公共卫生研究摘要 (2025-12-27)
共收录 70 篇研究文章
1. Country-specific progress toward the Sustainable Development Goals: Past, present, and prospects.
期刊: Proceedings of the National Academy of Sciences of the United States of America 发表日期: 2025-Dec-30 链接: PubMed
摘要
Two-thirds of the journey to achieving the Sustainable Development Goals (SDGs) has passed. However, insights into country-specific progress covering pre- and post-SDG and the prospects remain limited. Here, we compare the progress of 117 SDG indicators for 167 countries and project the achievements by 2030. Our results reveal the progress of the SDGs across the world varies depending on the initial SDG scores of the indicators in 2015. For indicators with low scores (0 to 50%), the proportion of countries showing advancement is greater than that demonstrating regression (25 vs. 16%). Countries that foster scientific research and promote manufacturing industry (SDG9) have the best performances. For indicators with high scores (70 to 90%), the proportion showing regression is greater than that with advancement (16 vs.10%). The increased coverage of immunization vaccines and prevention of infectious diseases (SDG3) have the worst performances. For indicators with moderate scores (50 to 70%), the proportion showing regression is slightly greater than that showing advancement (11 vs. 9%). When the score was low and high, the impact of the pandemic was significantly greater than that for moderate scores. By 2030, the global SDG score will reach approximately 63%, with a SD of 8%. Overall, 78 countries will reach the moderate score (60 to 70%), and 12 countries will remain with a low score (40 to 50%). Countries need to achieve an annual growth rate of 4% to meet the overall SDGs by 2030. Our comprehensive long-term assessment provides essential knowledge on global SDG progress, complementing UN reports.
2. Identifying core components of healthcare administration and leadership training programs: A comprehensive website document analysis.
期刊: American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists 发表日期: 2025-Dec-26 链接: PubMed
摘要
To identify the core components and knowledge, skills, and abilities (KSAs) prioritized in US-based educational programs focused on healthcare administration. Once identified, these core components and KSAs can inform curriculum development and standardize pharmacy administration and leadership (PAL) training to better prepare future healthcare leaders. A comprehensive website document analysis was conducted using a 3-phased methodology: (1) identifying programs through systematic website searches, (2) extracting data on mission statements, vision statements, learning outcomes, core competencies, and course descriptions of identified programs, and (3) performing inductive thematic coding to identify recurring KSAs and curricular themes. Data were collected from 147 programs, with Master of Business Administration programs constituting the largest group (48.3%), followed by Master of Health Administration programs (41.5%), PAL Master of Science programs (6.1%), and Master of Science in Health Services Administration (4.1%). Leadership development, financial management, and strategic planning were emphasized across programs. Many programs include courses on healthcare operations, law and policy, data analysis, and finance. However, areas such as change management and cultural competence were underrepresented, highlighting gaps in current curricula. The study identified key KSAs and core components that can serve as a foundation for designing more comprehensive healthcare administration curricula. Notably, critical areas such as change management, cultural competence, and human resources/conflict management were underrepresented across programs, highlighting opportunities for targeted curricular enhancement. Standardizing and refining PAL programs based on these components can help ensure that pharmacy administrators and leaders acquire the competencies necessary to address the evolving challenges of healthcare. Future research should explore the alignment of current programs with these core components and assess their impact on educational and practice outcomes.
3. Making human derived data FAIR: feedback from NCI office of data sharing workshop.
期刊: Journal of the National Cancer Institute 发表日期: 2025-Dec-26 链接: PubMed
摘要
The US federal government is committed to maximizing its return on biomedical research investment. This tenet is exemplified by policies that promote broad, responsible sharing of research products generated with public funds, including the recent National Institutes of Health (NIH) Final Data Management and Sharing (DMS) Policy and the NIH Updated Public Access Policy. Scientific data management and sharing must occur in a FAIR (findable, accessible, interoperable and reusable) manner for it to be broadly usable and thereby most impactful [1,2]. The NCI Office of Data Sharing (ODS) conducted a series of workshops to identify clinical features and profiles derived from patients and study participants that inform these respective basic, translational, clinical, and populational science research analyses. The workshop outputs lay the groundwork for developing best practice recommendations on high-value, impactful clinical data features to collect and share with the wider research community. The workshop also highlighted additional data types and methodologies represented across the NCI-funded research portfolio that need structured outputs to be better defined to similarly allow broad sharing in a FAIR manner. In this article we summarize the workshop discussions on data use challenges, present potential solutions, and outline attendee consensus on the minimum patient-derived clinical information needed to complete a wide spectrum of cancer research. We further propose preliminary guidance for policymakers and researchers to implement regarding collection and management of human derived clinical data in consistent and impactful ways that can improve the sharing process and outcomes for data end users.
4. Impact of age and frailty on acute care use during immune checkpoint inhibitor treatment.
期刊: Journal of the National Cancer Institute 发表日期: 2025-Dec-26 链接: PubMed
摘要
Older and frail adults were under-represented in clinical trials evaluating ICIs, leading to a knowledge gap on their risk of acute care use and immune-related adverse events (irAEs). We performed a population-level study evaluating the impact of age and frailty among older adults receiving ICIs on acute care use and irAE-related hospitalizations. Patients with cancer, age ≥ 65 initiating ICIs between June 2012-October 2018 (Ontario, Canada) were identified using systemic therapy administration data. The cohort was linked to other databases to obtain covariates and outcomes. Multivariable Cox proportional models evaluated the impact of age and frailty on acute care use and irAE-related hospitalizations. Among 2,737 patients, median age was 73 and 26% were pre-frail and 4% frail; 72% required acute care use, while 8% had an irAE-related hospitalization. Increasing frailty was associated with increased risk of acute care use (pre-frail vs robust, aHR = 1.20,95% CI[1.07-1.36], p = .003; frail vs robust, aHR = 1.45[1.12-1.86], p = .004), while age was not associated with acute care use. Increasing age was associated with reduced risk of irAE-related hospitalization (aHR = 0.97 per year[0.95-0.99], p = .01); patients age ≥ 80 compared to 65-69 had reduced risk of irAE-related hospitalization (aHR = 0.63[0.39-1.01], p = .05). Frailty was not associated with irAE-related hospitalizations. Associations remained consistent when evaluating age and frailty in the same models. Age was associated with reduced risk of an irAE-related hospitalization but not acute care use, while increasing frailty was associated acute care use, but not irAE-related hospitalization. Age and frailty may need to be considered independently when evaluating their impact on toxicity among older adults receiving ICIs.
5. Theory Guided Analysis of Women's Toileting-Related Beliefs, Behaviors, and Bladder Health.
期刊: Nursing research 发表日期: 2025-Dec-26 链接: PubMed
摘要
Women commonly experience lower urinary tract symptoms (LUTS), such as frequent urination, urgent urination, and urinary incontinence. Health education for women rarely focuses on LUTS prevention and promotion of bladder health. The Theory of Reasoned Action and Theory of Planned Behavior has been used to explain and change a variety of health behaviors. Missing from the literature is an explicit test of whether constructs of these theories are associated with LUTS and bladder health, and whether toileting habits explain this association. To inform prevention strategies, this investigation tested whether the Theory of Reasoned Action and Theory of Planned Behavior constructs (attitudes towards, perceived norms of, and perceived control over specific toileting behaviors) are associated with women’s toileting habits, and whether these habits mediate associations of theoretical constructs and women’s LUTS and bladder health. The Prevention of Lower Urinary Tract Symptoms Research Consortium developed theoretical constructs to match four toileting behavior domains (delayed voiding, straining, crouching/hovering over toilets when away from home, and avoiding public toilets) assessed by the validated Toileting Behaviors: Women’s Elimination Behaviors scale. Using a population-based survey, data were then collected from women at nine sites in the United States. Cross-sectional regression analyses tested whether toileting habits in a given domain mediated associations of corresponding theoretical constructs with reported LUTS, bladder health, and bladder function. The overall analytic sample included 1,472 women with a mean age of 48 years. Associations of norms favoring delayed voiding and low perceived control over timing of voiding with more frequent LUTS and poorer bladder health and function were partially mediated by delayed voiding habits. Favorable attitudes towards and norms of straining (i.e., pushing down to urinate) and avoiding public toilets were associated with more frequent LUTS through corresponding toileting habits. Longitudinal research is needed to confirm study findings. Future prevention intervention research may include nursing and public health messaging designed to shape attitudes towards and perceived norms of specific toileting behaviors, as well as policies to enhance control over healthy toileting practices in public spaces, including schools and workplaces.
6. Dysfunctional variants of ABCG2 create strong individual and population risks for progression of hyperuricemia: the potential for implementation of genome-personalized nursing.
期刊: Human cell 发表日期: 2025-Dec-26 链接: PubMed
摘要
Gout, a common disease, develops after prolonged hyperuricemia with elevated serum uric acid (SUA) levels. Sex, overweight/obesity, heavy drinking, and aging all increase risk. Common dysfunctional variants (polymorphisms) in the ABCG2/BCRP gene are major genetic causes of gout/hyperuricemia. Early management would thus have potential benefits for public health. Several studies report the effectiveness of nurse-led care for gout management. We evaluate here the individual and population genetic effects of ABCG2 in 9244 Japanese study participants, in all of whom ABCG2 variants had a higher population-attributable fraction (PAF; approximately 30%) for progression of hyperuricemia than those for other typical environmental risk factors (overweight/obesity, heavy drinking, and aging). PAFs for aging in males and heavy drinking in females were not significant. All these factors also showed significant individual risk of increased SUA level, and ABCG2 variants had sufficient effect size to allow them to be converted into other environmental factors. To implement genome-personalized nursing, we then mapped onto the process a theoretical framework that is based on a psychological model from behavioral change theory. Because the present results for convertibility will improve the predictability of genetic effects, cognitive interventions by nurses based on individual variants could therefore encourage both inducements of behavioral change: efficacy expectations (self-efficacy) and outcome expectations. We conclude that the framework would function effectively based on cognitive interventions by nurses/paramedics. This theoretical framework has potential as a basis for implementing genome-personalized prevention, medicine and nursing of gout/hyperuricemia, and for optimizing nurse-led care.
7. One-year post-discharge health-related quality of life in digestive and oncology patients: a three-group comparison by nutritional status and care.
期刊: Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation 发表日期: 2025-Dec-26 链接: PubMed
摘要
We evaluated changes in health-related quality of life (HRQoL) twelve months after admission among three groups of patients with digestive and oncological pathologies by nutritional status and nutritional intervention. We also sought to identify factors influencing those changes, taking into account the patients’ baseline status. This pragmatic effectiveness trial study comprised 619 hospitalized patients who completed HRQoL instruments on admission and twelve months later. Of these, 365 were classed as non-malnourished and 254 as malnourished (of whom 59 underwent nutritional intervention). Sociodemographic and clinical data were gathered. Patients completed the Short-Form 36; the EuroQol generic health-related quality of life questionnaire and the Barthel Index. Descriptive, univariate and multivariate linear regression models were applied to identify factors associated with changes in HRQoL. Participants had a mean age of 63.5 years; 61.6% were male. Malnourished patients showed significant improvement in mental, social and physical components at the change. In the multivariate analysis, several variables affected the HRQoL of hospitalized patients one year after admission, such as level of malnutrition, pathology on admission, gender, age, Charlson Comorbidity Index, number of drugs prescribed, length of stay or surgical intervention. The nutritional intervention provided during the days of admission was not found to be associated with better HRQoL, except for role physical and body pain. Identifying the factors influencing changes in HRQoL amongst patients one year after their admission could help determine how important it is to improve these factors, when possible, for example through nutritional intervention prior to admission for surgery. Many people who are hospitalized with digestive or cancer-related illnesses also struggle with poor nutrition, which can affect their overall well-being. This study looked at how patients’ quality of life changed one year after being admitted to the hospital, especially in relation to their nutritional status and whether they received any nutritional support during their stay.The main goal was to understand if being malnourished or receiving nutritional help made a difference in how patients felt physically, mentally, and socially over time. The study followed 619 patients and found that those who were malnourished showed noticeable improvements in several areas of life quality after a year. However, the nutritional support given during their hospital stay only had a small effect, helping mainly with physical roles and pain.The results suggest that many factors—like age, gender, type of illness, and how many medications a person takes—can influence recovery and well-being. This means that improving nutrition before surgery or hospital admission might be more helpful than focusing only on care during the hospital stay, although it is important to take into account the limited effect of in-hospital intervention and the importance of pre-admission/preventive nutrition.
8. Acute effects of flossing band application on hamstring muscle mechanical properties and stretch tolerance: a randomized controlled crossover trial.
期刊: European journal of applied physiology 发表日期: 2025-Dec-26 链接: PubMed
摘要
9. Alcohol consumption is prevalent among Chinese adolescents: a national survey.
期刊: World journal of pediatrics : WJP 发表日期: 2025-Dec-26 链接: PubMed
摘要
The consumption of alcohol by adolescents has deleterious effects on their health and cognitive functions. Adolescent alcohol consumption represents a significant public health issue. Up-to-date national surveys examining alcohol use among Chinese adolescents is lacking. This study aims to offer nationally representative insights into the prevalence and patterns of alcohol consumption among Chinese adolescents. A school-based, nationally representative cross-sectional survey targeting middle and high school students (aged 12- < 19 years) was conducted using a multi-stage stratified cluster random sampling design in 2021. Self-reported questionnaires were used to collect data on the prevalence of drinking and drunkenness over lifetime, past year, and past month, early onset of drinking and drunkenness, alcoholic beverage types, drinking frequency, emotional motives during drinking episodes and drinking occasions and locations. Estimates were weighted for the complex sampling design. The survey revealed that 44.1%, 32.7%, and 11.2% had consumed alcohol in their lifetime, past year and past month respectively. Prevalence of drunkenness for the same periods was 12.1%, 5.9%, and 1.6%. Totally 31.2% of students reported alcohol use at age 13 or younger and 6.8% reported early drunkenness. The most consumed alcoholic beverages among past-year drinkers were beer (71.1%) followed by wine (69.4%). Adolescent drinking is often passive without emotional motives (36.0%), or motivated by joy (31.3%) or sadness (23.6%). Adolescent drinking primarily occurs during family gatherings (51.0%), with private homes being the most common drinking location (68.9%). Alcohol consumption is prevalent among Chinese adolescents, increasing with school grade; percentages of drunkenness are relatively lower. Drinking and drunkenness in some time frames has significantly decreased. Of note, boys demonstrate higher percentages across almost all patterns of alcohol use. Adolescents display disparities in alcohol consumption based on their urban-rural residence and geographical location.
10. Fatty acid metabolic signature reveals FASN as an immunosuppressive factor in DLBCL tumor microenvironment.
期刊: Medical oncology (Northwood, London, England) 发表日期: 2025-Dec-26 链接: PubMed
摘要
Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of non-Hodgkin lymphoma (NHL). Targeting fatty acid metabolism pathway represents a promising therapeutic strategy, particularly for patients with refractory or relapsed DLBCL. In this study, fatty-acid metabolism index (FMI) signature including 20 genes was constructed by univariate Cox and LASSO-Cox regression analysis using transcriptomic data from Gene Expression Omnibus database to predict overall survival of DLBCL patients. The FMI signature exhibited a negative association with anti-tumor immune response, with FMI-high patients had decreased immune cell infiltration and downregulated immune-associated signaling pathways. Based on the FMI signature, FASN was identified as the most essential gene that negatively regulated the tumor microenvironment of DLBCL. High FASN expression was associated with reduced anti-tumor immune activity, including decreased immune score, lower T-cell inflamed score, and downregulated expression of IFN molecules. Infiltration of immune cells, including CD4+T cells, CD8+T cells, dendritic cells, and macrophages were also significantly decreased in FASN-high than FASN-low patients. Accordingly, key signal molecules and chemokines for immune cells exhibited negative correlations with FASN expression. Through FASN knockdown in DB cell line, we further validated that FASN significantly suppressed chemokine secretion and promoted DLBCL proliferation in vitro. The FMI signature can effectively distinguish the prognostic stratification of DLBCL patients, further suggesting that FA metabolism imbalance may play an important role in DLBCL heterogeneity and treatment resistance. FASN is a potential negative regulator of immune microenvironment, providing novel insights into the metabolic-immune crosstalk in DLBCL treatment.
11. Self-Reflective Chest X-Ray Report Generation with Clinical-Aware Detection and Multilevel Readability.
期刊: Journal of medical systems 发表日期: 2025-Dec-26 链接: PubMed
摘要
Clinical documentation demands necessitate automated solutions balancing clinical precision with patient comprehension. This study aims to develop and validate a unified framework that maintains diagnostic accuracy while dynamically adapting medical report complexity to diverse literacy levels, and to establish comprehensive evaluation methodologies for patient-centered medical documentation. We developed a unified framework integrating three innovations: a hybrid detection method combining CheXFusion and Eigen-CAM for clinical finding detection and anatomical localization; an advanced LLaVA-based pipeline synthesizing clinical predictions with anatomical data for contextually rich medical reports; and a self-reflective large language model system dynamically adapting report complexity across reading levels (6th, 11th, and 18th-grade) while preserving clinical integrity. Our methodology introduces novel evaluation using the Mistral-small model assessing report quality through consistency, coverage, and fluency metrics. Validation on MIMIC-CXR and IU X-Ray datasets demonstrated substantial improvements: 19.78% enhancement in classification accuracy (AUROC), 17.29% improvement in mean average precision, 56.88% increase in patient comprehension scores, and 5.26% gain in diagnostic precision. The framework successfully addresses maintaining clinical rigor while enhancing patient accessibility, reducing documentation burden on healthcare providers and improving patient engagement through comprehensible reporting. This work establishes new standards for automated medical documentation that effectively reconcile clinical precision with patient comprehension in healthcare communication.
12. Ex vivo air-liquid interface respiratory mucosa platform to study type 2-driven Asthma.
期刊: The Journal of asthma : official journal of the Association for the Care of Asthma 发表日期: 2025-Dec-26 链接: PubMed
摘要
Asthma is a heterogeneous disorder in which a subset of patients exhibits a type 2 (Th2- or T2-high) endotype driven by eosinophilic, IL-4/IL-13-mediated inflammation. Traditional animal and 2D cell-based models incompletely reproduce human airway immune responses, particularly the Th2 phenotype. To address this gap, we developed a three-dimensional (3D) ex vivo model of human nasal respiratory mucosa incorporating type-2-biased immune stimulation. Primary nasal mucosal biopsies were expanded under air-liquid interface (ALI) conditions and either exposed to IL-4/IL-13 or co-cultured with autologous polarized CD4+ Th2 lymphocytes and dendritic cells to generate a Th2-dominated microenvironment. Tissue morphology and barrier function were monitored longitudinally by phase-contrast microscopy and transepithelial electrical resistance (TEER). Induction of a type-2 inflammatory state was confirmed by increased secretion of periostin, STAT-6, IL-4 and IL-13 in apical and basal compartments, together with modest TEER reduction and evidence of epithelial remodeling, whereas IL-8 and chitinase family proteins did not increase, thereby excluding a COPD-like or type-2-low phenotype. Rather than fully recapitulating clinical asthma, this methodological model reproduces key immunopathologic features of T2-high airway inflammation in a patient-derived 3D context. It provides a stable, human-relevant platform for mechanistic studies and for future preclinical screening of targeted anti-inflammatory therapies.
13. Exploring how men and women improve their relationships through participation in HIKA, a group-based, couples-focused IPV prevention program in the Democratic Republic of Congo.
期刊: Culture, health & sexuality 发表日期: 2025-Dec-26 链接: PubMed
摘要
Group-based IPV prevention programmes use participatory learning to impart new information, encourage critical reflection on gender and power dynamics, and develop new skills. Understanding whether and how these programmes are internalised and acted upon can allow for programme designs to enhance facilitators of positive change, inform efforts to adapt and scale the programme, and understand the potential for sustained change. This paper presents a qualitative study that explored men’s and women’s perceptions, experiences, and learning from participating in HIKA, a group-based couples’ IPV prevention programme, together with facilitator experience. HIKA, a 22-session participatory curriculum, was adapted from the Indashykirwa couple’s programme for couples living in South Kivu Province, Democratic Republic of Congo. Men and women described important shifts in the way they perceived and used power, conflict, violence, and communication. Despite some resistance and ongoing gendered roles, the programme’s group-based, couple-centred approach, underpinned by safe spaces, empathy-building exercises, and skills for managing power and conflict, demonstrated promise in encouraging new non-violent behaviours and strengthening relationships.
14. Prediction of inclisiran efficacy in patients with established atherosclerotic cardiovascular disease: the SIRIUS In-Silico modelling of cardiovascular outcomes.
期刊: European journal of preventive cardiology 发表日期: 2025-Dec-26 链接: PubMed
摘要
Inclisiran, an siRNA-targeting hepatic PCSK9 mRNA, reduces low-density lipoprotein cholesterol (LDL-C), but its effect on major adverse cardiovascular event (MACE) remains unconfirmed. The SIRIUS in-silico modelling program aimed to predict the efficacy of inclisiran on MACE in virtual patients with atherosclerotic cardiovascular disease (ASCVD). The SIRIUS simulation (NCT05974345) used a validated mechanistic model of ASCVD and lipid-lowering therapy (LLT) effects in a virtual population with established ASCVD and LDL-C ≥70 mg/dL. Each virtual patient served as their own control to compare inclisiran versus placebo as an adjunct to high-intensity statin therapy, alone or with ezetimibe over 5 years. The model did not account for non-adherence, recurrent events, or adverse effects. Among 204 691 virtual patients, inclisiran was predicted to reduce LDL-C by 49.7% versus placebo (from 91.1 to 48.3 mg/dL). Relative to placebo, inclisiran was predicted to lower 5 years risk of 3-point MACE by 25.2% (11.3% vs. 14.9%), myocardial infarction by 34.8% (5.7% vs. 8.6%; HR 0.65), ischaemic stroke by 26% (2.6% vs. 3.4%; HR 0.74), and major adverse limb event by 34.1% (0.5% vs. 0.8%; HR 0.66). A 7.1% relative reduction of cardiovascular death was predicted (4.2% vs. 4.5%; HR 0.93). SIRIUS is the first in-silico simulation using a knowledge-based mechanistic model to predict the efficacy of LLT on cardiovascular outcomes in ASCVD. These findings offer early model-based prediction of inclisiran’s potential cardiovascular benefit ahead of phase 3 outcome trials. The SIRIUS in-silico simulation used a validated knowledge-based mechanistic computational model to computationally simulate inclisiran efficacy on 5-year MACE in 204 691 virtual patients with atherosclerotic cardiovascular disease (ASCVD).Mean predicted percentage reduction in LDL-C with inclisiran versus placebo was 49.7% at 5 years, with a 25.2% reduction in 3-point MACE.This simulation provides early insights into the potential effect of inclisiran on cardiovascular event reduction in advance of results from ongoing phase 3 trial.
15. Prevalence and Risk Factors for Hepatitis C Virus Infection in Vulnerable Populations in Romania: A Population-based Screening from the LIVE(RO)2 Program.
期刊: Journal of gastrointestinal and liver diseases : JGLD 发表日期: 2025-Dec-26 链接: PubMed
摘要
Viral hepatitis C remains one of the leading causes of virus-related morbidity and mortality worldwide, being the main etiological cause of cirrhosis and hepatocarcinoma which transforms it into a global health problem. It investigated the prevalence and risk factors for hepatitis C virus (HCV) infection in Romania. This prospective study was conducted between 2021 and 2023 by an extensive national Romanian screening program LIVE(RO)2 of 320,000 participants, most of whom being a part of deemed vulnerable populations. All participants agreed to an informed written consent and potential risk factors for HCV transmission were investigated by questionnaire. Out of the 320,000 screened individuals, 3,859 were infected with HCV meaning 1.21% prevalence (95%CI: 1.17-1.24). HCV-infected individuals were meanly aged at 65.8 ± 12.93 years, significantly higher as compared to non-infected participants (54.03 ± 16.41 years, p<0.0001). The main risk factors associated with HCV chronic infection included male gender, being aged between 30-49 or 60-69 years old, low level of education, being unvaccinated, unemployed, not married, with personal history of blood or blood products transfusion, hemodialysis, surgical interventions, tattooing, being in contact with family members with hepatitis, with hospitalizations, imprisoned, and performing unprotected sexual contacts or with partners diagnosed with sexually transmitted infectious diseases. The prevalence of HCV infection in Romania is 1.21%. Additional to providing supplemental healthcare support to vulnerable populations, the current study contributes in Romania’s national HCV elimination objectives.
16. Intestinal Barrier healing is superior to transmural healing to prevent disease progession in clinical remittent patients with IBD.
期刊: Journal of Crohn’s & colitis 发表日期: 2025-Dec-26 链接: PubMed
摘要
Achieving endoscopic remission is a key therapeutic goal in IBD that is associated with improved disease outcome. Transmural and intestinal barrier healing represent emerging targets, as they have similarily been associated with favourable disease behaviour. To date, no study has compared these novel endpoints and their impact on avoiding deleterious disease outcome. Clinically remittent IBD patients underwent ileocolonoscopy with assessment of intestinal barrier function by endomicroscopy. Transmural healing was assessed by magnetic resonance imaging (MRI) or intestinal ultrasonography (IUS). Endoscopic and histologic disease activity were prospectively assessed along established scores. During subsequent follow-up (FU), patients were closely monitored for disease activity and major adverse outcomes (MAO): Disease flares, IBD-related hospitalization/surgery, initiation or escalation of systemic steroid, immunosuppressive or targeted advanced therapy. 80 patients (47 CD, 33 UC) were included. During a mean FU of 34 (CD) and 18 (UC) months, 72% of CD and 85% of UC patients experienced MAO. Intesinal barrier healing exhibited the highest accuracy for predicting MAO-free survival in UC and CD patients and outcompeted transmural healing for predicting the further disease course. Both, barrier healing and transmural healing showed higher diagnostic accuracy in forecasting the future course of disease when compared to endoscopic and histologic remission. Intestinal barrier healing is superior to transmural healing to prevent disease progession in clinical remittent IBD patients while both barrier and transmural healing showed superiority over endoscopic and histologic remission. Hence, barrier and transmural healing are emerging endpoints potentially refining disease monitoring and outcome prediction.
17. Genomic Analysis of IncH Plasmids Reveals Their Role as Drivers of Antimicrobial Resistance and Adaptive Traits in Enterobacterales.
期刊: FEMS microbiology letters 发表日期: 2025-Dec-26 链接: PubMed
摘要
Plasmids of the incompatibility group H (IncH) are large mobile elements that confer multidrug resistance and are prevalent in Enterobacterales from clinical and environmental sources. We analyzed 1,308 globally distributed IncH plasmid sequences to assess their genomic features and functional potential. IncH plasmids were classified into IncHI1 and IncHI2, with IncHI1 subdivided into IncHI1B and IncHI1AB based on co-occurring replication proteins. These subtypes exhibited distinct host preferences and genomic patterns. IncH plasmids carried antimicrobial resistance genes (ARGs) and other adaptive determinants at comparable frequencies across environments. They encoded multiple replication and relaxase proteins, supporting broad host range and plasmid exclusion. Core genes included the Hha regulator, involved in virulence and conjugation; a DNA (cytosine-5)-methyltransferase contributing to AT-rich content; CobS, potentially linked to metal tolerance; and the ter operon, associated with tellurium resistance and stress adaptation. Integron-associated genes such as qacEΔ1, sul1, and blaIMP promoted resistance to quaternary ammonium compounds, sulfonamides, and carbapenems. Notably, ∼60% of non-redundant IncH plasmids encoded sulfonamide, QAC, and β-lactam resistance, while over 70% harbored aminoglycoside resistance genes. These findings highlight IncH plasmids as reservoirs of clinically relevant genes and stress-response functions, reinforcing their importance for monitoring antibiotic resistance dissemination and environmental adaptability within Enterobacterales.
18. Comparative study on the acute and developmental toxicity of the Bisphenol S and F in medaka (Oryzias latipes).
期刊: Environmental toxicology and chemistry 发表日期: 2025-Dec-26 链接: PubMed
摘要
Due to the known adverse effects of bisphenol A (BPA), bisphenol F (BPF) and bisphenol S (BPS) have been widely adopted as substitutes. However, they are now detected at significant levels globally, often at levels rivaling or exceeding those of BPA, raises concerns regarding their potential ecological and health risks. Our previous work indicated that BPS exhibits lower toxicity than BPF in Chinese medaka (Oryzias sinensis). To validate this, we compared their toxicity in Japanese medaka (Oryzias latipes) using both acute and developmental exposure tests. In the 96-hr acute test, embryos exposed to concentration gradient showed a BPF median lethal concentration of 128 mg/L, while BPS exposure resulted in high survival even at the highest concentrations. Based on the observed acute toxicity, we investigated the underlying mechanism of BPF and evaluated vitamin C rescue. Vitamin C treatment effectively improved embryos survival rates. Subsequently, in the 15-day developmental exposure, 2 μg/L BPF significantly increased yolk sac edema and malformation rates. Bisphenol exposure did not show concentration-dependent malformation increases. Transcriptomic analysis revealed BPF induced more differentially expressed genes (DEGs) than BPS at the tested concentrations (0.02, 0.2, 2 μg/L): 177, 14 and 24 DEGs were identified in BPF-treated groups, respectively. In contrast, only 4, 2, and 12 DEGs were detected in the corresponding BPS-treated groups. Further analysis of the Gene Ontology and Kyoto Encyclopedia of Genes and Genomes pathways enrichments provided further insights into the potential toxicological mechanisms of BPF. This study provides a comparative toxicity assessment of BPF and BPS, elucidates BPF’s acute and developmental toxicity pathways, and offers toxicological data for risk assessment and regulation, which also provides a direction for in-depth research on toxicity mechanisms.
19. Linking Polycarbonate Plastics to Perfluorobutanesulfonate Emissions in Landfill Leachates via Suspect and Nontarget Screening of Diverse Plastic Products.
期刊: Environmental science & technology 发表日期: 2025-Dec-26 链接: PubMed
摘要
Driven by strict global regulations on legacy per- and polyfluoroalkyl substances (PFAS), short-chain alternatives such as perfluorobutanesulfonate (PFBS) are increasingly used, resulting in widespread environmental detection, notably at elevated concentrations in landfill leachates, while emission sources remain uncertain. Plastics, recognized as reservoirs of numerous chemical additives with documented but rarely investigated PFAS usage, represent a potential unidentified source. Here, 105 plastic products representing 11 types of polymers were analyzed, with 20 PFAS from 6 classes identified (confidence levels of 3 or better). Polycarbonate (PC) exhibited the highest average total PFAS concentration (713 ng/g), primarily dominated by PFBS (97%), reaching up to 6130 ng/g. PFBS, commonly co-occurred with a monohydrogen-substituted PFBS (H-PFBS), particularly enriched in PC components from electronic products, indicating intentional use as flame retardants. Consistent PFBS to H-PFBS peak area ratios observed in PC samples (∼4%) and industrial PFBS products (0.07-3%), along with patent records, suggest H-PFBS as a manufacturing impurity. Simulated leaching experiments in a realistic scenario showed rapid migration of PFBS and H-PFBS into both freshwater and seawater, achieving equilibrium releases up to 39% within 14 days. Annual PFBS emissions from PC plastics to landfill leachates in China were estimated at ∼40 kg, contributing ∼10% of the total landfill-derived PFAS flux. These findings identify that PC plastics may represent a previously underrecognized contributor to PFBS contamination in landfill leachates, emphasizing the urgent need for safer plastic additives and enhanced waste management.
20. A conserved enzymatic toolkit targeting host cell metabolism is associated with Cryptococcus neoformans intracellular survival in protozoal and mammalian phagocytic cells.
期刊: PLoS pathogens 发表日期: 2025-Dec-26 链接: PubMed
摘要
The outcome of the interaction between Cryptococcus neoformans and infected hosts can be determined by whether the fungal cell survives ingestion by phagocytic cells. This applies to both unicellular and multicellular hosts such as amoeba and animals, respectively. Ingestion by phagocytic cells results in the formation of the cryptococcal phagosome but this structure has proved difficult to isolate. In this study, we report the successful isolation of cryptococcal phagosomes from murine and human phagocytes, followed by their characterization using proteomic and transcriptional analysis. Comparison of cryptococcal proteins from Acanthamoeba castellanii, Mus musculus, and Homo sapiens phagocytes revealed the existence of a shared set suggesting a conserved fungal response to ingestion by phagocytic cells. Given that the cryptococcal intracellular pathogenic strategy is ancient, dating to at least to the cretaceous epoch, these results are consistent with the notion that the fungal response to ingestion reflects the result of selection pressures by environmental ameboid predators over eons of evolutionary time. We propose the existence of a conserved cryptococcal toolkit for intracellular survival that includes metabolic enzymes, which disrupt host cell metabolic function, thus providing a common strategy for cryptococcal survival after ingestion by phylogenetically distant phagocytic hosts.
21. Exploring Implicit Bias in Occupational Therapy: A Qualitative Study of Practitioner Awareness and Strategies for Change.
期刊: Occupational therapy in health care 发表日期: 2025-Dec-26 链接: PubMed
摘要
Implicit bias among service providers has a role in how clients receive and experience care within healthcare organizations. There is minimal inquiry related to implicit bias within occupational therapy practice. This exploratory qualitative study was designed to explore the level of awareness of implicit bias among occupational therapy practitioners (OTPs). Nine OTPs self-selected and completed an Implicit Association Test (IAT) and then participated in a individual interviews or one small focus group. Four themes emerged: (1) most understand implicit bias, moving past acknowledgement is challenging but possible; (2) talking about implicit bias is not easy; (3) tenets of cultural humility can mitigate impacts of implicit bias; (4) education and trainings should be comprehensive. Addressing implicit bias is necessary to reduce disparities in care for minoritized populations. Management of implicit bias requires multiple strategies, based on readiness for change to reduce disparities in healthcare.
22. The relationship between burnout, occupational accidents and workforce loss among resident physicians working at a university hospital.
期刊: International journal of occupational safety and ergonomics : JOSE 发表日期: 2025-Dec-26 链接: PubMed
摘要
Objectives. Burnout has been shown to be associated with the risk of occupational accidents and workforce loss, and it has been reported that the initial signs of burnout among physicians begin during medical school or during residency training. This study therefore aimed to determine the prevalence of burnout and the relationship between burnout, occupational accidents and workforce loss among resident physicians working at a university hospital in Ankara, Türkiye. Methods. The cross-sectional study was conducted among 144 resident physicians in a university hospital using a face-to-face questionnaire focusing on burnout subscales, occupational accidents and absenteeism. Results. The study proved that having an occupational accident, the number of occupational accidents, the type of occupational accidents such as sharp injuries, exposure to blood and body fluids, and experiencing trip-and-fall incidents were associated with burnout subscale scores (except personal accomplishment). No relationship was found between all other variables and burnout subscale scores. Conclusion. A relationship was identified between the occurrence of occupational accidents and the number of accidents experienced with the level of burnout. This finding suggests that interventions aimed at preventing burnout may also contribute to a reduction in occupational accidents. This provides evidence for future prospective and interventional studies.
23. Non-Pharmacological and Non-Surgical Management of Parkinson's Disease: A Systematic Review of Clinical Practice Guidelines.
期刊: Movement disorders clinical practice 发表日期: 2025-Dec-26 链接: PubMed
摘要
Non-pharmacological and non-surgical interventions from nursing and allied health professionals play an important role in management of Parkinson’s disease, but there is no clear source of evidence-based recommendations to guide these therapies. To critically appraise the content and quality of recommendations regarding non-pharmacological and non-surgical interventions from high-quality PD clinical practice guidelines (CPGs). CPGs were identified through database searches (inception to September 2025) and hand searching. Quality was assessed using validated tools (AGREE-II and AGREE-REX), and recommendations from higher-quality CPGs were mapped to the International Classification of Functioning, Disability and Health (ICF). Confidence in these recommendations was assessed using the Grading of Recommendations Assessment, Development and Evaluation Confidence in Evidence from Reviews of Qualitative Research (GRADE-CERQual) assessment. Of 29 guidelines identified, nine met the threshold for high quality and contained 114 recommendations. From the included guidelines, 40 GRADE-CERQual summary statements were developed: one with “high confidence,” 16 with “moderate confidence,” 22 with “low confidence” and one with “very low confidence.” The high confidence recommendation was related to use of augmentative technology in speech pathology, and moderate confidence in interventions related to a range of clinical domains including bladder and bowel management, nutrition, movement strategies, exercise, handwriting, dysphagia and dysphonia management. This breadth of high to moderate confidence recommendations in high quality clinical practice guidelines highlights the importance of the multidisciplinary allied health team in managing symptoms of people with PD to improve function, reduce symptom burden and improve quality of life.
24. The Impact of Theory of Mind on Real-Time Social Interactions and Momentary Social Anxiety: A Comparison Between Young Autistic and Neurotypical Children.
期刊: Autism research : official journal of the International Society for Autism Research 发表日期: 2025-Dec-26 链接: PubMed
摘要
There is a growing need to examine how Theory of Mind (ToM) abilities impact real-time social engagement in autistic children. Caregivers of 45 young autistic children (70.7 ± 23.3 months) and those of 36 neurotypical peers (59.2 ± 11.8 months) carried a mobile device for 7 days to repeatedly record their child’s social interactions and in-the-moment anxiety. They also completed the Social Responsiveness Scale-2 and the Theory of Mind Inventory-2 to evaluate their child’s severity of autistic symptoms and ToM abilities. Multilevel analyses found that young autistic children with higher ToM abilities were more likely than those with lower abilities to interact with peers (OR = 1.12, 95% CI = 1.01-1.23) but also experienced more anxiety during interactions with both peers and adults (OR = 1.36, 1.28, 95% CI = 1.12-1.67, 1.01-1.63). In contrast, no significant associations between ToM and social interactions or anxiety were found in the neurotypical group. This study highlights the critical role of ToM abilities in the real-life social engagement of autistic children and emphasizes the importance of understanding real-time subjective social experiences. This study found that autistic children with better ToM abilities were more likely to engage with their peers, but they also experienced more anxiety during interactions with both peers and adults. For neurotypical children, there was no significant link between ToM and social interactions or anxiety. These findings show that ToM challenges are a key part of ASD and have an important impact on how autistic children experience social situations. The study suggests that helping autistic children enhance their ToM skills, manage anxiety, and feel more confident in social settings can better support them in navigating everyday social interactions.
25. Exposure to Fine Particulate Air Pollution and Risk of Adverse Health Outcomes in Women and Children in Bangladesh.
期刊: Current environmental health reports 发表日期: 2025-Dec-26 链接: PubMed
摘要
Bangladesh frequently appears among the top five countries with the most polluted air. Research is essential to understand the various health impacts of air pollution in vulnerable populations. This review compiles evidence from January 2000 to May 2025 on the adverse health effects of air pollution among Bangladeshi women and children. Long-term exposure mainly from biomass fuel burning leads to various health consequences in women, especially during pregnancy. Early life exposure also results in harmful health outcomes in children. Research on the effects of air pollution exposure in Bangladesh has primarily focused on adverse pregnancy or birth outcomes, chronic respiratory diseases and hypertension. There is limited information on childhood mortality, malnutrition, developmental disorders, and noncommunicable diseases such as cancer and mental illness, and occupational exposure-related outcomes. Further research is needed to establish a causal link between air pollution exposure and health impacts and inform interventions. Policies for air pollution mitigation require strict monitoring and enforcement by the government.
26. Electrochemical oxidation degradation of polystyrene nanoplastics by Sm-Mn intermediate layer Ti/Sb-SnO2 anode: Composite metal elements enhance electron transfer and promote the generation of hydroxyl radicals.
期刊: Journal of hazardous materials 发表日期: 2025-Dec-25 链接: PubMed
摘要
As an emerging pollutant, Micro/nano plastics (M/NPs) pose a serious threat to the aquatic ecosystem and human health. Electrochemical oxidation technology has advantages such as high catalytic performance, environmental friendliness, and simple operation, and it has the potential to degrade M/NPs in water. In this work, we proposed a Ti/Sb-SnO2 anode modified by co-doping with Sm-Mn composite intermediate layer for the electrochemical oxidation degradation of polystyrene nanoplastics (PS NPs) in water. Experimental results showed that the Ti/Sm-Mn-Sb-SnO2 anode exhibited the best PS NPs removal efficiency (58.75 %) and the longest electrode lifespan (825 h). The doping of composite intermediate layer elements possessed a more uniform and dense crack structure on the anode surface, as well as the formation of a fuller crystal structure, effectively increasing the active sites and specific surface area for electrochemical process. Moreover, material characterization and theoretical calculations confirmed that the synergistic effect of the bimetal facilitates the electron transfer process between Sn and Sb, improves current mass transfer efficiency, and promotes the occurrence of redox reactions. Combined with DFT calculations and the identification of intermediate products, the degradation pathways of PS NPs were analyzed, which mainly included electrophilic substitution (benzene ring hydroxylation), C-C and C-H bond cleavage (chain breakage and ring opening), and hydrogen atom addition reactions. This modification strategy not only provides a new approach for NPs degradation through electrochemical oxidation but also offers theoretical basis and technical support for the future application of M/NPs pollution control in water environments.
27. Caring for youth who are transgender, nonbinary, and gender expansive: Why nursing care and support matters.
期刊: Nursing outlook 发表日期: 2025-Dec-24 链接: PubMed
摘要
Transgender, Nonbinary, and Gender-Expansive (TNGE) youth report experiencing greater violence, unstable housing, and mental health issues, including suicidality, depression, and anxiety compared with cisgender youth. The American Nurses Association (ANA) is not alone in its long-time advocacy for the elimination of health disparities among marginalized populations. Nurses play an important role in providing respectful, person-centered care that honors a youth’s individuality and unique needs. The purpose of this paper is a call to action for nurses to provide nonjudgmental and compassionate care and respect the decisions of TNGE youth, consistent with professional mandates. This paper provides an evidence-based overview of the current health care needs and social-emotional vulnerabilities that many TNGE youth and their families have been experiencing. This paper includes recommendations for nursing interventions and highlights implications for education, research, and advocacy for health policy. Healthcare organizations, including the ANA, American Academy of Nurses, American Association of Pediatrics, International Council of Nurses, and many other groups, have long been advocating for the elimination of health disparities among marginalized populations. Nurses need to be aware of the diverse perspectives and misinformation surrounding gender identity that may generate stigma, create barriers to compassionate and unbiased health care. To promote optimal health for TNGE youth, nurses should provide a safe, gender-affirming environment that respects the rights of TNGE youth and supports open discussions around the youth’s gender identity and associated stress.
28. Radiation dose assessment on operator during the dental postmortem procedure using handheld radiograph system.
期刊: The Journal of forensic odonto-stomatology 发表日期: 2025-Dec-24 链接: PubMed
摘要
Portable handheld radiograph devices are increasingly common in forensic odontology, particularly in postmortem dental examinations. However, concerns remain regarding radiation exposure to operators handling these devices in mortuary settings. This study aimed to assess the radiation dose to the lens of the eye and fingers of the operator that is exposed to radiation from the NOMAD™ Pro handheld Radiograph. The radiation exposure on the operator of a dental portable handheld radiograph device in the dental postmortem procedure was monitored from March 2020 to February 2021. NanoDot™ OSL Dosimeters (Landauer, IL, USA) were positioned near the eyes and fingers of the operator to estimate the radiation dose. The dosimeters were then analysed using the LAUNDER’s MicroStar reader and corrected based on the background reading and calibration parameters. Data from 80 procedures were analysed with the equivalent yearly doses for eyes and fingers were estimated and compared to the International Commission on Radiological Protection (ICRP) recommended limits. Results showed that the annual dose estimation for the lens of the eyes was 1.34 (range 0.56-6.57) mSv/yr while the fingers were 1.52 (range 0.40-5.51) mSv/yr. Radiation exposure to the fingers was slightly higher than exposure to the eyes but remained within requirements of the ICRP dose limits. In conclusion, even though portable radiograph equipment is useful in forensic odontology, operators only receive safe and low levels of radiation exposure. The continuous safe use of these devices in postmortem dental examinations is ensured by appropriate monitoring and adherence to safety procedures.
29. Systematic characterization of in vivo exposure and pharmacokinetic features of Tongmaijiangzhi capsule in humans using integrated HRMS and intelligent data processing.
期刊: Journal of chromatography. B, Analytical technologies in the biomedical and life sciences 发表日期: 2025-Dec-22 链接: PubMed
摘要
Hyperlipidemia is a major risk factor for cardiovascular diseases and fatty liver. Its incidence has increased in recent years, becoming a major public health concern that poses a serious threat to human health. Tongmaijiangzhi Capsule (TMJZC), a classical pure traditional Chinese medicine (TCM) formulation, has been widely applied in the clinical management of hyperlipidemia with confirmed efficacy and favorable safety. However, its in vivo exposure profile and pharmacokinetic characteristics in humans remain insufficiently characterized, limiting its rational clinical use. In this study, a human exposure-driven analytical strategy was employed, integrating high-resolution mass spectrometry (HRMS), untargeted intelligent data mining, and multi-component quantitative analysis to systematically elucidate the pharmacokinetic behavior and potential bioactive constituents of TMJZC in humans. Using a self-developed untargeted HRMS data-processing platform, a total of 215 TMJZC-related compounds (including 74 prototype constituents and 141 metabolites) were successfully identified in human plasma and urine. Based on human exposure abundance, quality-control components of the herbal medicine, and their circulating forms in vivo, selected seven potential active compounds for further investigation (Cryptochlorogenic acid, Chlorogenic acid, Kaempferol 3-O-β-sophoroside, Hyperoside, Nuciferine, Ginsenoside Rg1, and Notoginsenoside R1). Subsequently, a sensitive and selective multi-component quantification method was subsequently established to systematically characterize their metabolic profiles in humans. Meanwhile, sex-related differences in pharmacokinetics were observed, with the geometric mean ratios (GMRs, female/male) of Nuciferine, Ginsenoside Rg1 and Hyperoside showing substantially higher Cmax (1134.13 %, 447.65 %, 261.53 %,) and AUC0-∞ (580.47 %, 422.63 %, 290.51 %) in females, respectively. In addition, pharmacological evaluation using hyperlipidemic hepatocyte models (AML12 and HepG2 cells) demonstrated that Hyperoside, Nuciferine, Notoginsenoside R1, and Ginsenoside Rg1 significantly reduced intracellulartriglyceride accumulation. Overall, this study provides the first comprehensive human exposure and pharmacokinetic characterization of TMJZC, highlighting representative circulating constituents and sex-related metabolic differences, and offers a robust analytical basis for quality evaluation, rational clinical application, and further mechanistic studies of this traditional Chinese medicine formulation.
30. Implementation and Effectiveness Outcomes of a Pilot Comparative Effectiveness Randomized Controlled Trial Evaluating a Food Is Medicine Program Among At-Risk Pediatric Populations.
期刊: Childhood obesity (Print) 发表日期: 2025-Dec-19 链接: PubMed
摘要
Introduction: Food Is Medicine (FIM) programs have demonstrated effectiveness in improving diet quality and food insecurity. There remains a lack of evidence of their impacts in pediatric populations. This pilot comparative effectiveness randomized control trial assessed two FIM strategies on implementation and health outcomes in Medicaid-eligible children aged 5-12 years with a BMI ≥85th percentile. Methods: Participants (n = 150) were enrolled for a 32-week intervention through recruitment at two urban pediatric primary care clinics in Houston, TX. Participants were randomized 1:1:1 into three arms: (1) biweekly $25 produce vouchers + nutrition education, (2) biweekly produce home delivery + nutrition education, or (3) wait-listed control (n = 50 per arm). Implementation outcomes included retention, redemption, dosage, reach, fidelity, and acceptability. Child outcome measures included diet, food security, BMI z-scores, hemoglobin A1c, liver panels, and lipid panels. Multilevel mixed-effects regression models were used to assess the effectiveness of the intervention on outcomes. Results: On average, voucher participants redeemed $353 out of $400 (88%) of their funds, and 100% of the home delivery group received ∼18 lb (52 servings) of produce per week. Parents found the program helpful in reducing grocery costs (voucher: 95%, delivery: 76%). Compared to the control group, voucher group participants had a significant decrease in aspartate aminotransferase (-5.50, 95% confidence interval: -9.43, -1.57, p = 0.006) from baseline to post-intervention. Conclusions: This pilot study found FIM programs are both feasible and well accepted among at-risk populations, with slightly higher acceptability of the voucher model. More adequately powered studies with a stringent design are needed to test their effectiveness.
31. Comparison of Ultra-high speed 250 kHz OCTA With High speed 125 kHz Mode Using Heidelberg Spectralis SHIFT: A Paired-Eye Analysis.
期刊: Retina (Philadelphia, Pa.) 发表日期: 2025-Dec-15 链接: PubMed
摘要
Optical coherence tomography angiography (OCTA) is widely used to detect choroidal neovascularization (CNV) in retinal diseases, but acquiring high-density raster scans can prolong acquisition time and increase motion artifacts due to patient fatigue. This study evaluates whether the 250 kHz ultra-high-speed mode (3× faster than baseline) reduces scan time and motion artifacts while maintaining image quality compared to the FDA-approved 125 kHz mode. Fifty-eight eyes underwent 10°×10° fovea-centered OCTA imaging using both modes. In 38 CNV eyes, AngioTool was used to analyze vascular metrics. In 20 non-CNV eyes, superficial foveal avascular zone (FAZ) area was measured using ImageJ. Two masked retina specialists graded paired images for image quality, motion artifacts, and clinical diagnosis. Acquisition time was recorded. The 250 kHz mode reduced acquisition time by 43% (17.5 ± 9.0 s vs. 33.6 ± 20.7 s, p < 0.00001). Image quality and motion artifacts favored the 250 kHz mode. Clinical diagnosis was rated similarly across modes. Quantitative metrics, including vessel area, junctions, lacunarity, and FAZ area, showed no significant differences (all p > 0.1). This is the first intra-individual comparison of Heidelberg’s 250 kHz and 125 kHz OCTA modes. The findings demonstrate that ultra-high-speed scanning can enhance efficiency and image quality without compromising diagnostic or quantitative utility, highlighting its potential clinical impact pending FDA approval.
32. Visual estimation of vertebral marrow fat on lumbar MRI as a screening tool for osteoporosis: A retrospective study.
期刊: Journal of clinical densitometry : the official journal of the International Society for Clinical Densitometry 发表日期: 2025-Dec-11 链接: PubMed
摘要
Osteoporosis is the most common metabolic bone disease in the elderly. This study aimed to assess whether routine T1-weighted MR images can visually indicate the presence of osteoporosis by estimating vertebral bone marrow fat content. Lumbar spine MRI and DEXA scans from 320 patients (performed within a 6-month interval) were retrospectively reviewed. Two radiologists independently graded the percentage of high T1 signal within the L4 vertebral body into <50 % or ≥50 %, representing marrow fat content. Visual fat scores were compared with T-scores from DEXA scans. Inter-reader agreement was assessed using Cohen’s and Fleiss’ kappa statistics. Spearman’s correlation was used to evaluate the association between MRI grading and DEXA scores. Of the 320 patients (mean age 56.8 years; 80.3 % female), 48.4 % had osteopenia or osteoporosis. Visual MRI grading yielded 141 patients with <50 % and 179 with ≥50 % marrow fat. A weak but statistically significant correlation was observed between MRI visual fat scores and DEXA T-scores (ρ = 0.139, p = 0.013). Inter-reader agreement was moderate (Cohen’s kappa = 0.509, 95 % CI: 0.415 to 0.603). Routine T1-weighted lumbar spine MRI may serve as an opportunistic screening tool for osteoporosis. Visual estimation of vertebral marrow fat content shows potential to identify patients who may benefit from further DEXA evaluation.
33. Assessing Environmental, Nutritional, and Genetic Factors for Otitis Media-Related Hearing Loss in Rural Alaska Native Children.
期刊: Ear and hearing 发表日期: 2025-Dec-05 链接: PubMed
摘要
The majority of childhood hearing loss is from preventable ear infections, and rural regions, such as Alaska, home to Alaska Native peoples, are disproportionately affected. The underlying mechanisms for otitis media-related hearing loss are not yet well understood; however, if left untreated, hearing loss has well-known lifelong consequences. A better understanding of the link between ear infections and genetic (Carnitine Palmitoyltransferase 1A [CPT1A] Arctic variant), environmental, and nutritional factors for rural Alaska Native children is necessary to establish effective interventions for early detection and management of otitis media-related hearing loss. This prospective cohort study enrolled Alaska Native children 1 to 4 years of age across 16 communities in Northwest Alaska during the Coronavirus disease pandemic (2021 to 2022). Delays in enrollment required study design changes to maximize recruitment. Participants received an ear and hearing assessment upon enrollment, and caregivers completed questionnaires assessing nutritional and environmental factors. A comprehensive chart review from birth to 6 months following enrollment was conducted to capture ear and hearing health history. Analysis used modified Poisson regression to assess relationships between household environmental, nutritional, and genetic factors and ear- and hearing-related outcomes. An exploratory subgroup analysis was performed to evaluate potential modification of associations by CPT1A status. A total of 245 children were enrolled in the study, and 236 were included in the final analytic sample. The mean age was 3 years (interquartile range: 2 to 4), and 49.6% of enrolled children were female. The prevalence of otitis media-related hearing loss was 34.8%, and 51.3% had visits for otitis media in the first year of life. The majority (72.5%) of enrolled children were fed breastmilk, 52.3% were homozygous for CPT1A Arctic variant, 22.6% lacked access to indoor plumbing, 5.9% had exposure to wood burning smoke, and 59% had at least one person in the home who smoked. There was some evidence that children who were homozygous for CPT1A had a higher prevalence (21%) of otitis media-related hearing loss (prevalence ratio [PR] = 1.21, 95% confidence interval [CI]: 0.78 to 1.86) compared with those not homozygous for CPT1A. Children who had any breastmilk had a 43% lower relative probability (PR = 0.59, 95% CI: 0.39 to 0.90) of otitis media-related hearing loss. There was little evidence of associations between otitis media-related hearing loss and indoor plumbing (PR = 0.92, 95% CI: 0.62 to 1.36) or the number of people living in the home (PR = 1.01, 0.92 to 1.11). There was a negative association between otitis media-related hearing loss and the presence of anyone who smoked (PR = 0.77, 95% CI: 0.58 to 1.01), the number of people who smoked (PR = 0.83, 95% CI: 0.75 to 0.93), and the ratio of persons who smoke to total adults in the home (PR = 0.64, 95% CI: 0.44 to 0.93). This study attempted to characterize environmental, nutritional, and genetic factors in rural Alaska Native peoples of Northwest Alaska; however, results are inconclusive, and careful consideration for how the Coronavirus disease pandemic may have affected healthcare behavior and potentially introduced bias in the sample is prudent. There continues to be a need for prospective research to characterize factors influencing otitis media-related hearing loss so that children at the highest risk can be identified early and receive preventive care.
34. Understanding Risk Factors for Otitis Media in Rural Alaska Native Children: A Cohort Study.
期刊: Ear and hearing 发表日期: 2025-Dec-05 链接: PubMed
摘要
To characterize the relationship between risk factors and otitis media in a rural Alaska Native population ages 1 to 4 yr. This prospective cohort study was a substudy to an analysis of hearing loss determinants in Alaska Native children. This study enrolled Alaska Native children ages 1 to 4 yr from 16 communities in the Bering Strait region of northwest Alaska between October 2021 and August 2022. The aim was to characterize the relationship between environmental, genetic, and dietary risk factors and otitis media in this population, including exposure to household running water, smoke from a wood-burning stove, cigarette smoke, number of people in the household, breastfeeding, and homozygosity for the carnitine palmitoyltransferase 1 (CPT1A) arctic variant, a genetic factor in arctic populations associated with increased risk for respiratory infections. At enrollment and 6-mo follow-up, a parental questionnaire was used to assess environmental risk factors, and ear and hearing status was evaluated through audiometric screening, including tympanometry and otoscopy. A comprehensive chart review was performed to extract data from health care visits containing ICD-10 codes for otitis media. Descriptive statistics were used to summarize demographic data, and logistic regression models were used to identify associations between risk factors and otitis media incidence. There were 245 children enrolled in the study, and the final analytic sample consisted of 236 Alaska Native children ages 1 to 4 yr. The median age was 3.0 yr, and females made up 50% of the sample. Regarding heritage, 63% were Iñupiaq, 29% were Yupik, and 22% were St. Lawrence Island/Siberian Yupik. Geographically, 73% were from villages in the Norton Sound catchment area, and the remaining 27% were from the regional center of Nome. Of the children in the study, 53% were homozygous for the CPT1A arctic variant gene. Among the key risk factors identified, 72% of children had a history of being breastfed, 23% lacked household running water, and 6% were exposed to wood smoke. The mean number of people in the household was 6.2, and the mean number of people who currently smoked tobacco in the household was 1.1. The mean ratio of people who smoked tobacco to adults in the household was 0.4. During the 6-mo study period, 53% of children were diagnosed with one or more episodes of otitis media. CPT1A arctic variant homozygosity showed a trend toward a positive association with 6-mo cumulative odds of otitis media and moderating the effect of other risk factors on the odds of otitis media incidence. Otitis media is common in this population of rural Alaska Native children. CPT1A arctic variant homozygosity increased both the odds of otitis media incidence and the effect of all studied risk factors on otitis media incidence. Results should be interpreted cautiously, as the coronavirus disease 2019 pandemic negatively affected enrollment and likely affected the incidence of otitis media. Further prospective research is needed to better understand these relationships.
35. Biomarkers.
期刊: Alzheimer’s & dementia : the journal of the Alzheimer’s Association 发表日期: 2025-Dec 链接: PubMed
摘要
Plasma amyloid-beta (Abeta) reflects brain amyloid pathology, with a lower plasma Abeta42/40 ratio linked to a higher risk of Alzheimer’s disease and related dementias (ADRD). This study investigates the effect of the Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diet on the longitudinal changes in plasma Abeta 42/40 levels. MIND trial was a 3-year, two-site, randomized controlled clinical trial comparing the MIND diet with a usual diet in 604 participants aged 65 to 85 years with a family history of dementia but without cognitive impairment, being overweight and with suboptimal diets at baseline; both diets promoted weight loss through mild caloric restriction. MIND diet intervention promoted 9 brain-healthy food groups (e.g., green leafy vegetables, nuts, berries) and limited consumption of 5 unhealthy food groups (e.g., red and processed meats, fried foods). Multivariable-adjusted linear mixed-effect models with a random intercept were utilized to estimate the effect of dietary interventions on the rate of change in plasma Abeta42/40 levels during the 3-year trial period. Of 604 individuals enrolled in the trial, 598 had measured plasma levels of A 42 and 40 at the baseline and 504 (84.3%) at the end of the trial (year 3). The average (SD) age at enrollment was 70.4 (4.2) years; 388 (64.9%) were female, and 524 (87.6%) were white individuals. At the baseline, Abeta42/40 levels were similar in people randomized to the MIND diet group (mean = 0.069 pg/ml) and those in the control group (mean = 0.068 pg/ml). At year 3, Abeta42/40 levels decreased in the control group while remaining statistically unchanged in the MIND diet group. Compared to the individuals in the MIND diet group, those in the control group showed an average 2.8% decline in plasma Abeta42/40 levels (beta= -0.012; SE = 0.005; p-value=0.024) over a 3-year follow-up period. This study showed that dietary intervention influences longitudinal changes in plasma Abeta 42/40 levels. Compared to the MIND diet group, individuals in the control group showed a modest decline in plasma Abeta 42/40 levels, suggesting that the MIND diet intervention may reduce Alzheimer’s disease pathology in the brain and, potentially, the risk of ADRD.
36. Biomarkers.
期刊: Alzheimer’s & dementia : the journal of the Alzheimer’s Association 发表日期: 2025-Dec 链接: PubMed
摘要
Data sharing within international collaborations enhances research by expanding dataset diversity, improving reproducibility, and fostering cross-border knowledge exchange- leading to stronger evidence and scientific discoveries. However, little is known about AD/ADRD investigators with international collaborations and their data-sharing practices and experiences. Understanding these patterns is essential for optimizing global research and ensuring equitable participation. This study characterizes AD/ADRD researchers working with and without international collaborators and examines their data-sharing practices and experiences. A NIH-funded survey (NIH-1R01AG080093-01) collected self-reported cross-sectional data on data-sharing practices and experiences. This analysis examined whether working with international collaborators influenced data-sharing practices or experiences. Demographics, data-sharing practices, and experiences were compared between groups using Chi-squared tests (α < 0.05), with Benjamini-Hochberg correction for multiple comparisons. Of the 585 survey respondents, 193 (33%) worked with international collaborators. Gender [χ2(2) = 9.27, p = 0.009] and race/ethnicity [χ2(3) = 13.24, p = 0.004] distributions significantly differed, with men (60.6% vs. 50.3%) and White researchers (73.6% vs. 61.1%) more represented among those working with international collaborators. Researchers with international collaborations had longer research experience [χ2(3) = 35.99, p < 0.001], with more having conducted ADRD research for 20+ years (23.3% vs. 10.9%). They were more often ADRC investigators (38.9% vs. 26.4%) [χ2(1) = 8.79, p = 0.003] and more likely to analyze/generate data outside the U.S. (25.9% vs. [χ2(1) = 94.71, p < 0.001]. Additionally, they had higher publication rates, with 26.9% publishing 11+ articles vs. 10.1% [χ2(2) = 36.95, p < 0.001]. They were also more likely to make (64.1% vs. 38.6%) [χ2(1) = 32.35, p < 0.001] and receive (59.1% vs. 37.0%) [χ2(1) = 24.39, p < 0.001] formal data-sharing requests. However, researchers with international collaborators were more likely to report negative data-sharing outcomes (43.8% vs. 20.3%) [χ2(1) = 14.88, p < 0.001]. All p-values remained significant after multiple comparison correction. These findings highlight the role of international collaborations in advancing AD/ADRD research through data sharing, while revealing disparities in researcher representation. Future studies should examine mechanisms linking international collaboration with data-sharing practices and their broader impact on AD/ADRD research equity.
37. 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
Driving is essential for independence while relying on physical and cognitive abilities. Many mature drivers struggle with decisions to adjust or stop driving. Physicians in Ontario, Canada are required to report patients they believe are no longer safe to drive. Understanding driving risk is challenging, with limited tools to analyze individualized driving. This work uses a database of mature driver in-car data to investigate behaviors predictive of increased risk. The Candrive Risk Stratification tool (RST) predicts driving collision risk based on clinical measures. This project explores if naturalistic driving parameters correlate to the RST. This work provides knowledge to assist drivers in monitoring enabling proactive decisions about driving behaviour and driving retirement. Candrive dataset analysis had ethics approval from the Bruyère Health and Carleton Research Ethics boards. This dataset includes up to seven years of in-car sensor and annual health assessments for 250 drivers >70 years of age in Ottawa. This work focuses on telematics, including speed-related measures, lateral/longitudinal acceleration, and jerk (change in acceleration), to determine if they are predictive of driving risk as indicated by RST scores. Key telematics scenarios are used for left and right turns, both known to challenge mature drivers. Results are presented in Figures 1 (Left Turns) and 2 (Right Turns) in the form of Shapley plots that provide a visualization of a given measure’s predictive ability to indicate driver risk. Maximum and minimum measures of velocity show a clear indication of risk, with drivers with lowest minimum speeds having higher risk while average velocity results are inconclusive as the red (high average velocity) and blue (low) are mixed with no distinction. Low values of maximum longitudinal acceleration and minimum lateral acceleration are also related to lower risk. The work demonstrates the potential for ongoing driving assessment to provide new insights for clinicians, drivers, and families related to risk derived from actual driving. Individualized knowledge about driving risk supports proactive measures, such as retraining, to mitigate declines or to prepare for driving retirement. Data from driving provides timely knowledge to the mature driver and offers significant advantages as compared to waiting for clinical assessments.
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
Assessing care-related activities and burden most often involves self-report, without objective information on activities in the home. Previous work has demonstrated that home sensor data from daily activities can be collected over extended time periods and is acceptable, though it is unknown which activities in the home contribute to care partner burden. This project aims to develop a digital signature that identifies the level of care partner burden associated with PLWD/care partner dyads living in the community. Clinical and sensor data from longitudinal studies involving the Oregon Center for Aging & Technology platform were analyzed using machine learning (ML). Participant dyads consisted of a care partner living with an individual with mild cognitive impairment (MCI) or dementia. Care partners completed the Zarit Burden Interview Short Form (ZBI-12) weekly for up to 18 months. Data analyzed from motion sensors placed in each room in a participant’s home are presented here. Features from the sensor data (e.g., time spend in different rooms in the home, number of trips to each room) were evaluated with independent component analysis (ICA) and a decision tree ML model. SHAP values representing how much each feature contributed to the model were generated to identify the most relevant prediction of low versus high burden. Data from 44 dyads contributed to the model. Using only data from the motion sensor, the model’s accuracy was 69.8% to predict low versus high burden. ICA generated 3 components with a mix of sensor data features. SHAP value analysis identified one component that included features that more distinctly corresponded to low or high burden based on ZBI-12 scores. Features that more strongly contributed to high levels of burden included the number of trips to the bathroom and average time spend in the bathroom. Home sensors may provide a method to continuously assess daily activities that contribute to the stress level and burden of care partners. Novel ML analysis techniques could help to identify relevant outcome measures from the large amount of data collected by home sensors. Ongoing work is determining the combination of sensors from the technology platform that best predict burden level.
39. Biomarkers.
期刊: Alzheimer’s & dementia : the journal of the Alzheimer’s Association 发表日期: 2025-Dec 链接: PubMed
摘要
Amyloid beta peptide 40 and 42, tau and phosphorylation tau are the main pathological proteins in AD and have been targets for biomarker development. The ability to measure these molecules in biofluids could provide evidence of ongoing pathophysiology. Extracellular vesicles (EV) play a role in the spread of these pathological proteins, which may explain why associated biomarkers may be used to diagnose and track AD. Examining how distinct NEV biomarkers of AD such as distinct pTau species are associated with cognition as well as with each other, sex and age is essential to define their value as AD biomarkers. This longitudinal study cohort includes 30 participants with AD from University of South California that were cognitively evaluated over time with RBANS. Plasma samples from 2 timepoints 6 months apart were used in this study. We immunocaptured neuronal extracellular vesicles targeting L1CAM, NLGN3, GAp43 and measured Ab40 and 42, and Total, p181, p217 and p231-Tau. A linear mixed model was used to determine whether these EV biomarkers are associated with cognitive test scores, with and without including sex as a factor and age and education as covariates. p231-Tau was uniquely positively associated with RBANS (beta=0.035, p-value = 0.0208). When age was used as a covariate in the model, total-Tau was also positively associated (beta=0.1805p=0.0475). All pTau species were positively associated with each other, however a negative association was observed between Total Tau and p231-Tau. Our findings show evidence of distinct pattern of associations between different pTau species and cognition, suggesting some unique properties of p231-Tau in tracking disease severity in AD. This would suggest that p231-Tau, one of the earliest phosphorylation to occur in the development of AD, may be best suited for monitoring disease activity in AD and for showing response to experimental treatments. Further basic research and application in large cohorts is needed to validate and elucidate the basis of this unique feature.
40. 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
South Asian (SA) family caregivers living in the U.S. are understudied despite being a fast-growing population with a disproportionate risk of Alzheimer’s disease. The primary aim of this study was to characterize care practices, preferences, and psychological wellbeing among SA caregivers providing care to older generation family members. Given the collectivist nature of SA cultures, we expected most caregivers to live with their care partners and prefer similar, family-based care for their future. Community outreach and an Asian American caregiver registry (CARES) were used for recruitment. Participants completed questionnaires asking about caregiving practices (e.g., frequency, involvement), perspective on their personal future care (evaluated on a 1-5 scale where 1=strongly agree and 5=strongly disagree), and caregiver stress/strain (Zarit Burden Interview). Participants included 14 SA caregivers (age M = 49.5, SD = 15.5; education M = 17.1, SD = 2.3,). Seventy-one percent identified as 1st generation immigrant, 21% as 2nd generation, and 7% did not specify. Most caregivers provided care to parents/in-laws (79%). Common tasks requiring assistance were transportation (100% of caregivers surveyed) medical appointments (93%), cooking and medication management (71% for both). Seventy-one percent provided physical support, whereas 57% provided support for cognitive limitations. Regarding future care, 43% of participants want to live with their family (non-spouse) in the future, and this desire was significantly correlated with currently co-residing with their care partner (r = -.68, p = .01). Sixty-four percent indicate they would like to live alone/with spouse and 54% desire to not live in a retirement community. Mild to moderate levels of stress/strain were endorsed overall (M = 14.2, SD = 9.4), and were significantly correlated with a future care preference of living alone/with spouse (r = -.820, p < .001). In our sample, SA caregivers primarily live with the older generation family member they care for. Although less than half of the participants desire to live with family beyond their spouse in the future, currently providing in-home care increased likelihood of wanting similar care. Importantly, caregiver stress/strain strongly increased desire to live alone/with spouse. These findings suggest that caregiver wellbeing influences desires for future care, potentially resulting in perspectives that are not in-line with cultural values. As such, culturally tailored interventions are recommended to meet everyday care needs.
41. 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
The global prevalence of dementia is continually rising and is expected to double in the coming years. This demographic shift underscores the need for care facilities that prioritize the health and quality of life (QOL) of people with dementia (PWD). While the built environment (BE) significantly impacts user well-being, holistic research in this area remains scarce. This study explores the correlations between BE quality and PWD health outcomes. A validated evaluation tool was used to assess two facilities, followed by an analysis of clinical data from 20 PWD. Results revealed that residents in the higher-rated facility (S2) experienced improvements in QOL and depression compared to those in the lower-rated facility (S1). Cognitive decline, daily living activities, and fall rates decreased similarly across both facilities. These findings highlight the importance and implication of BE in health and wellbeing of PWD, with future studies aiming for larger sample sizes for robust conclusions.
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
Alzheimer’s disease (AD) and mild cognitive impairment (MCI) are leading causes of dementia in the elderly worldwide, characterized by abnormal cognition and behavior, which complicates diagnosis and treatment. Metabolites play a critical role in cellular process related to the pathogenesis of AD and MCI. However, the metabolic alterations, particularly in lipid metabolism, in AD and MCI are poorly understood. In this study, we applied a quantitative and targeted metabolomics approach to a cohort of AD patients (n = 22), MCI patients (n = 19) and cognitively normal (CN) (n = 19) using ultra-performance liquid chromatography triple quadrupole mass spectrometry to identify metabolic changes associated with AD and MCI. Compared to CN, we identified 32 differential metabolites in AD and 49 in MCI serum. Notably, differential metabolites related to AA, organic acid, FA, phosphatidylcholine (PC), sphingomyelin (SM) metabolism in AD and free fatty acid (FFA), acylcarnitine, PC, SM in MCI were strongly associated with cognitive level, memory, attention and execution function as evaluated by scales including Mini-Mental State Examination (MMSE), the Alzheimer’s Disease Assessment Scale-cognitive Section (ADAS), the Montreal Cognitive Assessment (MoCA), the Clinical Dementia Rating (CDR), the Auditory Verbal Learning Test (AVLT) and the Trail Making Test (TMT). Pathway analysis based on the differential metabolites revealed perturbation in pathways related to phospholipid metabolism, sphingolipid metabolism, amino acids (AAs) metabolism, beta oxidation of FAs, and carnitine metabolism. Using random forest (RF), support vector machine (SVM) and Boruta analysis for classification and validated by gradient boosting (GB), logistic regression (LR) and random forest diagnostic model, we identified panels of 10 metabolites in AD and 13 metabolites in MCI that effectively discriminate AD and MCI individuals from CN with high accuracy, sensitivity and specificity. In summary, this novel study combing metabolomics and lipidomics approaches and found that perturbations in serum sphignolipids, glycerophospholipids, AAs, FFA and acylcarnitines are consistently associated with pathology and progression of AD and MCI. These metabolic biomarkers provided promising molecular targets for the early diagnosis and treatment of AD and MCI.
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
The DELIGHT (Dementia Lifestyle Intervention for Getting Healthy Together) program was co-designed with people living with dementia, care partners, health/social care providers, and researchers to support the health and wellness of people living with dementia and care partners. DELIGHT is an 8-week program that includes exercise and shared learning related to healthy eating, sleep quality, social connection, mental wellbeing, and physical activity. There is a need to adapt the program to meet the needs of diverse ethno-cultural communities in Canada. We assembled a Chinese Co-adaptation Team with eight members who were part of the Chinese community, including Cantonese and Mandarin speakers with various perspectives (i.e., person living with dementia, care partners, health/social care providers) and six researchers/project manager. Meetings were held mainly via Zoom using an authentic partnership approach with an aim to tailor DELIGHT materials to ensure relevancy for the Chinese community. The team met inperson once with ten virtual meetings to co-adapt the DELIGHT materials (Table 1). For the physical activity and sleep sections, there were few content changes. However, when discussing the resources for emotional well-being and social connection, the Team shared insights regarding widely held stigma of dementia and mental health. For example, dementia directly translates into “crazy” in the Chinese language. Due to filial piety in the Chinese culture, adult children often experience caregiver burden, rather than empowering their elderly parents. The Team then suggested developing three new resources on understanding dementia and altered the language from mental to emotional well-being. For the healthy eating resources, the Team provided preferred Chinese food choices and ingredients and, under the supervision of a research team member and Registered Dietitian, a Chinese Undergraduate Research Assistant created 15 brain-healthy recipes for the Chinese DELIGHT offerings. The Team co-adapted 27 resources, created 6 new factsheets and 15 Chinese recipes. Through the co-adaption process, we recognized the value of working with and for the communities to ensure cultural sensitivity. We intend to use the lessons learned from this process to inform future co-design for other ethno-cultural groups. The dementia-related resources are available in several languages at www.dementiawellness.
44. 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
The potential associations between “social health” and cognitive frailty is less explored. An inquiry of this nature would be particularly relevant in the Indian context, where family structures and, consequently, family dynamics are continuing to evolve, and income inequalities can greatly limit or improve health outcomes. In this study, we examined the associations between social isolation, loneliness, and cognitive frailty among community-dwelling older persons in India. Moreover, we explored whether these associations vary by gender and rural-urban residence. Data are from the Longitudinal Study of Ageing in India (LASI), which included 31,464 older adults aged 60+. Social isolation was measured using indicators like marital status, social group membership, and social engagement. Loneliness was assessed using a single question on feeling alone. Cognitive frailty was defined as the co-occurrence of cognitive impairment and physical frailty. Multivariate logistic regression models were used to analyze the data, adjusting for socio-demographic, health, and lifestyle factors. Social isolation and loneliness were common, affecting 38.8 and 37.2% of participants, respectively, with higher rates among women and rural residents. Cognitive frailty was more prevalent in socially isolated and lonely individuals. The association between social isolation and cognitive frailty was stronger than the linkage between loneliness and cognitive frailty. Gender differences showed that the odds of physical frailty (AOR: 1.23; 95% CI: 1.01-1.35), cognitive impairment (AOR: 1.72; 95% CI: 1.57-1.90), and cognitive frailty (AOR: 1.50; 95% CI: 1.28-1.75) were elevated in socially isolated women. Rural residents with social isolation (AOR: 1.63; 95% CI: 1.40-1.90) and urban residents with loneliness (AOR: 1.51; 95% CI: 1.11-2.56) had significantly greater odds of cognitive frailty compared to their peers. Social isolation and loneliness are key factors linked to cognitive frailty in older Indians, with significant variations by gender and place of residence. Addressing these social challenges, especially in rural areas and among vulnerable groups, is crucial for promoting healthier aging. Future research should explore how these associations change over time and identify effective interventions.
45. Temporal analysis and factors associated with visceral leishmaniasis-HIV-AIDS coinfection in an endemic region of Brazil.
期刊: PLoS neglected tropical diseases 发表日期: 2025-Dec 链接: PubMed
摘要
The rising incidence of visceral leishmaniasis (VL) and VL/Human Immunodeficiency Virus/ Acquired Immunodeficiency Syndrome (VL-HIV/AIDS) coinfection in parts of Brazil since the early 2000s underscores the need for research to better understand the dynamics of this dual disease burden. Previous analyses from 2000 to 2015 showed increasing trends in occurrence and mortality due to VL/HIV/AIDS. This study aimed to analyze temporal trends in VL and VL/HIV/AIDS coinfection and to identify associated factors. We conducted an ecological time-series analysis combined with a cross-sectional study of all confirmed VL cases reported to the Brazilian Notifiable Diseases Information System among residents of Mato Grosso do Sul, Brazil, from 2012 to 2022, including VL-HIV/AIDS coinfections. Temporal trends were evaluated using Joinpoint regression with inflection points identified by the Monte Carlo permutation test. Annual Percentage Change (APC) and Average Annual Percentage Change (AAPC) were estimated with 95% confidence intervals. For the cross-sectional component, VL cases with and without HIV were compared using the chi-square and Mann-Whitney tests. Associated factors were identified through multivariable logistic regression with stepwise selection based on the Akaike Information Criterion. Multicollinearity was assessed using the variance inflation factor, and model fit was evaluated with the Hosmer-Lemeshow test. A significance level of p ≤ 0.05 was adopted. A total of 1,525 confirmed cases of VL were studied, of which 466 (30.55%) presented coinfection. Over the study period, the temporal trend of VL remained stable, while the highest incidence of coinfection occurred in 2022, reaching 1.99 cases per 100,000 inhabitants. Older age, male sex - (adjusted odds ratio [aOR]: 1.58; 95% confidence interval [CI]: 1.19-2.11), and clinical signs such as weight loss (aOR = 2.19; 95% CI: 1.64-2.93) and cough (aOR = 1.89; 95% CI: 1.44-2.49) were significantly associated with a higher likelihood of coinfection. In contrast, symptoms such as fever (aOR=0.28; CI = 0.22-0.37), edema (OR=0.48; CI = 0.36-0.65), splenomegaly (OR=0.52; CI = 0.41-0.65), hepatomegaly (OR=0.62; CI = 0.49-0.78), jaundice (OR=0.62; CI = 0.46-0.84), and other coinfections (OR=0.71; CI = 0.54-0.92) were less frequent among coinfected individuals. Specific clinical signs and symptoms differ in frequency between coinfected and non-coinfected individuals, which may help identify clinical patterns and improve differential diagnosis strategies. Although temporal trends indicate a stationary pattern over the past 11 years, strengthened interventions are still needed to reduce the incidence of VL-HIV/AIDS coinfection and mitigate its impact in endemic regions. Our findings highlight the importance of early clinical recognition of coinfection patterns and the implementation of targeted public health strategies to mitigate the impact of VL-HIV in endemic regions.
46. 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
As a caregiver, EDI advocate, Alzheimer Society Director, and researcher: I am uniquely positioned to participate in this session and ensuring that the voices of patients, care partners, and equity-seeking communities are heard. As the Director of Health Equity and Access for the Alzheimer Society of Ontario, I have designed, led, and supported the development of health equity initiatives to support our provincial federation of 26 local Alzheimer’s societies. I provide strategic support and advice on health equity programs; develop and implement Knowledge Translation and Exchange products and community engagement strategies; and collect data and conduct research. I have built strong, collaborative relationships with community partners across the province. I sit on the Board of Directors for the Black Health Alliance, a non-profit that supports, advocates, and develops programs to enhance and protect the health status of Black Canadians. I am a PhD scholar at York University in Health Policy & Equity and have sizeable experience and training in health policy research, especially dementia care through the perspective of people with lived experience and/or from marginalised communities. I received the Doctoral Personnel Award for Black Scholars from the Heart and Stroke Foundation of Ontario as recognition for my work including national and international articles and presentations on dementia, diversity, and community engagement. I regularly conduct media presentations, and public speaking engagements in various equity deserving communities, discussing dementia from a community centered lens, helping to destigmatize the disease and build health literacy and resilience. As the primary guardian for my father for over 17 years, I have been heavily involved with the entire dementia journey: first identification, early diagnosis, and accessing supports and health services. My experience as a caregiver and advocate has given me insight into how care is delivered, and received (from a cultural perspective), and where opportunities for growth and change exist. By leveraging these experiences, I am able to participate and fulsomely contribute to discussions on dementia, research inclusivity, caregiving, and systems level responses to the needs of people living with dementia and their care partners.
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
African Americans are underrepresented in aging research. Few studies have assessed methods for recruiting older African Americans into clinical trials. The Reducing African Americans’ Alzheimer’s Disease Risk Through Exercise (RAATE) study is a year-long, randomized controlled trial that exclusively enrolled sedentary, cognitively healthy older African Americans and provides an opportunity to assess the effectiveness of various recruitment methods. Community-based strategies which included attending community events, churches, health fairs, and strategic placement of flyers were implemented by a designated recruiter. The academic institution implemented media-based strategies including listserv emails, emails to past participants, social media, postcard mailouts, and advertisements on the institutional website, TV, and newspaper. Recruitment occurred from September 2019 - November 2024, with a year-long pause due to the COVID pandemic. There were 608 older African American adults who screened for the study and 129 were enrolled (mean age 68 +/- 5 years; 76% female; 34% with income < $50k/year; 45% married). The recruitment strategies that resulted in the greatest number of screeners included email (25.2%), friend/family (11.5%), community event (10.7%), past participant (10.2%), and social media (9.0%). The recruitment strategies that resulted in the greatest number of screeners included email (28.0%), family/friend (15.5%), social media (11.7%), past participant (7.8%), and community event (7.0%). Media-based methods which are largely electronic, including email, social media, and contacting past participants, accounted for 44.3% and 47.4% of screeners and enrollees, respectively. Community based efforts, including community events, church, and health fairs were responsible for 27.5% of screeners and 16.4% of enrolled participants. The participant’s high education level or the increased reach of electronic media into older populations may have contributed to the effectiveness of these methods. Community-based efforts have historically been the most effective means of recruiting this population. It is believed that the pandemic limited the effectiveness of these efforts. These data suggest that a variety of strategies are important for recruiting an underrepresented group into a year-long non-pharmacological clinical trial.
48. 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
Cognitive Reserve (CR) is the brain’s inherent capacity to withstand neurological changes and maintain cognitive functionality despite pathological or age related changes. It also provides valuable insight into one’s resilience to Alzheimer’s disease pathology. Epidemiological research indicates, attainment of higher cognitive reserve reduces the risk of developing Alzheimer’s disease by maintaining better brain functionality. Here, we propose a novel mobile application, Cognitive Reserve Measurement, designed for comprehensive assessment, longitudinal monitoring and targeted augmentation of CR to alleviate the risk of Alzheimer’s disease. To meticulously track behaviours germane to cognitive well-being, our application employs interfaces like a home screen, journal data, and game screen to encourage user engagement and regular participation in cognition-boosting activities. The established Cognitive Reserve Index Questionnaire (CRIq) is seamlessly integrated to provide a robust quantitative evaluation. App was developed using Flutter and Dart for cross-platform functionality, the application’s backend relies on Firebase for secure and real-time storage of user data, such as journal entries and CRI scores. Ensuring data security is a top priority given the sensitive nature of cognitive health. Upon initial setup, user’s attain their baseline based score on Cognitive Reserve Index Questionnaire (CRIq) score. The Journal section prompts users daily to reflect on activities from the previous day and the Journal Data section is for tracking activities that influence cognitive health shall purposefully track user habits stimulus for CR (e.g. regular physical activity, social engagement, sleep regimen, stress management etc.) and progress over time through sophisticated data visualization. Users can also engage in brain training games designed to enhance memory and reasoning skills. Currently the app is in the testing phase with a prototype being evaluated for usability and engagement to promote cognitive resilience and support healthy aging. Aiming to address the escalating global need for effective cognitive health intervention within an increasing geriatric population, the application leverages the accessibility of mobile technology and provides a tool for precise measurement and optimization of CR. The foundational rationale for this application underscores the pivotal role of CR in preserving healthy brain functionality across lifespan, eventually preventing or delaying Alzheimer’s disease onset.
49. 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
Cognitive Reserve (CR) is the brain’s inherent capacity to withstand neurological changes and maintain cognitive functionality despite pathological or age related changes. It also provides valuable insight into one’s resilience to Alzheimer’s disease pathology. Epidemiological research indicates, attainment of higher cognitive reserve reduces the risk of developing Alzheimer’s disease by maintaining better brain functionality. Here, we propose a novel mobile application, Cognitive Reserve Measurement, designed for comprehensive assessment, longitudinal monitoring and targeted augmentation of CR to alleviate the risk of Alzheimer’s disease. To meticulously track behaviours germane to cognitive well-being, our application employs interfaces like a home screen, journal data, and game screen to encourage user engagement and regular participation in cognition-boosting activities. The established Cognitive Reserve Index Questionnaire (CRIq) is seamlessly integrated to provide a robust quantitative evaluation. App was developed using Flutter and Dart for cross-platform functionality, the application’s backend relies on Firebase for secure and real-time storage of user data, such as journal entries and CRI scores. Ensuring data security is a top priority given the sensitive nature of cognitive health. Upon initial setup, user’s attain their baseline based score on Cognitive Reserve Index Questionnaire (CRIq) score. The Journal section prompts users daily to reflect on activities from the previous day and the Journal Data section is for tracking activities that influence cognitive health shall purposefully track user habits stimulus for CR (e.g. regular physical activity, social engagement, sleep regimen, stress management etc.) and progress over time through sophisticated data visualization. Users can also engage in brain training games designed to enhance memory and reasoning skills. Currently the app is in the testing phase with a prototype being evaluated for usability and engagement to promote cognitive resilience and support healthy aging. Aiming to address the escalating global need for effective cognitive health intervention within an increasing geriatric population, the application leverages the accessibility of mobile technology and provides a tool for precise measurement and optimization of CR. The foundational rationale for this application underscores the pivotal role of CR in preserving healthy brain functionality across lifespan, eventually preventing or delaying Alzheimer’s disease onset.
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
Despite the advancement of wearable technologies, widespread adoption and implementation of these potentially transformative technologies to support aging individuals, including those with mild cognitive impairment (MCI), Alzheimer’s disease, and related dementias (ADRD), has yet to be achieved. This barrier to adoption has prevented us from fully realizing the potential transformative impact wearables could have - both in the delivery of compassionate and accessible dementia care and in improving outcomes for aging individuals. This session will share lessons learned from the Ontario Brain Institute’s journey to co-design and launch a program called CORTEX (Community-led Real-world neuroTech Experience) that empowers community groups and people with lived experience in testing, implementing, and scaling wearable technology. We will share how the initial concept for CORTEX emerged, how the program was initially co-designed with community groups and people with lived experience, and the learnings from the first pilots conducted in partnership with patient groups. Finally, we will show how the learnings informed the launch of our flagship CORTEX initiative, the Canadian Dementia Registry, which was co-created in partnership with the Alzheimer Society of Ontario. This registry allows us to (1) understand the earliest stage of the dementia journey diagnosis (including how conducting cognitive assessments in the community, on behalf of primary care practitioners fills an early detection gap), (2) test neurotechnologies in diverse populations and compare them to clinically-relevant scales (e.g., MoCA), and (3) look at how these technologies can fit into the care pathway in local communities so that we can increase access to the right clinicians and care they need and deserve.
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
At-home rehabilitation programs for people with dementia require essential components that are both person-centred and goal-directed. While several interventions have been evaluated in Australia, they often require significant resources and time to deliver. This research investigates end-user priorities for developing a cost-effective and accessible home-based dementia rehabilitation program, for people unable to participate in group settings in the Australian Capital Territory. A co-design working group was established to ensure the views of all stakeholders contributed to the intervention design, which has funding allocated for six home visits per participant. An occupational therapist and physiotherapist will design and monitor the intervention which will be delivered by an allied health assistant. Four two-hour co-design workshops were held over a period of six months. Sixteen experts were recruited, comprising three dyads, and ten healthcare professionals with a minimum of three years cumulative experience working with people with dementia. Workshops were recorded and transcribed, and iterative thematic analysis was applied. Four overarching themes and seven subthemes were identified. Themes: 1) Awareness, acceptance and access; 2) Person-centred care: Understanding unique needs, preferences, and goals, with two subthemes: a) Respect and dignity, b) Flexibility and adaptability; 3) Empowerment through community engagement & continuous support, with three subthemes: a) Building confidence & self-efficacy. b) A gateway to engaging with other services c) Preventing information overload & overwhelm; and 4) Multidisciplinary coordinated care, with two subthemes: a) creating a raft and b) ensuring robust handover processes. Engaging relevant stakeholders in the co-design process helped to identify key components deemed feasible and valuable for an at-home intervention for people with dementia. Findings demonstrate confidence from participants that the program would be feasible and valuable to people with dementia living at home. Assessing the feasibility and effectiveness of the at-home rehabilitation program is necessary to determine whether it should be implemented in the public health system in the Australian Capital Territory.
52. Malnutrition at diagnosis of acute lymphoblastic leukemia negatively affects survival in children.
期刊: Boletin medico del Hospital Infantil de Mexico 发表日期: 2025 链接: PubMed
摘要
La leucemia linfoblástica aguda (LLA) es el cáncer pediátrico más frecuente. El estatus nutricional desempeña un papel crucial y puede incrementar el riesgo de mortalidad; sin embargo, esta área ha recibido una atención insuficiente. El objetivo fue evaluar el estado nutricional mediante el Z-score del índice de masa corporal (Z-IMC) en las fases de diagnóstico, inducción y vigilancia, así como su impacto sobre las tasas de mortalidad en pacientes con LLA. Se diseñó un estudio de cohorte retrospectiva de pacientes atendidos entre 2015 y 2020, de 2 a 18 años, sin otras comorbilidades crónicas. La variable de exposición fue el estado nutricional, estimado con el Z-IMC. El desenlace primario fue la mortalidad por cualquier causa. De una muestra de 94 pacientes (sexo masculino: 65% [n = 61]; mediana de edad: 6 años [RIQ: 3.5-10]), 79 (84%) estaban vivos y 15 (16%) fallecieron durante el seguimiento. En las curvas de Kaplan-Meier observamos que los pacientes con normopeso al diagnóstico presentaron mayor probabilidad de supervivencia, mientras que el grupo con desnutrición presentó la menor supervivencia (p = 0.045). En el modelo ajustado de regresión de Cox, encontramos que los pacientes con sobrepeso/obesidad y desnutrición al diagnóstico tuvieron 4.95 veces (IC 95%: 0.20-122; p = 0.30) y 12.5 veces (IC 95%: 1.25-126; p = 0.032) mayor riesgo de mortalidad, respectivamente. El estado nutricional al momento del diagnóstico es un predictor de mortalidad en niños con LLA, lo que enfatiza la necesidad de implementar intervenciones multidisciplinarias tempranas. Acute lymphoblastic leukemia (ALL) is the most common pediatric cancer worldwide. Nutritional status plays a crucial role and may increase mortality risk; however, this area has not been completely addressed. We aimed to evaluate nutritional status using the body mass index Z-score (Z-BMI) at diagnosis, induction, and surveillance, and its impact on mortality in patients with ALL. We conducted a retrospective cohort study of patients treated between 2015 and 2020, aged 2-18 years, without other chronic comorbidities. The exposure was nutritional status, estimated with Z-BMI. The primary outcome was all-cause mortality. Among 94 patients (male: 65% [n = 61]; median age: 6 years [IQR 3.5-10]), 79 (84%) were alive and 15 (16%) died during follow-up. Kaplan-Meier curves showed that patients with normal weight at diagnosis had higher survival probability, whereas those with malnutrition had the lowest survival (p = 0.045). In an adjusted Cox regression model, patients with overweight/obesity and malnutrition at diagnosis had 4.95 times (95% CI: 0.20-122; p = 0.30) and 12.5 times (95% CI: 1.25-126; p = 0.032) higher risk of mortality, respectively. Nutritional status at diagnosis is a predictor of mortality in children with ALL, underscoring the need for early, multidisciplinary interventions.
53. Screen use and physical activity in children under 6 years old: what has changed after the COVID-19 pandemic?
期刊: Boletin medico del Hospital Infantil de Mexico 发表日期: 2025 链接: PubMed
摘要
Desde que los niños son pequeños tienen acceso a la tecnología. Debido al confinamiento en sus hogares, han modificado sus hábitos cotidianos, apropiándose de Internet como su fuente de juego, socialización y aprendizaje. Los objetivos de esta investigación son comparar los hábitos de uso de pantallas y de actividad física en niños menores de 6 años durante y después de la pandemia de COVID-19, y explorar los factores sociodemográficos de las personas cuidadoras y de los niños asociados a estos hábitos. Estudio transversal, mediante encuesta anónima en línea a tutores legales y cuidadores de niños menores de 6 años de la región del Área Metropolitana de Buenos Aires, Argentina. Las encuestas se efectuaron en dos periodos: pandemia (aislamiento social, preventivo y obligatorio, entre los meses de agosto y octubre de 2020) y pospandemia (durante los meses de agosto a octubre de 2022). Fueron respondidas 883 encuestas. Después de la pandemia disminuyó significativamente el las pantallas, y menor uso para videollamadas con familiares y para actividades escolares; por consecuencia, hubo un aumento de las horas de actividad lúdicas diarias. Los hábitos relacionados con el uso de pantallas y la actividad física están condicionados por características sociodemográficas tanto de las personas cuidadoras (sexo, lugar de residencia, cantidad de horas trabajadas e ingresos) como de los niños (edad y acceso a dispositivos con pantalla). Se observaron cambios favorables tras la pandemia de COVID-19 en los niños menores de 6 años, con una reducción en el tiempo de uso de pantallas y un aumento en el tiempo dedicado a actividad física. Sin embargo, la televisión y el smartphone permanecieron como los dispositivos más utilizados. Los hábitos de uso de pantallas y de actividad física se ven influenciados por las características sociodemográficas de las personas cuidadoras y de los niños. Since children are young, they have access to technology. Due to confinement in their homes, they have modified their daily habits, appropriating the Internet as their source of play, socialization, and learning. The objectives of this study are to compare screen use and physical activity habits in children under 6 years of age during and after the COVID-19 pandemic, and explore the sociodemographic factors of caregivers and children associated with these habits. A cross-sectional study using an anonymous online survey of legal guardians and caregivers of children under 6 years of age in the Buenos Aires Metropolitan Area, Argentina. The surveys were carried out in two periods: pandemic (social, preventive, and mandatory isolation, between the months of August and October 2020) and post-pandemic (during the months of August to October 2022). 883 surveys were completed. After the pandemic, there was a significant decrease in the use of screens, less use for video calls with family and for school activities. Consequently, there was an increase in the hours of daily recreational activity. Screen use and physical activity habits are influenced by sociodemographic characteristics of both caregivers (such as gender, place of residence, number of hours worked, and income) and children (age and access to screen devices). Favorable changes were observed after the COVID-19 pandemic in children under 6 years of age, with a reduction in screen time and an increase in time spent on physical activity. However, television and smartphones remained the most used devices. Screen time and physical activity habits are influenced by the sociodemographic characteristics of caregivers and children.
54. WeeFIM and CRIDI-TEA results in children with Down syndrome and autism spectrum disorder at the CRIT Guanajuato.
期刊: Boletin medico del Hospital Infantil de Mexico 发表日期: 2025 链接: PubMed
摘要
El síndrome de Down (SD) puede coexistir con el trastorno del espectro autista (TEA), complicando el diagnóstico y tratamiento. Entre el 16 y 42% de los niños con SD cumplen criterios para TEA, frente al 1.7% en la población general. La detección oportuna de esta comorbilidad es crucial para implementar intervenciones tempranas que favorezcan el desarrollo funcional. Este estudio tuvo como objetivo analizar la relación entre los puntajes de las escalas WeeFIM y CRIDI-TEA en pacientes con diagnóstico dual atendidos en el Centro de Rehabilitación Infantil Teletón (CRIT) Guanajuato. Estudio observacional y prolectivo en pacientes con SD registrados en CRIT Guanajuato. Se aplicó la prueba de tamizaje VEANME y, en quienes superaron el punto de corte, se utilizó CRIDI-TEA para confirmación diagnóstica. La funcionalidad se evaluó mediante WeeFIM. Se empleó estadística descriptiva y prueba exacta de Fisher para el análisis. De 42 pacientes, 22 fueron evaluados con CRIDI-TEA; el 90% resultó positivo, equivalente al 47.6% del total. No se encontró asociación estadísticamente significativa entre VEANME y CRIDI-TEA. Los niños con diagnóstico dual mostraron mayores niveles de dependencia en movilidad, cognición y autocuidado. Asimismo, se observó una reducción en conductas TEA con el tiempo. La alta prevalencia de TEA en niños con SD justifica el uso sistemático de tamizaje. La coexistencia de ambas condiciones tiene un efecto negativo en la funcionalidad, por lo que se requiere un abordaje rehabilitador integral y personalizado. Down syndrome (DS) may coexist with autism spectrum disorder (ASD), creating complex diagnostic and therapeutic challenges. It is estimated that 16-42% of children with DS meet diagnostic criteria for ASD, compared to a 1.7% prevalence in the general pediatric population. Early AD detection in this group is essential to initiate timely interventions that promote functional development. This study aimed to describe and analyze the relationship between WeeFIM and CRIDI-ASD scores in children with a dual diagnosis of DS and ASD treated at CRIT Guanajuato. An observational, protective study was conducted on patients with DS registered in the CRIT Guanajuato database. The VEANME screening tool was used to detect potential ASD traits; those exceeding the established cut-off were subsequently assessed with the CRIDI-ASD diagnostic tool. Functional status was evaluated using the WeeFIM scale. Data were compiled in Excel and analyzed using descriptive statistics and Fisher’s exact test. Of the 42 children with DS, 22 exceeded the VEANME cut-off and were assessed with CRIDI-ASD, with 90% testing positive, representing 47.6% of the total sample. No statistically significant association was found between VEANME and CRIDI-ASD, likely due to the absence of diagnostic confirmation in those with negative screening. Children with dual diagnoses showed higher dependency in mobility, cognition, and self-care domains. Behavioral improvements over time were also observed. The high prevalence of ASD in children with DS supports systematic screening. Co-occurrence of both conditions significantly impacts functionality, highlighting the need for comprehensive, individualized rehabilitative approaches.
55. Visualization and emerging topics in the global scientific production on neonatal abstinence syndrome: a bibliometric approach.
期刊: Boletin medico del Hospital Infantil de Mexico 发表日期: 2025 链接: PubMed
摘要
El síndrome de abstinencia neonatal (SAN) afecta a los recién nacidos expuestos a opioides o sustancias adictivas durante la gestación. Esta afección ha mostrado un incremento en las últimas décadas, especialmente en países de altos ingresos. El objetivo de este estudio fue identificar las características bibliométricas y visualizar los temas emergentes en la producción científica global sobre el SAN. Se realizó un análisis bibliométrico de documentos recuperados de la base de datos SCOPUS entre 1994 y 2023. Se empleó una estrategia de búsqueda con términos del Medical Subject Headings (MeSH), Emtree y términos libres. Se analizaron el crecimiento anual, las redes de colaboración, las palabras clave más frecuentes y los artículos más citados. Se captaron 1,455 documentos, con un crecimiento anual del 9.57% y un coeficiente de determinación de 0.89. El 37.59% de los estudios se encuentran en acceso abierto. EE.UU. lideró la producción científica con un 52.4% de los documentos, seguido de Canadá (4.9%) y Australia (3.9%). Las palabras clave más frecuentes después de 2020 fueron “sleep”, “neonatal opioid withdrawal syndrome” y “neurodevelopment”. La producción científica sobre el SAN ha aumentado considerablemente en las últimas décadas, con preponderancia de estudios en EE.UU. y Canadá. Los futuros estudios deberían enfocarse en el diagnóstico, tratamiento y la carga de incidencia y prevalencia en países de ingresos bajos y medianos. Neonatal abstinence syndrome (NAS) is a condition that affects newborns exposed to opioids or addictive substances during gestation. The prevalence of this condition has increased significantly in recent decades, particularly in high-income countries. This study aimed to identify the bibliometric characteristics and visualize emerging topics in the global scientific production on NAS. A bibliometric analysis was conducted using documents retrieved from the SCOPUS database between 1994 and 2023. The search strategy incorporated terms from Medical Subject Headings (MeSH), Emtree, and free-text keywords. Annual growth, collaboration networks, the most frequent keywords, and the most cited articles were analyzed. A total of 1,455 documents were retrieved, with an annual growth rate of 9.57% and a coefficient of determination of 0.89. Open-access publications accounted for 37.59% of the studies. The United States led the scientific production with 52.4% of the documents, followed by Canada (4.9%) and Australia (3.9%). The most frequent keywords after 2020 were “sleep,” “neonatal opioid withdrawal syndrome,” and “neurodevelopment.” Scientific production on NAS has increased substantially over the past decades, with a predominance of studies conducted in the United States and Canada. Future research should focus on the diagnosis, treatment, and burden of incidence and prevalence in low- and middle-income countries.
56. Multisystem inflammatory syndrome in children treated at a hospital in Yucatan.
期刊: Gaceta medica de Mexico 发表日期: 2025 链接: PubMed
摘要
Multisystem inflammatory syndrome in children (MIS-C) has not been described in southeastern Mexico. To report the clinical and epidemiological aspects of MIS-C in a private hospital in Mérida, Yucatán. Retrospective, descriptive, consecutive case series study in children under 18 years of age, treated from January 2021 to March 2024. Patients diagnosed with MIS-C were selected. Patients underwent PCR testing, serological testing, or had known exposure to a family member with COVID-19. Descriptive statistics were analyzed with the X2 test. Seventy patients were included: 59 (84%) were hospitalized and 11 (16%) were followed up in the outpatient clinic, all with a diagnosis of MIS-C, median age 48 months (4-192), 44 (74.58%) were < 5 years old (p < 0.001) and predominance of males with 36 (61%). Of the hospitalized cases, 40 (67.79%) had the MIS-C phenotype and 19 (32.2%) had Kawasaki disease and MIS-C. MIS-C predominated in those aged ≤ 60 months. Gastrointestinal symptoms predominated in 68.5% of cases, and cardiovascular symptoms in 68.5%. There were 6 cases with coronary aneurysms (8.5%). Cases were most frequent in those aged < 5 years, with gastrointestinal and cardiovascular symptoms predominating. The presence of coronary aneurysms was low. El síndrome inflamatorio multisistémico en niños (MIS-C) no ha sido descrito en el sureste de México. Reportar los aspectos clínicos y epidemiológicos del MIS-C en un hospital privado en Mérida, Yucatán. Estudio retrospectivo, descriptivo, de una serie de casos consecutivos en menores de 18 años, atendidos de enero de 2021 a marzo de 2024. Se seleccionaron pacientes con diagnóstico de MIS-C. A los pacientes se les realizó prueba de PCR, prueba serológica o se conoció su exposición a un familiar con COVID-19. Se realizó análisis con estadística descriptiva; prueba de X2. Se incluyeron 70 pacientes: 59 (84%) fueron hospitalizados y 11 (16%) seguidos en la consulta externa; todos con diagnóstico de MIS-C, mediana de edad 48 meses (4-192), 44 (74.58%) fueron < 5 años (p < 0.001) y predominio del sexo masculino con 36 (61%). En los casos hospitalizados, 40 (67.79%) tuvieron fenotipo de MIS-C y 19 (32.2%) de enfermedad de Kawasaki y MIS-C. El MIS-C predominó en ≤ 60 meses. Predominaron los síntomas gastrointestinales en el 68.5% y cardiovasculares en el 68.5%. Hubo 6 casos con aneurismas coronarios (8.5%). Los casos fueron más frecuentes en < 5 años, predominando síntomas gastrointestinales y cardiovasculares. La presencia de aneurismas coronarios fue baja.
57. Risk factors for invasive candidiasis in the neonatal intensive and intermediate care unit: a case-control study at a referral center in Mexico City.
期刊: Gaceta medica de Mexico 发表日期: 2025 链接: PubMed
摘要
Invasive candidiasis is a high-impact pathology in the neonatal intensive care unit (NICU). To evaluate risk factors for invasive candidiasis in a referral center in Mexico City. Observational case control study. Neonates diagnosed with invasive candidiasis were included, matched 1:3 with controls hospitalized in the NICU of the National Institute of Perinatology in Mexico City between 2011 and 2021. Risk factors for invasive candidiasis were explored using logistic regression. Among 2640 patients hospitalized in the NICU, we identified 51 cases of invasive candidiasis, with a prevalence of 1.95% (95% CI: 1.44-2.53). Invasive candidiasis cases were premature with low birth weight and higher exposure to antimicrobials compared to controls (n = 153). The most frequently isolated pathogens of invasive candidiasis were Candida albicans (62.7%), Candida parapsilosis (25.5%) and Nakaseomyces glabratus (5.9%). In multivariate analysis, gestational age at birth < 28 weeks (OR, 2.79; 95% CI: 1.05-7.43) and use of three or more antimicrobials prior to blood culture positivity (OR, 2.83; 95% CI: 1.22-6.59) were identified as risk factors for the development of invasive candidiasis compared to controls. Prematurity and higher exposure to multiple antimicrobial regimens increased the risk of invasive candidiasis in the NICU. La candidiasis invasiva es una patología de alto impacto en la unidad de cuidados intensivos neonatales (UCIN). Determinar los factores de riesgo de candidiasis invasiva en un centro de referencia en la Ciudad de México. Estudio observacional de casos y controles. Se incluyeron neonatos con diagnóstico de candidiasis invasiva, pareados 1:3 con controles hospitalizados en la UCIN del Instituto Nacional de Perinatología entre 2011 y 2021. Se exploraron factores de riesgo para candidiasis invasiva mediante regresión logística. En 2640 pacientes hospitalizados en la UCIN identificamos 51 casos de candidiasis invasiva, con una prevalencia del 1.95% (IC95%: 1.44-2.53). Los casos de candidiasis invasiva correspondieron a prematuros con bajo peso al nacer y mayor exposición a antimicrobianos en comparación con los controles (n = 153). Los patógenos de candidiasis invasiva aislados con mayor frecuencia fueron Candida albicans (62.7%), Candida parapsilosis (25.5%) y Nakaseomyces glabratus (5.9%). En el análisis multivariable se identificó la edad gestacional al nacimiento < 28 semanas (OR, 2.79; IC95%: 1.05-7.43) y el uso de tres o más antimicrobianos previo a la positividad por hemocultivo (OR, 2.83; IC95%: 1.22-6.59) como factores de riesgo para candidiasis invasiva. Ser prematuro y una mayor exposición a esquemas de antimicrobianos múltiples aumentan el riesgo de candidiasis invasiva en la UCIN.
58. Sex hormones, obstetric and gynecologic characteristics of multiple sclerosis women with and without relapse.
期刊: Gaceta medica de Mexico 发表日期: 2025 链接: PubMed
摘要
Several studies show evidence of the relationship between sex hormone (SH) levels and Multiple Sclerosis (MS). To describe serum SH levels and gynecological and obstetric characteristics of women with MS in remission and relapse. This was a cross-sectional study. Gynecological, obstetric, clinical and laboratory measurements were analyzed. Serum determinations included 17b-estradiol, progesterone, luteinizing hormone, follicle-stimulating hormone, testosterone, and dehydroepiandrosterone. Eighty-nine patients were studied, with a mean age of 35.33 ± 9.5 and a mean age of 12.7 ± 1.7 menarche. 65.2% reported regular menstrual cycles (MC), 25.9% reported irregular MC, and 11 postmenopausal patients. Twenty-six patients experienced one or more miscarriages, 37 patients were nulligravidae, and in those who reported pregnancies, the median was two. Thirty-six patients were evaluated during a relapse; 22 of these patients had regular MC, and 59.1% of relapses occurred during the follicular phase. There was no difference in serum HS levels when compared between relapsed and non-relapsed groups. There is a high frequency of irregular MCs and abortions in this sample of women with MS. In patients with regular BC, relapses occurred most frequently during the follicular phase. Diversos estudios muestran evidencia de la relación entre los niveles de hormonas sexuales (HS) y la Esclerosis Múltiple (EM). Describir los niveles séricos de HS y las características gineco-obstétricas de mujeres con EM en remisión y en recaída. Estudio transversal. Se analizaron evaluaciones ginecológicas, obstétricas, clínicas y mediciones de laboratorio. Las determinaciones séricas incluyeron 17b-estradiol, progesterona, hormona luteinizante, hormona folículo estimulante, testosterona y dehidroepiandrosterona. Se estudiaron 89 pacientes, con edad media de 35.33 ± 9.5 y 12.7 ± 1.7 de edad media de menarca. El 65.2% reporto ciclos menstruales (CM) regulares, 25.9% reportaron CM irregulares y 11 pacientes eran postmenopáusicas. Veintiséis pacientes experimentaros uno o más abortos, 37 pacientes fueron nuligravidas; y en quienes reportaron embarazos la mediana fue de dos. Treinta y seis pacientes fueron evaluadas durante una recaída; 22 de estas pacientes tenían CM regulares y 59.1% de las recaídas ocurrieron durante la fase folicular. No hubo diferencias en los niveles séricos de las HS cuando se compararon entre grupos con y sin recaída. Existe una alta frecuencia de CM irregulares y abortos en esta muestra de mujeres con EM. En pacientes con CM regulares, las recaídas ocurrieron con mayor frecuencia durante la fase folicular.
59. Implementation of neural networks for predicting metabolic syndrome: a multinational data study.
期刊: Gaceta medica de Mexico 发表日期: 2025 链接: PubMed
摘要
Metabolic syndrome (MS) is composed of abnormalities such as central obesity, insulin resistance, hypertension and dyslipidemia. To implement a neural network to predict MS from cholesterol, triglycerides, high density lipoproteins (HDL), obesity and hypertension. Analytical and cross-sectional study with 1878 patients from databases in Venezuela, Thailand and Indonesia. Variables such as MS, hypertension, obesity, HDL, triglycerides and total cholesterol were included. Multilayer perceptron neural networks were used, evaluated with classification tables, area under the curve (AUC) and performance metrics (sensitivity, specificity, positive and negative predictive values). The neural network showed a high capacity to predict MS, with a low percentage of incorrect predictions both in the training set (15.80%) and in the test set (18.20%). In training, the overall accuracy was 84.20%, with higher accuracy for cases without MS (88.30%) than for cases with MS (77.80%). In testing, the overall accuracy was 81.80%, also with higher accuracy for cases without MS (86.60%) than for cases with MS (74.80%). The AUC was 0.911, indicating an outstanding predictive capacity. Regarding the model performance, the sensitivity was 81.25% in training and 79.26% in testing, while the specificity reached 85.92% and 83.33%, respectively. The positive predictive value was 77.80% in training and 74.78% in testing, and the negative predictive value was 88.30% and 86.57%, respectively. The multilayer perceptron neural network is an effective tool to predict MS, showing an outstanding predictive capacity. El síndrome metabólico (SM) está constituido por anomalías como la obesidad central, la resistencia a la insulina, la hipertensión y la dislipidemia. Implementar una red neuronal para predecir el SM a partir del colesterol, los triglicéridos, el colesterol unido a lipoproteínas de alta densidad (HDL), la obesidad y la hipertensión. Estudio analítico y transversal con 1878 pacientes de bases de datos de Venezuela, Tailandia e Indonesia. Se incluyeron las variables SM, hipertensión, obesidad, HDL, triglicéridos y colesterol total. Se usaron redes neuronales tipo perceptrón multicapa, evaluadas con tablas de clasificación, área bajo la curva (AUC) y métricas de desempeño (sensibilidad, especificidad y valores predictivos positivo y negativo). La red neuronal mostró una alta capacidad para predecir el SM, con un bajo porcentaje de pronósticos incorrectos tanto en el conjunto de entrenamiento (15.80%) como en el de prueba (18.20%). En el entrenamiento, la precisión global fue del 84.20%, con mayor precisión para casos sin SM (88.30%) que para casos con SM (77.80%). En las pruebas, la precisión global fue del 81.80%, también con mayor precisión para casos sin SM (86.60%) que con SM (74.80%). El AUC fue 0.911, indicando una capacidad predictiva sobresaliente. Respecto al desempeño del modelo, la sensibilidad fue del 81.25% en el entrenamiento y del 79.26% en la prueba, mientras que la especificidad alcanzó el 85.92% y el 83.33%, respectivamente. El valor predictivo positivo fue del 77.80% en entrenamiento y del 74.78% en prueba, y el valor predictivo negativo del 88.30% y el 86.57%, respectivamente. La red neuronal tipo perceptrón multicapa es una herramienta eficaz para predecir el SM, mostrando una capacidad predictiva sobresaliente.
60. A protocol for development of a microsimulation model platform to evaluate the potential benefits, harms, and cost-effectiveness of risk-tailored melanoma screening.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
In populations of European descent, melanoma is a high burden cancer in terms of incidence and healthcare costs, with early detection linked to better prognosis. There is no organised population screening program for melanoma in most countries, as more information is required about the potential benefits, harms and costs of population-based screening to develop policy. To assess the cost-effectiveness of a potential risk-tailored organised melanoma screening program in Australia, we have developed a protocol for a comprehensive microsimulation model (Policy1-Melanoma) that can evaluate multiple potential screening strategies. We outline the development of Policy1-Melanoma, a natural history model developed to be flexibly used to evaluate a range of scenarios related to melanoma screening, diagnosis, surveillance and management. We specify the types of data sources used for calibration and validation of Policy1-Melanoma, and the steps in this process.
61. Beyond the prescription: Global observations on the social implications of GLP-1 receptor agonists for weight loss.
期刊: PLOS global public health 发表日期: 2025 链接: PubMed
摘要
Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are transforming medicine globally. Given the efficacy and the demand for these drugs for weight loss, significant and complex social implications will follow. Drawing on our current qualitative studies with users in Brazil, Denmark, Japan, the United States, and online communities, alongside our pre-GLP-1RA studies in ten additional countries, we identify nine emerging global trends. These include the profound sense of “normality” users describe after weight loss, demand driven by pervasive weight anxiety, and the willingness of many to endure significant side effects, costs, and sacrifices to maintain access. We also observe extensive medication tinkering, unregulated sourcing, changing dynamics in clinical consultations, entwinement with disordered eating, gendered patterns in use and outcomes, and the central role of social media in shaping beliefs and practices. Rather than reducing weight stigma, these drugs may intensify social judgments and inequalities. GLP-1RAs are thus not only biomedical innovations but also social technologies that reshape bodies, identities, and health systems. Anticipating their global impact requires integrating social science with health research and policy.
62. Extent and causes of the collapse in the registration of innovative medications in Lebanon: A mixed-methods analysis.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
Delays in innovative drug registration across countries, or the “drug approval lag”, can cause inequities in treatment access, thereby worsening patient outcomes. Registration delays hinder the first step in making treatments available, and are often linked to regulatory inefficiencies, constrained healthcare financing, and fragmented decision-making. Since late 2019, Lebanon’s health system has faced overlapping socioeconomic and political crises, yet their impact on innovative medication registration remains undocumented. This study aimed to measure this impact by comparing Lebanon’s drug approval lag before (2014-2019) and after (2020-2024) the crisis and to develop an interpretive framework exploring the rationale behind an informal policy to delay innovative medication registration. A mixed-methods approach was adopted. Innovative medications approved by the Food and Drug Administration (FDA) or the European Medicines Agency (EMA) between 2014 and 2024 were included and compared to local registration timelines in Lebanon. In-depth interviews with policymakers, industry leaders, and healthcare providers informed the interpretive framework. Findings revealed a dramatic fall in innovative medication registrations post-crisis over these two periods. The proportion of FDA-approved innovative medications registered in Lebanon dropped from 43.6% to 0% and EMA-approved medications dropped from 59.4% to 0%. Pre-crisis, average registration time was under two years; post-crisis, delays are estimated to exceed four years. Our interpretive framework suggests the intermediate effects of delaying innovative medication registration are mainly to control costs and reduce reimbursement pressures on the Ministry of Public Health. However, key stakeholders believe the resulting negative consequences, such as reduced access to life-saving treatments and greater dependence on parallel market importation, outweigh the short-term benefits. Health systems are complex adaptive systems, where policies affecting innovative drug approvals may not only delay access, but also trigger unintended consequences. In Lebanon, the registration of innovative medications should remain independent from reimbursement decisions and grounded in evidence-informed health policies.
63. Impact of Chinese national centralized volume-based drug procurement policy on health costs and utilization: An interrupted time series analysis using panel data (2009-2022).
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
Chinese volume-based procurement (VBP) policy, implemented nationally in 2019, represents a cornerstone of healthcare reform aiming to reduce drug prices through centralized drug procurement. While existing studies have demonstrated the success of the VBP policy in lowering drug costs, comprehensive assessments of system-wide impacts on healthcare expenditures and service utilization remain underexplored. This study evaluates its effects on outpatient and inpatient service costs and volumes. We conducted an interrupted time series analysis using panel data (2009-2022) from the China Health Statistical Yearbook and the China Statistical Yearbook. Primary outcomes included CPI(Consumer Price Index)-adjusted per-visit outpatient(OP)/inpatient(IP) expenditures, hospital OP rates, hospital IP rates, and length of stay. Segmented regression models quantified immediate and long-term policy effects, with two-stage meta-analysis evaluating regional heterogeneity. When the VBP implementation occurred, per-visit outpatient costs (β2 = 21.400, P < 0.001) and inpatient costs (β2 = 693.749, P = 0.006) showed an instantaneous increasing trend. The post-policy long-term trend was decreasing annually by 5.702 Chinese Yuan (CNY) (P < 0.001) for per-visit outpatient costs and 270.670 CNY (P = 0.012) for per-visit inpatient costs compared to the pre-policy period. Hospital OP rates immediately decreased by 0.510 visits (P < 0.001) while hospital IP rates dropped by 3.775 percentage points (P < 0.001), with length of stay increasing by 0.522 days (P < 0.001) immediately after the policy was implemented. Hospital OP rates had a modest increasing trend (β3 = 0.069, P = 0.046). Marked regional heterogeneity was observed (I² = 64.6-88.3%), with municipalities showing the most pronounced variations. Chinese national centralized volume-based drug procurement policy has significantly reduced drug prices but initially increased non-drug costs. Regional disparities linked to aging demographics and complementary reforms (e.g., Diagnosis Related Group) shaped outcomes, while COVID-19 temporarily suppressed utilization. Future policy optimization should integrate Diagnosis Related Group payment reforms with regionally tailored strategies to balance cost containment and service quality. We recommend enhancing temporal resolution and extending observation periods to enable more precise policy evaluation.
64. Immunogenicity and safety of tetravalent dengue vaccines: a systematic review of clinical trials.
期刊: Gaceta medica de Mexico 发表日期: 2025 链接: PubMed
摘要
Tetravalent dengue vaccines have been the subject of study, particularly in the prevention of severe cases of the disease. However, the variability in results and the methodological quality of existing studies raise questions about their effectiveness. The objective is to evaluate the immunogenicity and safety of tetravalent vaccines compared to placebo in the prevention of severe dengue cases through a systematic review of randomized clinical trials. A systematic search was conducted in databases PubMed, Scopus, and Web of Science, including randomized clinical trials published between 2019 and 2024. Inclusion and exclusion criteria were applied to select relevant studies, and methodological quality was assessed using the level of evidence from the Oxford Centre for Evidence-Based Medicine (OCEBM). Six randomized clinical trials were included, with a total of 24,249 participants. The studies evaluated outcomes such as the incidence of severe dengue, seropositivity, and immune response to the vaccines TV003 and TV005. Tetravalent vaccines show a promising outlook in reducing the incidence of severe dengue, although limitations were identified in study designs and heterogeneity in the studied populations. Further research is needed to confirm efficacy and safety in diverse populations. Las vacunas tetravalentes contra el dengue han sido objeto de estudio, especialmente en la prevención de casos graves de la enfermedad. Sin embargo, la variabilidad en los resultados y la calidad metodológica de los estudios existentes plantean interrogantes sobre su efectividad. El objetivo es valuar la inmunogenicidad y la seguridad de las vacunas tetravalentes en comparación con placebo en la prevención de casos graves de dengue mediante una revisión sistemática de ensayos clínicos aleatorizados. Se realizó una búsqueda sistemática en las bases de datos PubMed, Scopus y Web of Science, incluyendo ensayos clínicos aleatorizados publicados entre 2019 y 2024. Se aplicaron criterios de inclusión y exclusión para seleccionar los estudios relevantes, y se evaluó la calidad metodológica utilizando el nivel de evidencia del Oxford Centre for Evidence Based Medicine (OCEBM). Se incluyeron seis ensayos clínicos aleatorizados, con un total de 24,249 participantes. Los estudios evaluaron desenlaces como la incidencia de dengue grave, la seropositividad y la respuesta inmunitaria a las vacunas TV003 y TV005. Las vacunas tetravalentes muestran un panorama prometedor en la reducción de la incidencia de dengue grave, aunque se identificaron limitaciones en los diseños de los estudios y heterogeneidad en las poblaciones estudiadas. Se requieren más investigaciones para confirmar la eficacia y la seguridad en diversas poblaciones.
65. Decalogue of prediabetes: recommendations for its identification and comprehensive management.
期刊: Gaceta medica de Mexico 发表日期: 2025 链接: PubMed
摘要
Prediabetes is a condition that precedes diabetes with similar damage mechanisms but different diagnostic criteria. In prediabetes, there are certain promoting factors that encourage its development and once established, they favor the progression of comorbidity, especially cardiovascular. Excessive body weight is a main risk factor, usually part of prediabetes so it is recommended to implement lifestyle changes to prevent the development of diabetes, or even get to revert to normoglycemia. This may be possible if there is an adequate identification of risk factors and screening to establish individualized modifications and avoid associated complications. Prediabetes should not be underestimated, since it is part of the diabetes spectrum, and in the long term it has repercussions on quality and life expectancy. This document proposes 10 basic guidelines to broaden the vision of this entity, identifying in which cases there is a probability of remission, related damage mechanisms, risk factors, macrovascular complications that it entails, start of screening, diagnostic criteria, recommendations for lifestyle changes, and pharmacological and non-pharmacological treatment options. La prediabetes es un estado que antecede a la diabetes con mecanismos de daño similares, pero tiene criterios diagnósticos distintos. En la prediabetes existen ciertos factores promotores que fomentan su desarrollo, y que una vez establecida favorecen la progresión de comorbilidad, especialmente cardiovascular. Un factor de riesgo principal, que suele ser parte de la prediabetes, es el exceso de peso corporal, por lo que se recomienda implementar cambios en el estilo de vida para prevenir el desenlace a diabetes, o inclusive revertir a un estado de normoglucemia. Esto es posible siempre y cuando exista una adecuada identificación de factores de riesgo y un tamizaje para establecer modificaciones individualizadas y evitar complicaciones asociadas. La prediabetes no debe ser subestimada, pues forma parte del espectro de la diabetes y a largo plazo tiene repercusiones en la calidad y la esperanza de vida. Este documento propone 10 pautas básicas para ampliar la visión de esta afección, identificando en qué casos hay probabilidad de remisión, los mecanismos de daño relacionados, los factores de riesgo a tomar en cuenta, las complicaciones macrovasculares que conlleva, el inicio de tamizaje, los criterios diagnósticos, las recomendaciones de cambios en el estilo de vida y las opciones de tratamiento farmacológico y no farmacológico.
66. Longitudinal association between self-rated health and psychological well-being in a sample of Spanish university graduates.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
Previous research has shown that psychological well-being (PWB) is associated with self-rated health (SRH) over time, but limited research has explored the reciprocal association. This study examined the longitudinal association between self-rated health and subsequent psychological well-being in a Spanish cohort. Data were collected from participants of the “Seguimiento Universidad de Navarra” (SUN) Project, a dynamic university graduate cohort study. Psychological well-being was measured using the Ryff scale. Multivariable linear regressions analyse assessed the relationships between self-rated health, measured at study’s baseline and after 4 years, and psychological well-being measured after a mean follow-up of 14.6 years. The association with Ryff’s six dimensions (self-acceptance, positive relations with others, autonomy, environmental mastery, purpose in life, and personal growth) was also assessed. A total of 2,927 participants, mean age 38.7 years (SD = 11.2) at pre-baseline, 55.5% women, were followed-up for a mean of 14.6 years (SD 0.7). Compared to participants reporting poor/fair health, those with excellent self-rated health at baseline showed substantially higher subsequent psychological well-being scores (ajusted β = 15.1, 95% CI: 11.4-20.3) and were three times more likely to have above-median psychological well-being (adjusted OR=3.0, 95% CI: 1.8-4.8). A dose-response relationship was observed across self-rated health categories, with significant associations for all PWB dimensions. Additionally, self-rated health improvements during the first 4 years were associated with higher subsequent psychological well-being scores. Self-rated health showed a direct, long-term association with subsequent PWB among Spanish university graduates, suggesting that perceived health status may be an important determinant of future PWB. However, our findings are limited by the single measurement of PWB and the use of self-reported measures. Further studies in more diverse populations are warranted to confirm these results.
67. Perceptions and practices on substandard and falsified medicines in humans and animals in Wakiso district, Uganda: A qualitative study.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
Few studies have taken a broad perspective on substandard and falsified medicines (SFMs) in community settings in Uganda. We therefore qualitatively assessed the perceptions and practices on SFMs for humans and animals in Wakiso District, Uganda. This qualitative study employed 12 focus group discussions among community health workers and farmers, as well as 11 key informant interviews among health professionals, local leaders, veterinary and human drug shop operators, and Ministry of Health and Ministry of Agriculture, Animal Industry and Fisheries officials. Data was analysed thematically using NVivo (2020). Findings are presented under four themes: definition of SFMs; identification of SFMs; drivers of SFMs; and challenges in reporting SFMs. Although participants felt that the term SFMs was too broad to define, many explained it in relation to consequences (such as side effects, disabilities, and death), and the different methods that may be employed to identify SFMs. SFMs were said to be identified through changes in appearance such as colour, texture and packaging. However, the most reported way of identifying SFMs was based on negative effects on humans and animals after use. Customer drivers of SFMs included inadequate knowledge, lack of finances, and lack of access to licensed drug shops/ pharmacies. Supplier drivers of SFMs included limited regulation and enforcement, and the business orientation of drug shops/ pharmacies. Lack of knowledge of how to report suspected cases of SFMs, lack of proof of purchase of SFMs, fear of reporting, and lack of trust in government procedures were the challenges identified to reporting SFMs. Several drivers of SFMs in the community were established related to individuals, sources of medicine, and regulatory frameworks. Increased awareness on SFMs, improved traceability of purchases and reporting, and better enforcement of regulations are needed to reduce the use and risks associated with SFMs to protect public health.
68. Incidencia y transiciones de presión arterial en trabajadores: análisis longitudinal.
期刊: Archivos de cardiologia de Mexico 发表日期: 2025 链接: PubMed
摘要
Intermediate blood pressure states, such as high-normal blood pressure and prehypertension, represent a continuous spectrum of cardiovascular risk. Their natural history in the working population has not been fully characterized. The objective of this study was to describe the transitions between different blood pressure states (normopressure, prehypertension, and hypertension) and to analyze their trajectories during a 7-year follow-up in an occupational cohort. Retrospective longitudinal study including 12,027 workers evaluated between 2013 and 2021. They were classified as normotension < 120/80 mmHg and hypertension ≥ 140/90 mmHg. Intermediate states were analyzed using two categories: prehypertension with 120-139/80-89 mmHg and high-normal blood pressure with 130-139/85-89 mmHg. Incidence rates were calculated and evolutionary trajectories were analyzed. The incidence of prehypertension was 25.80 per 1,000 person-years (95% CI: 25.05-26.55), higher than high-normal blood pressure (9.64; 95% CI: 9.25-10.03) and hypertension (9.86; 95% CI: 9.54-10.19). In the transition analysis, of the workers who started with normopressure, 60.1% progressed to prehypertension and 26.7% developed hypertension. Of those with initial prehypertension, 49.7% remained in their state and 43.8% progressed to hypertension. In the alternative classification, 21.2% progressed from normopressure to high-normal blood pressure, and of the latter, 55.9% developed hypertension. Intermediate blood pressure states show distinctive patterns of progression, with significant transition rates toward hypertension. These findings underscore the importance of strengthening occupational surveillance and developing early preventive interventions in workers with intermediate blood pressure states. Los estados intermedios de presión arterial, como la presión arterial normal-alta y la prehipertensión, representan un espectro continuo de riesgo cardiovascular. Su evolución natural en población trabajadora no ha sido completamente caracterizada. El objetivo de este estudio fue describir las transiciones entre los diferentes estados de presión arterial (normopresión, prehipertensión e hipertensión) y analizar sus trayectorias durante un seguimiento de 7 años en una cohorte ocupacional. Estudio longitudinal retrospectivo que incluyó 12,027 trabajadores evaluados entre 2013 y 2021. Se clasificó como normotensión < 120/80 mmHg y como hipertensión ≥ 140/90 mmHg. Los estados intermedios se analizaron utilizando dos clasificaciones: prehipertensión con 120-139/80-89 mmHg y presión arterial normal-alta con 130-139/85-89 mmHg. Se calcularon las tasas de incidencia y se analizaron las trayectorias evolutivas. La incidencia de prehipertensión fue de 25.80 por 1,000 personas-año (IC 95%: 25.05-26.55), mayor que la de presión arterial normal-alta (9.64; IC 95%: 9.25-10.03) y la de hipertensión (9.86; IC 95%: 9.54-10.19). En el análisis de transiciones, de los trabajadores que iniciaron con normopresión el 60.1% progresó a prehipertensión y el 26.7% desarrolló hipertensión. De aquellos con prehipertensión inicial, el 49.7% mantuvo su estado y el 43.8% progresó a hipertensión. En la clasificación alternativa, el 21.2% progresó de normopresión a presión arterial normal-alta, y de estos últimos el 55.9% desarrolló hipertensión. Los estados intermedios de presión arterial muestran patrones distintivos de progresión, con significativas tasas de transición hacia hipertensión. Estos hallazgos subrayan la importancia de fortalecer la vigilancia ocupacional y desarrollar intervenciones preventivas tempranas en trabajadores con estados intermedios de presión arterial.
69. Self-reflection, sense of agency, and underlying neural correlates: A pilot study.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
The sense of agency refers to the feeling of controlling one’s actions to influence the outside world. The association between an individual’s sense of agency and their psychological or behavioral characteristics has been extensively studied in recent years. However, the direct impact of self-reflection, a key strategy for modulating one’s cognitive state, on implicit measures of agency remains largely unexplored. We employed a between-subjects experimental design, to investigate the effect of two types of self-reflection - self-centered and selfless upon the implicit sense of agency. Additionally, we explored neural activity during self-reflection to see if there are any correlations with the sense of agency. Agency was measured using intentional time binding experiments, assessing the ability to perceive event sequences over time. Results indicated that self-centered reflection enhances time binding and agency, while selfless reflection has the opposite effect. Traditional spectral density measures and topological data analysis revealed distinct neural patterns for each type of reflection. Specifically, selfless reflection showed increased Hodge spectral entropy and persistent entropy compared to self-centered and control groups, indicating greater topological complexity in EEG time series. A significant negative correlation between second-order Hodge spectral entropy and time binding effect was observed. The study provided initial evidence that topological EEG features could serve as potential neural markers of the sense of agency modulated through self-reflection.
70. Persistence of human enteric viruses in artificial and human saliva.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
Enteric viruses, such as Adenovirus 41 (AdV41) and Coxsackievirus B3 (CVB3), are significant contributors to gastrointestinal infections, particularly among young children and immunocompromised individuals. While fecal-oral transmission is the primary route of infection, emerging evidence indicates that saliva may also function as a reservoir for these viruses, posing a potential risk for oral transmission. Previous studies have primarily focused on the decay of viruses in aqueous matrices, like wastewater and freshwater, but the persistence of these viruses in human saliva remains underexplored. This study aimed to investigate the persistence of AdV41 and CVB3 in both human and artificial saliva under various conditions, including the presence of fecal particles and specific oral bacteria. Our findings demonstrated that human saliva significantly reduced viral stability compared to artificial saliva, with marked reductions in viral titers observed within 24-48 hours. Particularly, the presence of fecal particles in both saliva types extended CVB3 viral persistence, suggesting a protective effect due to particle adsorption. However, AdV41 demonstrated an opposite trend when in the presence of fecal particles, suggesting virus-specific differences in how particulate matter influences stability. Additionally, specific oral bacteria, such as Streptococcus mutans, significantly enhanced CVB3 stability, with a mean viral recovery of 23.2% of the viral titer after 24 hours in the presence of the bacteria compared to 0.7% in their absence (p = 0.001). This study shows complex interactions between viruses, oral bacteria, and fecal particles within the oral environment, emphasizing the need for further research on oral viral persistence and transmission dynamics. Understanding these mechanisms behind viral persistence in saliva can inform public health strategies aimed at mitigating the risk of transmission.