公共卫生研究摘要 (2025-12-30)
共收录 56 篇研究文章
1. Eradicating cervical cancer in the poorest regions of the world.
期刊: Current opinion in obstetrics & gynecology 发表日期: 2026-Feb-01 链接: PubMed
摘要
Cervical cancer is the fourth most common type of cancer found in women and the most common type of gynecologic cancer globally. Despite adequate prevention through the human papillomavirus vaccine, screening methods, and treatment strategies, cervical cancer remains one of the leading causes of morbidity and mortality. There are alarming disparities and geographical variations that exist among incidence rates and mortality of women with cervical cancer around the world. The burden of this disease shows marked disproportions among incidence, mortality, and survival rates among high-income countries and low-income and middle-income countries. There are notable barriers to screening and prevention to include health literacy, education, and public awareness, societal and cultural factors, poverty and economic inequality, limited professional workforce capacity, and overall health infrastructure. These inequities emphasize a major global health concern. Globally, there is a need for international participation to help in the fight to eradicate cervical cancer. The three regions with the highest rates of cervical cancer include Southeast Asia (including India), Latin America and the Caribbean, and Sub-Saharan Africa. This review article highlights the current methods of screening and prevention within these regions to combat the rising global epidemic that is cervical cancer.
2. Risk of New Indications for Anticoagulants and Thrombolytics in People With Cognitive Impairment: Implications for Anti-Amyloid Therapy.
期刊: Neurology 发表日期: 2026-Jan-27 链接: PubMed
摘要
Anticoagulants and thrombolytics may interact with anti-amyloid monoclonal antibodies (mAbs) to increase intracranial hemorrhage risk, so expert guidance recommends against their co-prescription. We aimed to estimate how many people with mild cognitive impairment (MCI) or dementia develop a new cardiovascular indication for anticoagulant and thrombolytic drugs. In a longitudinal cohort of adults aged 65 years or older from the Health and Retirement Study (2010-2020) with linked Medicare claims and no previous indication for anticoagulants, cognition was categorized as normal, MCI, or dementia. We fit separate Fine-Gray survival models accounting for competing risk of death to estimate 1-year incidence of atrial fibrillation (AF), deep vein thrombosis (DVT), pulmonary embolism (PE), acute myocardial infarction (AMI), and stroke. Among 12,373 participants (mean age 73 years, 59% female), the 1-year risk in those with MCI was 1.7% for AF, 1.2% for DVT, 0.4% for PE, 1.2% for AMI, 2.0% for stroke, and 5.7% for any indication. In those with dementia, the 1-year risk was 1.7% for AF, 1.8% for DVT, 0.3% for PE, 1.0% for AMI, 2.4% for stroke, and 6.7% for any indication. Our findings inform shared decision making about the tradeoffs of anti-amyloid mAbs but should be validated in populations with confirmed treatment eligibility.
3. Association Between Circadian Rest-Activity Rhythms and Incident Dementia in Older Adults: The Atherosclerosis Risk in Communities Study.
期刊: Neurology 发表日期: 2026-Jan-27 链接: PubMed
摘要
Aging is associated with changes in circadian rhythms. Rest-activity rhythms (RARs) measured using accelerometers are markers of circadian rhythms. Altered circadian rhythms may be risk factors of neurocognitive outcomes; however, results are mixed, and previous studies were often conducted in homogeneous populations. We aimed to assess the association between circadian RARs and incident dementia in a racially diverse sample of older adults. This was a retrospective examination of data from the Atherosclerosis Risk in Communities (ARIC) study, a community-based cohort study conducted at 4 US centers. ARIC participants who wore the Zio XT® long-term continuous monitoring patch in 2016-17 for ≥3 days and were free of prevalent dementia were included. RARs were derived from investigational accelerometer data from the patch. Nonparametric RARs included relative amplitude (rhythm strength), intradaily variability (rhythm fragmentation), and interdaily stability (rhythm consistency). Cosinor RARs included measures of rhythm strength (amplitude, mesor) and circadian timing (acrophase). Dementia cases were adjudicated through 2020 using in-person and phone assessments, hospitalization codes, and death certifications. Cox proportional hazards models were used. Of the 2,183 participants (mean ± SD age 79 ± 4.5 years, 58% female, 24% Black), 176 (8%) developed dementia. The median follow-up time was 3 years, and the mean Zio XT Patch wear time was 12 days. After multivariable adjustment, each 1-SD decrement in relative amplitude and 1-SD increment in intradaily variability were associated with 54% (95% CI 32%-78%) and 19% (95% CI 2%-38%) greater risk of dementia, respectively. Amplitude and mesor were associated with elevated dementia risk after multivariable adjustment (hazard ratios per 1-SD decrement: 1.43 [95% CI 1.15-1.78] and 1.33 [95% CI 1.08-1.63], respectively). A later acrophase was associated with 1.45 times (95% CI 1.01-2.07) greater risk of dementia compared with a normal acrophase. Using accelerometer data from a commonly used ambulatory ECG monitor, weaker and more fragmented circadian RARs and later peak activity time were prospectively associated with elevated dementia risk in older Black and White adults. Limitations of our study include the lack of dementia subtype data and objective sleep disorder measurements. Further research to determine whether circadian rhythm interventions can reduce dementia risk is warranted.
4. Association of Plasma GFAP and NfL in Middle-Aged Adults With MRI Markers of Cerebral Small Vessel Disease Later in Life.
期刊: Neurology 发表日期: 2026-Jan-27 链接: PubMed
摘要
Cerebral small vessel disease (cSVD) is a major contributor to stroke and dementia, often beginning decades before clinical symptoms appear. While MRI markers offer critical insight into cSVD burden, blood-based biomarkers may offer a more accessible complement to neuroimaging. We investigated whether plasma glial fibrillary acidic protein (GFAP) and neurofilament light chain (NfL) are associated with MRI markers of cSVD in middle-aged adults and whether they are associated with longitudinal progression. We conducted a retrospective analysis of prospectively collected data from the UK Biobank cohort. Participants aged 40-60 years at baseline (2006-2010) with plasma biomarker measurements and follow-up MRI scans (2014-2019) were included. Individuals with prevalent neurologic conditions were excluded. We assessed 3 MRI markers of cSVD: white matter hyperintensities (WMHs), fractional anisotropy (FA), and mean diffusivity (MD). Three analytical approaches were used: associations between baseline biomarkers and future MRI markers, associations between baseline biomarkers and longitudinal MRI changes, and correlations between longitudinal biomarker and MRI changes. Robust regression models were adjusted for age, sex, and cerebrovascular risk factors. Among 5,270 participants (mean age 54.2 ± 7.8 years; 53.4% female), higher baseline GFAP levels were significantly associated with all 3 MRI cSVD markers-WMH volume (β = 0.06, 95% CI 0.01-0.10, p = 0.014), FA (β = 0.08, 95% CI 0.03-0.13, p = 0.001), and MD (β = 0.14, 95% CI 0.09-0.18, p < 0.001)-after a follow-up of 9 years. Among 1,317 participants with longitudinal MRI data, baseline GFAP was associated with progression of FA (β = 0.012, 95% CI 0.001-0.023, p = 0.033) and MD (β = 0.020, 95% CI 0.003-0.038, p = 0.025) over 3 years. NfL was not significantly associated with any MRI cSVD marker. Longitudinal changes in both biomarkers showed no significant associations with concurrent MRI progression. Plasma GFAP levels were associated with subsequent changes in white matter integrity among middle-aged adults, suggesting potential utility as an early indicator of cSVD vulnerability. These associations, observed nearly a decade after biomarker measurement, highlight GFAP’s potential for long-term risk stratification. Blood-based biomarkers may support earlier identification of individuals at heightened risk of cSVD, enabling preventive strategies when interventions may be most effective.
5. Proximal Tubule-Specific Genetic Deficiency of PPARα Worsens Systemic Lipid and Glucose Metabolism During Fasting.
期刊: FASEB journal : official publication of the Federation of American Societies for Experimental Biology 发表日期: 2026-Jan-15 链接: PubMed
摘要
The proximal tubule (PT) of the kidney is a highly metabolic organ that regulates systemic homeostasis through ketogenesis and gluconeogenesis. Peroxisome proliferator-activated receptor alpha (PPARα), a nuclear receptor controlling fatty acid oxidation (FAO) and homeostasis, is expressed in the PT and is activated by fasting. Although the activation of systemic PPARα is essential for renal and systemic energy metabolism, the role of PPARα in PT has not been established. In this study, kidney PT-specific PPARα knockout mice (Ppara∆KPT) were generated, and the metabolic changes caused by 48 h of fasting were compared between Ppara∆KPT mice and controls. In Ppara∆KPT mice, renal FAO and ketogenesis were severely impaired, leading to lipid accumulation in the kidney after 48 h of fasting. The increase in the renal expression of gluconeogenesis-associated genes due to fasting was insufficient in Ppara∆KPT mice, causing a decrease in serum glucose levels and liver glycogen content. Fasting caused hepatic micro-steatosis and significantly increased the expression of genes linked to FAO and ketogenesis in the liver of Ppara∆KPT mice, as well as those associated with lipolysis in the white adipose tissue. These activities likely compensate for the impaired kidney FAO and ketogenesis in Ppara∆KPT mice and show that PPARα in PT regulates renal and systemic lipid and glucose metabolism during fasting. PPARα in PT may be a critical component in systemic lipid and glucose homeostasis during fasting.
6. Sex and Gender Issues in Cardiovascular Disease: Introduction to a Special Issue.
期刊: Biopsychosocial science and medicine 发表日期: 2026-Jan-01 链接: PubMed
摘要
7. Exploring clinical profile and treatment outcome differences based on baseline smoking and alcohol co-use status among individuals initiating medication for opioid use disorder treatment.
期刊: The American journal on addictions 发表日期: 2026-Jan 链接: PubMed
摘要
Tobacco smoking and alcohol use disorder (AUD) are highly prevalent among individuals receiving medication for opioid use disorder (MOUD) treatment, yet their combined impact on treatment outcomes remains underexplored. This study investigates the differences in clinical profiles and treatment outcomes based on smoking and AUD status among individuals initiating MOUD. This secondary analysis utilized data from a multi-site randomized clinical trial (CTN-0027) evaluating the hepatotoxicity during 24 weeks of buprenorphine or methadone treatment. Participants were categorized into four groups based on baseline smoking and AUD status: Non-AUD/Non-smoker, Smoker Only, AUD Only, and AUD+Smoker. Clinical profiles and treatment outcomes were compared across groups. Among 973 participants (68.6% male, 70.5% White, mean age 37.5 years), 50% were Smoker Only, 16% AUD+Smoker, 8% AUD Only, and 27% Non-AUD/Non-smoker. Smoking prevalence was high (66%), while AUD prevalence was lower (24%). AUD+Smoker and AUD Only groups had significantly higher rates of additional substance use disorders (p < .01). However, treatment outcomes-measured by urinalysis results, retention, and completion-did not differ significantly across groups. Smoking and AUD status were not associated with poorer MOUD outcomes, but the high prevalence of smoking, and the clustering of additional substance use disorders among individuals with AUD suggest the need for integrated care. These findings support inclusion of adjunctive behavioral and public health interventions within MOUD programs. This study uniquely examines the joint impact of smoking and AUD on MOUD outcomes, offering insight into clinical complexity not previously explored in combination.
8. Commentary on "The Perceived Role and Contributions of Physical Therapists in Health Promotion Practices Within School-Based Settings".
期刊: Pediatric physical therapy : the official publication of the Section on Pediatrics of the American Physical Therapy Association 发表日期: 2026-Jan-01 链接: PubMed
摘要
9. Clinical Frailty Scale as a Predictor of Early Treatment Discontinuation in Elderly Patients With Chronic Lymphocytic Leukemia Treated With Zanubrutinib: A Multicenter Real-World Study.
期刊: Hematological oncology 发表日期: 2026-Jan 链接: PubMed
摘要
The management of chronic lymphocytic leukemia (CLL) in older patients requires careful balancing of therapeutic efficacy with the risks of treatment intolerance. Frailty assessment is increasingly recognized as a critical determinant of clinical outcomes, but its specific role in guiding therapy with second-generation Bruton tyrosine kinase inhibitors remains poorly defined. We conducted a prospective, multicenter investigation of 326 consecutive CLL patients aged 65 years or older who received zanubrutinib across 52 Italian centers, aiming to evaluate whether the Clinical Frailty Scale (CFS) could predict treatment discontinuation in real-world practice. The cohort was characterized by advanced age (median 78.1 years, range 65.1-94.5), with over half of the patients presenting with Binet stage C disease. Two-thirds were treated in the frontline setting, while the remainder received zanubrutinib as salvage therapy. After a median follow-up of 8 months, 48 patients (14.7%) discontinued treatment, most commonly due to toxicity or disease progression. Receiver operating characteristic curve analysis identified a CFS of 3 as the optimal threshold for predicting discontinuation, with an area under the curve of 0.65 (95% CI 0.56-0.73, p < 0.001). At 12 months, the discontinuation rate was significantly higher among patients with a CFS > 3 (29.2%) compared with those with a CFS ≤ 3 (8.8%) (p < 0.001); among conventional prognostic variables, only relapsed/refractory disease demonstrated an independent association with TTD. These findings highlight the CFS as a simple yet powerful clinical tool that provides incremental prognostic information beyond standard disease-related factors. Incorporating frailty assessment into treatment planning may enhance patient selection and optimize therapeutic strategies for elderly CLL patients in daily practice.
10. Feeling Blue and Trying Not to Lose Heart: Associations Between Mental Health and Cardiovascular Health Groups for Black Young Adult Women.
期刊: Biopsychosocial science and medicine 发表日期: 2026-Jan-01 链接: PubMed
摘要
Black women in the United States experience a high burden of incident cardiovascular (CV) disease, yet research often focuses on midlife and beyond. One psychological correlate of CV health for Black young adults is mental health. The current study fills a gap in existing CV health prevention knowledge by using an intersectional (ie, racially gendered age-specific) person-centered approach to investigate the CV health groups of Black young adult women and group differences in depression, anxiety, and stress symptoms. Data came from a non-probability sample of 482 Black young adult women (ages 18 to 35). Participants completed an online survey in which they self-reported depression, anxiety, and stress, 6 indicators of CV health, and sociodemographics using standardized measures. A latent class analysis was used to identify CV health classes and test differences in class membership by mental health symptoms. Four classes of CV health were uncovered: moderate high CV health (36.93% of the sample), healthy fiber (12.67%), healthy BMI (17.01%), and moderately healthy physical activity (33.4%). Black young adult women in the moderate high CV health class had fewer depression, anxiety, and stress symptoms compared with all other classes (P<.005). Additional differences in symptoms between suboptimal CV health classes emerged. Groups with varied combinations of CV health indicators and associations with mental health emerged. These nuances might help tailor prevention efforts for Black young adult women based on the heterogeneity in cardiovascular health groups and mental health symptoms for this population.
11. Commentary on "Exploring the Feasibility of a Vestibular/Oculomotor Caregiver-Supervised Exercise Program in Children Post Moderate-Severe Traumatic Brain Injury".
期刊: Pediatric physical therapy : the official publication of the Section on Pediatrics of the American Physical Therapy Association 发表日期: 2026-Jan-01 链接: PubMed
摘要
12. Exploring the Feasibility of a Vestibular/Oculomotor Caregiver-Supervised Exercise Program in Children Post Moderate-Severe Traumatic Brain Injury.
期刊: Pediatric physical therapy : the official publication of the Section on Pediatrics of the American Physical Therapy Association 发表日期: 2026-Jan-01 链接: PubMed
摘要
To explore the feasibility of a vestibular/oculomotor caregiver-supervised exercise program in children post moderate-severe traumatic brain injury (TBI). The study included 37 children aged 6-18 years, with a median of 42-days post moderate-severe TBI. The intervention-group participated in a vestibular/oculomotor caregiver-supervised exercise program for 8 weeks; the control-group continued with standard-care only. Feasibility was evaluated based on the number of adverse-events and practices reported, and the ability to perform assessments. Vestibular/oculomotor function was evaluated by the number abnormal tests in the Vestibular/Ocular-Motor-Screening. Balance was evaluated by the Pediatric Balance Scale and Functional-Gait-Assessment. All participants completed the tests and no adverse-events were observed during the study. However, only 6 participants in the intervention-group performed ≥80% of the recommended practice. All assessments were significantly improved (P < .05) in both groups, with no significant differences between them. Although the vestibular/oculomotor caregiver-supervised intervention program was safe, the cooperation-rate was low, indicating difficulties with feasibility.
13. Associations Between Genetic Polymorphisms and Psychological Variables in Women With Fibromyalgia: A Cross-Sectional Study.
期刊: European journal of pain (London, England) 发表日期: 2026-Jan 链接: PubMed
摘要
Fibromyalgia (FM) is a multifactorial syndrome involving chronic pain and psychological distress. Psychological traits such as anxiety, depression, and catastrophising are linked to symptom severity. Genetic variability may contribute to these dimensions through mechanisms related to pain modulation and stress response. To examine associations between selected genetic polymorphisms and psychological variables in women with FM. A cross-sectional study was conducted in 67 women diagnosed with FM. Pain intensity, FM impact and psychological variables-anxiety, depression and catastrophising-were assessed using validated questionnaires. Saliva samples were collected and 10 SNPs were genotyped (COMT rs4680, DRD3 rs6280, OPRM1 rs1799971, BDNF rs6265, MAOA rs1137070, FKBP5 rs1360780, IL6 rs1800796, TNF rs1800629, IL10 rs1800896, IFITM3 rs12252). Correlations were assessed using Pearson or Spearman coefficients, and associations were examined using ANOVA or Kruskal-Wallis with Tukey or Mann-Whitney post hoc tests. Pain intensity correlated with depression (r = 0.476, p < 0.001), catastrophising (r = 0.414, p < 0.001), and anxiety (r = 0.314, p = 0.009). Catastrophising was related to depression (r = 0.615, p < 0.001), anxiety (r = 0.453, p < 0.001), and kinesiophobia (r = 0.445, p < 0.001). BDNF rs6265 was associated with catastrophising (p = 0.044), OPRM1 rs1799971 with anxiety (p = 0.030), and MAOA rs1137070 with depression (p = 0.020). Psychological variables in FM are interrelated and linked to pain perception. BDNF, OPRM1 and MAOA polymorphisms are associated with indices of psychological vulnerability, underscoring the importance of integrating genetic and psychological perspectives to understand variability in FM. Genetic variability influences psychological vulnerability in fibromyalgia. Specific variants were associated with key psychological traits: BDNF rs6265 with pain catastrophising, OPRM1 rs1799971 with anxiety, and MAOA rs1137070 with depressive symptoms. These findings reveal an interplay between genetic and psychological factors that may guide more personalised strategies for managing fibromyalgia.
14. Management of Conflicts of Interest in Practice Guidelines: Time to Also Account for Open-Mindedness?
期刊: Annals of internal medicine 发表日期: 2025-Dec-30 链接: PubMed
摘要
15. Effectiveness and Safety of Statins in Type 2 Diabetes According to Baseline Cardiovascular Risk : A Target Trial Emulation Study.
期刊: Annals of internal medicine 发表日期: 2025-Dec-30 链接: PubMed
摘要
Whether statins benefit patients with type 2 diabetes mellitus (T2DM) with low predicted 10-year cardiovascular risk is uncertain. To evaluate the effectiveness and safety of statin initiation for primary prevention among adults with T2DM stratified by predicted 10-year risk for cardiovascular disease (CVD). Cohort study using target trial emulation. U.K. primary care using the IQVIA Medical Research Data database. Persons aged 25 to 84 years with a diagnosis of T2DM between 2005 and 2016 and no history of coronary artery disease, myocardial infarction, stroke, heart failure, myopathy, liver disease, rheumatic heart disease, schizophrenia, or cancer. Statin initiation versus noninitiation, with estimation of the observational analogues of the intention-to-treat effect. Statin initiators were propensity score-matched to noninitiators in a 1:4 ratio within 4 QRISK3 strata of 10-year predicted cardiovascular risk: low (<10%), intermediate (10% to 19%), high (20% to 29%), and very high (≥30%). Absolute risk differences (RDs) and risk ratios (RRs) at 10 years of follow-up for all-cause mortality and major CVD, as well as myopathy and liver dysfunction. Statin initiation was associated with reductions in all-cause mortality and major CVD across QRISK3 strata. In the low-risk stratum, RDs and RRs were -0.53% (95% CI, -0.90% to -0.08%) and 0.80 (95% CI, 0.67 to 0.97), respectively, for all-cause mortality and -0.83% (95% CI, -1.28% to -0.34%) and 0.78 (95% CI, 0.66 to 0.91), respectively, for major CVD. A small increased risk for myopathy was observed in the moderate-risk stratum only, and there was no associated increased risk for liver dysfunction in any stratum. Unmeasured confounding and underascertainment of some hospitalization outcomes. Statin use in T2DM for primary prevention was associated with reductions in all-cause mortality and major CVD across the full spectrum of predicted cardiovascular risk. National Natural Science Foundation of China.
16. 2025 U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice Guideline for the Primary Care Management of Chronic Kidney Disease.
期刊: Annals of internal medicine 发表日期: 2025-Dec-30 链接: PubMed
摘要
Management of chronic kidney disease (CKD) has been rapidly evolving, now involving many interventions that can be managed in the primary care setting. In April 2025, leadership within the U.S. Department of Veterans Affairs (VA) and U.S. Department of Defense (DoD) approved a joint clinical practice guideline (CPG) for the primary care management of CKD. This synopsis reviews the 2025 recommendations related to diagnosis, assessment, and management of CKD. The VA/DoD Evidence-Based Practice Work Group assembled a team to update the 2019 VA/DoD CPG for the management of CKD. Guideline development conformed to the National Academy of Medicine’s tenets for trustworthy CPGs. The work group developed 12 key questions to guide a systematic evidence review and distilled 23 recommendations using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. The work group also created algorithms and appendices to help guide clinical decision making. Funding for the development of the guideline was provided by the VA. This synopsis reviews updated recommendations for the diagnosis, assessment, and monitoring of CKD; general management strategies including team management and education; shared decision making and indications for referral to nephrology for consideration of kidney replacement therapy or conservative management; management of hypertension; pharmacotherapy to reduce the risk for major adverse cardiovascular events, progression of kidney disease, and mortality; and prevention of contrast-associated acute kidney injury. New and updated recommendations about pharmacotherapy, such as angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers, sodium-glucose cotransporter 2 inhibitors, glucagon-like peptide 1 receptor agonists, nonsteroidal mineralocorticoid receptor antagonists, and statins, are highlighted in this synopsis.
17. Stigma as a facilitator of the 2022 mpox outbreak.
期刊: Current opinion in HIV and AIDS 发表日期: 2025-Dec-30 链接: PubMed
摘要
This review aims at exploring how stigma played a role in the naming of mpox, its classification, and how anti-LGBT+ bias and systemic racism all played roles in facilitating the outbreak. The naming of mpox is in flux with recent efforts to change back to monkeypox in the United States, which could exacerbate stigma and discrimination. Anti-LGBT+ bias affected access to mpox testing, treatment, and prevention, but mpox also served as a facilitator of homophobic rhetoric. Systemic racism and colonialism both affect the global response to mpox and could further promote endemic fatalism and a lack of equitable global health mpox prevention. Stigma served as a facilitator of the 2022 mpox outbreak, which was unique from previous outbreaks due to it affecting multiple historically neglected and marginalized populations. Anti-LGBT+ stigma, systemic racism, endemic fatalism, and colonialism all played roles within this outbreak and must be addressed to prevent future outbreaks of mpox.
18. HIV-associated drug-resistant TB: expanded treatment options and emerging threats.
期刊: Current opinion in HIV and AIDS 发表日期: 2025-Dec-30 链接: PubMed
摘要
To summarize recent advances in drug-resistant tuberculosis (DR-TB) treatment for people with HIV (PWH), including drug-drug interactions, investigational medications and host-directed therapy, as well as emerging evidence on novel treatment regimens, post-TB complications, and DR-TB medication resistance among PWH. Treatment for DR-TB has evolved to shorter, all-oral regimens with reduced drug-drug interactions. However, emerging dolutegravir resistance may necessitate protease inhibitor-based ART regimens resulting in interactions that complicate DR-TB management. Investigational TB medications including BTZ-043, sutezolid, and delpazolid demonstrate promising bactericidal activity in early phase trials. Several clinical trials have demonstrated the efficacy of 6-9 month DR-TB regimens and have included PWH; however, all successful shortened regimens currently contain bedaquiline, which limits options for PWH in areas with emerging bedaquiline resistance. While treatments targeting Mycobacterium tuberculosis are the mainstay of treatment, host-directed therapy is being evaluated both as an intervention for treatment and for the prevention of immune reconstitution inflammatory syndrome and post-tuberculosis lung disease. Treatment options for DR-TB have improved dramatically with less toxic, more effective regimens, but managing HIV-associated DR-TB continues to require careful attention to drug-drug interactions and HIV related co-morbidities. Research into novel DR-TB regimens, especially for people with bedaquiline resistance, and host-directed therapies are critical to realize continued improvement in HIV-associated DR-TB outcomes.
19. Public health surveillance and outbreak preparedness for mpox.
期刊: Current opinion in HIV and AIDS 发表日期: 2025-Dec-30 链接: PubMed
摘要
The 2022 global mpox outbreak showed that surveillance systems were not ready to quickly detect or adapt to the new dynamic of human-to-human spread. While many lessons were learned, ongoing mpox outbreaks underscore the need for focused attention on enhancing mpox surveillance systems. This review presents ongoing challenges, successes, recent advances, and future considerations for seven areas related to surveillance for mpox. The development of real-time polymerase chain reaction assays has greatly improved MPXV detection, though there remain diagnostic gaps and critical needs for expanding genomic surveillance. Challenges to complete case ascertainment, data sharing, and reporting also persist. At the same time, key advances have been made regarding the integration of mpox into existing surveillance and healthcare service delivery for HIV and sexually transmitted infections; use of the One Health approach to understand the interconnectedness of human, animal, and environmental health; and application of newer innovations in surveillance efforts such as wastewater monitoring and artificial intelligence. This review highlights recent work that informs how to maintain nimble, sustainable, and coordinated surveillance systems that will not only strengthen the response to the evolving mpox outbreaks but also contribute to future pandemic preparedness initiatives.
20. Occupational Health Disparities: A Profile of Firefighters and Police Officers.
期刊: Journal of strength and conditioning research 发表日期: 2025-Dec-30 链接: PubMed
摘要
Wohlgemuth, KJ, Conner, MJ, Burnham, E, and Mota, JA. Occupational Health Disparities: A Profile of Firefighters and Police Officers. J Strength Cond Res XX(X): 000-000, 2025-Firefighters and law enforcement officers belong to a group of workers within the public safety sector in the U.S. workforce. Public safety workers have physically demanding jobs, and the effect of the specific occupation on health outcomes deserves further elucidation. The primary purpose of this study was to examine differences in demographic characteristics between police officers and firefighters. A secondary purpose was to quantify the effect of occupation on cardiopulmonary function across age. Cardiometabolic, aerobic capacity, and body composition data from yearly agency screenings were retrospectively assessed for 399 workers (firefighters, n = 200; police officers, n = 199). To quantify the influence of occupation and age on cardiopulmonary function (V̇o2peak, METs), separate linear mixed-effect models were employed. The a priori criterion for significance was set at p = 0.05. The results show that 90.5% of public safety workers were categorized as overweight or obese, and 50.4% were considered obese. Firefighters displayed better cardiopulmonary function (e.g., higher V̇o2) than police officers (+2.05, t = 4.94, p = 0.01); however, not greater than industry recommendations. The present study indicates both public safety occupations have negative impacts on cardiopulmonary function across our sample of workers. Although, firefighters may have less impairments to health when compared with police officers.
21. Implementing Digital Tools for Mental Health Support in Young Individuals in Colombia: Mixed Methods Feasibility Study.
期刊: JMIR formative research 发表日期: 2025-Dec-29 链接: PubMed
摘要
The growing prevalence of mental health disorders among young people is a pressing global concern, particularly in low- and middle-income countries where access to care is limited. Digital tools, leveraging Information and Communication Technologies, offer promising approaches to bridge these gaps. This study evaluated the feasibility of 2 digital mental health tools-Youth Collective Minds (YMC), a web-based platform, and Mental Beat (MB; Avicenna Research), a smartphone app-targeted at young individuals aged 18-25 years in Bogotá, Colombia. Participants (N=35) engaged with both platforms over 3 weeks in this mixed methods feasibility study, which incorporated thematic analysis with a deductive framework for qualitative data. Univariate analyses were performed to examine baseline patterns and data distributions, while bivariate analyses were conducted to investigate relationships and associations between variables, providing a comprehensive evaluation of the platforms’ feasibility in the acceptability, demand, implementation, and practicality domains. Participants were primarily women (22/35, 63%) with a median age of 23 (IQR 21-24) years. A total of 1308 annotations were coded: acceptability (annotations=707), demand (annotations=116), implementation (annotations=276), and practicality (annotations=209). Participants highlighted YMC’s psychoeducational resources and MB’s ease of use as strengths. However, technical issues, including server malfunctions and insufficient feedback, impacted engagement. Quantitatively, 83% (29/35) expressed willingness to reuse YMC and 83% (29/35) MB. Sensor data from MB indicated significant associations between psychological distress and smartphone usage. Participants with higher psychological distress showed greater median battery charging of 585 (IQR 321-615) compared to those without distress, 188 (IQR 42-309; P=.04). Poor sleep quality was also associated with increased median battery discharge of 2867 (IQR 1697.5-3935.5) compared to participants who reported sufficient sleep, 556 (IQR 200-2968; P=.003). GPS data showed that participants who visited more unique locations had lower psychological distress scores, with a negative correlation (r=-0.424; P=.05). In terms of platform usage, in YMC, surveys on emotions (30/35, 86%) and stress (28/35, 80%) were the most frequently completed, while telecounseling services were underused, with only 8.6% (3/35) of participants accessing mental health telecounseling. In MB, surveys of positive emotions (97.1%) and relationships (97.1%) were answered by more than 90% (32/35) of participants. This study demonstrated the feasibility and acceptability of digital tools for mental health support among Colombian youth, suggesting that these tools promote self-awareness and mental health management but require technical refinements to enhance engagement. The study’s limitations, including a small sample size and short duration, underscore the need for broader research. Implementing participant feedback, strengthening cybersecurity, and scaling these tools could address mental health challenges in low- and middle-income countries, where such interventions are critically needed. These digital platforms represent promising steps toward bridging gaps in mental health care access.
22. Diagnostic Accuracy, Implementation Barriers, and Equity Implications of Teledermatology in Rural Skin Cancer: Scoping Review.
期刊: JMIR dermatology 发表日期: 2025-Dec-29 链接: PubMed
摘要
Skin cancer is the most commonly diagnosed malignancy in the United States, with rural populations facing disproportionate delays in diagnosis due to geographic isolation, workforce shortages, and limited access to dermatologic care. These delays contribute to higher rates of late-stage diagnosis and poorer outcomes. Teledermatology has emerged as a promising solution to expand access to dermatologic evaluation and treatment in underserved settings. The review aims to evaluate the diagnostic performance, implementation challenges, and equity considerations of teledermatology in the context of rural skin cancer care, and to assess its potential to improve clinical outcomes in underserved populations. A comprehensive literature search was conducted across PubMed, Scopus, Web of Science, and Google Scholar to identify studies published between January 2015 and March 2025. Search terms included “teledermatology,” “skin cancer,” “rural health services,” “telemedicine,” “diagnostic accuracy,” and “health disparities.” Studies evaluating diagnostic metrics, time to diagnosis, patient satisfaction, and implementation barriers were included. Nine key studies spanning various countries and health care settings were included. Diagnostic sensitivity ranged from 41.9% to 100%, and specificity from 46% to 90%, depending on modality and lesion type. Teledermatology consistently reduced time to diagnosis, in some cases by over 75%, and was associated with high patient satisfaction due to increased convenience and reduced travel. Key barriers included technological limitations, inconsistent imaging protocols, and reimbursement variability. Successful implementation was facilitated by standardized workflows, dermoscopy integration, and centralized platforms. Teledermatology is a viable and effective approach to addressing disparities in rural skin cancer care. It offers diagnostic accuracy comparable to face-to-face evaluations while reducing wait times and improving patient satisfaction. Overcoming technological and systemic barriers is critical to ensuring equitable, long-term integration of teledermatology in rural health systems.
23. Fostering Multidisciplinary Collaboration in Artificial Intelligence and Machine Learning Education: Tutorial Based on the AI-READI Bootcamp.
期刊: JMIR medical education 发表日期: 2025-Dec-29 链接: PubMed
摘要
The integration of artificial intelligence (AI) and machine learning (ML) into biomedical research requires a workforce fluent in both computational methods and clinical applications. Structured, interdisciplinary training opportunities remain limited, creating a gap between data scientists and clinicians. The National Institutes of Health’s Bridge to Artificial Intelligence (Bridge2AI) initiative launched the Artificial Intelligence-Ready and Exploratory Atlas for Diabetes Insights (AI-READI) data generation project to address this gap. AI-READI is creating a multimodal, FAIR (findable, accessible, interoperable, and reusable) dataset-including ophthalmic imaging, physiologic measurements, wearable sensor data, and survey responses-from approximately 4000 participants with or at risk for type 2 diabetes. In parallel, AI-READI established a year-long mentored research program that begins with a 2-week immersive summer bootcamp to provide foundational AI/ML skills grounded in domain-relevant biomedical data. To describe the design, iterative refinement, and outcomes of the AI-READI Bootcamp, and to share lessons for creating future multidisciplinary AI/ML training programs in biomedical research. Held annually at the University of California San Diego, the bootcamp combines 80 hours of lectures, coding sessions, and small-group mentorship. Year 1 introduced Python programming, classical ML techniques (eg, logistic regression, convolutional neural networks), and data science methods, such as principal component analysis and clustering, using public datasets. In Year 2, the curriculum was refined based on structured participant feedback-reducing cohort size to increase individualized mentorship, integrating the AI-READI dataset (including retinal images and structured clinical variables), and adding modules on large language models and FAIR data principles. Participant characteristics and satisfaction were assessed through standardized pre- and postbootcamp surveys, and qualitative feedback was analyzed thematically by independent coders. Seventeen participants attended Year 1 and 7 attended Year 2, with an instructor-to-student ratio of approximately 1:2 in the latter. Across both years, postbootcamp evaluations indicated high satisfaction, with Year 2 participants reporting improved experiences due to smaller cohorts, earlier integration of the AI-READI dataset, and greater emphasis on applied learning. In Year 2, mean scores for instructor effectiveness, staff support, and overall enjoyment were perfect (5.00/5.00). Qualitative feedback emphasized the value of working with domain-relevant, multimodal datasets; the benefits of peer collaboration; and the applicability of skills to structured research projects during the subsequent internship year. The AI-READI Bootcamp illustrates how feedback-driven, multidisciplinary training embedded within a longitudinal mentored research program can bridge technical and clinical expertise in biomedical AI. Core elements-diverse trainee cohorts, applied learning with biomedical datasets, and sustained mentorship-offer a replicable model for preparing health professionals for the evolving AI/ML landscape. Future iterations will incorporate additional prebootcamp onboarding modules, objective skill assessments, and long-term tracking of research engagement and productivity.
24. Pro- and Antifluoride Use Messages on YouTube in Japan: Content Analysis.
期刊: JMIR formative research 发表日期: 2025-Dec-29 链接: PubMed
摘要
Dental caries is one of the most prevalent chronic conditions globally. In Japan, fluoride application-mainly via toothpaste, mouth rinses, and professional treatments-is a key preventive measure, as community water fluoridation is not implemented. Despite its proven effectiveness, fluoride use faces opposition from certain groups citing potential health risks. Social media platforms, especially YouTube, have become major sources of health information, but also facilitate the spread of misinformation, which may influence public perceptions and behaviors toward fluoride use. This study aimed to analyze YouTube videos addressing fluoride use for caries prevention, focusing on the types of information presented and comparing the messages shared by proponents and opponents of fluoride use. A comprehensive search was conducted on YouTube using fluoride-related keywords in Japanese. The top 50 videos for each keyword were screened, and after excluding irrelevant or duplicate content, 86 videos were analyzed. Videos were categorized as proponent (“pro”), opponent (“anti”), or others. The sources, intended audiences, and content themes were assessed. Interrater reliability was confirmed using the Cohen κ coefficient. Of the 86 analyzed videos, 58% (n=50) were categorized as “pro,” 22% (n=19) as “anti,” and 20% (n=17) as others. Proponent videos, mainly produced by dental professionals, emphasized scientific evidence, such as the mechanism of fluoride in preventing caries and guideline-based recommendations. Opponent videos, largely uploaded by laypersons, highlighted potential dangers of fluoride, including health risks and additives, and frequently promoted fluoride-free products. Opponent videos had higher daily viewership and engagement than proponent videos. Anti-fluoride content on YouTube appears to reach broader audiences than expert-generated profluoride videos. Opponent messages tend to use emotionally charged communication, whereas proponents focus on scientific information. These differences in style may influence public perceptions of fluoride use. Public health professionals should develop engaging and accessible communication strategies to counter misinformation and promote evidence-based practices.
25. Correction: Structural and Functional Impacts of SARS-CoV-2 Spike Protein Mutations: Insights From Predictive Modeling and Analytics.
期刊: JMIR bioinformatics and biotechnology 发表日期: 2025-Dec-29 链接: PubMed
摘要
26. A Web-Based Contraception Decision Tool for Individuals With Health Conditions in US Outpatient Clinics: Protocol for a Mixed Methods Cluster Randomized Controlled Trial.
期刊: JMIR research protocols 发表日期: 2025-Dec-29 链接: PubMed
摘要
Choosing contraception is a highly personal, often complex decision. People with acute and chronic health conditions (eg, pulmonary embolism, diabetes, and hypertension) must deliberate additional factors including whether and to what extent a contraceptive method may affect their health conditions or interact with their medications. “My Health My Choice” (web application developed by Alfa Jango) is a web-based decision support tool designed to help patients understand their contraceptive options considering their health conditions, medications, and personal priorities. We will evaluate the efficacy of “My Health My Choice” (MHMC) use among people with diverse health conditions who seek contraception in US outpatient clinics. This mixed methods cluster randomized controlled trial will compare MHMC and usual contraceptive care (intervention arm) to usual contraceptive care only (control arm). Fourteen clinics that specialize in primary care or obstetrics and gynecology will be enrolled, with 7 clinics in each arm. We will enroll 726 patients (363 in each group) who (1) are 18-49 years old, (2) are able to speak and read English, (3) are seeking contraception for pregnancy prevention, and (4) have at least 1 health condition among 60 eligible health conditions and characteristics (eg, cigarette smoking and postpartum state). Aim 1 (quantitative) is to assess the primary outcome of patient-reported contraceptive nonuse (yes or no) at 3 months. Aim 2 (mixed methods) starts with a quantitative summary of patient-reported contraceptive use by method type (eg, pills and shot) and corresponding Medical Eligibility Risk Category (Category 1, 2, 3, or 4) based on the Centers for Disease Control and Prevention (CDC) US Medical Eligibility Criteria (US MEC) Contraceptive Guidelines. We will conduct exit interviews of a subsample of approximately 30 patients and 30 clinicians to qualitatively understand how MHMC and other contextual factors influenced perceptions about contraceptive risk and contraceptive decisions. Aim 3 (quantitative) is to explore patient-reported contraceptive decisional conflict (measured by the Decisional Conflict Scale) and patient-reported quality of interaction with their contraceptive provider (measured by the Interpersonal Quality of Family Planning Scale) as mediators of the effects of MHMC on the primary outcome. This paper describes the study protocol per the SPIRIT (Standard Protocol Items: Recommendations for Intervention Trials) checklist. The National Institute of Child Health and Human Development funded this study (R01HD110570, Principal Investigator JPW) in 2023. The study team is collaborating with the DARTNet Institute (Aurora, Colorado) to enroll and prepare health clinics for trial launch. Fourteen clinics have enrolled in the trial and are in various stages of study preparation and regulatory approval. We anticipate patient enrollment to run from October 2025 to September 2028. This is the first mixed methods cluster randomized controlled trial of MHMC, a novel web-based decision support tool for people with health conditions. ClinicalTrials.gov NCT07075536; https://clinicaltrials.gov/study/NCT07075536. DERR1-10.2196/71101.
27. Estimating the Frequency of Inpatient Adverse Events Using a 2-Step Retrospective Chart Review: Initial Observational Cohort Study.
期刊: JMIR formative research 发表日期: 2025-Dec-29 链接: PubMed
摘要
Lower- and middle-income countries bear a disproportionate share of the global burden of adverse events in health care. Despite this, patient safety research is predominantly conducted in high-income countries with well-developed health care systems, resulting in evidence and methodologies that have limited applicability in resource-constrained settings. This pilot study primarily aimed to identify the most suitable methodology for a full-scale study to detect inpatient adverse events at a tertiary care hospital in a lower- to middle-income country. Second, we aimed to use our experience with this study to further adapt the selected methodology to our setting. This external pilot study used a 2-step retrospective chart review methodology. Two separate screening tools, tools 1A and 1B, were compared to identify which performed better in our setting. We reviewed the medical records of patients who were discharged between January 1, 2019, and December 31, 2019, from a tertiary care hospital in a lower- to middle-income country in South Asia. The main outcome of interest was the rate of adverse events among hospitalized patients reported as the total number of adverse events experienced per 100 admissions. A total of 100 medical records were screened using tool 1A, with the mean patient age being 39.2 (SD 27.7) years and the mean length of stay being 3.3 (SD 2.8) days. Only 1 adverse event was identified using tool 1A, resulting in an adverse event rate of 1 event per 100 hospital admissions. Tool 1B was also used to screen a total of 100 medical records. The mean patient age was found to be 39.8 (SD 28.4) years, with the mean length of stay being 3.5 (SD 3.4) days. A total of 30 adverse events were identified across 22 patient files, with 18 (60%) considered preventable, resulting in an adverse event rate of 30 events per 100 hospital admissions. This study demonstrates that tool 1B, adapted from the Global Trigger Tool for Measuring Adverse Events, represents an appropriate and sensitive methodology to identify adverse events among hospitalized patients in a lower- to middle-income country. Furthermore, the findings and experiences of this study were used to improve the design and procedures of our research methodology before implementation in a full-scale study. RR2-10.1136/bmjopen-2023-076971.
28. Systematic Determinants of Global COVID-19 Burden: Longitudinal Time-Series Analysis Using Big Data-Driven Artificial Intelligence.
期刊: Journal of medical Internet research 发表日期: 2025-Dec-29 链接: PubMed
摘要
The COVID-19 pandemic has transitioned into an endemic phase with heterogeneous resurgences. Despite widespread vaccination and public health measures, the interplay of viral evolution, population immunity, and environmental factors drives diverse global patterns of COVID-19 burden. However, how these systematic factors dynamically shape disease transmission and severity across populations remains incompletely understood. This study aims to determine the relative contributions and temporal dynamics of viral variants, population immunity (natural infection and vaccination), environmental conditions, and public health measures in determining COVID-19 disease burden. This retrospective longitudinal time-series study used a big data-driven interpretable machine learning approach to analyze global multifaceted data across 38 countries from pandemic onset through December 31, 2022. Daily time-series data encompassing viral variants, natural infection, vaccination coverage, environmental conditions, policy interventions, health care infrastructure, and migration trends were integrated. The gradient-boosted trees (XGBoost [extreme gradient boosting]) model, coupled with Shapley Additive Explanations interpretation, quantifies the complex interdependencies and their spatiotemporal effects on 4 COVID-19 burden metrics-effective reproduction number (Rt), hospitalizations, intensive care unit (ICU) admissions, and deaths. Variant-related factors dominance drives transmission/Rt (24.02%, 95% CI 10.10-66.88 contribution) but progressively attenuates across severe outcomes (4.24%, 95% CI 1.59-10.89 for ICU; 5.52%, 95% CI 1.94-15.39 for deaths). Omicron 21K and Delta 21J demonstrate exceeding baseline transmissibility by 12.2% and 3.4% respectively. Conversely, immunity-related factors show inverse patterns: natural infection contributions escalate with severity (12.82% for Rt, 14.91% for hospitalization, 21.96% for ICU [95% CI 7.36-47.55], rising to 36.00% [95% CI 10.25-78.56] for deaths). COVID-19 vaccination maintains substantial influence on severe outcomes (18.04% [95% CI 6.39-42.49] for ICU; 20.31% [95% CI 6.53-58.31] for deaths), with protective critical population thresholds: 29.9% (95% CI 29.8-29.9) coverage for transmission reduction and 72.3% (95% CI 72.2-72.8) for ICU prevention. Routine immunizations exhibit cross-protective effects, particularly the yellow fever vaccine at doses exceeding 600,000 for Rt reduction and >100,000 for ICU protection. Temperature demonstrates threshold effects: 14.95°C (95% CI 14.86-15.43) for hospitalizations and 11.89°C (95% CI 11.81-11.97) for ICU admissions. Health care infrastructure contributed 23.98% (95% CI 7.03-73.13) to hospitalization outcomes. The large-scale epidemiological data mining reveals previously unrecognized patterns through three innovations: (1) quantifying variant evolutionary fitness with transmission thresholds, (2) identifying dual vaccination coverage thresholds for transmission versus severe disease prevention, and (3) discovering dose-specific cross-protection from routine immunizations. Unlike black-box predictions, this interpretable framework integrates multidomain surveillance data to reveal how variants, immunity, and environment jointly shape disease burden with temporal resolution. Real-world applications include tiered vaccination strategies targeting specific coverage goals, variant surveillance prioritizing lineages with demonstrated fitness in contemporary immunity contexts, and expanding routine immunization programs as pandemic preparedness measures. This framework provides quantifiable benchmarks for adaptive pandemic response across immunization strategies, variant surveillance, and health care capacity planning.
29. Draft genomes of three XDR Mycobacterium tuberculosis clinical isolates from Morocco.
期刊: Microbiology resource announcements 发表日期: 2025-Dec-29 链接: PubMed
摘要
We report draft whole-genome sequences of three extensively drug-resistant Mycobacterium tuberculosis strains (UM29, UM64, and UM66) isolated in Morocco in 2013. These assemblies support resistance profiling, molecular epidemiology, and comparative genomics. Raw sequencing reads and genome assemblies are publicly accessible through the NCBI database under BioProject PRJNA1302428.
30. Health inequalities in post-COVID-19 Chile: Health system coverage and effective access by sex and migrant status.
期刊: Medwave 发表日期: 2025-Dec-29 链接: PubMed
摘要
In 2022, after the COVID-19 pandemic, approximately 93% of the countries in the Region of the Americas continued to report interruptions in essential health services, with worse outcomes in vulnerable social groups. The present study aims to describe barriers to access to health care in Chile, disaggregated by sex and international migrant status. Cross-sectional study, analyzing the results of the CASEN 2022 survey of persons ≥18 years of age. We calculated ascription, effective access and health barriers by international migrant status and sex. Multiple logistic regression models were performed adjusting for age, rurality, educational level, occupation, and income quintile. The model was expressed as an adjusted Odds Ratio (ORadj) with a 95% confidence interval in STATA v.18.5. For the year 2022 in Chile, a total of 14,767,688 people were represented in this study, with a mean age of 45.4 years (SD: 17.8), 51.2% were women and 9.27% were migrants. Regarding health insurance, 3.11% of the population was not affiliated with the health system, with men (ORadj: 0.6; 95% CI: 0.54-0.68) and immigrants (ORadj: 10.3; 8.78-12.15) being the most affected groups. In terms of effective access, 17.4% had health needs, with a predominance of the female sex (ORadj: 1.3; 95% CI: 1.21-1.32). However, of those who had needs and expressed them, 39.2% expressed unmet needs, with a higher probability of showing it in women (ORadj: 1.2; 95% CI: 1.10-1.27). In Chile, health system coverage remains a challenge for men and the migrant population. We observe with concern high percentages of unmet health needs, particularly among women. The intersection of sex and international migration reveals a dual vulnerability in access to health care that warrants further study. El año 2022, posterior a la pandemia de COVID-19, aproximadamente 93% de los países de la región de Las Américas continuaban reportando interrupciones en los servicios esenciales de salud, con peores desenlaces en grupos sociales vulnerables. El presente estudio tiene por objetivo describir las barreras en el acceso a la atención en salud en Chile, desglosado por sexo y condición migrante internacional. Estudio de corte transversal, analizando los resultados de la Encuesta de Caracterización Socioeconómica Nacional (CASEN) 2022, realizada en Chile a personas desde los 18 años. Se calculó la adscripción, acceso efectivo y barreras en salud por condición migrante internacional y sexo. Se utilizaron modelos de regresión logística múltiple ajustando por edad, ruralidad, nivel educativo, ocupación y quintil de ingreso. El modelo fue expresado en ajustados con un intervalo de confianza del 95% en STATA v.18.5. Para el año 2022 en Chile, un total de 14 767 688 personas estuvieron representadas en este estudio, con una edad promedio de 45,4 años (desviación estándar: 17,8). De ellas, 51,2% eran mujeres y 9,27% población migrante. Respecto a la adscripción en salud, 3,11% de la población no estaba afiliada al sistema de salud, siendo los hombres (ajustado mujeres/hombres: 0,6; intervalo de confianza 95%: 0,54 a 0,68) y migrantes (ajustado migrantes/chilenos: 10,3; 8,78 a 12,15) los grupos más afectados. Respecto al acceso efectivo, 17,4% tuvo necesidades en salud, a predominio del sexo femenino (ajustado mujeres/hombres: 1,3; intervalo de confianza 95%: 1,21 a 1,32). Sin embargo, de las personas que tuvieron necesidades y la expresaron, 39,2% manifestaron necesidades no satisfechas, con mayor probabilidad de evidenciarlo en el sexo femenino (ajustado mujeres/hombres: 1,2; intervalo de confianza 95%: 1,10 a 1,27). En Chile, la adscripción al sistema de salud sigue siendo un desafío en el sexo masculino y en población migrante. Observamos con preocupación altos porcentajes en demandas no satisfechas, especialmente en mujeres. La intersección entre sexo y migración internacional revela una doble vulnerabilidad en el acceso a la atención en salud, lo que requiere su abordaje.
31. Serological and viral prevalence of Oropouche virus (OROV): A systematic review and meta-analysis from 2000-2024 including human, animal, and vector surveillance studies.
期刊: PLoS neglected tropical diseases 发表日期: 2025-Dec-29 链接: PubMed
摘要
Oropouche virus (OROV) is an emerging arbovirus primarily transmitted by biting midges and is increasingly recognized as a public health threat in Central and South America. With over 11,000 confirmed cases reported in 2024, a ten-fold increase from the previous year, its transmission dynamics and true burden remain poorly understood due to diagnostic challenges and fragmented surveillance systems. This systematic review and meta-analysis (SRMA) synthesizes OROV prevalence data in humans and summarizes the available data for vectors and animal hosts sampled between 2000 and 2024 to provide updated estimates and identify key surveillance gaps. We systematically searched Web of Science, PubMed, Embase, Medline, and LILACS for OROV seroprevalence and viral prevalence studies in human, insect, and animal populations, published up to September 12, 2024. The review protocol was registered with PROSPERO (CRD42024551000). Studies were extracted in duplicate, and data were meta-analyzed using generalized linear mixed-effects models. Risk of bias was appraised using a modified Joanna Briggs Institute checklist. We included 71 articles reporting serological or viral prevalence of OROV across nine countries. Between 2000-2024, pooled human seroprevalence among individuals with febrile illness or suspected of Oropouche infection was 12.6% [95% CI 5.3-26.9%] across four South American countries and seroprevalence of 1.1% [95% CI 0.5-2.3%] was observed in asymptomatic groups. Viral prevalence among individuals with febrile illness or suspected of Oropouche infection was 1.5% [0.8-3.0%] across seven South American countries and Haiti. Most studies used convenience sampling and RT-PCR or hemagglutination assays. In vector populations, positive OROV prevalence in Aedes aegypti and Culex quinquefasciatus was reported in two of 18 sources, while 10.0% and 7.5% animal host prevalence was reported in dogs and cattle, respectively. We found high risk of bias in 11.3% of studies in our critical appraisal, with most animal, human, and vector studies falling in the moderate risk of bias range. Despite rising numbers of OROV reported cases, prevalence estimates remain limited by sparse surveillance and variable methodology. This review highlights the urgent need for standardized serological assays, community-based studies, and expanded surveillance in animal and vector reservoirs. A One Health approach is essential to monitor OROV transmission and inform regional preparedness efforts.
32. Agricultural Copper Pesticide Exposure and Metabolic Profiles among Parkinson's Disease Cases and Community Controls in California.
期刊: Chemical research in toxicology 发表日期: 2025-Dec-29 链接: PubMed
摘要
Copper-based pesticide exposures have been linked to increased Parkinson’s disease (PD) risk through oxidative stress, mitochondrial dysfunction, and neuroinflammation, yet their metabolic effects in PD remain poorly understood. Using high-resolution metabolomics (HRM) data from 642 PD patients and 277 controls from the Parkinson’s Environment and Gene (PEG) study, we evaluated alterations associated with chronic copper pesticide exposure. Composite and individual copper pesticide estimates were derived within a 500-m buffer around residential and workplace addresses over 5 years prior to the blood draw. Metabolome-wide association studies (MWAS) using partial least-squares (PLS) and empirical Bayes linear models were conducted to identify copper-associated metabolites, and pathway enrichment was performed using the Mummichog algorithm with 100 permutations to identify enriched metabolic pathways. In the primary analysis of the composite copper metric, we detected 215 copper-associated metabolite features, 88 of which were annotated, while none of them survived the FDR < 0.05 threshold. In individual-pesticide analyses, only copper sulfate (pentahydrate) yielded significant results: 57 metabolite features passed the FDR < 0.05 threshold (51 in PD patients, 4 in controls, and 2 in the full sample). The strongest metabolite association was with a phosphatidylcholine, PC(22:2(13Z,16Z)/16:1(9Z)) (β = 0.07, p = 1.51 × 10-05). Pathway enrichment supported involvement of inflammation metabolism, lipid metabolism, amino acid metabolism, etc. These findings suggest that chronic copper pesticide exposure is linked to serum metabolic changes, particularly in inflammation-related metabolism pathways. Given the cross-sectional study design, these associations should be interpreted cautiously, as they do not establish causality.
33. Comment impliquer le public et les patient(e)s dans la recherche en prévention primaire: Perspectives internationales et leçons tirées du réseau de recherche en prévention primaire des cancers CANCEPT.
期刊: Canadian journal of public health = Revue canadienne de sante publique 发表日期: 2025-Dec-29 链接: PubMed
摘要
This article explores the methods and benefits of involving patients and the public in primary prevention (PP) cancer research. Through the experience of the CANCEPT PP research network, it aims to clarify practices and propose methodological guidelines for developing interventions tailored to the needs of populations. The Methodological Exchange Group GEM MIXTE, made up of 9 researchers and 9 co-researchers, met monthly (2023-2024, France) in order to define public and patient involvement in PP, take stock of participatory practices among CANCEPT members via a questionnaire (14 researchers, 8 institutions, 22 projects), and develop methodological guidelines in the form of a mind map. The participatory approaches were evaluated using the Public and Patient Engagement Evaluation Tool (PPEET) questionnaire. GEM MIXTE has enabled us to clarify the methodology of participatory research in PP and to propose practical guidelines. This work highlights the importance of diversifying the profiles of the co-researchers to enhance the relevance of interventions, while emphasizing the role of the group coordinator in structuring and facilitating exchanges. The PPEET evaluation confirmed that the co-researchers were committed to the objectives, although socio-cultural diversity remains a challenge. This work proposes a methodological framework for integrating lived experience into research. The guidelines developed provide tools to inspire other networks to structure their approaches effectively, thereby strengthening citizen participation in public health. RéSUMé: OBJECTIFS: Cet article explore les modalités et bénéfices de l’implication des patient(e)s et du public dans la recherche en prévention primaire (PP) des cancers. À travers l’expérience du réseau CANCEPT, il vise à clarifier les pratiques et proposer des repères méthodologiques pour développer des interventions adaptées aux besoins des populations. MéTHODES: Le Groupe d’Échange Méthodologique GEM MIXTE, composé de 9 chercheur(e)s et de 9 co-chercheures, s’est réuni mensuellement (2023–2024, France) afin de: livrer une définition de l’implication des patient(e)s et du public en PP, faire un état des lieux des pratiques participatives au sein des membres de CANCEPT via un questionnaire (14 chercheur(e)s, 8 institutions, 22 projets), élaborer des repères méthodologiques sous forme de carte mentale. L’évaluation des démarches participatives a été réalisée à l’aide du questionnaire Public and Patient Engagement Evaluation Tool (PPEET). RéSULTATS: Le GEM MIXTE a permis de clarifier le cadre méthodologique de la recherche participative en PP et de proposer des repères pratiques. Ces travaux mettent en évidence l’importance de diversifier les profils des co-chercheur(e)s pour enrichir la pertinence des interventions, tout en soulignant le rôle du coordinateur pour structurer et animer les échanges. L’évaluation PPEET a confirmé l’adhésion des co-chercheurs aux objectifs, bien que la diversité socioculturelle reste un défi à relever. CONCLUSION: Ce travail propose un cadre méthodologique pour intégrer les savoirs expérientiels dans la recherche. Les repères élaborés offrent des outils pour inspirer d’autres réseaux à structurer efficacement leurs démarches, renforçant ainsi la participation citoyenne en santé publique.
34. Broadening sources of finance for health promotion and disease prevention: Smart capacitating investment.
期刊: The European journal of health economics : HEPAC : health economics in prevention and care 发表日期: 2025-Dec-29 链接: PubMed
摘要
35. Provider Adaptations to Legislative Efforts to Ban Gender-Affirming Care for Adolescents.
期刊: The Journal of adolescent health : official publication of the Society for Adolescent Medicine 发表日期: 2025-Dec-29 链接: PubMed
摘要
States have passed policies restricting gender-affirming care for adolescents (e.g., hormones, puberty blockers) forcing gender-affirming care providers to navigate new and complex political, legal, and interpersonal landscapes. Notably, there are no guidelines or competency trainings focused on helping providers to adapt and preserve clinical practice amidst evolving legal restrictions. We sought to explore how providers were adapting to the introduction of these restrictions. From March to July 2022, we conducted in-depth qualitative interviews with 31 adolescent gender-affirming care providers who worked in states that had introduced or passed bans on gender-affirming care for adolescents. The interviews probed the adaptations providers were making in response to restrictions. We conducted thematic analyses using a combined inductive and deductive approach using MAXQDA Plus. The thematic results were organized into 6 overarching themes: violence and intimidation, advocacy, consoling patients and families, adapting to institutional decisions, navigating where to focus efforts, and anticipatory adaptations. Providers discussed the steps they were taking to avoid violence, such as maintaining personal safety and negotiating workplace security with employers, such as removing public-facing personal and work information. Providers advocated against restrictive policies, which was described as necessary yet laborious and emotionally exhausting. Proposed and enacted restrictions on gender-affirming care have forced providers to engage in safety and advocacy efforts that go beyond their clinical work. Providers want their employers and professional organizations to support their work by advocating for gender-affirming care and ensuring safe working conditions.
36. An umbrella review of systematic reviews of the impact of wrist-worn wearables on health outcomes.
期刊: Physiological reviews 发表日期: 2025-Dec-29 链接: PubMed
摘要
We conducted an umbrella review to synthesize the evidence on the effectiveness of interventions incorporating wrist-worn wearables* feedback on diverse health outcomes including health promotion (i.e., health behaviors and disease risk perception) morbidity, mortality, functioning, and other health-related metrics in humans. We searched in MEDLINE, Web of Science, Embase and Cochrane Library until 18th March 2025 for eligible systematic reviews. After screening 9 487 citations, we identified 39 systematic reviews, which included 98 original studies (one observational study, 95 randomized controlled trials, and two pre-post studies). The reviews primarily focused on adult populations, individuals with cardiometabolic conditions, and cancer survivors. The original interventional studies mainly included Fitbit (40.2%), Polar (12.4%), and ActiGraph (10.3%) devices. Over 80% of the clinical trials involved complex behavioral interventions with wearable-based feedback, and the control groups varied. Most systematic reviews were rated as low confidence, with common flaws including inadequate considerations for risk-of-bias and heterogeneity. Interventions incorporating wrist-worn activity trackers increased physical activity in diverse populations. The effect of interventions incorporating wrist-wearables’ feedback on cardiometabolic risk markers, quality of life, depression/anxiety and pain was limited and remained inconsistent. Our findings rely on existing systematic reviews, which may vary in quality, review methodologies and comprehensiveness. There is also potential for missing more recent evidence not yet captured in these reviews. These limitations should be considered when interpreting our results. Acknowledging these caveats, wrist-worn wearables seem to increase physical activity, and may have also additional benefits that require further study.
37. Prevalence of respiratory symptoms among brick kiln workers in Baddi (Himachal Pradesh) & Kalka (Haryana).
期刊: Archives of environmental & occupational health 发表日期: 2025-Dec-29 链接: PubMed
摘要
The objective of the current study is to assess the different respiratory symptoms of 200 brick kiln workers. A cross-sectional study was conducted among brick kiln workers in Baddi and Kalka region of Himachal Pradesh and Haryana. Workers answered a questionnaire, and a spirometer was used to test pulmonary function. In addition to this, respiratory symptoms were also analyzed among exposed brick kiln workers. It was found that 95% of employees had impaired lung function, with 15% showing restrictive, 80% showing obstructive impairments and 5% are normal. In addition to this, 67% of workers had severe obstructive impairment, 27% had moderate obstructive impairment, and only 6% had mild obstructive impairment. Pulmonary abnormalities in brick kiln workers were strongly associated with prolonged occupational exposure to dust and smoke, highlighting the need for improved protective measures.
38. Inert-Atmosphere Regeneration of Sulfur-Poisoned Cu/SSZ-13 Catalysts Unexpectedly Enhances Low-Temperature NH3-SCR Activity Beyond the Fresh Catalyst.
期刊: Environmental science & technology 发表日期: 2025-Dec-29 链接: PubMed
摘要
Nitrogen oxide (NOx) emissions pose a persistent environmental threat due to their adverse impacts on air quality, climate, and human health. Among current control strategies, Cu-exchanged SSZ-13 (Cu/SSZ-13) catalysts are widely recognized for their excellent low-temperature NH3-SCR activity and hydrothermal stability. However, their real-world performance is limited by sulfur poisoning, which deactivates active Cu sites through the formation of Cu-S species. Previous regeneration methods often result in incomplete recovery due to the formation of stable sulfates and/or insufficient redispersion of active Cu ions. In this study, we demonstrate that regeneration of sulfur-poisoned Cu/SSZ-13 in an inert atmosphere (Ar) at 800 °C can effectively prevent the oxidation of metastable Cu-S species into stable sulfate species while also promoting the decomposition of Cu-S species, thereby enabling a more complete recovery and redistribution of Cu ions into the zeolite framework. What is particularly noteworthy is that this regeneration method not only recovers the catalyst’s functionality but also leads to a significant enhancement in low-temperature NH3-SCR efficiency, outperforming the fresh catalyst. Advanced microscopic and spectroscopic analyses reveal that this enhancement is associated with increased formation of [ZCu2+(OH)]+ species located in the 8-membered rings of SSZ-13, which are known to be the most active sites for low-temperature NH3-SCR.
39. Environmental Release of Zoonotic Pathogens by Pomacea canaliculata Drives Competitive Dominance by Infecting Native Snails.
期刊: Environmental science & technology 发表日期: 2025-Dec-29 链接: PubMed
摘要
Pomacea canaliculata is an invasive species distributed globally, yet the mechanisms behind its rapid ecosystem dominance and lethal effects on native species remain unclear. This study analyzed the dissemination pattern of pathogens from the gut of P. canaliculata to the aquatic environment. Combined with field surveys and mesocosm experiments, the impact of pathogens released by P. canaliculata on the native snail Cipangopaludina chinensis was evaluated. The direct lethal effects of the core bacterium on native snails were further demonstrated through in vivo and in vitro infection. Results show that 168 species of zoonotic pathogens existed in the gut of P. canaliculata, carrying 82 virulence factors and half of the high-risk antibiotic-resistant genes known to cause diseases. These pathogens released by P. canaliculata in the aquatic environment ultimately caused gut microbiota dysbiosis, mortality, and population decline in native snails, while it can be alleviated in the pathogen-limited P. canaliculata model. Aeromonas strains, the primary pathogen isolated from P. canaliculata, induced intestinal necrosis and death in native snails. Therefore, the release of pathogens is considered a previously overlooked invasion strategy of P. canaliculata, which poses a substantial public health threat within the One Health framework.
40. Receiver-Operating Characteristic (ROC) Curve Analysis in Determining Minimum Requirements for Occupational Performance in Firefighters.
期刊: Journal of occupational and environmental medicine 发表日期: 2025-Dec-29 链接: PubMed
摘要
To determine the diagnostic accuracy of using cardiovascular health (CVH) and physical fitness as indicators of physical ability test (PAT) performance in firefighters. Using a cross-sectional study 282 firefighters were recruited. A researcher-generated questionnaire and physical measures were used to obtain sociodemographic, CVH, physical fitness and PAT data. Receiver-operating characteristic (ROC) curve analysis was performed. A bodyfat percentage cut-off of 22.1% had a specificity of 75% of failing the PAT. An abV̇O2max of 3.2 L·min, a grip and leg strength higher than 73.2 kg and 96.3 kg had a sensitivity of 84%, 92% and 88%, respectively, of passing the PAT. A push-up and sit-up capacity higher than 25 repetitions had a sensitivity of 74% and 75% for passing the PAT. Measures of CVH and physical fitness could be used as indicators of PAT performance.
41. Posture, machinery and risk: ergonomic characterization of industrial driving work in forklifts and electric pallet trucks.
期刊: International journal of occupational safety and ergonomics : JOSE 发表日期: 2025-Dec-29 链接: PubMed
摘要
Objectives. The use of machinery in industrial tasks like load transportation exposes workers to ergonomic risk factors, particularly from non-neutral postures, increasing the chance of musculoskeletal disorders (MSDs). This study aimed to assess posture-related ergonomic risk among forklift and electric pallet truck operators. Methods. Conducted at a beverage bottling plant in Viña del Mar, Chile, the cross-sectional study involved 75 operators. Personal and occupational data were gathered through questionnaires, and the rapid entire body assessment (REBA) method was used to evaluate postural risk based on video analysis during machine operation. Results. Findings revealed that 49.3% of workers were at high ergonomic risk and 50.7% at very high risk, with pallet truck operation strongly associated with increased ergonomic risk (odds ratio [OR] 6.7; 95% confidence interval [2.5, 19.5]). The most significant risk factors were operating electric pallet trucks and being aged under 30 years. Pallet truck operation was strongly associated with increased ergonomic risk (crude OR 6.7), especially in workers with less experience. Conclusion. The study concludes that targeted ergonomic interventions, such as redesigning handle height or improving vibration isolation systems in electric pallet trucks, may be essential to protect younger and less experienced workers.
42. Is pregnancy a major risk factor for musculoskeletal pain? A cross-sectional study.
期刊: Musculoskeletal science & practice 发表日期: 2025-Dec-27 链接: PubMed
摘要
Musculoskeletal pain during pregnancy is commonly considered prevalent, though evidence primarily comes from cross-sectional studies lacking appropriate control groups. To examine the prevalence of musculoskeletal pain among pregnant women compared to non-pregnant women as a reference group. Observational cross-sectional. 1651 women (589 pregnant, 1062 non-pregnant) in Israel completed an online survey using the Hebrew Extended Nordic Musculoskeletal Questionnaire and SF-12. Chi-square tests and logistic regression analyses examined associations between pregnancy status and pain prevalence while controlling for confounding factors including age, BMI, education, employment, lifestyle factors, and medical history. Pregnant women reported higher rates of upper back pain (67.1 % vs. 56.4 %, p = 0.02) and lower back pain (73.9 % vs. 64.9 %, p = 0.004), while non-pregnant women reported more hip/thigh pain (54.5 % vs. 48.4 %, p < 0.001). However, after controlling for confounders in multivariate regression, these associations became non-significant. Pregnant women had significantly lower physical component scores (43.31 ± 9.33 vs. 48.08 ± 8.41, p < 0.001). Physical health status (PCS-12) was the strongest predictor of current low back pain (OR = 0.92, 95 % CI: 0.90-0.94, p < 0.001), pregnancy status showed no independent association (OR = 1.19, 95 % CI: 0.77-1.84, p = 0.430). Smoking emerged as a significant risk factor (OR = 2.02, 95 % CI: 1.03-3.96, p = 0.042). This study challenges the assumption that pregnancy inherently causes higher musculoskeletal pain prevalence. Physical health status plays a more substantial role than pregnancy status per se, highlighting the multifactorial nature of pregnancy-related musculoskeletal pain.
43. Evaluation of a novel viral nucleic acid extraction kit from a variety of clinical specimens.
期刊: Diagnostic microbiology and infectious disease 发表日期: 2025-Dec-24 链接: PubMed
摘要
Nucleic acid extraction represents a critical preanalytical step in clinical molecular diagnostics. This study evaluated a novel viral nucleic acid extraction kit (HeSheng) against three commercial kits (Qiagen QIAamp, Daan, and Yocon) using 170 clinical samples across five specimen types. Performance was assessed through plaque-based serial dilution combined with RT-qPCR to determine the limit of detection (LOD), alongside measurements of nucleic acid concentration, OD260/280 ratio, and Ct values. While all kits demonstrated equivalent LODs (10 PFU/mL), the HeSheng kit consistently yielded lower Ct values, indicating enhanced sensitivity. It also produced nucleic acids with superior concentration, purity, and amplification efficiency. Clinical sample RT-qPCR results showed high concordance with diagnoses (sensitivity 98.6%; specificity 97.4%). The protocol combines viral lysis with rapid column-based adsorption and completes extraction within 10 minutes using standard equipment. These findings demonstrate that the HeSheng kit provides a simplified, cost-effective, and broadly applicable method suitable for molecular diagnostics in resource-limited or high-throughput settings.
44. Unveiling risk factors for transient osteoporosis of the hip in Middle-Aged Men: Insights from a Cross-Sectional study.
期刊: European journal of radiology 发表日期: 2025-Dec-23 链接: PubMed
摘要
To identify clinical, environmental, and lifestyle-related risk factors for transient osteoporosis of the hip (TOH) in men, compared with a control group of men without TOH and peripartum women with TOH. This retrospective cross-sectional study included men aged ≥ 18 years who underwent pelvic/hip MRI for hip pain at a tertiary care center between 2010 and 2023. Among 231 men, 31 (13.4 %) were diagnosed with TOH. Prospective data were collected via telephone questionnaire. Controls included 190 men without TOH (questionnaires administered to an age-matched subgroup of 31) and a previously described cohort of 34 women with peripartum TOH. Data on demographics, medical history, physical activity, occupation, vitamin D/calcium supplement use, and corticosteroid exposure were analyzed. Men with TOH were significantly younger than controls (45.4 vs. 57.3 years; P = 0.006) with higher BMI (29.62 vs. 28.24p = 0.03) and more frequently reported vitamin D/calcium use (58.1 % vs. 10 %; P < 0.001). They tended to have more physically demanding occupations, higher activity levels, and more childhood dental issues (P > 0.05). Compared to women with peripartum TOH, men were older, had a similar BMI at symptom onset, a greater corticosteroid use, and a lower prevalence of family history of osteoporosis. Patients consulted an average of 3.7 physicians before diagnosis. Symptoms resolved within 3-6 months in most cases, and MRI findings normalized within 2-11 months. TOH in men is underrecognized and may be associated with mechanical overload and altered bone turnover. Identifying potential risk factors may aid in earlier diagnosis and management.
45. What cancer patients may or may not be surprised to know about survivorship.
期刊: Clinical advances in hematology & oncology : H&O 发表日期: 2025-Dec 链接: PubMed
摘要
The number of US cancer survivors has increased from fewer than 4 million in the 1970s to 18.1 million in 2022, with the increase reflecting advancements in screening, diagnosis, treatment, and supportive care. Despite these advancements, cancer remains the second leading cause of death in the United States. Survivors face a myriad of health concerns, including residual effects of treatment, psychological issues like distress and depression, and an elevated risk of secondary cancers. This article highlights the need for long-term surveillance and a multidisciplinary approach to care, emphasizing the importance of personalized health plans and regular monitoring. It also discusses the challenges encountered in addressing fatigue, sexual health, and disparities in outcomes that negatively affect minorities and financially disadvantaged persons. The article concludes by describing different models of care and the role of primary care providers in managing survivorship care and advocating for a shared-care model to improve access to and integration of care.
46. Sensory-Based Interventions in Occupational Therapy for Children and Youth (May 2015-January 2024).
期刊: The American journal of occupational therapy : official publication of the American Occupational Therapy Association 发表日期: 2025-Mar-01 链接: PubMed
摘要
Systematic review briefs provide a summary of the findings from systematic reviews evaluated in conjunction with the American Occupational Therapy Association’s Evidence-Based Practice Program. Each systematic review brief summarizes the evidence on a theme related to a systematic review topic. This systematic review brief presents findings from the systematic review on the effectiveness of sensory-based interventions (excluding Ayres Sensory Integration® [ASI]) for children and youth 0-21 yr of age.
47. Development of an automated ultrasonographic detection method for fecal retention using a transgluteal cleft approach.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
This study aimed to develop an artificial intelligence-based classification system using ultrasound images obtained via a transgluteal cleft scanning approach for detecting fecal retention in the lower rectum. The goal was to support accurate, objective constipation assessment by nurses in home care settings, where traditional diagnostic tools are often unavailable. Ultrasound videos of the lower rectum were collected from 24 patients undergoing dialysis at a mixed-care hospital. From 90 videos, 2,855 still images were extracted and labeled by expert sonographers based on the presence or absence of hyperechoic areas indicating fecal retention. A deep learning segmentation model using U-Net with a ResNeXt-50 encoder was trained and evaluated. Performance was measured using the intersection over union threshold of 0.5 to define true positives. Accuracy, sensitivity, and specificity were calculated on a test dataset of 758 images. Among the test images, 376 (49.6%) showed fecal retention. The AI system achieved a sensitivity of 81.6%, specificity of 84.0%, and overall accuracy of 82.8%. The mean IoU was 0.601 ± 0.185, indicating a high level of agreement between expert annotations and AI-generated predictions. The tool reliably detected fecal retention in ultrasound images obtained using the transgluteal cleft approach, which overcomes limitations of traditional transabdominal scanning caused by obesity, bladder emptying, or bowel gas. The proposed AI-assisted ultrasound system showed high diagnostic performance in identifying fecal retention in the lower rectum. It may enable non-specialist nurses to assess constipation more safely and accurately, particularly in home-care environments. This technology has the potential to reduce unnecessary laxative use and invasive interventions, ultimately improving the quality of bowel care for older adults with impaired communication or mobility.
48. To test or not to test? Study protocol for a best-worst scaling to understand decision-making and preferences for genetic testing in moderate-risk individuals.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
Genetic testing is usually offered to individuals at high risk of carrying disease-causing variants. For those at moderate risk of genetic conditions, testing could also help in early detection, prevention, and treatment. Although individuals’ preferences to undergo genetic testing can influence their treatment decisions, there is limited research on preferences of moderate-risk individuals. This study aims to estimate the relative importance of factors that influence decision-making for genetic testing of moderate-risk individuals from different disease cohorts and testing types. We outline the study protocol for a best-worst scaling (BWS) object case (Case 1) and a ranking exercise around primary genetic testing and secondary analyses, respectively. Individuals (n = 350) at moderate risk of breast cancer or aortic disease will be recruited through genetic clinics who are part of PreventGene to complete an online preferences survey after deciding whether to have genetic testing, but before receiving the test results. Thirteen BWS items were selected based on the results of a scoping review and input from clinical experts. A balanced incomplete block design will be used. Respondents are asked to select the most (best) and least (worst) important factors in their decision-making. Data will be analysed using count analysis, multinomial logit, and latent class analyses. The data collection started in March 2025 and is expected to be finished by spring 2026. Understanding how individuals at moderate risk make genetic testing decisions can help to better understand the decision-making process about what testing types should be available in which contexts and for which individuals. Findings can inform clinical and health policy decision-makers in planning and offering additional future genetic testing programs for moderate-risk individuals. The study is registered in the Open Science Framework (10.17605/OSF.IO/JFPH9).
49. Sustained illness burden over time among Australians with myalgic encephalomyelitis/chronic fatigue syndrome.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is a disabling chronic illness. Many people with ME/CFS (pwME/CFS) are unable to continue employment and require support to complete activities of daily living. Despite this, ME/CFS remains unrecognised as a disability in Australia. The present study aimed to highlight the profound burdens experienced by pwME/CFS over time to provide evidence of permanency and necessitate reforms to Australian healthcare policies. Data were collected for this longitudinal investigation between 1st October 2021 and 3rd October 2024. All participants were Australian residents aged between 18 and 65 years fulfilling the Canadian or International Consensus Criteria. Sociodemographic information, medical history, illness presentation and patient-reported outcomes were collected using three self-administered questionnaires distributed at approximately six-month intervals. Illness presentation and patient-reported outcomes were investigated over 12 months with Cochran’s Q, Friedman and one-way repeated measures ANOVA tests using Statistical Package for the Social Sciences version 29.0. Quality of life data were compared with Australian population norms using one-sample Wilcoxon signed-rank tests. Thirty-two pwME/CFS (n = 22/32, 68.8% female) participated at all three time points. At baseline, the mean age was 44.03 years and median illness duration was 12.50 years. Participants reported a median of 30 symptoms at each time point - the most common of which were also the most severe in presentation. Importantly, there were no significant changes in any symptom or patient-reported outcome over the 12-month study period. Overall health status, physical health and the ability to participate in daily and work life activities were the most substantially impacted. Quality of life was significantly reduced among pwME/CFS when compared with population norms at all time points. PwME/CFS face substantial and sustained illness burdens. These consistent, profound impairments emphasise the need for improved access to disability and social support services for pwME/CFS in Australia through policy reform.
50. The influence of social determinants of health on orthopedic trauma outcomes in the United States: A scoping review.
期刊: PLOS global public health 发表日期: 2025 链接: PubMed
摘要
Orthopedic trauma disproportionately affects vulnerable populations in the United States, yet the influence of social determinants of health (SDOH) on patient outcomes remains underexplored. This scoping review aims to map and evaluate existing literature on the relationship between SDOH and adult orthopedic trauma outcomes in the U.S., with the goal of identifying research trends, gaps, and priorities for future investigation. Following the JBI methodology for scoping reviews and reported according to PRISMA-ScR guidelines, seven databases were systematically searched. Eligible studies included adult patients (≥18 years) treated for orthopedic trauma in U.S. trauma centers and examined outcomes in relation to SDOH domains. From 8,105 initial records, 40 studies met inclusion criteria. The majority employed retrospective designs (70%) and were conducted at single institutions (52.5%). Social and community context (80%) and healthcare access (57.5%) were the most frequently studied SDOH domains, whereas education access and quality was rarely addressed (7.5%). Lower extremity (35%) and hip (22.5%) injuries were most studied, with surgical management predominating (70%). Reported outcomes varied widely, with mortality (32.5%), length of stay (30%), infection (22.5%), and re-operation (22.5%) being most common. This review highlights both the breadth and fragmentation of current evidence, revealing significant gaps in the study of underrepresented SDOH domains and non-surgical trauma care. Future research should prioritize standardized SDOH data collection and increased investigation of non-surgical trauma outcomes in order to inform equitable clinical practice and guide policy in US orthopedic trauma care.
51. Mapping the mortality-to-incidence ratios of Alzheimer's Disease and Related Dementias (ADRDs): Evidence from the South Carolina Alzheimer's disease registry.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
Mortality-to-incidence ratios (MIRs) are useful in assessing disease burdens and illustrating disparities. Unlike cancer, MIRs have not been applied to ADRDs. Therefore, we estimated and mapped the MIRs for ADRDs to show disparities in South Carolina. Using data from the South Carolina Alzheimer’s Disease Registry (2017-2021), ADRD MIRs were calculated by demographic and geospatial characteristics. To account for the influence of the COVID-19 pandemic, data from 2015 to 2019 were also examined. MIRs were calculated as age-adjusted mortality rates divided by age-adjusted incidence rates. Overall, Black people and rural individuals consistently experienced higher MIRs, with the COVID-19 pandemic increasing this disparity gap. MIRs greater than 1.00 were only observed among Black people. The MIR for 31 out of 46 counties exceeded the state average. Estimating and mapping ADRDs has aided in identifying specific areas with the greatest burden of ADRD in South Carolina for targeting interventions.
52. Assessment of hypertension and diabetes among lecturers in a Ghanaian university: Setting lifestyle practices as precursors.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
Research works relating to the lifestyle of students, non-academic staff, and communities have had considerable attention. However, studies on the lifestyles of university lecturers in Ghana and their association with the occurrence of hypertension and diabetes have received very scanty attention. This study assesses the modifiable lifestyle practices among lecturers in a Ghanaian university, and how these are associated with the occurrence of hypertension and diabetes. It was a cross-sectional study design with a quantitative approach involving 205 lecturers in a Ghanaian university. Data were analyzed using descriptive statistics and regression. The study found that 50.73% and 33.66% of lecturers were overweight (25.0 < 30 Kg/m2) and Obese (<30 Kg/m2) respectively. Also, 97.07% and 85.85% % of Lecturers had normal fasting blood sugar (<5.6 mmol/L) and normal random blood sugar (<11.1mmol/dL) respectively. Again, 62% of lecturers eat breakfast and only 5.4% take fruits and vegetables of 5 servings per day/week. Moreover, 34.6% of lecturers are habitual late meal takers. Again, 30% of lecturers do not undertake any form of exercise. A Lecturer’s age was found to be statistically significant (p = 0.044). It was found that, lecturer aged over 50 years accounted for about 91.25%. Also, 18.54%, 16.10%, and 12.68% of lecturers in Health Sciences, Engineering, Agriculture, and Natural Resources had high blood pressure (systolic >130mmgH, diastolic >90mmgH). Lecturers from the Colleges of Health Science and Engineering were 4 times [COR: 4.11; 95% CI (1.30-12.95)] more likely to develop high blood pressure when compared to those in other Colleges. The prevalence of hypertension and diabetes among the university lecturers was found to be 54.6% and 17.07% respectively. The study concludes that modifiable lifestyles are precursors for the occurrence of hypertension and diabetes among the lecturers studied in a Ghanaian university.
53. Task sharing for point-of-care testing: Review of national health policies and implementation landscape in 19 African countries.
期刊: PLOS global public health 发表日期: 2025 链接: PubMed
摘要
World Health Organization recommends task sharing (TS) for point-of-care testing (POCT) with lay health workers (LHW) to improve access when professional capacity is limited. Despite many benefits of POCT, TS remains underutilized. This study examined uptake of TS for POCT in national policies and the implementation landscape in 19 African countries from November 2024 to March 2025. A mixed-methods approach included an online cross-sectional survey with stakeholders (national ministries of health, medical associations, private laboratories, implementation supporting partners, LHWs); review of national health strategic and policy documents and key informant interviews (KII) with national laboratory directors. Standardized emails recruited participants, whilst documents came from requests and online searches. Quantitative data were analysed descriptively, and KII data with framework analysis. Of 217 policy documents collected, 197 (91%) were relevant. Over half of national health strategic plans (10/19; 53%) recognize LHWs as vital for expansion of primary healthcare services, but fewer (7/19; 37%) mention TS. While 58% (11/19) of national laboratory strategic plans aimed to expand POCT access and quality, 84% did not mention LHW to support TS. Among national HIV/AIDS strategic plans, 53% (9/17) referenced TS for POCT, mainly for HIV diagnosis; with only one addressing POCT for advanced HIV disease. Outside HIV and malaria, LHW POCT was rarely emphasised in disease-specific strategic plans. Seventy-five stakeholders (67% male) completed the online survey, and six KII were conducted. All reported that LHW conduct POCT, mainly with donor-support. HIV rapid testing was cited as having the most structured training program. National laboratory leaders acknowledged implementation challenges but saw opportunities to expand LHW-led POCT. Shifting from fragmented, disease-specific approaches to multi-disease TS model is crucial for sustainable POCT. Coherent policy and implementation reforms are needed to institutionalize TS amid declining resources. National laboratory leadership should drive the adoption of training and quality assurance for TS for multi-disease POCT.
54. Factors associated with perceived weight gain among the adult population of Kazakhstan during the COVID-19 pandemic.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
Obesity has been recognized as a major public health problem globally. The COVID-19 pandemic has negatively affected behavioral patterns and, as a result, the weight gain of people around the world. We aimed to explore factors associated with perceived weight gain among the adult population of Kazakhstan during the COVID-19 pandemic. A cross-sectional study using a multi-stage sampling approach was conducted in Kazakhstan in the summer of 2021. We collected socio-demographic characteristics, information about health-related factors, behavioral risk factors, and self-reported weight change during the pandemic. Multivariable logistic regression was performed to identify factors related to weight gain during the pandemic. Data were analyzed using SAS 9.4 Software. Among 931 participants, 20.95% (N = 195) of individuals gained weight. In the multivariable regression model, the weight gain was associated with increased snacking (AOR = 3.36, 95% CI: 2.20-5.12, p-value < .0001), decreased physical activity (AOR = 1.83, 95% CI: 1.24-2.70, p-value = 0.002), and increased alcohol consumption (AOR = 3.64, 95% CI: 1.72-7.70, p-value < 0.001). We found that older age (≥60 y.o.) was a protective factor for weight gain (AOR = 0.31, 95% CI: 0.15-0.62, p-value = 0.001). One-fifth of adults have gained weight during the COVID-19 pandemic which was associated with potentially modifiable unhealthy behavioral patterns. Our findings highlight that targeted health promotion strategies on global and national levels are needed to emphasize the avoidance of unhealthy behavioral patterns in times of crisis, like the COVID-19 pandemic.
55. Prevalence and incidence of Coats disease in a large claims database.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
To determine the prevalence and incidence of Coats disease in the Japan Medical Data Center (JMDC) claims database. Data on patients with Coats disease were collected from the JMDC claims database that were collected over a five-year period between 2019-2023. The patients with were grouped by their sex and age. The prevalence and incidence were then calculated relative to all of the members in the JMDC database. The treatment rate was calculated as the ratio of patients receiving retinal photocoagulation or vitrectomy to the total number of patients over the five-year period. The age-adjusted prevalence of Coats disease in the JMDC database was 1.7/100,000 with 2.4 males to 0.9 females for the five-year period. The age-adjusted prevalence in children <20-years-of-age with Coats disease was 3.6/100,000 with 5.7 boys to 1.5 girls, while that of adults age ≥ 20 years was 1.3/100,000 with 1.7 males to 0.7 females. The age-adjusted incidence of Coats disease was 0.7/100,000 individuals with 1.0 males to 0.4 females, and for different ages, the age-adjusted incidence was 1.4/100,000 children (2.1 boys to 0.6 girls), and 0.6/100,000 adults (0.8 men to 0.3 women). The treatment rate was 21.9% for all Coats individuals with children having a significantly higher treatment rate of 28.0% than adults of 18.2%. This is the first study that determined the prevalence and incidence of Coats disease in the JMDC database. The prevalence and incidence in children were approximately double that of adults. The proportion of females was higher among adults than among children.
56. Mechanistic study of plastic monomers in gestational diabetes mellitus: A network toxicology and molecular docking approach.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
Plastics are widely used in various fields such as food packaging, textile fibers, building materials, and transportation. Although the relationship between plastic additives and diseases has been reported, there is limited research on the association between plastic monomers (PM) and gestational diabetes mellitus (GDM). This study aims to investigate the link between environmental PM and GDM. By employing advanced network toxicology and molecular docking techniques, we successfully elucidated the molecular mechanisms by which PM may induce GDM. Utilizing databases such as PubChem, SEA, Super-PRED, SwissTargetPrediction, PharmMapper, Gene Cards, and OMIM, we identified potential targets associated with the disease. Further analysis using STRING and Cytoscape software helped determine the core targets most significantly related to these metabolic disorders. Additionally, Gene Ontology and Kyoto Encyclopedia of Genes and Genomes pathway enrichment analyses were conducted using the David database to characterize these core targets. Finally, molecular docking with CB-Dock2 was used to validate the binding affinity of PM to these target proteins. Our findings suggest that PM may potentially induce GDM by modulating the insulin signaling pathway through STAT3, AKT1, and TP53. In summary, this work provides novel insights into the mechanisms by which environmental pollutants may trigger GDM, thereby laying a theoretical foundation for disease prevention and treatment. It offers valuable references for the safety evaluation of plastics, urging food safety regulatory agencies to strengthen oversight and encouraging the public to reduce plastic usage.