Fractures (SOF). Sleep measures included sleep duration, time in bed, subjective sleep quality, excessive daytime sleepiness, and difficulty falling/staying asleep. Cognitive outcomes, including mild cognitive impairment (MCI) and dementia, were assessed through clinical diagnoses, crosswalk MMSE scores (MrOS and SOF), and adjudicated diagnosis (MAP and MARS). Using Poisson regression, we examined associations between sleep characteristics and incident cognitive impairment in age-stratified groups (60-70, 70-80, 80-90, 90+ years), adjusting for age, sex, race, marital status, follow-up time, smoking, alcohol use, sleep medication use, depression, hypertension, and diabetes. After exclusion of baseline MCI and dementia (N = 208), the pooled cohort (N = 4935; 60-70: N = 428, 70-80: N = 2306, 80-90: N = 2070, 90+: N = 131) included 2061 (41.8%) females and 849 (17.2%) non-White participants. During a mean follow-up of 3.92±1.17 years, 867 (17.6%) developed MCI or dementia. Prolonged sleep duration (>8 hours/day) in the 90+ age group (Risk Ratio [RR] = 2.167, 95% CI 1.327∼3.539, p = 0.002), and excessive time in bed (> 8 hours/day) in the 80-90 age group (RR = 1.201, 95% CI 1.037∼1.389, p = 0.014) were associated with an increased risk of cognitive impairment. Difficulty staying asleep >=3 times /week was associated with lower risk of cognitive impairment in the 80-90 age group (RR = 0.831, 95% CI 0.720∼0.959, p = 0.011). No significant associations were observed in other age groups and for other sleep characteristics. Prolonged sleep duration and excessive time in bed were associated with a higher risk of cognitive impairment in adults over 80, independent of comorbidities. These findings highlight somnolence as a potential marker for cognitive impairment in advanced aging, suggesting that tailored sleep monitoring could aid detection.
34. Biomarkers.
期刊: Alzheimer’s & dementia : the journal of the Alzheimer’s Association 发表日期: 2025-Dec 链接: PubMed
摘要
Insulin resistance (IR) and hypertension, two well-known vascular risk factors, have been closely linked to vascular brain injury. Evidence has suggested a causal relationship of IR to hypertension. However, population-based studies have rarely explored the associations of the triglyceride glucose-body mass index (TyG-BMI), a surrogate marker of insulin resistance, with MRI markers of vascular brain injury, and the role of hypertension in their associations. This population-based study included 1268 participants (age ≥60 years; 58.60% women) from the MIND-China MRI sub-study (2018-2020). White matter hyperintensities (WMH), enlarged perivascular spaces (EPVS), cerebral microbleeds (CMBs), and lacunes were assessed following the STRIVE-1 criteria. TyG-BMI index was calculated as ln(fasting triglyceride(mg/dL)×fasting glucose(mg/dL)/2)×BMI. Data were analyzed using general linear, logistic, and mediation models. A higher TyG-BMI index was significantly associated with greater volumes of total WMH (multivariable-adjusted β=0.018; 95% confidence interval=0.002-0.024), periventricular WMH (0.017; 0.001-0.033), and deep WMH (0.010; 0.002-0.019), and an increased likelihood of WMH burden (multivariable-adjusted odds ratio=1.15; 95% confidence interval=1.02-1.29), but not with EPVS, CMBs or lacunes (p >0.05). In the mediation analysis, hypertension significantly mediated around 42.86% of the association of TyG-BMI index with WMH volume. The observed associations between TyG-BMI index and WMH as well as the mediation by hypertension remained significant among non-diabetic participants. IR, as indicated by high TyG-BMI index, is associated with vascular brain injury in older adults, even among those free of diabetes, in which their associations are largely mediated by hypertension.
35. Clinical Manifestations.
期刊: Alzheimer’s & dementia : the journal of the Alzheimer’s Association 发表日期: 2025-Dec 链接: PubMed
摘要
Neuropsychiatric symptoms (NPS) are core features of AD and COVID-19 pandemic had a strong effect in people with AD, affecting overall outcomes and decreasing quality of life. It is an applied ex-post-facto and data survey research, with a quantitative approach. The median educational level of this sample of 91 elderly with AD (median age: 77 years old) was 3,9 years. Before COVID-19 pandemic, the median MMSE score was 19,25. After COVID-19 pandemic, the median MMSE score was 19. In this sample of patients with AD, COVID-19 pandemic did not significantly influence the MMSE scores, indicating that more research is demanded to examine the pandemic effects over time.
36. Dementia Care Research and Psychosocial Factors.
期刊: Alzheimer’s & dementia : the journal of the Alzheimer’s Association 发表日期: 2025-Dec 链接: PubMed
摘要
In recent years, patients in Indonesia started to actively use Chat-Based Telemedicine Services to consult for their cognitive complaints, especially during the COVID-19 pandemic. This study describes the characteristics of patients with cognitive complaints who used chat-based telemedicine services in Indonesia and its correlation with the physicians’ decisions on treatment and referral. This study was a retrospective cross-sectional study during the peak of the COVID-19 pandemic era (March 2020 to December 2021) using anonymous secondary data derived from patient chat databases on Indonesian chat-based telemedicine services (Halodoc, Alodokter, Good Doctor, and Milvik). We applied bivariate and multivariate analysis. There were 1016 patients with cognitive complaints (4/10.000 from 2.199.527 users) and most of them were females under 40 years old. Multivariate analysis showed neurologists and other specialists were more likely to give pharmacological treatment (p <0.01) and referral (p <0.01). Patients tend to get pharmacological treatment if aged ≥60 years old (p <0.01), were females (p <0.01), complained about forgetfulness (p <0.01), and with a history of previous diagnosis of cognitive disorders (p = 0.02). Patients were more likely to get a referral if there was a history of previous diagnosis of cognitive impairment (p <0.01), and if the patient’s caregiver was the one who filed the complaints (p <0.01). In this study, we found that in a chat-based telemedicine setting, clinicians’ decisions in providing treatment and referral were influenced by age, gender, types of cognitive complaints, history of previous diagnosis, and the complainants. Further development and research to better chat-based telemedicine services for cognitive disorder patients are needed.
37. Clinical Manifestations.
期刊: Alzheimer’s & dementia : the journal of the Alzheimer’s Association 发表日期: 2025-Dec 链接: PubMed
摘要
Screening for cognitive decline and dementia in primary care practices (PCP) can be burdensome and time consuming, even when using validated and reliable tools such as the MMSE or MoCA. As such, these instruments lack “ecologic validity” (i.e. they are not practical given the time constraints on PCP visits). There is a high-priority need for less time-consuming, but still highly sensitive and specific screening tools. The present study explored tests of existing cognitive assessment tools to identify combinations that were optimal for dementia screening in PCP. Participants from the UK ADRC underwent a full neuropsychological test battery and consensus diagnosis. Logistic regression and receiver operating characteristic (ROC) curves were used to model the probability of conditional on summary test scores and their subcomponents. Youden’s J was used to identify cut points that jointly maximized sensitivity and specificity. Boolean logic using “and” and “or” relationships were then used to maximize sensitivity and specificity for this combination of tests. While using all tests resulted in an AUC of 0.90 (95% CI 0.87 - 0.93)(Fig-1), this battery takes over an hour to perform. Using only the MoCA 5-word delayed recall and Animal Naming tests which could be performed in 3 minutes, the AUC was 0.87 (95% CI 0.84 - 0.90). The Youden J cut point indicating cognitive impairment for 5-word recall was ≤ 2 and for Animal Naming was ≥ 19. Using a Boolean “and” that required both tests to be abnormal resulted in a specificity of 98.41% (95% CI 96.74-99.36) and a positive predictive value of 93.07% (95% CI 86.33-96.62). Using a Boolean “or” that required only one of the tests to be abnormal resulted in a sensitivity of 94.59% (95% CI 91.47-96.81) and a negative predictive value of 93.17% (95% CI 89.50-95.62)(Table 1). These data demonstrate that effective dementia screening in the primary clinic can be both practical and highly accurate compared to the gold standard of a full medical and neuropsychological evaluation but can be accomplished in a fraction of the time. Further work validating this screening tool in primary care clinic settings is underway currently.
38. Dementia Care Research and Psychosocial Factors.
期刊: Alzheimer’s & dementia : the journal of the Alzheimer’s Association 发表日期: 2025-Dec 链接: PubMed
摘要
Globally, dementia is a leading cause of mortality and morbidity, necessitating high-quality care across healthcare specialties. Only a few education and training programmes developed to enhance healthcare students’ dementia care competencies are evidence based. We aimed to systematically review existing evidence on the effectiveness of dementia education and training for health and social care students. We searched five electronic databases for primary research studies (published between 2015-2024), and unpublished grey literature, evaluating dementia training for health and social care students. We assessed risk of bias using the Mixed Methods Appraisal Tool (MMAT), prioritising studies scoring 4+ (higher quality) that reported significant findings on primary outcomes from controlled intervention trials. We reported outcomes using Kirkpatrick’s framework. Professional stakeholders were consulted in focus groups regarding how findings might inform practice. The included studies spanned 13 countries across 4 continents, covering diverse training programmes such as experiential learning, placement-based, online learning, simulation, and classroom-based approaches. 15/35 eligible studies were rated 4+ on the MMAT; only one met our a priori criteria for priority evidence. An experiential programme for UK medical students, “Time for Dementia”, which combined skill-learning and reflective sessions with visits to people with dementia, was found to improve attitudes and knowledge over two years of participation, with qualitative studies supporting these findings. Asynchronous, self-directed learning did not improve learning outcomes, relative to standard training. None of the programmes evaluated patient outcomes as an impact of students’ training. Nine focus group attendees agreed that the evidence reflected their experiences that consistent support, combined with skills-based and reflective sessions, optimised student learning from initial patient-focused encounters. Effective interventions increased confidence and enjoyment of dementia care encounters, and interest in dementia specialty careers. Mandating evidence-based dementia skills programmes across specialties could ensure that students learn the skills and competencies required to be part of an effective future workforce and drive improvements in care quality. The findings offer valuable insights into developing a skilled dementia care workforce, with implications for both UK and international policy. Future research should incorporate patient perspectives to better evaluate the impact of educational programmes.
39. Multisociety response to the proposed multi-jurisdictional local coverage determination on peripheral nerve blocks and procedures for chronic pain: A critical moment in Healthcare Policy for the United States.
期刊: Interventional pain medicine 发表日期: 2025-Dec 链接: PubMed
摘要
40. Obesity care in Chinese adults: from evidence to clinical practice.
期刊: Precision clinical medicine 发表日期: 2025-Dec 链接: PubMed
摘要
More than 500 million Chinese adults suffered from overweight or obesity in 2023. The pandemic of obesity consumes healthcare and economic resources by imposing enormous burden from its complications such as cardiovascular, kidney and metabolic diseases. In response, China launched a series of important policy changes including “Weight Management Year”, facilitating the engagement of public health, clinical practitioners, industry and stakeholders in different fields. The shift triggered rapid evolution of technologies in obesity care including both treatment and prevention, which added great opportunities for all stakeholders. Nevertheless, challenges exist, including misdiagnosis of obesity secondary to other diseases, population disparity, indirect evidence supported by trials conducted in other ethnic groups, health inequalities and the collaboration across stakeholders with diverse backgrounds. Traditional Chinese diets such as Jiangnan Diet and activities such as Tai Chi represent tradition-based lifestyle interventions that provide Chinese people with cultural benefits. The evolution of technologies, especially digital healthcare and novel medications, will play critical roles in future obesity care in China. Policy makers and clinical and public health practitioners must make every effort to address the urgent crisis posed by obesity pandemic in China.
41. Biomarkers.
期刊: Alzheimer’s & dementia : the journal of the Alzheimer’s Association 发表日期: 2025-Dec 链接: PubMed
摘要
β-amyloid(Aβ) plaques and neurofibrillary tau tangles are key hallmarks of Alzheimer’s disease (AD). Previous studies suggest that Aβ plaques are strongly linked with faster tau accumulation in the early AD stage. However, it is still not fully understood how other factors, such as educational attainment (EA), neuroinflammation, and vascular disease, contribute to cortical tau tangle aggregation and spread in AD. To reveal how these factors affect cortical tau accumulation in AD, we analyzed tau PET imaging data from both the East Asian older population (Greater-Bay-Area Healthy Aging Brain Study, GHABS) and the Westen older population (ADNI and A4 studies). We investigated how EA status (Higher> Median Vs. < Median), plasma soluble triggering receptor expressed on myeloid cell 2 (sTREM2) and Glial fibrillary acidic protein (GFAP) concentration, and white matter hyperintensities (WMH) correlate with cortical tau accumulation or modulated the Aβ-, entorhinal tau-, and plasma phosphorylated tau (p-Tau)-related cortical tau aggregation. Across the ADNI, A4 placebo, and GHABS cohorts, faster tau accumulation or higher follow-up tau PET standardized uptake value ratio (SUVRs) in Aβ+ individuals with High-EA were more strongly associated with higher global Aβ burden, entorhinal tau levels, and plasma p-Tau217 levels (Figure 1), compared to those with Low-EA. Higher plasma sTREM2 and GFAP were related to the weaker and stronger Aβ-related tau accumulation, respectively (Figure 2). Furthermore, we found that higher WMH burden was associated with faster tau accumulation in the occipital lobe independent of Aβ pathology, which may be potentially explained by that greater occipital WMH burden linked to faster connectivity-associated tau spread in the occipital lobe (Figure 3). These findings unveiled that longer education periods, lower plasma sTREM2 levels, higher plasma GFAP levels, and larger WMH burden are related to faster tau accumulation in AD in addition to Aβ pathology. This study emphasizes the importance of controlling these factors beyond Aβ to prevent tau aggregation in AD.
42. Biomarkers.
期刊: Alzheimer’s & dementia : the journal of the Alzheimer’s Association 发表日期: 2025-Dec 链接: PubMed
摘要
We investigated retinal and choroidal microvascular parameters as potential biomarkers for vascular cognitive impairment (VCI) in patients with internal carotid artery stenosis (ICAS). We enrolled 123 asymptomatic ICAS patients and categorized them into vascular mild cognitive impairment (VMCI) and vascular dementia (VaD) using the Montreal Cognitive Assessment. Optical coherence tomography angiography (OCTA) was used to evaluate vessel densities and perfusion areas in various retinal layers. Magnetic resonance imaging (MRI)-based neuroimaging biomarkers for cerebral small vessel disease (CSVD) were also assessed. LASSO logistic regression identified predictor variables, and receiver operating curve (ROC) analysis assessed the ability to distinguish between VMCI and VaD. The radial peripapillary capillary (RPC) perfusion area in both affected and unaffected eyes correlated positively with VaD, whereas CSVD burden score and white-matter hyperintensity (WMH) volume correlated negatively (all P < 0.05). ROC analysis showed that the RPC perfusion area of the affected eye had superior discriminatory power for distinguishing VaD from VMCI compared with CSVD burden score (Z = 1.99, p = 0.047) and WMH (Z = 1.97, P = 0.049). The optimal cutoff value for the 0-1-mm macular RPC perfusion area was determined to be 0.068 mm2. OCTA-derived RPC perfusion area effectively differentiates VaD from VMCI, suggesting its potential as a noninvasive diagnostic method to support clinical decision-making and prevent cognitive decline in ICAS patients.
43. Dementia Care Research and Psychosocial Factors.
期刊: Alzheimer’s & dementia : the journal of the Alzheimer’s Association 发表日期: 2025-Dec 链接: PubMed
摘要
Alzheimer’s disease (AD) is an age related neurodegenerative disease which is mainly characterized by progressive cognitive decline, synaptic loss, extracellular amyloid-beta (Aβ) deposits and intracellular accumulation of neurofibrillary tangles of tau protein. Multiple etiological factors have been linked with AD pathophysiology, oxidative stress, neuroinflammation, neurotransmitter deficit and foremost are the deregulation of lipid metabolism, consistently involve in AD pathology and cognitive deficit. In the present study we have explored the neuroprotective potential of Fingolimod (FTY720), against intracerebroventricular colchicine (ICV-COL) induced experimental sporadic dementia in rats. COL was administered bilaterally at a dose of (15μg/rat) on the first day. Spatial and non-spatial memory was evaluated by using Morris water maze and object recognition test. Locomotor activity was evaluated by using open field test. Fingolimod (0.25 and 0.5 mg)/kg, p.o.) was administered on alternate days from 8th day after ICV -infusion in rats. The parameters of oxidative stress were accessed by measuring the malondialdehyde, reduced glutathione and catalase levels in the hippocampus and cortex region. ICV-COL infusion in rats produced cognitive deficit and caused significant elevation in markers and oxidative stress and degenerative changes in hippocampus and cortical brain region. On the contrary, Fingolimod treatment attenuate COL-induced cognitive decline, reduced oxidative burden and able to preserve the neuronal architecture and prevent neuronal loss in hippocampus and cortical brain region of the rats. The neurodegeneration in hippocampus and cortex regions was observed through histopathological examination. The outcome of the present study clearly indicates that the neuroprotective potential of fingolimod and suggesting its therapeutic potential in cognitive disorders.
44. Drug Development.
期刊: Alzheimer’s & dementia : the journal of the Alzheimer’s Association 发表日期: 2025-Dec 链接: PubMed
摘要
The Dominantly Inherited Alzheimer Network Trials Unit (DIAN-TU) trial is an adaptive platform trial evaluating various therapies intended to slow or prevent the Alzheimer disease (AD) progression in Dominantly Inherited Alzheimer’s disease (DIAD). In the Tau NexGen DIAN-TU-001 arm, the potential benefits of the anti-tau therapy etalanetug (E2814), a novel monoclonal antibody that binds to the MTBR, are being investigated with the anti-amyloid treatment lecanemab given as background therapy. While lecanemab has been shown to be well tolerated in multiple clinical trials, known risks include amyloid-related imaging abnormalities (ARIA) and infusion reactions. Herein, we provide an overview of 6-month safety results for DIAD participants in the symptomatic cohort (CDR 0.5-1, n=97) receiving lecanemab only in the Tau NexGen DIAN-TU-001 Trial. DIAN-TU-001 is a phase II/III multicenter randomized, double-blind, placebo-controlled platform trial of potential disease modifying therapies utilizing biomarker, cognitive, and clinical endpoints in DIAD. Safety evaluations included monitoring of vital signs, physical examinations, adverse events, clinical laboratory parameters, and 12-lead electrocardiograms. ARIA occurrence was monitored throughout the study by MRI, read both locally and centrally. Lecanemab was generally well-tolerated during the 6-month lecanemab-only treatment period. Overall, 80.4% of the 97 participants enrolled and treated experienced an adverse event. The most common AEs were ARIA-H (26.8%), headache (25.8%), ARIA-E (20.6%), and infusion-related reactions (11.3%). The incidence of ARIA-E was 20.6% and the incidence of ARIA-H was 26.8%. The rate of symptomatic ARIA-E was 4.1% and symptomatic ARIA-H was 1.0%. ARIA-E most commonly occurred within the first 3 months of treatment (80.0%) and resolved within 4 months (75%). There were no cases of symptomatic isolated ARIA-H, no intracerebral hemorrhage (>10 mm), and 2 (2.06%) individuals who experienced ARIA leading to lecanemab withdrawal. The majority AEs were mild or moderate, with a total of 6 (6.19%) participants experiencing a serious AE. Lecanemab was generally well-tolerated. The most common adverse events of lecanemab in the DIAD population were ARIA-H, headache, ARIA-E, and infusion-related reactions. DIAD population may have a higher rate of cerebral amyloid angiopathy with ARIA rates between heterozygotes and homozygotes in sporadic AD.
45. Biomarkers.
期刊: Alzheimer’s & dementia : the journal of the Alzheimer’s Association 发表日期: 2025-Dec 链接: PubMed
摘要
Functional network integrity is important for maintaining cognitive performance during the 10-20 year presymptomatic period of frontotemporal dementia (FTD), conferring resilience to advancing neuropathology and atrophy. The extent to which functional integrity relies on preserved structural connectivity is unclear. Here, we test the relationship between functional connectivity and structural connectivity, termed structure-function coupling, against genetic risk for FTD and disease progression. We studied 56 symptomatic and 165 pre-symptomatic FTD-mutation carriers, and 141 family members without mutations, from the GENFI cohort. Diffusion weighted imaging and functional magnetic resonance imaging (Siemens MR platforms) were acquired and analysed using established approaches to quantify participant-level structural and functional connectomes (Figure 1-(1)). Connectomes were defined in the Brainnetome Atlas and re-mapped onto a subcortical network and seven resting-state networks based on the Yeo Networks (Figure 1-(2)). An inter-subject regularized canonical correlation analysis (CCA) with permutation-based cross-validation was used to jointly analyse the structural and functional connectomes (Figure 1-(3-4)). Second-level analysis with robust multiple linear regression models tested for differences between non-carriers, pre-symptomatic carriers and symptomatic carriers in the strength of association between structural and functional CCA subject scores. Age, sex, head motion and scanner site were included as covariates. Canonical correlation analysis identified significant components linking structural and functional connectivity. The first component (r=0.656, p <0.001) reflected a structural connectivity pattern with high within- and between-networks loadings (Figure 1-(5)) with strong within-networks functional connectivity and weak-to-negative between-network functional connectivity (Figure 1-(6)). This component associated structural integrity with function segregation, whereby individuals with high structural connectivity within and between networks exhibit greater functional network segregation as shown by strong within-network functional connectivity and weak between network connectivity. The strength of this structure-function coupling was greater for non-carriers compared to pre-symptomatic carriers (Figure 1-(7)). Symptomatic carriers showed minimal relationship between structural and functional scores, indicating structure-function decoupling, consistent with the hypothesis that cognitive decline is triggered by critical decoupling of previously synergistic neural systems. Our findings demonstrate progressive de-coupling between structural connectivity and functional segregation over the course of genetic frontotemporal dementia. These results have implications for designing pre-symptomatic disease-modifying ‘preventative’ trials, supported by imaging-based surrogate markers of neural system dynamics.
46. Biomarkers.
期刊: Alzheimer’s & dementia : the journal of the Alzheimer’s Association 发表日期: 2025-Dec 链接: PubMed
摘要
At the beginning of the century, Alzheimer disease (AD) biomarkers were only used in research studies and included hippocampal volume and cerebrospinal fluid (CSF) concentrations of Aβ42, total tau, and tau phosphorylated at position 181 (p-tau181). Twenty-five years later, imaging and fluid biomarkers have become critical tools in AD clinical trials and are increasingly being used in clinical care. The development of imaging and fluid AD biomarkers will be reviewed. The evolving roles of different modalities of biomarkers in research, clinical trials, and clinical care will be described. In 2004, the first radiotracer that bound amyloid plaques was reported, which enabled visualization of the amount and regional distribution of amyloid plaques in the brains of living individuals via positron emission tomography (PET). Radiotracers binding to insoluble tau aggregates were described in 2013 and 2014. The use of amyloid and tau PET as a reference standard, as well as improvements in fluid biomarker assay technology, led to the first of many accurate AD blood tests in 2017 and 2018. These imaging and fluid biomarkers of AD have undergone waves of development, validation, and regulatory approval. AD research studies now use biomarkers extensively to study the biology of disease. Clinical trials use biomarkers to confirm that participants have AD pathology and to monitor the effects of treatment. AD biomarkers are increasingly being used in the clinical diagnosis of AD. The high acceptability and accessibility of AD blood tests may enable AD biomarker testing to become the standard of care in patients with cognitive impairment. In the future, if trials of preventative treatments are positive, AD biomarker testing of cognitively unimpaired older individuals may become routine. Advances in imaging and fluid biomarkers over the past quarter century have enabled greater understanding of AD biology and led to the successful development, approval, and clinical use of disease-modifying AD treatments that target amyloid pathology. The clinical availability of AD-specific treatments and high-accuracy AD blood tests is currently transforming the clinical diagnosis and care of patients with AD.
47. Dementia Care Research and Psychosocial Factors.
期刊: Alzheimer’s & dementia : the journal of the Alzheimer’s Association 发表日期: 2025-Dec 链接: PubMed
摘要
Social determinants of health (SDoH) represent multiple interconnected social and economic factors that have been proposed by the World Health Organization as critical non-medical influences on health outcomes. However, few studies have investigated the relationships and potential mechanisms between SDoH and dementia in large-scale population-based cohorts. This population-based prospective study utilized data from the UK Biobank. Our study incorporated seven factors acrossfour domains-economic stability, educational attainment, social contact, and environmental factors-to assess SDoH levels. Cox proportional hazard models and linear regression models were conducted to examine the relationship between SDoH and risk of all-cause and cause-specific dementia, brain structure (focusing on hippocampal volume), and cognitive performance. Causal mediation analysis explored potential mediating factors, including mental health, biological aging, and lifestyle, linking SDoH and dementia. Survival models were applied to estimate differences in life expectancy. Among 359,419 participants (median follow-up: 13.46 years), those with favorable SDoH levels demonstrated significantly lower risks of developing all-cause dementia (HR: 0.57, 95% CI: 0.53-0.60), Alzheimer’s disease (HR: 0.62, 95% CI: 0.56-0.68), and vascular dementia (HR: 0.48, 95% CI: 0.41-0.55) compared to those with unfavorable SDoH levels. In terms of impact on dementia risk, SDoH ranked second only to age among all analyzed factors. Higher SDoH levels were positively associated with larger hippocampal volume and better performance across cognitive domains. The relationship between SDoH and dementia was mediated by multiple factors: depression (24.00%), frailty (13.60%), biological aging measured by PhenoAge (6.33%), and smoking (2.82%). At age 65, participants with dementia who had favorable SDoH levels demonstrated an average life expectancy 0.909 (95% CI 0.002-1.873) years longer than those with unfavorable SDoH levels. Higher levels of SDoH are associated with a reduced risk of dementia, and the associations are mediated by mental health, biological aging, and lifestyle. These findings highlight that prioritizing improvements in SDoH should be a key component of global efforts aimed at mitigating dementia risk and promoting cognition and longer lifespans across populations.
48. Nature Is a Valuable Source for the Biosynthesis of Nanoparticles and Their Effects on the Treatment of Osteomyelitis.
期刊: Journal of cellular and molecular medicine 发表日期: 2025-Dec 链接: PubMed
摘要
Infection is still one of the biggest threats to global health. Today, treating infections such as osteomyelitis is challenging due to the rise in drug-resistant and biofilm-forming pathogens. Therefore, researchers worldwide are seeking new ways to combat these infections. Nanotechnology, which is of interest in the medical field, has provided a platform for drug delivery and the treatment of osteomyelitis. Various biological, chemical, and physical methods are used for the biosynthesis of nanoparticles. Among these methods, biological methods, or green synthesis, are of great interest due to their non-toxicity, high stability, low cost, and environmental friendliness. This study aimed to investigate nanoparticles biosynthesised from natural sources and use them for the treatment of osteomyelitis.
49. Clinical Manifestations.
期刊: Alzheimer’s & dementia : the journal of the Alzheimer’s Association 发表日期: 2025-Dec 链接: PubMed
摘要
Functional communication (FC) is an indispensable feature of daily functioning and is predictive of patient autonomy and care partner well-being. Concrete quantitative measures to assess FC in neurodegenerative conditions are lacking. Language-led conditions such as primary progressive aphasia (PPA) require easily implementable and minimally burdensome FC assessment. This work describes the development of the first instrument to document FC for people living with PPA. The Functional Communication Checklist (FCC) will be developed by incorporating feedback from field experts, partners in research, and item-level validation. The FCC is intended to document FC within a setting representative of occupational and community-based interactions. Initial candidate FCC items were generated by a panel of PPA experts and refined by expert speech-language pathologists (SLPs) using an electronic Delphi consensus process (see Figure 1). SLP experts were identified and recruited through the International Speech-Language Therapist/Pathologist PPA Network or via FC publication record. In each Delphi round, participants were asked to rank existing FCC candidate items and provide additional or alternative items. We incorporated feedback from each round to refine the evolving FCC. We provided feedback summaries along with the evolving FCC for each Delphi round. Once no further refinement is suggested, we will evaluate validity and inter-rater reliability by having 15 additional SLPs use the FCC on PPA assessment videos. A total of 67 experts have contributed to the FCC development thus far. The current iteration of the FCC evaluates 55 aspects of discourse, social-pragmatics, language, speech, and cognition. Each domain is evaluated on the spectrum of strength or interference on communication in the context of a short conversational prompt. Background, instructions, conversational examples and item-level definitions have also been developed through the Delphi process. The FCC combines clinician observation, patient self-report, and partner insight to quantify FC and contributing strengths and interferences of speech, language, and nonverbal communication. The quantitative outcomes will facilitate a common taxonomy of FC, enabling interdisciplinary collaboration and consistency across evaluators and sites. The FCC is made possible by partners in research across disciplines and perspectives.
50. Dementia Care Research and Psychosocial Factors.
期刊: Alzheimer’s & dementia : the journal of the Alzheimer’s Association 发表日期: 2025-Dec 链接: PubMed
摘要
Joint contractures are very common in persons with dementia who are confined to bed in the terminal stage, which will lead to difficulty in transferring the patients from one place to another, difficulty in maintaining the posture while feeding all those will increase the caregiver burden, and also affects the patient’s quality of life. The aim of the study is to prevent contractures by applying earlier occupational therapy interventions. Patients diagnosed with Dementia who are registered under the Neuropalliative care project at NIMHANS a tertiary care center for neurological conditions were consecutively recruited. The study follows a case series design. Informed consent was obtained from all the participants. All the four participants received routine Occupational Therapy interventions aimed at preventing contractures. The interventions were tailored to the specific needs of each participant and the intervention included: Passive Range of Motion, Assistive device prescription like an Elbow immobilizer, Resting Hand Splint, Knee immobilizer, Ankle Foot Orthosis, Positioning strategies, and Caregiver education regarding long-term care management. The impact of the interventions was routinely assessed throughout follow-up visits. The recruited participants who were confined to wheelchair-bound stage received an earlier intervention through home care visit. These interventions continued throughout the patient’s life (up to two years in some cases) and are ongoing for those still alive. It was identified that Patients who consistently follow the occupational therapy early intervention techniques helped to avoid developing contractures, even in the terminal stage. In contrast, patients whose families did not adhere to the prescribed techniques experienced severe contractures, leading to increased caregiver burden. A detailed analysis will be presented. This study highlights that occupational therapy’s early intervention plays a major role in contracture prevention, reducing caregiver strain, and enhancing patient well-being.
51. Dementia Care Research and Psychosocial Factors.
期刊: Alzheimer’s & dementia : the journal of the Alzheimer’s Association 发表日期: 2025-Dec 链接: PubMed
摘要
Latin America (LA) faces heightened vulnerability to modifiable dementia risk factors. Early identification of at-risk individuals is crucial for implementing effective preventive strategies. The Free and Cued Selective Reminding Test with Immediate Recall (FCSRT-IR) is promising in early detection of mnemonic impairment, with high sensitivity and specificity for Alzheimer’s Disease (AD) risk. While sociodemographic and genetic factors, including APOE ε4 genotype, are associated with elevated dementia risk, their influence on cognitive performance in LA populations remains unclear. We aim to investigate sociodemographic factors and APOE ε4 genotype influence on mnemonic performance in high-risk LA individuals. Cross-sectional analysis of LatAm-FINGERS baseline data, a randomized, multicenter trial evaluating non-pharmacological interventions for cognitive decline prevention in LA. age 60-77 years; CAIDE ≥ 6; -1.5 ≤ z score ≤ 0 on MMSE or CERAD word list. MMSE < 20; dementia; illiteracy. Participants from Argentina, Brazil, Chile, and Uruguay were included. Memory assessment used FCSRT-IR and SOMI (Stages of Objective Memory Impairment) classification. APOE genotyping was performed on blood samples using PCR-RFLP analysis. Jamovi software (v2.3) analyzed correlations and associations (p < 0.05). Sample (N = 358 participants): age 67.75 ± 4.86 years; education 13.41 ± 3.14 years; 72.3% female; 61.2% white; 22.3% APOE ε4 carriers. FCSRT-IR scores correlated significantly with sociodemographics (p < .001) and varied among countries (p < .001). SOMI distribution: 58% SOMI-0 (preserved memory), 27.6% SOMI-1/2 (mild impairment). Argentina showed 36% in SOMI-3/4 (severe impairment); Uruguay 75% in SOMI-0. No significant sociodemographic differences were found between APOE ε4 carriers/non-carriers. Non-carriers performed better on FCSRT-IR, significant only for identification score (p = .017). No significant APOE ε4-SOMI association. Sociodemographic profile significantly influences memory performance, while APOE ε4 genotype shows limited association. This suggests environmental and social factors may play a more central role in cognitive performance than genetic predisposition in LA populations.
52. Dementia Care Research and Psychosocial Factors.
期刊: Alzheimer’s & dementia : the journal of the Alzheimer’s Association 发表日期: 2025-Dec 链接: PubMed
摘要
Black Caribbean British people living with dementia show higher rates of dementia yet poorer access to dementia care services (Mukadam et al., 2023). In the UK, the use of recovery approaches with people living with dementia has increasingly been endorsed along with a call for an emphasis on dementia research focusing on early diagnosis and interventions (West et al., 2022; Handley et al., 2024). The CHIME (Connectedness, Hope and Optimism, Identity, Meaning in life, Empowerment) framework (Leamy et al., 2011) operationalised the recovery approach in this study. The World Health Organisation has identified the profession of occupational therapy (OT) as one of the key health disciplines with the professional competence to provide skilled therapeutic services to people living with dementia at all stages of the disease (Jeon et al., 2023). In order to enquire into the suitability of applying the CHIME framework with the population of people living with mild dementia with a special focus on Black Caribbean British people living with mild dementia an exploratory descriptive qualitative (EDQ) study (Hunter, Mccallum and Howes, 2019) was conducted. (OTs) from both White British and Black Caribbean British heritages were recruited, consented and participated in semi-structured interviews of 60-90 minutes each. Reflexive thematic analysis (RTA) was utilised following the process outlined by Braun and Clarke (2019). High information power (Malterud et al., 2016) of the sample group (N = 9) generated a rich and descriptive dataset comprised of 14 hours of dialogue and 111,000 words in verbatim transcriptions. RTA led to the development of four overarching themes: CHIME Model is Core to OT Dementia Practice yet Tacit; OT Practitioners Recognise the Limitations of Cultural Competence; Operationalising CHIME in Dementia Practice through Transformative Learning; and Flexible and Adaptive use of Technology in Dementia OT practice. The findings of the study suggest that while OTs already practice with a tacit understanding of recovery (CHIME) principles, a more explicitly CHIME-informed approach could strengthen therapeutic relationships and enhance trust and engagement. This is particularly indicated among Black Caribbean British people living with mild dementia. OT’s would welcome post-registration continuing education to facilitate this skillset.
53. The effectiveness of heat prevention plans in reducing heat-related mortality across Europe.
期刊: Environmental research letters : ERL [Web site] 发表日期: 2025-Dec-01 链接: PubMed
摘要
Heat-health warning systems and action plans, referred to as heat prevention plans (HPPs), are key public health interventions aimed at reducing heat-related mortality. Despite their importance, prior assessments of their effectiveness have yielded inconsistent results. The objective of this study is to systematically assess the effectiveness of HPPs in reducing heat-related mortality risk across Europe. We analysed daily mortality and mean temperature data from 102 locations in 14 European countries between 1990 and 2019. Using data from national experts, we identified the year of HPP implementation and categorised their development class. A three-stage analysis was conducted: (1) quasi-Poisson time series models were used to estimate location-specific warm-season exposure-response functions in 3 year subperiods; (2) mixed-effect meta-regression models with multilevel longitudinal structures were employed to quantify changes in pooled exposure-response functions due to HPP implementation, adjusted for long-term trends in heat-related mortality risks; and (3) the heat-related excess mortality due to HPP was calculated by comparing factual (with HPP) and counterfactual (without HPP) scenarios. Estimates are reported by country, region, and HPP class. HPP implementation was associated with a 25.2% [95% CI: 19.8% to 31.9%] reduction in excess deaths attributable to extreme heat, corresponding to 1.8 [95% CI: 1.3-2.4] avoided deaths annually per 100 000 inhabitants. This equates to an estimated 14 551 [95% CI: 10 118-19 072] total deaths avoided across all study locations following HPP implementation. No significant differences in HPP effectiveness were observed by European region or HPP class. Our findings provide robust evidence that HPPs substantially reduce heat-related mortality across Europe, accounting for temporal changes and geographical differences in risks. These results emphasise the importance of monitoring and evaluating HPPs to enhance adaptation to a warming climate.
54. Validation of Fractional Anisotropy and Apparent Diffusion Coefficient Obtained From Diffusion Tensor Imaging With Reverse Encoding Distortion Correction.
期刊: Cureus 发表日期: 2025-Nov 链接: PubMed
摘要
Background Diffusion-weighted imaging acquired using echo-planar imaging is susceptible to distortion due to its sensitivity to static magnetic field inhomogeneity and eddy currents induced by motion-probing gradients. Although “topup” and “eddy” in the FMRIB (Functional Magnetic Resonance Imaging of the Brain) Software Library (FSL) are widely used for distortion correction in research, their reliance on offline post-processing, as well as the considerable time and multiple steps required, limits their feasibility in routine clinical practice. Diffusion tensor imaging (DTI) with reverse encoding distortion correction (RDC), which can be obtained directly on the MRI scanner console, reduces post-processing time by eliminating the need for FSL. Objective This study aimed to visually assess distortions in non-RDC fractional anisotropy (FAnon-RDC), topup- and eddy-corrected fractional anisotropy (FA) in FSL (FAFSL), and FARDC relative to MPRAGE (Magnetization-Prepared Rapid Gradient-Echo), and to validate FA and apparent diffusion coefficient (ADC) derived from RDC DTI. Materials and methods This prospective study included 10 healthy volunteers (mean age, 40.1 ± 5.7 years). Non-RDC b0 images, non-RDC DTI, RDC DTI, and MPRAGE were acquired on a 3T MRI scanner. Non-RDC b0 images and non-RDC DTI were subsequently processed using topup and eddy in FSL for distortion correction. FA and ADC were registered to the standard space, and the mean values were calculated for each of the 50 regions of interest (ROIs) defined using the Johns Hopkins University-International Consortium of Brain Mapping (JHU-ICBM)-labels 1 mm white matter atlas. All statistical analyses were performed using Bonferroni-corrected Wilcoxon signed-rank tests, with the significance level set at P < 0.05. Results The processing time for RDC DTI was approximately two minutes, whereas topup and eddy in FSL required about 90 minutes per subject. Distortions observed at the cranial base and near the frontal sinuses on FAnon-RDC were substantially mitigated in FARDC, comparable to FAFSL. Although 10 ROIs in FAnon-RDC and nine ROIs in FAFSL showed significant differences compared with FARDC, the FA differences for each ROI were minimal, with a mean ± 95% confidence interval (CI) of -0.003 ± 0.006 and -0.002 ± 0.005. Furthermore, two ROIs in ADCnon-RDC and none in ADCFSL showed significant differences compared with ADCRD C; however, the ADC differences for each ROI were minimal, with a mean ± 95% CI of 2 ± 16 and -1 ± 10 × 10-6 mm2/s. Conclusion RDC DTI effectively reduced distortions while yielding FA and ADC values comparable to those of non-RDC DTI and FSL DTI. Given the shorter post-processing time and fewer processing steps, RDC DTI may be considered promising for clinical applications.
55. Closing the surveillance gap: Development of a technology-integrated model for nurse anesthesia student controlled substance oversight.
期刊: Journal of nursing regulation 发表日期: 2025-Oct 链接: PubMed
摘要
Controlled substance (CS) diversion poses serious risks to patient safety, provider well-being, and institutional compliance, particularly in anesthesia practice where potent medications are routinely handled. Nurse anesthesia students are often entrusted with CS preparation and administration under indirect supervision but are frequently excluded from automated dispensing systems. When preceptors retrieve medications on students’ behalf, transactions are recorded under the preceptor’s credentials, eliminating individual accountability and rendering students invisible to surveillance systems. To address this oversight gap, a newly established nurse anesthesia program partnered with a large academic health system to design a standardized, technology-enabled oversight framework. The model will provide each student with role-based, time-limited system credentials synchronized to clinical rotation schedules, ensuring that all CS transactions-dispensing, administration, and waste-are traceable to the individual performing the task. The framework’s five pillars-interprofessional collaboration, standardized policy, annual diversion prevention education, analytics-based surveillance, and clear reporting pathways-align with best-practice recommendations from the American Society of Health-System Pharmacists and standards from the Drug Enforcement Administration and The Joint Commission. Although full implementation is pending, this proactive approach exemplifies a scalable, systems-based solution that strengthens diversion prevention while serving as a pedagogical imperative. Furthermore, embedding students in the same surveillance infrastructure as licensed providers prepares them for the regulatory realities of modern healthcare and sets a new standard for safety, accountability, and professional integrity in anesthesia education. This report describes the pre-implementation phase of this quality improvement initiative, highlighting the rationale, development, and expected benefits and challenges of the framework.
56. Cost-effectiveness analysis of commercial Chinese polyherbal preparations for primary insomnia: based on network meta-analysis.
期刊: Frontiers in pharmacology 发表日期: 2025 链接: PubMed
摘要
Building upon prior systematic reviews and network meta-analyses, this study evaluated the cost-effectiveness of four commercial Chinese polyherbal preparations (CCPPs)-Tian Meng Oral Liquid/Capsules (TM), Shen-Qi-Wu-Wei-Zi Tablets (SQWWZ), Wu Ling Capsules (WL), and Bai-Le-Mian Capsules (BLM)-for treating primary insomnia. Comparative findings informed clinical decision-making and health policy formulation. A cost-effectiveness analysis was conducted from a healthcare system perspective. A patient disease course model was developed using systematic literature search and network meta-analysis combined with drug pricing data. Intervention strategies (monotherapy or combination therapy) were simulated to assess per-capita costs and health outcomes. Incremental cost-effectiveness ratios were calculated and compared against the willingness-to-pay threshold. Deterministic sensitivity analysis (DSA), Monte Carlo simulations for probabilistic sensitivity analysis and cost-effectiveness acceptability curves were used to test the overall stability and acceptable probability of the evaluation results. At a WTP threshold of ¥89,358.00 per quality-adjusted life year (QALY), the combination of TM and benzodiazepines (BZDs) ranked highest in terms of cost-effectiveness, followed by WL, BLM, and SQWWZ. When the WTP threshold exceeded ¥5,897.63 per QALY, the probability that TM + BZDs was more cost-effective than WL increased. Likewise, when the WTP threshold was above ¥19,658.76 per QALY, the probability that BLM was more cost-effective than SQWWZ became greater. Within the 60-day time horizon of this analysis, TM + BZDs demonstrated optimal cost-effectiveness for primary insomnia from a healthcare system perspective, followed by WL and BLM. Limitations in data sources constrain the generalizability of findings. Future studies adopt a societal perspective and incorporate individual-level data over longer time horizons to validate and extend current results through more comprehensive cost-utility evaluations. Furthermore, research should focus on Traditional Chinese medicine (TCM)-specific health utility scales and informing equity-focused reimbursement policies to fully capture the value of CCPPs, thereby ultimately optimizing healthcare access and resource allocation.
57. Population Health and Systems Science: Medical Student Feedback on a Novel Approach That Follows a National Curricular Framework.
期刊: Journal of medical education and curricular development 发表日期: 2025 链接: PubMed
摘要
Population Health and System Science, a longitudinal course at a new medical school in northeast Texas, incorporates case-based learning and experiential field visits during an 18-month pre-clerkship phase. The course integrates content from public and population health, preventive medicine disciplines, and health administration and leadership. A cross-sectional survey assessed student self-reports on achievement of session objectives and introduction to national core curricular, cross-cutting, and systems thinking domains. Of 36 students, 33 responded. Most rated objectives favorably. Open-ended responses highlighted relevance to future practice and requested more content on biostatistics, epidemiology, health equity, and healthcare economics, financing, and policy. Findings suggest the course effectively introduces key concepts, with opportunities to enhance foundational content in measurement, policy, and financial aspects of healthcare. Future studies should investigate application during required clinical rotations.
58. Health Promotion in European Higher Education Institutions: An Integrative Literature Review.
期刊: Public health reviews 发表日期: 2025 链接: PubMed
摘要
This research aimed to determine the state of the art of health promotion actions in higher education institutions of European Union member countries. To achieve the proposed objective, an integrative literature review was conducted. The collection of analyzed articles was carried out across four databases and a data compilation, where studies published between 2016 and 2022 were reviewed. The analysis was conducted through the description of the actions in health promotion (HP). Fourteen articles were selected for analysis. The HP actions described primarily target students. Some of the main topics covered in the studies are health habits related to gender differences, recreational substances and health education. Although research in this area is increasing, it appears necessary to further disseminate the principles of the health promotion universities movement to raise awareness across the entire academic community. This could more easily lead to the development of more effective HP actions directed at the entire academic community and those outside the institutions.
59. Co-evolution of private and public hospitals: spatiotemporal disparities, geospatial interactions, and social determinants over 19 years in Sichuan, China.
期刊: Frontiers in public health 发表日期: 2025 链接: PubMed
摘要
The global rise of private hospitals is crucial for achieving universal health coverage, yet the development of public and private hospitals remains uncoordinated. This study explores the co-evolution of private and public hospitals, focusing on their spatiotemporal disparities, geospatial interactions, and the social determinants under policy guidance. We used Sichuan province, China, as a case study and collected hospital-level annual report data from 2002 to 2020. Spatiotemporal analyses examined the co-evolution of public and private hospitals across different hierarchical levels. The Gini coefficient assessed the spatial equity of hospital bed resources, while spatial accessibility was measured using the provider-to-population ratio at district and county levels. Trend analysis quantified changes in accessibility over time. Fixed-effects models identified social determinants influencing hospital resource allocation. Between 2002 and 2020, the proportion of districts/counties in Sichuan with more than 4.8 hospital beds per 1,000 population increased significantly, from 5.46% to 43.72%. The equity of medical bed resources also improved across the province. The proportion of districts/counties with more than 3.3 public hospital beds per 1,000 population rose from 12.57% to 50.27%, and the share of districts/counties where private hospitals made up 25% or more of total beds grew from 2.19% to 53.01%. Geospatial interaction maps revealed regional disparities: complementarity in advantaged areas, persistent deficits in remote regions, and geographical compression of public hospitals in urban centers. Our analysis further showed that private hospital accessibility positively correlates with population density, per capita GDP, and government health expenditure, while public hospital accessibility is positively linked to per capita GDP, urbanization, and health expenditure. However, public primary hospital accessibility negatively correlates with per capita GDP. While private hospitals have rapidly expanded bed capacity, policy biases and market incentives have caused a structural imbalance, with a shortage of high-end services and an excess of low-end resources. In contrast, public hospitals have upgraded hierarchically, concentrating high-quality resources in urban areas. However, basic medical supply remains insufficient in remote regions, exacerbating disparities in healthcare accessibility and quality, and hindering the achievement of universal health coverage.
60. From Dysregulation to Coherence: Exploring the HeartMath® Approach to Emotional and Physiological Regulation.
期刊: Global advances in integrative medicine and health 发表日期: 2025 链接: PubMed
摘要
Mounting evidence suggests that the long-term effects of trauma and adversity are rooted not only in psychological distress, but in persistent dysregulation of the body’s stress response and its associated neuroendocrine systems. This physiological dysregulation has emerged as a critical contributor to health outcomes, yet remains under-addressed in conventional clinical care. Emotional states are integrated with core physiological functions through dynamic, bidirectional autonomic signaling between the heart, lungs, brainstem, limbic system, and higher cortical areas. This interconnected network enables conscious regulation of breathing, heart rhythms and emotions to influence autonomic and higher cortical functions. Research has demonstrated that heart rhythm patterns become more ordered during HeartMath’s® self-regulation techniques. This stable, high-oscillatory pattern, termed “coherence”, can be observed using heart rate variability biofeedback and induced through slow, deep breathing or experiencing regenerative emotions such as gratitude. Coherence is a state of physiological and emotional regulation that reflects increased vagal activity and synchronization across organ systems, promoting more efficient function. In addition to reductions in perceived stress, research has demonstrated improvements in energy, anxiety, mood, sleep, and cognitive performance with daily coherence practice over weeks. Gradually, coherent heart rhythm patterns can become a more familiar set-point for the body through repeated afferent input to the brain, supporting the emergence of a healthier, more regulated physiological baseline. This narrative review explores HeartMath as an emerging non-pharmacological intervention with therapeutic potential for emotional and physiological dysregulation, highlighting evidence and mechanisms by which coherence shifts the body toward a healthier, more resilient state.
61. Impact of COVID-19 school learning model on mental health, suicidal thoughts and behaviors, substance use, and violence related behaviors and experiences among U.S. high school students.
期刊: PLOS mental health 发表日期: 2025 链接: PubMed
摘要
The COVID-19 pandemic and associated prevention measures reshaped students’ lives. We estimated the effects of virtual learning during the pandemic on adolescents’ mental health, suicidal thoughts and behaviors, substance use, and violence-related experiences and behaviors. Using Youth Risk Behavior Survey data from 25 local jurisdictions, we compared overall and relative changes from 2019 (n = 49,740) to 2021 (n = 42,995) between jurisdictions where high school students predominantly attended school virtually vs. in-person during the 2020-2021 school year with Rao-Scott chi-square tests and difference-in-differences logistic regression. P-values<0.050 were considered significant. From 2019 to 2021, reported persistent feelings of sadness/hopelessness (2019 = 36.3%, 2021 = 41.3%), seriously considering suicide (17.0-18.7%), making suicide plan(s) (14.2-16.9%), and experiencing sexual dating violence in past 12 months (6.7-7.8%) increased significantly, while alcohol use (22.5-17.1%), binge drinking (8.5-6.2%), and marijuana use (20.2-14.3%) in past 30 days, ever prescription opioid misuse (16.0-13.2%), and gun-carrying (5.5-4.5%), physical fighting (22.3-17.3%), and any sexual violence (11.3-10.4%) in past 12 months decreased significantly. Students in virtual learning jurisdictions reported relative decreases in injury during suicide attempt(s) (OR=0.68, 95%CI = 0.52-0.88), experiencing sexual violence (OR=0.78, 95%CI = 0.67-0.91), using electronic vapor products (OR=0.81, 95%CI = 0.70-0.95), using alcohol (OR=0.84, 95%CI = 0.74-0.95), and misusing prescription opioids (OR=0.82, 95%CI = 0.72-0.94). Learning model was not associated with relative changes in persistent feelings of sadness/hopelessness, seriously considering suicide, making suicide plan(s), attempting suicide, binge drinking, marijuana use, gun-carrying, physical fighting, experiencing sexual dating violence, or being electronically bullied. Additional efforts to support schools in providing safe, supportive environments are needed, particularly where schools returned in-person in fall 2020.
62. Behavioral health interventions for pediatric acute lymphoblastic leukemia: a scoping review.
期刊: Frontiers in oncology 发表日期: 2025 链接: PubMed
摘要
Acute Lymphoblastic Leukemia (ALL) is the most common pediatric cancer, with significant advancements in treatment leading to over 90% five-year event-free survival rates in developed countries. However, disruptions in health behaviors during treatment, such as diet, activity, and sleep, can negatively impact treatment tolerance and increase risks of late effects. This scoping review aimed to assess the breadth of existing behavioral health interventions designed to improve immediate and long-term health outcomes for children and adolescents receiving treatment for ALL. The review focused on behavioral interventions for children (ages 2-18 years) undergoing active treatment for ALL. We followed the JBI Manual of Evidence Synthesis and PRISMA-ScR guidelines, including a comprehensive search across PubMed, Elsevier, and Web of Science databases. Articles were screened, assessed, and data extracted by multiple reviewers to identify behavioral health promotion interventions used during ALL treatment. A total of 157 full-text articles were screened, and 86 met inclusion criteria. Most interventions targeted physical activity and exercise (n=36), procedural distress (n=24), nutrition (n=8), and symptom reduction/management (n=6), with others targeting pain, sleep, and health-related quality of life. Date of publication, methodology, and behavioral intervention components varied considerably across studies. The literature on behavioral health promotion interventions during pediatric ALL treatment is broad but lacks depth, with many studies limited by small sample sizes and stalling at the feasibility stage. There is a need for larger, more rigorous trials to assess the effectiveness of these interventions and improve outcomes for youth with ALL.
63. Understanding perspectives on smoking cessation based on Self-Determination Theory: A qualitative study.
期刊: Tobacco prevention & cessation 发表日期: 2025 链接: PubMed
摘要
Implementing and maintaining smoking cessation requires high motivation. This study examines the role of Self-Determination Theory (SDT) in enhancing smoking cessation strategies by highlighting the significance of psychological needs for lasting behavioral change. We aimed to explore how participants perceive the importance of SDT’s basic psychological needs - autonomy, competence, and relatedness - in the context of smoking cessation treatment and support (SCTS). This qualitative study, employing SDT-driven content analysis, utilized a co-design workshop held in Finland in 2019, where 12 participants engaged in group dialogues. The workshop dialogues were examined to determine whether SDT influenced participants’ responses regarding SCTS. The qualitative analysis emphasized the respondents’ need for autonomous motivation. The study highlighted the importance of acknowledging individual differences and psychological needs for effective support in SCTS. We identified ten categories: Addiction, Aids and appliances, Characteristics, Collective quitting, Expert advice, Follow-up data, Personal experience, Rewards, Health political decision-making, Ways of quitting smoking. All were linked to basic psychological need. The desire for autonomy was the most common theme (41.2%) followed by competence (34.6%) and relatedness (24.2 %). Health practitioners should recognize and address the basic psychological needs of autonomy, competence, and relatedness when assisting smokers in their cessation efforts. By offering meaningful choices to support autonomy and enhance competence, and by providing positive, informative feedback while empathizing with the smoker’s situation, professionals can improve the effectiveness of SCTS interventions. To be truly effective, support must be tailored to individual differences and needs.
64. Risk Analysis of Patient Transport Personnel Using ISO 45001:2018 in Vajira Hospital, Thailand.
期刊: Risk management and healthcare policy 发表日期: 2025 链接: PubMed
摘要
This study aimed to evaluate occupational health and safety risks among patient transport personnel at Vajira Hospital, Thailand, using the ISO 45001:2018 Occupational Health and Safety Management System (OHSMS). The goal was to identify hazards, quantify risk levels, and propose targeted corrective measures to enhance workplace safety. Data were collected from 60 patient transport personnel and their supervisors using in-person, semi-structured interviews. Task-related hazards were identified through standardized checklists aligned with ISO 45001:2018. Descriptive statistics (frequencies, percentages, mean values) were applied to summarize participant characteristics and risk levels. Among 21 assessed work activities: 2 activities were categorized as very high risk (ergonomic hazards). 12 activities as high risk. 6 activities as medium risk. 1 activity as low risk. Key hazards included repetitive lifting, awkward postures, and potential exposure to infectious agents. ISO 45001:2018 clauses 6.1.2 (Hazard Identification and Risk Assessment) and 8.1 (Operational Planning and Control) were most relevant for these high-risk activities. The study identifies urgent needs for ergonomic interventions, staff training, and procedural adjustments to reduce high-risk activities. Implementing ISO 45001:2018 systematically can improve hazard control and promote a safer working environment for patient transport personnel in hospital settings.