公共卫生研究摘要 (2026-01-03)
共收录 58 篇研究文章
1. Clinical analysis of 255 children with multiple serous effusions.
期刊: Annals of medicine 发表日期: 2026-Dec 链接: PubMed
摘要
This study aimed to analyze the etiological spectrum, clinical features, and pathological correlates of multiple serous effusions in pediatric patients to inform clinical decision-making. A retrospective study was conducted on 255 children diagnosed with multiple serous effusions at the Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University between January 1, 2014, and July 1, 2024. The most common identified causes were pneumonia (n = 80, 31.37%), and trauma (n = 28, 10.98%). Etiologies demonstrated age and sex-specific patterns. Pneumonia predominated in preschool/school-aged children, and trauma was more common among preschool/school-aged boys. Tumors mainly affected school-aged/adolescent males, while connective tissue diseases (primarily systemic lupus erythematosus) predominated in adolescent females. Pleural effusion was the most common manifestation (n = 243, 95.3%), followed by peritoneal (n = 187, 73.3%) and pericardial effusions (n = 136, 53.3%). The nature and distribution of effusions correlated with the underlying disease. Pneumonia/tumor cases exhibited higher susceptibility to pleural and pericardial effusions, predominantly exudative. Connective tissue disease cases frequently demonstrated involvement of all three serous cavities, predominantly exudative. Cardiac insufficiency cases typically presented with transudative effusions. The triple serous cavity effusion group exhibited significantly lower hemoglobin, serum albumin, calcium, and IgM levels (p < 0.05), alongside significantly elevated C-reactive protein, brain natriuretic peptide, prothrombin time, international normalized ratio, and D-dimer levels (p < 0.05), indicating more severe disease progression. The etiology of pediatric multiple serous effusions is diverse and closely linked to patient age and effusion location. The number of affected cavities may serve as an indicator of disease severity.
2. Community Health Participatory interventions in the prevention and control of non-communicable diseases including mental health in crisis-affected Low-and Middle-Income Countries - a scoping review.
期刊: Global health action 发表日期: 2026-Dec 链接: PubMed
摘要
The rising burden of Non-Communicable Diseases (NCDs) requires a comprehensive strategy by integrating community-based interventions - especially in Low- and Middle-Income Countries (LMICs). Over the past decade, researchers have emphasized communities as key agents of change in health systems. While Community Health Participatory (CHP) interventions show promise in NCD management, their application in crisis-affected contexts remains underexplored. This scoping review examines the adoption of CHP interventions, strategies employed, their barriers and facilitators encountered in crisis-affected LMICs to prevent and control NCDs. Utilising the Arksey and O’Malley framework, comprehensive search was conducted across PubMed, Web of Science, Scopus, and Google Scholar. Primary studies and grey literature in English were included focusing on CHP interventions among adults in such settings. Studies on unrelated health issues, review articles, protocols, and conference abstracts were excluded. Data extraction was conducted using Covidence, with discrepancies resolved through consensus. The narrative analysis of the extracted data was conducted. The review identified varied CHP interventions, with the majority focusing on mental health. The included studies highlighted the role of community engagement and stakeholders’ involvement. Strategies included raising awareness, providing social support and focusing on lifestyle modifications. Barriers to interventions included limited resources, socio-cultural constraints, and logistical challenges, while facilitators involved community leadership and ownership, empathy, cultural adaptations of interventions, and multi-sectoral collaboration.CHP interventions represent a promising strategy for tackling NCDs in crisis-affected LMICs, however, limited evidence on their long-term impact needs further research.This review was registered on the Open Science Framework and funding was provided by NIHR-UK (NIHR203248). Main finding: Community Health Participatory interventions are increasingly applied in both urban and rural settings, utilizing varied strategies while maintaining community involvement as a core element to enhance empowerment for Non-Communicable Disease prevention and control.Added knowledge: This review underscores the emerging focus on Non-Communicable Disease prevention and control in crisis-affected Low- and Middle-Income Countries, expanding beyond mental health to include other Non-Communicable Diseases and related risk factors.Global health impact for policy and action: Integrating Community Health Participatory interventions into crisis-response strategies presents a significant opportunity for Non-Communicable Diseases prevention and control in Low- and Middle-Income Countries, strengthening health system resilience and fostering community cohesion in crisis-affected settings.
3. Associations between attitudes accepting of wife abuse and emotional abuse, forced heavy work, and food deprivation during pregnancy in Nepal: a cross-sectional study.
期刊: Global health action 发表日期: 2026-Dec 链接: PubMed
摘要
Social norms and gendered power relationships contribute to the acceptability of ‘wife abuse’ - a common form of domestic violence globally. To estimate the prevalence and overlap of emotional abuse, forced heavy work, and food deprivation during pregnancy and examine their association with women’s attitudes accepting of wife abuse in Nepal. Baseline data were used from a randomized controlled trial involving pregnant women aged 18 and older attending routine antenatal care at two public hospitals in Nepal between January 2023 and March 2025. Participants completed a color-coded audio computer assisted self-interview. Attitudes toward wife abuse were assessed using 16 items drawn from three existing instruments. Exploratory factor analysis identified three distinct attitudinal factors. The dependent variable was a composite indicator of emotional abuse, forced heavy work, or food deprivation (coded as present if any were reported). Associations between the three attitudinal factors and composite outcome were analyzed using multiple logistic regression, adjusting for relevant sociodemographic variables. Emotional abuse, forced heavy work, or food deprivation was reported by 6.7% of participants. Acceptance of wife abuse for domestic shortcomings (Factor 1) was significantly associated with higher odds of experiencing abuse (aOR [1.75 (1.23-2.50)]. Pregnant women who endorsed attitudes accepting wife abuse - particularly for perceived domestic shortcomings - had higher odds of experiencing emotional abuse, forced heavy work, or food deprivation. These findings highlight importance of addressing harmful gender norms within households and ensuring antenatal care settings include safe opportunities to identify and support women at risk. Main findings: Pregnant women who viewed wife abuse as justifiable for perceived domestic shortcomings were more likely to report emotional abuse, forced heavy work, or food deprivation, while higher education was associated with lower risk.Added knowledge: The study shows that deeply rooted gender norms around household responsibilities shape women’s acceptance of abuse and their vulnerability during pregnancy.Global health impact for policy and action: The findings can guide community-based education (targeting stakeholders such as teachers, lawyers, religious leaders, health care providers, and women), antenatal care screening practices, and policy efforts aimed at transforming harmful gender norms and reducing domestic violence during pregnancy.
4. Current knowledge and perspectives in respiratory management for immunocompromised patients with acute respiratory failure.
期刊: Current opinion in critical care 发表日期: 2026-Feb-01 链接: PubMed
摘要
One of the most common causes of intensive care unit admission in the immunocompromised population is acute respiratory failure. This population has many unique characteristics that render their respiratory failure risk factors, etiologies, and management different from the general nonimmunocompromised population. While mortality rates have improved in the setting of invasive mechanical ventilation, it remains higher than the general population, making prevention of intubation a key area of interest. Acute respiratory failure in immunocompromised patients is common, complex, and associated with a high case-fatality rate. Ventilatory strategies should be tailored to the clinical context and to the prognosis of the underlying condition. In eligible patients, early ICU admission, a thorough work up to identify the etiology and invasive mechanical ventilation should not be delayed once criteria for intubation are met, despite attempts at noninvasive oxygenation. Future research should aim move beyond a binary definition of immunosuppression and account for its complexities to identify sub-phenotypes most likely to benefit from specific therapeutic strategies, thereby advancing the personalization of care. This review explores the literature on noninvasive respiratory support, invasive mechanical ventilation, and extracorporeal life support and the unique considerations in the immunocompromised population.
5. The Radon Effective Dose Calculation Following the Dosimetric Approach: Examples and Challenges.
期刊: Health physics 发表日期: 2026-Feb-01 链接: PubMed
摘要
With the ICRP Publication 137 dealing with the occupational intake of radionuclides, an important and crucial path toward the practical implementation of the dosimetric approach also for radon was undertaken. However, some problems and difficulties must be overcome to use this new method to estimate the effective dose of radon in real situations. Direct dosimetric calculations are often not an easy task. The ICRP Publication 137 gives some examples of this new approach by providing the coefficients of the effective dose per exposure for some typical workplaces. In this work, some practical examples of the effective dose calculation in some selected workplaces were performed, studying the most important factors affecting the results. In particular, the role of the equilibrium factor F and of the dose conversion factor (DCF) as a function of the particulate size distribution were investigated and discussed. In this context, a few direct measurements of the equilibrium factor F were done as well as an experimental supporting tool for a comprehensive dose assessment.
6. Topical Issues for the Future of Radiation Protection.
期刊: Health physics 发表日期: 2026-Feb-01 链接: PubMed
摘要
This paper summarizes the presentations and panel discussion provided at Plenary Panel #2 on the first day of the 16th World Congress of the International Radiation Protection Association (IRPA) jointly organized with the 69th Annual Meeting of the Health Physics Society (HPS) in Orlando/Florida in July 2024. International organizations that play a key role in radiation protection and are close in contact with IRPA by official agreements or even MoU’s (Memorandum of Understanding) presented highlights of their projects in radiation protection as well as results. Topical issues on their current work program as seen in a list of statements, including future efforts, were presented and discussed. The needs of practitioners were stressed for recognition by the representatives of the international organizations to be included in their projects. Requested and presented topics were: • Key challenges for radiation protection practitioners in the next 10 y. • Potential effects of emerging science on radiation protection. • Challenges for implementation of IAEA Safety Standards in low- and middle-income countries. • Challenges in occupational radiation protection. • Broadening the process of optimization. • Impact of emerging technologies on radiation protection. • Ensuring radiation protection workforce for the future.
7. Bedside Clinical Ultrasound Performed by Family Physicians in Adult Patients With Abdominal Pain in a Hospital Emergency Department: Protocol for a Pilot Quasi-Experimental Study.
期刊: JMIR research protocols 发表日期: 2026-Jan-02 链接: PubMed
摘要
Point-of-care ultrasound is a valuable bedside tool that, with adequate training, can reduce diagnostic uncertainty and improve clinical accuracy. Abdominal pain is a frequent complaint in emergency departments and often requires imaging for appropriate management. This study aims to assess the impact of bedside clinical ultrasound performed by family physicians on length of stay, number of basic radiological tests, and need for further diagnostic evaluations in adult patients with abdominal pain. This is a pilot quasi-experimental study assessing feasibility and viability, with a nonrandomized control group, to be conducted in the Emergency Department of Hospital Comarcal de Riotinto. Adult patients (≥18 y) presenting with abdominal pain will be included. Both groups will receive standard care. In the intervention group, bedside ultrasound will be performed by trained family physicians; in the control group, ultrasound will be performed by radiologists only if deemed necessary. The primary outcome is the improvement in quality of care, assessed through a reduction in emergency department length of stay, fewer basic radiology tests requested, and diagnostic concordance. Secondary outcomes include the need for additional diagnostic studies and the appropriateness of referrals, evaluated through 1-month follow-up and reconsultation. The first phase of the project began in 2023 with the validation of the data collection form. Subsequently, the patient satisfaction questionnaire was validated, and the results were published in the journal Care Primary. The study has received external funding, and patient recruitment is currently ongoing and expected to be completed in December 2025. This study aims to demonstrate the clinical and organizational benefits of implementing bedside ultrasound by family physicians in emergency care.
8. Long-Term Effects of Mobile-Based Metamemory Cognitive Training in Older Adults With Mild Cognitive Impairment: 15-Month Prospective Single-Arm Longitudinal Study.
期刊: JMIR aging 发表日期: 2026-Jan-02 链接: PubMed
摘要
Mild cognitive impairment (MCI) is an intermediate state between normal aging and dementia, characterized by subjective cognitive decline and objective memory impairment. Cognitive training has consistently shown short-term benefits for individuals with MCI, but evidence on the long-term effectiveness is extremely limited. Given the progressive nature of MCI and the need for sustainable strategies to delay cognitive decline, research on the long-term impact of cognitive training is necessary and timely. Mobile-based platforms offer a promising solution by enhancing accessibility and adherence, but their durability of effect over extended periods remains underexplored. This study aimed to evaluate the long-term effects of a mobile-based cognitive training app on the cognitive function of older adults with MCI. In total, 28 older adults with MCI used Cogthera, a mobile cognitive training app based on metamemory training. Participants completed 2 training sessions daily for 3 months, and 9 (32%) continued for an additional 12 months. Cognitive function and quality of life were assessed using the Alzheimer’s Disease Assessment Scale-Cognitive Subscale 14 and EQ-5D-5L. Cognitive function improved over 15 months, as measured by Alzheimer’s Disease Assessment Scale-Cognitive Subscale (F2,35.56=7.08; P=.003). EQ-5D-5L scores increased at 3 months but did not show sustained change at 15 months (F2,42.14=3.40; P=.04). Greater cognitive improvements were associated with younger age, higher functional status, and lower baseline cognitive function. This study showed that long-term use of a mobile-based metamemory cognitive training app was associated with cognitive improvements over 15 months. Although limited by the small sample size and the absence of a control group, these findings suggest potential for mobile cognitive training as a sustainable intervention that warrants validation in larger trials.
9. Multimodal Transformer-Based Electrocardiogram Analysis for Cardiovascular Comorbidity Detection: Model Development and Validation Study.
期刊: JMIR formative research 发表日期: 2026-Jan-02 链接: PubMed
摘要
Cardiovascular diseases remain the leading global cause of mortality, yet traditional electrocardiogram (ECG) interpretation shows subjective variability and limited sensitivity to complex pathologies. This study aims to address these challenges by proposing the Cardiovascular Multimodal Prediction Network (CaMPNet), a transformer-based multimodal architecture that integrates raw 12-lead ECG waveforms, 9-structured machine-measured ECG features, and demographic data (age and sex) through cross-attention fusion. The model was trained on 384,877 records from the Medical Information Mart for Intensive Care IV - Electrocardiogram Matched Subset database and evaluated across 12 cardiovascular disease labels. To further assess temporal robustness, a temporal external validation was performed using the most recent 10% of the data, withheld chronologically from model development. On the internal test set, the model achieved a mean area under the curve (AUC) of 0.845 (SD 0.04) and area under the precision-recall curve of 0.489, outperforming the residual networks-ECG baseline (AUC=0.848 but F1-score=0.152) and all single-modality variants. Subgroup analyses demonstrated consistent performance across demographics (male AUC= 0.846 vs female=0.843; youngest quartile 0.884 vs oldest 0.811). CaMPNet retained moderate discriminative ability in temporal external validation with a mean AUC of 0.715 (SD 0.03) and area under the precision-recall curve of 0.298, although performance declined due to temporal distribution shifts. Despite this, major disease categories, such as atrial fibrillation, heart failure, and normal rhythm, maintained high AUCs (>0.84). Attention-based visualization revealed clinically interpretable patterns (eg, ST-segment elevations in ST-segment elevation myocardial infarction), and ablation experiments verified the model’s tolerance to missing structured inputs. CaMPNet demonstrates robust and interpretable multimodal ECG-based diagnosis, offering a scalable framework for comorbidity screening and continual learning under real-world temporal dynamics.
10. The Application of Mobile Health in Self-Management Among Patients Undergoing Dialysis: Scoping Review.
期刊: Journal of medical Internet research 发表日期: 2026-Jan-02 链接: PubMed
摘要
The incidence of end-stage renal disease continues to rise annually, with dialysis currently serving as the primary replacement therapy. The effectiveness of dialysis treatment and patients’ quality of life are highly dependent on their self-management. Mobile health (mHealth), which provides real-time medical support through portable devices, has become an essential tool for assisting patients undergoing dialysis in optimizing their self-management. This study aimed to systematically explore the core elements of self-management in patients undergoing dialysis and clarify the primary applications of mHealth, including types of mHealth, relevant theories and models, mHealth-based interventions, and evaluation indicators. This study was guided by Arksey and O’Malley’s methodology, PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews), and PRISMA-S (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Literature Search Extension). Databases, such as PubMed, Embase, CINAHL, PsycINFO, and Web of Science, were systematically searched from January 2010 until October 2025. The participants included in this study were patients undergoing dialysis, and the study design must incorporate quantitative research. Published protocols, reviews, editorials, conference papers, books, and non-English studies were excluded. The Mixed Methods Appraisal Tool was used to evaluate the quality of the included studies. Quantitative studies were extracted, mapped, and summarized. The results were collated and synthesized using a structured spreadsheet. Out of 1483 relevant studies, this scoping review ultimately selected 34 studies involving 2068 patients undergoing dialysis. Self-management among patients undergoing dialysis in this study included 6 major areas, including self-monitoring, diet and fluid management, medication management, disease-related knowledge, exercise management, and psychological management. Most studies used a single app (n=22) for management of patients undergoing dialysis, followed by 2 or more online interventions (n=6) and a remote patient monitoring system (n=3). The mHealth-based interventions in this study focused on self-monitoring, dietary and fluid management, and medication management. The transtheoretical model and stages of change (n=5), self-efficacy theory (n=4), and social cognitive theory (n=4) were the most commonly used theories. Among the evaluation indicators, interdialytic weight gain (n=12), serum potassium (n=14), serum phosphorus (n=20), and serum albumin (n=14) were the most commonly used objective indicators. Subjective indicators were assessed using scales, primarily covering adherence (n=17), self-efficacy (n=14), quality of life (n=12), knowledge (n=9), and diet and nutrition (n=9). Although mHealth holds promise for improving self-management and outcomes among patients undergoing dialysis, there remains significant room for advancement. Future research in this field should focus on enhancing adaptive software development, deeply integrating artificial intelligence technologies, addressing the needs of special populations, and establishing a standardized self-management evaluation system. Our findings not only provide a theoretical framework for optimizing clinical management strategies for patients undergoing dialysis but also offer targeted guidance and practical insights for the subsequent development of apps.
11. Using Indoor Movement Complexity in Smart Homes to Detect Frailty in Older Adults: Multiple-Methods Case Series Study.
期刊: JMIR aging 发表日期: 2026-Jan-02 链接: PubMed
摘要
The theory of complexity in aging indicates that the complexity of sensor-derived physiological and behavioral signals reflects an older adult’s adaptive capacity and, in turn, their frailty. Smart homes with ambient sensors offer a unique opportunity to longitudinally explore the complexity of older adults’ indoor movement in a real-world setting. Here, we introduce a computational method to estimate behavior complexity from sensor data. We further conduct a multiple-methods case series to explore the relationship between entropy-measured smart home data complexity and older adult frailty. This study aims to explore the relationship between entropy-measured ambient sensor data complexity and frailty in independent community-dwelling older adults. The nature of older adults’ indoor movement complexity is measured by quantifying the entropy of smart home data. Overall, 11 cases with persons aged 65 years and older were drawn from an ongoing smart home study to illustrate the method. We assessed weekly frailty for these cases using the Clinical Frailty Scale. For corresponding time ranges, we measured the complexity of smart home data using a fixed-width sliding window and an entropy-based complexity index (Rényi Complexity Index) built on a Universal Sequence Map (USM-Rényi). Descriptive statistics and graphical analysis were used to describe intraindividual frailty and sensor complexity change. The complexity of sensor-observed indoor movement does change over time in older adults as quantified by the computational method. In some individuals, these changes track with health transitions and frailty progression. The trends and monotonicity of complexity trajectories varied between cases. Overall, 3 of the cases demonstrated a negative association between frailty and complexity, while the association was not as clear for the other cases. The complexity of older adults’ smart home data is highly diverse. Changes in health and frailty influence indoor movement complexity. Although the findings suggest a relationship between frailty and complexity, confounding factors, such as home layout, visitors, external events, and technology disruptions, may influence sensor signals.
12. Effects of Oliceridine Versus Sufentanil on Postoperative Recovery Quality During Hysteroscopy Under Laryngeal Mask Airway Anesthesia: Protocol for a Single-Blind and Randomized Controlled Trial.
期刊: JMIR research protocols 发表日期: 2026-Jan-02 链接: PubMed
摘要
Hysteroscopy, the gold standard for diagnosing and treating intrauterine pathologies, has shown substantial increase in its adoption in clinical practice. Nevertheless, early postoperative pain and opioid-related adverse effects remain critical determinants of recovery quality. Oliceridine-a novel G protein-biased μ-opioid receptor agonist-demonstrates an improved therapeutic range over conventional opioids in preliminary studies. This study aims to evaluate whether oliceridine enhances recovery quality while reducing opioid-related complications compared to sufentanil in patients undergoing hysteroscopy under general anesthesia. This single-center randomized controlled trial will enroll 120 patients undergoing hysteroscopy under general anesthesia with 1:1 randomization to sufentanil- or oliceridine-based analgesia. The primary outcome is early recovery quality assessed by the 15-item Quality of Recovery scale at 24 hours after the surgery, while secondary outcomes include hemodynamic fluctuations during induction, total intraoperative opioid consumption and supplemental bolus frequency, proportion requiring vasoactive agents, incidence of respiratory depression in postanesthesia care unit, postoperative extubation time, opioid-related adverse events within 24 hours, and Visual Analog Scale pain scores at 30 minutes, 4 hours, 8 hours, and 24 hours postextubation. This study received approval from the Medical Ethics Committee of Deyang People’s Hospital, Deyang, China, on April 16, 2025 (approval 2025-03-009-K01). Participant recruitment is anticipated to be completed by December 2025. Data analysis, manuscript preparation, and submission for publication are expected to be completed by February 2026. The successful completion of this trial will generate evidence regarding whether oliceridine enhances recovery quality while reducing opioid-related complications compared to sufentanil in patients undergoing hysteroscopy under general anesthesia. Chinese Clinical Trial Registry ChiCTR2500104024; https://www.chictr.org.cn/showproj.html?proj=275501. DERR1-10.2196/84521.
13. Practice-Focused Research Based on Public Health Critical Race Praxis.
期刊: Annual review of public health 发表日期: 2026-Jan-02 链接: PubMed
摘要
A growing number of researchers use public health critical race praxis (PHCRP), an antiracism framework derived in part from critical race theory, to conceptualize racism as a public health problem and examine its contributions to health and health care inequities. Critical race scholars define racism as “the state-sanctioned and/or extralegal production and exploitation of group-differentiated vulnerability to premature death,” as stated by Ruth Gilmore in her 2007 book Golden Gulag. Despite solid evidence for the prevalence and potential effects of racism, few studies provide data to guide the development, implementation, and evaluation of antiracism interventions in diverse settings (e.g., community, health care), activities that we refer to in this review as practice. A central focus of PHCRP is to guide evidence-based action to disrupt racism; therefore, the framework may be useful in guiding antiracism practice. However, evidence for its use for practice has not been established. To encourage the development, implementation, and evaluation of antiracism solutions, this review examines the evidence applying PHCRP to practice-focused research. The findings provide a baseline assessment to guide future evidence-based antiracism mitigation efforts. We offer recommendations to support future practice-focused work.
14. Breaking Paradigms: Mexico's Stroke Roadmap Assessing Institutional Resources Using World Stroke Organization Stroke-Certification Parameters.
期刊: Cerebrovascular diseases (Basel, Switzerland) 发表日期: 2026-Jan-02 链接: PubMed
摘要
This study provided a comprehensive assessment of the geographic distribution and accessibility of stroke care resources in Mexico’s public health system. The World Stroke Organization (WSO) roadmap criteria classifies centers offering only intravenous thrombolysis as Essential Stroke Centers (ESCs) and those providing both thrombolysis and mechanical thrombectomy as Advanced Stroke Centers (ASCs). Despite recent progress, substantial disparities in access have persisted, particularly between the remote and underserved areas. Methods This cross-sectional study evaluated institutional resources for acute stroke care across public hospitals in Mexico. A structured online survey developed by the Deputy Secretariat for Health Policy and Population Well-Being in collaboration with experts was based on the WSO Roadmap and aligned with the institutional protocols. The instrument was validated by healthcare professionals and distributed via institutional email to the medical directors of IMSS, ISSSTE, IMSS-Bienestar (including the National Institutes of Health), PEMEX, and SEMAR. Data were collected between December 5, 2024, and January 25, 2025. Duplicate entries, nonhospital responses, and uncertified neurointerventional specialists were excluded. The analysis was restricted to general and regional hospitals, and eligible facilities were identified and validated against the Ministry of Health’s Catalogue of Health Establishments. All hospitals were georeferenced using the CLUES code and classified as ESCs or ASCs according to the WSO Roadmap criteria. Results In total, 1,032 facilities across 32 federal entities completed the survey. Hospitals without diagnostic or therapeutic capacity for stroke were excluded from further analysis. Isochrones were generated using national road network data and the estimated average travel speeds for different road types under normal conditions. Eighty-five percent of at-risk individuals reside within 60 minutes of an ESC, ensuring access to fibrinolytic therapy. In contrast, 14% of individuals aged ≥40 years (6,312,370 people) live more than 60 min from the nearest ESC. Despite advances in acute ischemic stroke (AIS) care, more than half of the population aged ≥40 years remains over one hour away from an ASC, highlighting critical “stroke care deserts,” particularly in access to thrombectomy, most notably in Colima, Nayarit, Oaxaca, Guerrero, Veracruz, and Sinaloa. Strengthening universal stroke care through interinstitutional collaboration, standardized protocols, certification programs, and optimization of referral networks could enable up to 85% of the at-risk population to access effective treatment at certified stroke centers. Our analysis highlights the major infrastructural and logistical barriers that impede equitable access to life-saving endovascular therapies. Addressing these gaps is essential to reduce mortality and disability in Mexico’s heterogeneous public health system.
15. Factors Associated With Leisure Time Physical Activity and Sedentary Behavior in Young Women 2-7 Years After Delivery of a Pregnancy in the nuMoM2b Heart Health Study.
期刊: American journal of health promotion : AJHP 发表日期: 2026-Jan-02 链接: PubMed
摘要
PurposeIdentify demographic, behavioral lifestyle, psychological, and clinical factors associated with suboptimal activity patterns several years after a first pregnancy and delivery.DesignCross-sectional, secondary analysis.Setting and SampleWomen (n = 2843) from eight U.S. centers assessed 2-7 years after delivery in the nuMom2b Heart Health Study.MeasuresSelf-reported leisure time moderate-to-vigorous intensity physical activity (MVPA) and sedentary behavior (SB) were used to define patterns based on meeting recommendations for MVPA (active at ≥150 minutes/week) and leisure time SB (low SB at ≤3 hours/day). Factors (demographic, behavioral lifestyle, psychological, and clinical) assessed at study visits and hypothesized to be related to MVPA-SB patterns were included.AnalysisMultinomial logistic regression with forward selection identified factors associated with MVPA-SB patterns.ResultsParticipants most frequently reported the optimal active + low SB pattern (37.8%). Modifiable factors significantly associated with suboptimal patterns included lower diet quality (odds ratios [OR] 0.18-0.62; P < 0.001), higher body mass index (BMI) (ORs 1.15-2.49; P = 0.001), less sleep (ORs 1.27-1.46; P = 0.0013), and higher perceived stress (ORs 1.20-1.52, P = 0.0015). Lower income (ORs 0.39-0.60, P = 0.0002), lower education (ORs 0.38-0.40; P = 0.0323) and working/studying full-time (ORs 1.42-1.97, P-0.0021) were also associated with suboptimal patterns.ConclusionsFuture research designing “sit less, move more” interventions following pregnancy and delivery could consider simultaneous intervention for modifiable factors and tailored strategies for low income/education and full-time working/student women who may face additional barriers.
16. Housing Cost Burden and Outcomes Among Medicaid Beneficiaries With Heart Failure.
期刊: JAMA health forum 发表日期: 2026-Jan-02 链接: PubMed
摘要
Housing cost burden is at an all-time high in the US and may disproportionately affect health outcomes among low-income populations. Medicaid-insured individuals and those diagnosed with cardiovascular (CV) disease, such as heart failure (HF), may be especially at increased risk of adverse health outcomes associated with housing cost burden. To assess the association between area-level housing cost burden and the probability of CV-related hospitalization or emergency department (ED) visits among Medicaid beneficiaries aged 19 to 64 years with HF. This cross-sectional study used individual-level health care utilization data obtained from the Transformed Medicaid Statistical Information System Analytic Files (2018-2019). All zip codes in the US with resident Medicaid beneficiaries aged 19 to 64 years who had a preexisting diagnosis of HF and were continuously enrolled in 2019 were included except for those in Alabama, Rhode Island, and Utah due to data quality issues. Data were analyzed from October 2024 to October 2025. Area-level housing cost burden was defined as the zip code-level proportion of housing units occupied by individuals with an annual household income less than $35 000 who spent 30% or more of their income on housing costs. The probability of a CV-related hospitalization and of a CV-related ED visit in 2019. Generalized estimating equation models were used to evaluate the association between housing cost burden and outcomes after adjusting for individual and area-level factors. This study included 233 195 individuals (mean [SD] age, 51.5 [9.6] years, 107 447 female [46.1%]) who were living in 19 577 zip codes. The mean (SD) zip code housing cost burden was 67.4% (16.5%). In 2019, 42 886 beneficiaries (18.4%) had at least 1 CV-related hospitalization and 75 392 (32.3%) had an ED visit. After covariate adjustment, a 10-percentage point increase in housing cost burden was associated with higher odds of CV-related hospitalizations (odds ratio [OR], 1.03; 95% CI, 1.01-1.06) and ED visits (OR, 1.03; 95% CI, 1.01-1.04). There were also higher odds of HF-related hospitalizations (OR, 1.04; 95% CI, 1.01-1.07). The findings of this study suggest that area-level housing cost burden may be associated with outcomes among Medicaid beneficiaries with HF and highlights the need to investigate whether strategies that address housing affordability can play a role in improving health outcomes in this population.
17. Data Resource Profile: Climate and Enteric Diseases Research Project (ClimED).
期刊: International journal of epidemiology 发表日期: 2026-Jan-02 链接: PubMed
摘要
18. Navigating the Infodemic: A Perspective Study on Media Health Literacy in the MENA Region.
期刊: American journal of health promotion : AJHP 发表日期: 2026-Jan-02 链接: PubMed
摘要
The COVID-19 infodemic underscored the urgent need to strengthen media health literacy (MHL) as a cornerstone of public health resilience. This perspective examines MHL within the complex sociopolitical, cultural, and digital landscape of the Middle East and North Africa (MENA) region, where misinformation, inequities, and limited institutional trust amplify health vulnerabilities. It proposes an integrated framework built on 4 pillars-policy and advocacy, multi-sectoral collaboration, empowerment of vulnerable populations, and technology-driven innovation-to foster equitable access to reliable health information. Advancing MHL in MENA is essential to building trust, enhancing informed decision-making, and promoting regional health equity.
19. PARP1 stabilizes FOXN3 to suppress pulmonary fibrosis through p38-related feedback regulation.
期刊: Science advances 发表日期: 2026-Jan-02 链接: PubMed
摘要
The transcriptional repressor forkhead box N3 (FOXN3) has been reported to suppress pulmonary fibrosis by inhibiting Smad transcriptional activity. However, FOXN3 becomes unstable in response to profibrotic stimuli. This study identifies poly(ADP-ribose) polymerase-1 (PARP1) as a stabilizing partner of FOXN3, preventing its degradation by blocking p38-mediated phosphorylation. Lung-specific knockout (KO) of PARP1 promotes the development of pulmonary fibrosis by reducing the abundance of FOXN3. Conditional overexpression of FOXN3 notably mitigates pulmonary fibrosis resulting from PARP1 KO by impeding Smad signaling, underscoring the critical role of the PARP1-FOXN3 axis in pulmonary fibrosis. Mechanistically, p38 is a Smad response gene that is transcriptionally repressed by the PARP1/FOXN3 complex. The disruption of PARP1 or FOXN3 increases p38 expression, which in turn facilitates FOXN3 degradation through a feedback mechanism. This cascade activates Smad signaling, leading to a profibrotic response and myofibroblast activation. Notably, levels of PARP1 and FOXN3 are significantly reduced in patients with pulmonary fibrosis, highlighting PARP1’s crucial role in suppressing the disease by regulating FOXN3-mediated Smad signaling.
20. Using Machine Learning for Green Substitution of Industrial Chemicals: Integrating Functionality, Hazard, and Life Cycle Impact.
期刊: Chemical reviews 发表日期: 2026-Jan-02 链接: PubMed
摘要
Industrial chemicals are characterized by their substantial production volumes, widespread applications, fugitive release into the environment, and the general lack of full awareness regarding their risks, carrying global unintended adverse effects on human and ecological health. In the ongoing pursuit of more sustainable and less hazardous industrial chemicals, a tremendous body of research has been developed. However, reliance on empirical molecular design based solely on human knowledge and expertise may not be adequate for avoiding regrettable substitution. Recent advances in generative machine learning (ML) technologies, and their applications in ML-assisted molecular design, possess immense promise to bring innovative solutions for green substitution of hazardous industrial chemicals. This review outlines the methodologies of ML-assisted molecular design and proposes design strategies for green alternative chemicals that possess both necessary functionalities and low environmental hazards throughout their life cycles. Additionally, case examples are provided to illustrate the methodologies and highlight areas that warrant further research, including the development of AI agents for both chemical risk management and green substitution. Applications of the methodologies can yield a sustainable and responsible way that both promotes the benefits of industrial chemicals and simultaneously minimizes their adverse impacts on humans and the environment.
21. Single-nucleus multiomics of murine gonads reveals transcriptional regulatory network underlying supporting lineage differentiation.
期刊: Science advances 发表日期: 2026-Jan-02 链接: PubMed
摘要
Sex determination of mammalian gonads hinges upon sex-specific differentiation of gonadal supporting cells: Sertoli cells in the testis and granulosa cells in the ovary. To gain insights into how supporting cells acquire their identities, we performed joint single-nucleus transcriptomics and chromatin accessibility assays on murine gonadal cells during sex determination. By contrasting sex-specific gene expression and corresponding chromatin accessibility among progenitor and differentiated cells, we found that sex-specific chromatin regions in supporting cells are established shortly after sex determination, accompanied by the acquisition of active histone marks. The presence of potential transcription factor-binding motifs in the open chromatin regions revealed regulatory networks underlying ovary-enriched factors LEF1 and MSX1, which promote granulosa fate by inducing granulosa-specific genes such as Foxl2 and Fst. Our results not only identify the gene regulatory framework underlying supporting cell sex differentiation but also provide invaluable resources for the field.
22. Deletion of the moeA gene in Flavobacterium IR1 drives structural color shift from green to blue and alters polysaccharide metabolism.
期刊: eLife 发表日期: 2026-Jan-02 链接: PubMed
摘要
Structural colors (SC), generated by light interacting with nano-structured materials, are responsible for the brightest and most vivid coloration in nature. Despite being widespread within the tree of life, there is little knowledge of the genes involved. Partial exceptions are some Flavobacteriia in which genes involved in a number of pathways, including gliding motility and polysaccharide metabolism, have been linked to SC. A previous genomic analysis of SC and non-SC bacteria suggested that the pterin pathway is involved in the organization of bacteria to form SC. Here, we focus on moeA, a molybdopterin molybdenum transferase. When this gene was deleted from Flavobacterium IR1, the knock-out mutant showed a strong blue shift in SC of the colony compared to the wild-type. The moeA mutant showed a particularly strong blue shift when grown on kappa-carrageenan and was upregulated for starch degradation. To further analyze the molecular changes, proteomic analysis was performed, showing the upregulation of various polysaccharide utilization loci, which supported the link between moeA and polysaccharide metabolism in SC. Overall, we demonstrated that a targeted approach, modifying a single gene identified by genomics, could change the optical properties of bacteria. Nature never disappoints in its display of colourful organisms. A striking example is the iridescent plumage of the peacock, with its magnificent blue and green shading. But these fantastical colours are not produced by conventional dyes or pigments. As early as the 17th century, natural philosophers such as Robert Hooke and Isaac Newton discovered that they arise from light interacting with nanostructures in the feathers, which selectively reflect the intense blues and greens. This optical phenomenon is known as structural colour, and it is widespread in nature – from flowers, seaweeds and seeds to many groups of animals. Structural colour serves a variety of functions, including light management, attraction of pollinators, photoprotection, and roles in sexual signalling, warning, or camouflage. More recently, structural colours have also been observed in certain marine bacteria, particularly when they grow in dense groups or colonies. For example, the Flavobacterium strain IR1 isolated from Rotterdam harbour forms strikingly iridescent colonies when grown in the laboratory. Despite these observations, little is known about why bacteria produce structural colour or how it is generated at the genetic level. To address this gap, Doncel et al. used a computational modelling approach to identify candidate genes potentially involved in structural colour formation in Flavobacterium IR1. Their analysis highlighted the moeA gene, which encodes the enzyme molybdopterin molebdenum transferase, as a likely candidate. The researchers then experimentally deactivated moeA and assessed the effects using optics, proteomics and cultivation assays. Bacterial colonies lacking this gene showed a pronounced shift in colour from green to an intense blue. This change was traced to alterations in cell shape and morphology: in the absence of moeA, cells adopted a more elongated and regularly ordered shape, leading to a modified photonic structure (a change in the colony organisation) and a corresponding shift in reflected colour. Further investigation of cellular processes affected by moeA revealed links to carbohydrate metabolism, particularly pathways associated with starch-like polysaccharides. Although the precise mechanistic role of moeA in regulating these processes remains to be fully elucidated, the results suggest that metabolic changes influence cell packing and, consequently, structural colour formation. Additional gene knockouts will be required to validate the proposed pathways and identify other genetic contributors. Overall, this study demonstrates that genes play a direct role in shaping structural colour in bacteria. However, further research is needed to identify additional candidate genes in other structurally coloured species and to determine whether similar mechanisms operate across different organisms. Beyond fundamental biology, structurally coloured bacteria also offer numerous possibilities. Differently coloured bacterial colonies could be harnessed as sustainable, bio-based materials. Indeed, colours made by cross-linking dead bacteria are already being used in art and design projects. In the future, such systems could potentially be scaled up and commercialised as environmentally friendly alternatives to synthetic pigments.
23. Narrative review: neutrophil activation and NETosis in carbon nanotube-induced lung injury reveal mechanistic insights and biomarker based risk assessment.
期刊: Inhalation toxicology 发表日期: 2026-Jan-02 链接: PubMed
摘要
Carbon nanotubes (CNTs) are increasingly applied in industrial and biomedical fields, yet their fiber-like geometry and structural durability raise concerns about inhalation risks in occupational settings. This review synthesizes current evidence on neutrophil recruitment, activation, and extracellular trap (NET) formation in CNT-induced lung injury, with emphasis on biomarker discovery, therapeutic strategies, and worker protection. A narrative synthesis integrating mechanistic, experimental, and translational studies on CNT-induced neutrophil activation and NETosis was conducted. Experimental data show that CNT deposition in distal airways rapidly recruits and activates neutrophil, initiating the release of reactive oxygen species (ROS), proteolytic enzymes, and chromatin-based NETs. While these responses contribute to host defense, sustained activation promotes epithelial injury and fibrotic remodeling. Translational studies in exposed workers reveal elevated myeloperoxidase (MPO), neutrophil elastase, neutrophil gelatinase-associated lipocalin (NGAL), and circulating DNA, supporting their value as early biomarkers of pulmonary injury. Remaining challenges include the absence of long-term human cohort data, heterogeneity in CNT physicochemical features, and technical limitations in detecting biologically meaningful exposure endpoints. Neutrophil activation and NETosis represent important contributing pathways in CNT-induced inflammation and fibrosis, although current evidence does not establish NETosis as a central or predictive mechanism. Future strategies should focus on safer CNT design, strengthened occupational controls, biomarker-based surveillance, and mechanism-targeted interventions to minimize health risks while advancing sustainable nanotechnology. Carbon nanotubes (CNTs) are tiny, tube-shaped materials that are widely used in electronics, energy, and medicine. Because of their small size and durability, they can be inhaled into the lungs of workers who make or handle them. Once inside the lungs, CNTs can trigger strong immune reactions. Our review focuses on neutrophils, a type of white blood cell that is one of the body’s first responders. When neutrophils encounter CNTs, they release harmful chemicals and form web-like structures called NETs. These responses are designed to protect the body, but they can damage lung tissue, cause inflammation, and lead to scarring known as fibrosis.Studies show that certain molecules released by neutrophils, such as enzymes and fragments of DNA, may serve as early warning signs of CNT-related lung injury. However, more long-term studies in human workers are still needed to fully understand the risks. Improving workplace protections, developing safer CNT materials, and using these biological signals to monitor exposed workers could help prevent serious health problems. By targeting neutrophil activity and reducing excessive immune reactions, new treatments may also be developed to limit lung damage.
24. BML-111 mitigates phosgene-induced acute lung injury in rats by activating ACE2.
期刊: Inhalation toxicology 发表日期: 2026-Jan-02 链接: PubMed
摘要
Phosgene is a highly toxic asphyxiating gas and also an important chemical raw material. Phosgene has been regarded as an environmental pollutant, and the accidental leakage of phosgene in the process of industrial production has posed a serious threat to related occupational groups. Phosgene exposure may lead to acute lung injury (ALI), marked by inflammation, heightened vascular permeability, and potentially life-threatening pulmonary edema. BML-111 is a lipid A4 receptor agonist which is compound with anti-inflammatory and antioxidant properties. The involvement of BML-111 in mitigating phosgene-induced ALI and the underlying mechanisms remain unclear. In this study, we established a phosgene induced ALI rat model, examined the effects of phosgene exposure on lung tissue and bronchoalveolar lavage fluid (BALF) of rats, and evaluated the lung tissue pathology, lung wet weight, lung coefficient and respiratory function of phosgene exposed rats after intervention with BML-111. The levels of pro-inflammatory cytokines and oxidative stress markers were measured in BALF and lung tissue. This study showed that BML-111 notably enhanced respiratory function, mitigated ALI severity, and reduced pulmonary edema in phosgene-exposed rats. Mechanistically, these protective effects were attributed to a reduction in pro-inflammatory cytokines and oxidative stress, alongside an enhancement of overall antioxidant capacity. Furthermore, it was found that the activation of ACE2 is a key mechanism through which BML-111 exerts its protection. The findings suggest that BML-111 can alleviate phosgene-induced ALI in rats by activating ACE2, thereby inhibiting inflammatory responses and oxidative stress. BML-111 shows promise as a preventive candidate for treating phosgene-induced ALI.
25. Factors Associated with High Risk of Cerebral Palsy: Development of a Multicriteria Index.
期刊: Physical & occupational therapy in pediatrics 发表日期: 2026-Jan-02 链接: PubMed
摘要
To develop a multicriteria index with the main factors associated with high risk of cerebral palsy (CP). Exploratory cross-sectional study. Ninety-two infants, mean age 94.8 (±13.5) days, discharged from neonatal intensive care units (NICU) in Brazil, were included, and assessed using the General Movements (GMs) and Hammersmith Infant Neurological Examination (HINE). The multicriteria index incorporated factors such as infections from the toxoplasmosis, rubella, cytomegalovirus, herpes, syphilis, and zika virus (TORCHSZ), prematurity, birth asphyxia, Apgar score, seizures, duration of mechanical ventilation, corticosteroid and magnesium sulfate medications, therapeutic hypothermia, and caffeine. Validation included the Pearson correlation, simple linear regression analysis, and one-way analysis of variance (ANOVA), with Tukey’s post hoc test. The multicriteria index showed a positive and moderate association with high risk of CP (R2=0.20, p < 0.0001), indicated by abnormal GMs and HINE results. Significant differences between the low- and high-risk groups (p < 0.0001) and between the medium- and high-risk groups (p = 0.005) of CP were found. The multicriteria high risk CP index, developed by combining clinical factors, enabled the identification of high-risk infants with CP and a history of NICU admission. These findings can support healthcare professionals in making more precise referrals for early intervention.
26. Parental Perspectives on the Impact of Adapted Motorized Ride-on Toy Vehicle Use for Children with Limited Mobility: A Multiple Case Study.
期刊: Occupational therapy in health care 发表日期: 2026-Jan-02 链接: PubMed
摘要
This study aimed to examine parents’ perspectives on the influence of independent mobility provided by an adapted motorized ride-on vehicle (MROV) on social participation for children with limited mobility. This qualitative, multiple-case study consisted of semi-structured interviews and field notes with caregivers of three children who had received an adapted MROV four to six months prior to data collection. Three major themes emerged from the three families’ responses: (a) increased independence and autonomy, (b) enhanced social engagement and participation, and (c) emotional growth, joy, and confidence. Additionally, six prominent subthemes were established based on parents’ perception of their child and the adapted MROV. The findings demonstrated the critical value of independent mobility through play from the lens of a parent or caregiver for their child with limited mobility. The adapted MROV not only served as a means for mobility but also facilitated improvements in autonomy, peer interactions, and self-expression. These results highlighted the potential of this intervention form for enhancing the quality of life and promoting engaged participation in children with limited mobility needs.
27. Mediating mechanisms of the association between prenatal tobacco exposure and adolescent suicide attempt: A 17-year longitudinal study.
期刊: Psychological medicine 发表日期: 2026-Jan-02 链接: PubMed
摘要
While prenatal exposure to tobacco has been associated with adolescent suicide attempt, little is known about the mechanisms explaining this association. This study aims to explore the mediating roles of internalizing symptoms, externalizing behaviors, and peer problems across childhood in the association between prenatal exposure to tobacco and adolescent suicide attempt. We analyzed data from N = 8,861 participants from the Millennium Cohort Study followed from ages 9 months to 17 years. Binary logistic regression models were used to investigate the total association between exposure to tobacco in pregnancy and suicide attempt, and mediation analyses were conducted using structural equation models to investigate the direct and indirect associations. In models adjusted for key covariates, we found a significant association between prenatal tobacco exposure and increased risk of adolescent suicide attempts (odds ratio = 2.08, 95% confidence interval = [1.68, 2.56]), partly mediated through internalizing problems, externalizing behaviors, and peer problems from ages 3 to 14 years (accounting for 37% of the total association, that is, 16%, 12%, and 9%, respectively). These findings suggest that interventions targeting mental health symptoms and peer problems may maximize suicide prevention efforts among children who were prenatally exposed to tobacco, thus potentially reducing the long-term risk of suicide attempt.
28. Arteriovenous fistula non-use: Insights from Thailand's healthcare experience.
期刊: The journal of vascular access 发表日期: 2026-Jan-02 链接: PubMed
摘要
While arteriovenous fistulas (AVFs) are preferred for hemodialysis access, the impact of prior central venous catheter (CVC) use on AVF outcomes and health-related quality of life (HRQoL) remain unclear. This study compared composite AVF non-use and complications between patients with prior CVC use and those with preemptive AVF creation over 24 months. This prospective longitudinal study consecutively enrolled patients with chronic kidney disease (CKD) referral for attended long-term vascular access planning consultations at two tertiary hospitals in northern Thailand (2016-2017). Eligible participants (⩾18 years) undergoing first-time AVF creation were categorized into CVC (first hemodialysis via CVC) and non-CVC (preemptive AVF) groups. Baseline characteristics were compared between groups. Multivariable logistic regression with backward stepwise selection identified predictors of composite AVF non-use in an exploratory analysis. Outcomes included composite AVF non-use (AVF non-use, hemodialysis suitability failure, and early mortality within 12 months), complications, and HRQoL. Among 167 patients (73 CVC, 94 non-CVC), AVF non-use at 12 months was significantly higher in the non-CVC group (32.9% vs 4.7%, p < 0.001), resulting in lower composite AVF non-use in the CVC group (19.2% vs 47.9%, p < 0.001). Each 1 mL/min/1.73 m² eGFR increase raised composite non-use risk by 7%, while prior CVC use reduced it by 22%. The CVC group had more symptomatic central vein stenosis (11.0% vs 3.2%, p = 0.060) but similar mortality rates. HRQoL improved physically in the CVC group by 18 months, with mental improvements in both groups by 24 months. Prior CVC use was associated with lower AVF non-use, reflecting better timing of AVF creation based on established dialysis need rather than CVC benefits. High preemptive AVF non-use often resulted from delayed dialysis initiation or changing preferences. These findings support kidney failure risk prediction tools and individualized ESRD life-planning to optimize AVF timing. For patients requiring urgent dialysis initiation, sequential CVC-to-AVF management may represent clinically appropriate care. Optimal results require individualized timing, ongoing reassessment, and strong multidisciplinary coordination.
29. Low FIBTEM amplitude in neurotrauma: True plasma fibrinogen depletion or functional fibrin activity reduction?
期刊: The journal of trauma and acute care surgery 发表日期: 2026-Jan-01 链接: PubMed
摘要
FIBTEM, a component of rotational thromboelastometry, assesses the functional contribution of fibrin to clot formation. Notably, impaired fibrin function using FIBTEM may be observed despite normal plasma fibrinogen levels measured by the Clauss assay. The clinical implications of such isolated functional deficits are poorly understood in traumatic intracranial hemorrhage (TICH) and are the focus of this brief report. From February 2022 to July 2023, we conducted a single-center retrospective study of patients with TICH and Glasgow Coma Scale score of ≤14. All participants had paired FIBTEM and Clauss fibrinogen levels from simultaneously drawn samples. Patients were grouped as follows: (1) FIBTEM-A5 >10 mm, (2) FIBTEM-A5 ≤10 mm with Clauss fibrinogen >2 g/L (isolated fibrin dysfunction), and (3) FIBTEM-A5 ≤10 mm with fibrinogen ≤2 g/L (true fibrinogen deficiency [TD]). Rates of progressive hemorrhagic injury and mortality were compared using univariate and multivariable analyses. Of 73 included patients, 37 (51%) had reduced FIBTEM-A5; among these, 12 (32%) experienced TD. Mortality occurred in 7 of 12 TD patients (58%), 11 of 36 (31%) with FIBTEM-A5 >10 mm, and 6 of 25 (24%) with isolated fibrin dysfunction. Progressive hemorrhagic injury occurred in 6 of 9 TD patients (66%), 2 of 26 (8%) with FIBTEM-A5 >10 mm, and 9 of 23 (39%) with isolated fibrin dysfunction. In multivariate analysis, TD was associated with a 4.5-fold increase in the log odds of progressive hemorrhagic injury (95% confidence interval, 1.5-7.4), while isolated fibrin dysfunction was associated with a 3.2-fold increase (95% confidence interval, 1.0-5.4). No significant associations with mortality were observed. In TICH, low FIBTEM-A5 may reflect either fibrinogen deficiency or impaired fibrin function. Progressive hemorrhagic injury is increased in both of these phenotypes. Further research is needed to validate these findings and to guide the optimal clinical response to low FIBTEM-A5 in neurotrauma. Prognostic and Epidemiologic; Level IV.
30. Digital health interventions in strengthening primary healthcare systems in Sub-Saharan Africa: Insights from Ethiopia, Ghana, and Zimbabwe.
期刊: PLOS digital health 发表日期: 2026-Jan 链接: PubMed
摘要
Digital Health Interventions (DHIs) refer to discrete technological functionalities designed to achieve specific objectives in addressing health system challenges. These interventions are considered tools for strengthening health systems, particularly in low- and middle-income countries. This study consolidates findings from Ethiopia, Ghana, and Zimbabwe, examining how three distinct digital health applications with varying intervention components implemented in primary healthcare settings contribute to health system strengthening. The interventions analyzed include Ethiopia’s District Health Information System 2 (DHIS2), Ghana’s District Health Information Management System (DHIMS) and the Lightwave Health Information Management System (LHIMS), and Zimbabwe’s Impilo Electronic Health Record (E-HR) system. In Ethiopia, DHIS2 enhanced health system accountability and data quality by streamlining district-level data aggregation, reporting, and performance monitoring. This led to more informed decision-making and improved resource distribution. In Ghana, DHIMSs functions as a public health-level DHI, facilitating national data-driven performance monitoring, while LHIMS operates at the patient level, supporting patient tracking and management, improving patient workflows and resource tracking. However, a lack of interoperability between these two systems has led to data duplication challenges. Zimbabwe’s Impilo E-HR, a patient-level DHI, has streamlined clinical workflows, improved information sharing, and enhanced decision-making at the point of care. Despite these successes, challenges persist across the three contexts: infrastructure limitations, high staff turnover, and insufficient user technical capacity. Interoperability issues, particularly in Ghana and Ethiopia, hinder seamless data exchange, while sustainability concerns such as funding gaps and inadequate government support undermine the systems’ full potential. The study findings demonstrate that investments in DHIs in primary healthcare may not result in health systems strengthening without addressing baseline conditions for their implementation and sustainability.
31. Geographic variation in lack of food group consumption among children in India: An analysis of change across 720 districts, 2016-2021.
期刊: PLOS global public health 发表日期: 2026 链接: PubMed
摘要
Adequate dietary intake in early childhood is essential for growth and development. However, evidence on geographic disparities and recent trends in food group consumption among young children in India remains limited. This study investigated district-level changes in the consumption of specific food groups among children aged 6-23 months in India. Data from two National Family Health Surveys conducted in 2016 and 2021 of India were used, and a harmonized 720-district geometry was applied to ensure comparability across survey rounds. Multilevel modeling accounting for children nested within communities, districts, and states was used to derive precision-weighted estimates for non-consumption of seven food groups. District-level changes in non-consumption prevalence showed substantial geographic heterogeneity across all food groups. Nationally, non-consumption prevalence declined for most food groups, including other solid, semi-solid, or soft food (-2.0 percentage points), fruits and vegetables (-2.3), dairy products (-1.9), meat/non-vegetarian foods (-1.1). In contrast, non-consumption of grains, roots, and tubers increased (+2.5). Substantial geographic heterogeneity was observed. Between 2016 and 2021, 380 districts experienced declines in non-consumption of other solid, semi-solid, or soft food and 379 in fruits and vegetables, whereas non-consumption of grains, roots, and tubers increased in 335 districts. District-level inequalities remained wide across all food groups. Geographically targeted nutrition interventions are needed to reduce within-country inequalities in young children’s diets.
32. Epidemiology of violence and suicide risk in Senegal: A nationwide survey in 2023.
期刊: PLOS global public health 发表日期: 2026 链接: PubMed
摘要
Assessing violence and suicide risk at the population level is essential to inform public health policies and guide prevention efforts for mental health. In Senegal, as in much of sub-Saharan Africa, such data remain scarce. This study aims to fill that gap by estimating the prevalence of violence and suicide risk, and identifying associated factors in the Senegalese population. This nationwide, observational, cross-sectional, population-based analytical survey received ethical approval from Senegal’s National Ethics Committee for Health Research. Conducted between July and August 2023, it covered 496 randomly selected households proportionally distributed by demographic zone. Participants were surveyed on their exposure to different forms of violence, help-seeking behaviours, suicidal ideation and behaviours, and psychiatric history. Data were collected via ODK and analysed in R. Out of 2174 respondents (33.58% youth, 49.95% adults, 16.47% elderly), 52.76% reported exposure to violence, predominantly psychological (47.38%), verbal (43.47%), and physical (32.84%). Co-occurrence was frequent: 37.14% reported combined psychological and physical violence. Age and marital status were strongly linked to violence exposure, with women being more exposed to sexual violence (OR = 1.75 [1.12-2.80]). Dakar was identified as the main violence hotspot. The overall suicide risk was 8.40%, with 1.66% at high risk. Exposure to any form of violence significantly increased suicide risk. Individuals diagnosed with a mental illness were at higher risk (OR = 4.76 [3.13-7.14]). Despite high violence prevalence, support remains rare: only 6.2% received psychological help, 10.4% police assistance. Findings reveal that violence and suicide risk are widespread but insufficiently addressed. The results call for urgent development of a national mental health policy centred on prevention and support for vulnerable groups, especially in the current socio-economic and environmental crisis context.
33. Willingness to pay for a dengue vaccine in Iran: Insights from a contingent valuation study.
期刊: PLoS neglected tropical diseases 发表日期: 2026-Jan 链接: PubMed
摘要
Vaccination is crucial for controlling infectious diseases like dengue. Vaccine acceptance and willingness to pay (WTP) significantly impact vaccination programs’ success but remain unexplored in Iran. This study estimates the population’s WTP for a dengue vaccine (DV) and its determinants. This descriptive-analytical study involved 1,031 adults aged over 18 years. WTP for the DV was estimated using the double-bounded dichotomous choice (DBDC) contingent valuation method (CVM) with an interval data approach. Model parameters were estimated via the maximum likelihood method. Data analysis was conducted using Stata version 17. Approximately 66% of participants indicated a WTP for a DV. The mean WTP was 11,129,000 Iranian Rials (IRR) (95% CI: 10,374-11,884; p < 0.001) (≈13.9 USD; 1 USD ≈ 800,000 IRR, December 2024-May 2025). Compared with reference groups, being married, having high school or university education, middle or high socioeconomic status, and moderate or high perceived dengue risk were associated with higher WTP, while participants aged ≥61 years had lower WTP. Higher risk perception, greater socioeconomic status, higher level of educational, and older age were identified as significant determinants of WTP for the DV. Subsidizing the vaccine for lower-income groups and raising awareness about dengue infection risk, particularly among individuals with lower educational levels, may enhance vaccine uptake and contribute to more effective dengue prevention efforts in Iran.
34. Economic evaluation of insulin glargine compared with human insulin for youth with type 1 diabetes in Tanzania and Bangladesh.
期刊: PloS one 发表日期: 2026 链接: PubMed
摘要
Long-acting insulin analogues are the standard of care for Type 1 diabetes (T1D) in high-income countries but remain inaccessible in many low-resource settings. Cost-effectiveness is a key consideration for their adoption. This analysis evaluated the cost-effectiveness of biosimilar insulin glargine (IGlar) versus neutral protamine Hagedorn (NPH) insulin in youth with T1D in Tanzania and Bangladesh. Data from the HumAn-1 trial informed a short-term economic model comparing NPH and IGlar over 12 months. The analysis, conducted from a health systems perspective, incorporated micro-costing data for insulin, injection supplies, blood glucose monitoring, and estimated hospitalization costs for complications. Effectiveness was based on a reduction in nocturnal hypoglycemia. In both countries, we calculated incremental cost-effectiveness ratios per quality-adjusted life year (QALY) gained in scenarios that compared IGlar against NPH across delivery devices (i.e., vials, cartridges, single-use pens). IGlar was cost-effective compared to NPH when provided in cartridges in Bangladesh at a threshold of three times gross domestic product per capita. Other delivery devices in Bangladesh and all options in Tanzania were not cost-effective at current prices. If offered, IGlar vials would be cost-effective in Tanzania and Bangladesh if the price introduced was no more than 32% or 134% higher, respectively, than the current prices of NPH vials. Annual per patient costs and other cost-effectiveness thresholds were explored. In low-resource settings, IGlar can be a cost-effective alternative to NPH, largely due to reduced nocturnal hypoglycemia, but the delivery device for the insulin has a major impact on the costs and cost-effectiveness comparisons.
35. A protocol for using rapid qualitative techniques to incorporate multi-level stakeholder feedback in a pragmatic clinical trial of mindfulness for chronic low back pain.
期刊: PloS one 发表日期: 2026 链接: PubMed
摘要
Engaging community members and context experts is increasingly recognized as key to developing research that is responsive to community needs. Here, we describe a protocol for incorporating stakeholder feedback using rapid qualitative techniques into OPTIMUM (Optimizing Pain Treatment In Medical settings Using Mindfulness), a pragmatic clinical trial comparing a telemedicine-delivered mindfulness-based stress reduction intervention to usual care to address chronic low back pain. The aim of this stakeholder feedback supplement to the OPTIMUM parent trial is to consider many viewpoints regarding recruitment, retention, facilitation, delivery, sustainability, and dissemination of this program which are critical to understand before it can be successfully implemented. Our team developed a multi-faceted approach to collecting feedback from representatives of three levels of influence: individuals, communities, and policy. We plan to conduct focus groups with study participants from both the intervention (MBSR) and usual care groups. We plan to conduct one-time semi-structured interviews with a diverse set of people with varied roles and perspectives (e.g., clinic personnel, health care system leadership, mindfulness instructors, patient pain advocacy groups, policy advocates). We will assemble a Community Advisory Board (CAB) to convene regularly throughout the project. Transcripts from interviews, focus groups, and meeting notes will be analyzed using rapid qualitative methods to facilitate timely incorporation of feedback into the trial. In-depth thematic content analysis will be conducted subsequently. Partnering with communities who are historically underrepresented in clinical research under the guidance of principles such as equity, inclusion, trust, and accountability can improve health outcomes that are most relevant and beneficial to the target community, accelerate uptake, and promote sustainability.
36. Targeting men to improve maternal and child health and nutrition: A qualitative process evaluation of a mass media campaign in Tanzania's Lake Zone.
期刊: PloS one 发表日期: 2026 链接: PubMed
摘要
Undernutrition in the 1000 days following conception can cause lasting damage. In Tanzania malnutrition is directly or indirectly responsible for 35% of all deaths among children under five. The ASTUTE project, delivered in the five Lake Zone regions of Tanzania (Mwanza, Shinyanga, Geita, Kagera, Kigoma), aimed to reduce the prevalence of child stunting by improving child and maternal nutrition practices. The project incorporated a mass media campaign designed to change behaviours, with a particular emphasis on shifting gender norms and engaging men. This paper focuses on the qualitative findings relating to the impact of the campaign on men’s knowledge, attitudes, norms and behaviours. Throughout the period of radio and TV broadcasting, a qualitative process evaluation was conducted to assess the impact of the campaign on knowledge, attitudes, norms and behaviours. Between October 2017 and February 2020, a total of 59 focus group discussions were conducted with mothers, fathers and elder caregivers of a child aged under two years. Data were analyzed thematically. Fathers reported that radio and TV spots increased their participation in maternal health by accompanying their partners to the ANC, supporting their nutrition intake, and reducing the workload of the mother during pregnancy. Radio and TV spots were also reported to increase men’s engagement in child health by encouraging exclusive breastfeeding and nutritious complementary feeding. Mass media campaigns that target men’s behaviour can have beneficial effects on maternal and child health. In particular, radio and TV messages targeting men appear to be able to mitigate some barriers arising from gender norms and women’s social position in Tanzania.
37. Could Preoccupation With Failure Lead Us to Fail?
期刊: Quality management in health care 发表日期: 2026-Jan-01 链接: PubMed
摘要
Preoccupation with failure is a foundational component of high reliability organizations. However, this can work in opposition to a simultaneous and arguably conflicting priority, the promotion of self-efficacy, which is linked to healthcare worker satisfaction, performance and wellness. This commentary posits that focusing on failures can undermine self-efficacy, which may lead to decreased task performance. This results in today’s healthcare quality and safety leaders facing a catch-22 and a preoccupation with failure-wellness paradox. We propose that institutional quality improvement initiatives, when well-structured with appropriate training and focused resources, can serve as a buffer between the preoccupation with failure and a confident, engaged, and productive workforce.
38. Attitude, self-efficacy, and perceived risk toward seasonal influenza vaccination among primary care physicians in Qatar: A cross-sectional study.
期刊: PloS one 发表日期: 2026 链接: PubMed
摘要
Primary care physicians (PCPs) play a critical role in influencing vaccination decisions, both for their patients and for themselves. However, the success of vaccination programs often depends on the attitudes, perceived risks, and self-efficacy Of PCPs. A cross-sectional study examined influenza-related attitude, self-efficacy, and perceived risk among 190 primary health care physicians using an online survey, 46% of participants believed healthcare professionals do not pose influenza transmission risks to patients. Self-efficacy for vaccination was strongly tied to time availability (73.7% agreement) and institutional vaccine provision (78.9%), with social support from colleagues (79.5%) and relatives (68.9%) further influencing adherence. Male physicians (87.5%) and those with ≥5 prior vaccine doses (88.6%) or recent vaccination (87.3%) reported higher self-efficacy, though chronic disease history showed no significant association. Risk perception disparities emerged: 94.2% acknowledged elevated occupational risk during epidemics, yet only 62.1% perceived personal risk. Similarly, 86.3% viewed influenza as dangerous for patients versus 64.2% for themselves. Higher perceived risk scores correlated with chronic disease history (84.5%), prior vaccination (81.1%), recent vaccination (82.8%), and ≥5 vaccine doses (85.0%). Information sources prioritized official health agencies (Ministry of Public Health: 59.5%; WHO/CDC: 56.3%), while traditional media were least utilized (7.9-21.1%). These findings highlight gaps between professional risk acknowledgment and personal risk mitigation, underscoring the need for targeted strategies to address vaccine hesitancy, improve access, and align perceptions with evidence-based practices in healthcare settings.
39. Spatial heterogeneity in the temperature-hand, foot, and mouth disease association among children: A multicounty time-series study in western China.
期刊: PLoS neglected tropical diseases 发表日期: 2026-Jan 链接: PubMed
摘要
While meteorological and socioeconomic factors are well-documented modifiers of spatial heterogeneity in temperature-hand, foot, and mouth disease (HFMD) associations, substantial unexplained heterogeneity remains. This study investigates underexplored environmental modifiers-including extreme temperature events (heat waves and cold spells), air pollution, and normalized difference vegetation index (NDVI)-by analyzing 484,928 HFMD cases among children under six years old in western China (2013-2019) using distributed lag nonlinear models and meta-regression. We found that cold spells (accounted for 3.84% of the spatial heterogeneity attributable above the baseline level), PM2.5 (3.06%), heat waves (2.72%), PM10 (2.08%), NDVI (1.57%) and O3 (0.78%) were statistically significant modifiers of spatial heterogeneity in the temperature-HFMD associations. Further analysis of PM2.5 components identified nitrate (1.78%) and ammonium (1.58%) as additional modifiers. Among these, cold spells, heat waves, PM2.5, and NDVI were the primary contributors. Specifically, the relative risk (RR) of HFMD at the 95th temperature percentile reached 3.17 (95% CI: 2.39-4.19) in frequent heat waves regions and 3.05 (2.35-3.95) in high-PM2.5 areas. Conversely, regions with low cold-spell frequency also exhibited increased temperature-related risk (RR = 3.13, 2.40-4.07) at the same temperature, as did low NDVI regions (RR = 2.16, 1.79-2.59). Spatial cluster analysis further revealed that the central and northeastern regions exhibited higher temperature-related HFMD risks compared to the southwestern region. These pronounced spatial modification effects challenge the generalizability of single-site study and highlight the importance of region-specific public health strategies that integrate early warning systems for extreme temperatures, air pollution mitigation, and locally adapted greening interventions.
40. Peer-led versus routine health education for schistosomiasis knowledge improvement among primary school students in Wuhan, China.
期刊: PLoS neglected tropical diseases 发表日期: 2026-Jan 链接: PubMed
摘要
Schistosomiasis, a neglected tropical disease (NTD), remains a public health concern in China. Health education is a fundamental intervention for its control. Even in transmission-interrupted areas like Wuhan, sustained awareness is crucial. However, recent literature on school-based interventions evaluating knowledge, attitudes and practices (KAP) among children in such areas is limited. This study aimed to evaluate and compare the effectiveness of peer-led education versus routine health education in improving schistosomiasis-related KAP among elementary students in an urban area where schistosomiasis transmission has been interrupted. A quasi-experimental school-level trial was conducted from October 2021 to January 2022 among 1013 fourth- and fifth-grade students of Yucai Hankou and Dijiao primary schools in Jiang’an district, Wuhan, China. Students were randomly assigned to two groups. Group I (n = 524) received peer-led education, while Group II (n = 489) received routine health education. Schistosomiasis-related KAP were assessed via standardized questionnaires at baseline and one month post-intervention. Statistical analyses followed the intention-to-treat principle, using multiple imputation for missing baseline data. Intervention effects were evaluated via analysis of covariance (ANCOVA) and multivariable logistic regression, adjusting for baseline scores and demographic covariates. Following the intervention, both peer-led and routine health education interventions significantly improved schistosomiasis-related KAP scores among schoolchildren. For knowledge scores, both groups showed significant improvement from baseline to follow-up (within-group change: 2.93 for Group I vs. 0.98 for Group II, both P < 0.001). After adjusting for baseline scores, age, sex, and grade, Group I demonstrated a significantly higher adjusted mean score of 8.73 (95% CI: 8.63, 8.84) compared to Group II, which had an adjusted mean of 7.21 (95% CI: 7.10, 7.32). The adjusted mean difference (AMD) was 1.52 (95% CI: 1.37, 1.68), which was statistically significant (P < 0.001). For attitude scores, both groups exhibited small but statistically significant increases from baseline (within-group change: 0.20 for Group I vs. 0.21 for Group II, both P < 0.001). However, the between-group comparison revealed no significant difference at follow-up. For practice scores, significant within-group improvements were observed in both Group I and Group II (within-group change: 0.30 vs. 0.33, both P < 0.001). The adjusted mean was 3.95 (95% CI: 3.93, 3.97) in Group I and 3.97 (95% CI: 3.95, 4.00) in Group II. The AMD was -0.02 (95% CI: -0.06, 0.01), and this between-group difference was not statistically significant (P = 0.237). In terms of binary outcomes, the odds of achieving good knowledge were 6.04 times higher in Group I compared to Group II (aOR = 6.04, 95% CI: 4.43 to 8.24, P < 0.001), while no significant effects were observed on positive attitude or favorable practices between the two groups. Peer-led education is more effective than routine health education in improving schistosomiasis-related knowledge among primary school students in a transmission-interrupted area. Although both approaches enhanced KAP, the peer-led model demonstrated superior knowledge gains. These findings support the integration of peer-led strategies into sustainable school-based health education programmes to maintain schistosomiasis awareness and support ongoing control efforts in post-transmission settings.
41. Single-use vs. reusable products for six respiratory procedures in an intensive care unit: A retrospective evaluation of plastic waste implications.
期刊: Intensive & critical care nursing 发表日期: 2026-Jan-01 链接: PubMed
摘要
Intensive care units (ICUs) are recognised as carbon “hotspots” within hospitals due to their reliance on resource-intensive technologies. This study aimed to compare reusable and disposable products used for six common respiratory procedures in an Italian ICU to determine the potential for reducing plastic waste generation and the carbon footprint associated with plastic waste incineration. We performed a retrospective evaluation in a 10-bed ICU over 12 months. The comparison between reusable and single-use devices was based on theoretical calculations: each device was weighed with a precision scale, and annual totals were estimated by multiplying individual device weights by the number of procedures recorded in the clinical information system. CO2e emissions were calculated using the European Environment Agency emission factor of 2.9 kg CO2e per kg of plastic waste incinerated. Reusable or low-waste products generated an estimated 143.50 kg of plastic waste, compared with 501.64 kg from single-use devices. Using reusable strategies could have potentially reduced plastic waste by 358.14 kg and avoided approximately 1038.60 kg CO2e over one year of respiratory procedures, equivalent to approximately 4258 km driven by an average gasoline-powered passenger vehicle. Reusable and low-waste alternatives can substantially reduce plastic waste and the carbon footprint associated with incinerating plastic from disposable ICU respiratory care products. Critical care nurses are well positioned to integrate these sustainable strategies into everyday clinical practice. Implementing reusable equipment and low-waste alternatives can become part of standard care pathways, aligning clinical excellence with environmental sustainability. These findings support the integration of sustainability into everyday nursing decisions and institutional policies in critical care settings in the future.
42. Spatial differentiation in public perception of peak summer heat based on microblog big data.
期刊: PloS one 发表日期: 2026 链接: PubMed
摘要
The health problems caused by heat waves have attracted widespread global attention. High temperature is characterized by human perception before triggering discomfort. Understanding the public perception of high temperature based on social big data can help the relevant authorities to take appropriate countermeasures and reduce the risk of morbidity. Heat-related posts from Sina Microblog platform during the summer of 2023 are collected, and daily maximum temperature data of all meteorological stations across China from 1991 to 2023 is downloaded in the NCEI website. The relationship between public perception and temperature is investigated using the Latent Dirichlet Allocation (LDA) topic model, the heat attention index, and the heat perception model. The results reveal that 1) Heat-related microblogs are primarily concentrated in the southeastern regions of China. “Complaints About High Temperatures” is the most prominent topic. The most densely distributed regions for the four heat-related topics are Guangdong and Beijing. This distribution is closely related to the climate conditions, economic development levels, and internet penetration. 2) Heat attention index and daily maximum temperature of each province have a similar spatial distribution, while several provinces show discrepancies between the distribution of heat attention index and daily maximum temperature. 3) The daily maximum temperature corresponding to the lowest value of heat attention index in Guangdong is higher than that in other provinces. 4) There are obvious regional differences in the public’s ability to heat tolerance and sensitivity. Regions with higher heat tolerance are mainly distributed in the southeastern part of China. People with higher heat sensitivity are mainly concentrated in the central and eastern regions of China. High temperature in Summer brings public discomfort and negative emotions. It is crucial to understand these regional perception differences and take timely measures to prevent heat-related health issues.
43. Leveraging Artificial Intelligence to Advance Quality Measurement.
期刊: Quality management in health care 发表日期: 2025-Dec-30 链接: PubMed
摘要
44. A review of the advances in insect evidence analysis for estimating postmortem interval and detecting drug toxicity.
期刊: Journal of forensic and legal medicine 发表日期: 2025-Dec-30 链接: PubMed
摘要
Forensic entomology plays a pivotal role in criminal investigations, particularly in postmortem interval (PMI) estimation, entomotoxicology, and molecular forensic applications. However, its reliability is influenced by environmental variability, toxicological factors, and the need for standardized forensic methodologies. This review systematically analyzes PMI estimation techniques, entomotoxicological applications, and molecular forensic advancements, drawing on case studies and recent scientific literature. Special emphasis is placed on toxicant-induced insect developmental alterations, forensic molecular techniques, and the legal admissibility of entomological evidence. Findings indicate that necrophagous insects follow predictable succession patterns, yet environmental fluctuations and toxicological exposures can alter their developmental timelines. PMI estimation and entomotoxicology are two critical domains within forensic entomology, but their relationship is not always clearly defined. PMI estimation focuses on determining the time since death by examining insect succession patterns and developmental stages. Entomotoxicology, on the other hand, examines the impact of toxic substances on insect development, offering insights into drug or poison exposure in the deceased. While these domains are distinct, they intersect in cases where toxicants affect insect physiology, potentially altering development rates and influencing PMI estimates. Forensic entomologists must consider both the environmental and toxicological context of insect colonization when estimating PMI. Understanding how drugs or poisons accumulate in insects can refine PMI estimations by providing additional evidence regarding the conditions under which insect development occurs. Despite forensic entomology’s increasing applicability, challenges persist regarding PMI estimation accuracy, entomotoxicological variability, and judicial acceptance of entomological evidence. Integrating machine learning models, multi-omic forensic analyses, and cross-disciplinary collaborations is crucial for advancing forensic entomology’s scientific and legal credibility. Furthermore, this review clarifies critical distinctions between postmortem interval (PMI), minimum PMI (minPMI), time of colonization (TOC), and period of insect activity (PIA), enhancing interpretive accuracy in forensic entomology.
45. Ultra-sensitive fluorene-based fluorescent sensors for Hg2+ detection using smartphone-assisted RGB analysis in water and food matrices.
期刊: Spectrochimica acta. Part A, Molecular and biomolecular spectroscopy 发表日期: 2025-Dec-30 链接: PubMed
摘要
Mercury is a highly toxic environmental pollutant due to its bioaccumulation, persistence, and severe neurotoxic effects on human health. In aquatic ecosystems, even trace levels of Hg2+ can undergo methylation to form methylmercury, a potent neurotoxin that enters the food chain through water and fish consumption. Developing straightforward, accessible, and reliable strategies for mercury detection remains essential. In this work, two fluorene-based Schiff base fluorescent sensors (2 and 3) were synthesized for highly selective detection of Hg2+. Upon interaction with Hg2+, both sensors showed a remarkable fluorescence enhancement, mainly due to the suppression of photo-induced electron transfer (PET) and the formation of rigid complexes that favor radiative emission. The 1:1 binding stoichiometry and sensing mechanism were confirmed by Job’s plot, Benesi-Hildebrand analysis, Nuclear Magnetic Resonance (NMR) titration, Matrix-Assisted Laser Desorption/Ionization Mass Spectrometry (MALDI-MS), lifetime measurements, and Density Functional Theory (DFT) calculations. Under optimized conditions (λex = 355/345 nm, pH 8.0), the sensors displayed wide linear ranges of 0.50-150.00 μM and 0.30-100.00 μM with low detection limits of 0.15 and 0.08 μM, respectively. Practical applicability was demonstrated through the determination of Hg2+ in environmental water and food samples, with recoveries ranging from 96.2 % to 100.6 % and no significant deviation from Inductively Coupled Plasma Mass Spectrometry (ICP-MS) (texp < tcritical). Moreover, polystyrene (PS) thin-film kits were developed for on-site analysis. These films, coupled with smartphone-based Red-Green-Blue (RGB) analysis, provided a reusable, robust alternative to paper-based tests. This dual-mode platform offers a practical route for portable and quantitative Hg2+ monitoring in environmental and food matrices.
46. Amplitude dependence in extracellular vesicle release from cultured myotubes under vibration stimulation.
期刊: Biochemical and biophysical research communications 发表日期: 2025-Dec-29 链接: PubMed
摘要
Skeletal muscle-derived extracellular vesicles (SkM-EVs) are promising mediators of intercellular communication, yet practical strategies to safely and efficiently enhance their release remain limited. Vibration is a non-invasive, parameter-controlled mechanical stimulus that is already widely used in musculoskeletal rehabilitation, making it an attractive candidate for enhancing SkM-EV release. However, it remains unclear whether vibration increases EV release and which vibration parameter (amplitude, frequency, or acceleration) regulates this effect. Accordingly, we investigated the parameter dependence of this process and the corresponding effective intensity. Differentiated C2C12 myotubes were exposed to sinusoidal vibration using a custom-built device. Two parameter-decoupled series were designed: an acceleration-variation series and an amplitude-variation series. EVs were isolated by ultracentrifugation and analyzed by western blotting and tunable resistive pulse sensing (TRPS). RNA sequencing with gene set enrichment analysis (GSEA) was used to identify pathways associated with vibration-induced EV secretion. Vibration did not reduce cell viability. SkM-EV concentration remained unchanged across acceleration conditions but significantly increased under medium-amplitude (MAm) stimulation. Transcriptomic analysis showed that MAm downregulated Wnt signaling and upregulated the NOD-like receptor pathway, with specific upregulation of Rab27a and Nlrp4e. Vibration promotes SkM-EV secretion in an amplitude-dependent manner, with the medium-amplitude (MAm) condition being the most effective. This effect appears to be mediated by modulation of the Wnt-Rab27a axis and NLR-Nlrp4e signaling.
47. Limitations (with apologies to Sir Philip Sidney).
期刊: Epidemiology (Cambridge, Mass.) 发表日期: 2025-Dec-29 链接: PubMed
摘要
48. What Would You Do?
期刊: Epidemiology (Cambridge, Mass.) 发表日期: 2025-Dec-26 链接: PubMed
摘要
49. Adapting back-calculation methods to estimate the incidence of tuberculosis.
期刊: Epidemiology (Cambridge, Mass.) 发表日期: 2025-Dec-05 链接: PubMed
摘要
Despite being the leading cause of death, the global tuberculosis (TB) burden is ill-defined. Existing methods to estimate incidence are time and/or resource intensive and often inaccurate. Back-calculation was developed to estimate HIV incidence by considering reported cases to be a convolution of the disease duration and the incidence of new cases. New estimates of TB natural history parameters allow us to develop Bayesian back-calculation methods for TB to assign case notification data to the time point of onset of disease. Recorded counts of TB cases are underestimates of the true burden of disease, so we include a multiplier derived from prevalence to notification ratios to account for underreporting. We assume a Poisson distribution for notifications and incidence and use a penalized-likelihood prior to smooth estimates. We estimate sex-stratified TB incidence for Vietnam, Cambodia, and The Philippines from via Markov chain Monte Carlo. Annual estimated TB incidence was on average 19% greater than recorded notifications. TB incidence amongst males was on average 3.8% higher than females in Vietnam, 1.3% in Cambodia, and 2.5% higher in the Philippines. These estimates account for the delay between bacteriologically positive subclinical disease and notification and as such may be more temporally accurate than existing methods.
50. Abbreviated gadoxetic acid-enhanced MRI versus ultrasonography for HCC surveillance in high-risk patients: A randomized trial protocol.
期刊: Hepatology communications 发表日期: 2025-Dec-01 链接: PubMed
摘要
Although ultrasonography (US) is widely recommended for HCC surveillance, its limited sensitivity for early-stage HCC remains a concern. Gadoxetic acid-enhanced abbreviated MRI (HBP-AMRI) has demonstrated high diagnostic performance; however, its role in routine surveillance settings remains uncertain due to limited prospective comparative evidence. The AMRIUS study (Abbreviated MRI using gadoxetic acid versus Ultrasonography for Surveillance of early-stage HCC in high-risk patients) aims to prospectively compare the effectiveness of HBP-AMRI and US for HCC surveillance in high-risk patients with cirrhosis. AMRIUS is a randomized controlled trial (RCT) enrolling 806 high-risk patients with cirrhosis, randomly assigned (1:1) to undergo either biannual HBP-AMRI or US for 2 surveillance rounds. The primary endpoint is the detection rate of early-stage HCC [Barcelona Clinic Liver Cancer (BCLC) stage 0 or A]. Secondary endpoints include false referral rate of BCLC 0 or A HCC, detection and false referral rates for BCLC stage 0 and all-stage HCC, BCLC stage distribution at initial HCC diagnosis, and the rate of curative treatment. Structured imaging protocols and quality assessments will be implemented. AMRIUS is the first RCT designed to provide high-level evidence comparing HBP-AMRI and US for HCC surveillance. Its findings are expected to inform future guidelines and support risk-adapted strategies that prioritize early detection and curative treatment eligibility, particularly for patients likely to benefit from high-sensitivity imaging. Registered at Clinical Research Information Service on May 22, 2022 (KCT0007417) and ClinicalTrials.gov on March 9, 2024 (NCT06312826). Participant recruitment began on August 26, 2022. Follow-up is ongoing.
51. Comprehensive Evidence-Based Guidelines for Regenerative Therapies in the Management of Chronic Low Back Pain: 2025 Update from the American Society Of Interventional Pain Physicians (ASIPP).
期刊: Pain physician 发表日期: 2025-Dec 链接: PubMed
摘要
Regenerative medicine is an evolving medical subspecialty dedicated to enhancing the body’s natural healing mechanisms to repair or replace damaged tissues. By using autologous or allogeneic biologics, it offers the potential to restore function where conventional therapies have shown limited success. While this field holds great promise and continues to generate enthusiasm among both patients and clinicians, it remains in early stages of clinical validation. Therefore, it must be approached with careful optimism and responsible application, ensuring that its presentation, promotion, and use in clinical settings are grounded in evidence and ethical standards. To provide updated, evidence-based recommendations for the role of regenerative therapies in managing moderate to severe chronic low back pain. A multidisciplinary panel of experts, convened by the American Society of Interventional Pain Physicians (ASIPP), systematically reviewed the current evidence and incorporated patient perspectives to develop practical, evidence-informed recommendations. The process included defining key clinical questions, reviewing the literature, formulating evidence-based statements, and reaching consensus through structured discussions and formal voting. A total of 35 authors contributed to the development of these guidelines, with 33 experts participating in the formal consensus process. Altogether, 19 recommendations were generated, with all of them achieving 100% agreement. These recommendations were informed by a comprehensive review of systematic reviews, randomized controlled trials (RCTs), and observational studies encompassing a broad range of regenerative therapies.Evidence was appraised using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology to determine certainty levels. Both qualitative and quantitative analyses were applied to synthesize the best available data, resulting in evidence-based recommendations summarized below.Intradiscal Injections (PRP): Evidence Level: III, Fair; Consensus-Based Clinical Recommendation: ModerateIntradiscal Injections (BMAC): Evidence Level: III, Fair; Consensus-Based Clinical Recommendation: ModerateEpidural Injections (PRP): Evidence Level: III, Fair; Consensus-Based Clinical Recommendation: ModerateFacet Joint Injections (PRP and MSCs): Evidence Level: IV, Limited; Consensus-Based Clinical Recommendation: Moderate Sacroiliac Joint Injections (PRP): Evidence Level: IV, Limited; Consensus-Based Clinical Recommendation: Low Functional Spine Unit Injections Evidence Level: Very Low; Consensus-Based Clinical Recommendation:Low. The primary limitation of these guidelines is the scarcity of high-quality studies, with much of the available evidence derived from small or heterogeneous trials. Regenerative therapies should be considered only after a thorough diagnostic evaluation confirming clinical necessity. Treatment decisions must account for the patient’s medical condition, preferences, and expectations. Patients should be fully informed about the nature, potential benefits, risks, and costs of regenerative treatments, most of which are not covered by commercial insurance.These therapies may be used alone or in conjunction with other evidence-based modalities, such as structured exercise, physical therapy, behavioral therapy, or conventional medical management. Clinicians must follow all applicable U.S. Food and Drug Administration (FDA) regulations and adhere to safety and ethical standards outlined in these guidelines. Based on current evidence, lumbar intradiscal injections of platelet-rich plasma (PRP) and mesenchymal stem cells (MSCs) are supported by Level III evidence. Lumbar epidural PRP injections are also supported by Level III evidence, while PRP injections for lumbar facet joints and sacroiliac joints are supported by Level IV evidence. Given the emerging status of biologic therapies and the limited quality of existing studies, the panel provides moderate, consensus-based recommendations for the use of all biologics in the lumbar spine.
52. Early-life tobacco exposure, genetic susceptibility and multiple digestive diseases: evidence from two large cohorts and genetic analyses.
期刊: International journal of surgery (London, England) 发表日期: 2025-Nov-25 链接: PubMed
摘要
Early-life tobacco exposure exerts adverse effects significantly impacting long-term health, however, the comprehensive association with multiple digestive diseases and its implications for accelerated disease progression remain unclear. Early-life tobacco exposure was measured based on in-utero exposure to tobacco and age of smoking initiation among participants from UK Biobank and Lifelines. Outcomes were 11 digestive diseases. To analyze the link between early-life tobacco exposure and digestive diseases, logistic regression and Cox proportional hazards models were applied. Multi-state model was applied to examine the impact of early tobacco exposure on the progression in digestive disease status. Mediation effects of biological aging acceleration and Linkage Disequilibrium Score Regression (LDSC) between early-life tobacco exposure and digestive diseases were additionally analyzed. The hazard ratios (HR) and 95% confidence intervals (CI) for participants exposed to tobacco in utero or who began smoking during childhood were 1.10 (1.09-1.12) or 1.32 (1.28-1.35) for any digestive disease in UK Biobank. Repeated analyses in the Lifelines cohort, and genetic correlation analysis confirmed these elevated risks. Accelerated biological aging plays a mediating role of 3% to 20% in these associations. The risks of digestive diseases were increased in all genetic risk categories, with a 17% to over fourfold increase in the high-risk group. Critically, childhood and adolescence smoking initiation increased the risk of transitioning from any digestive disease to death increased by 59% and 40%. Early-life tobacco exposure significantly increases risks of digestive diseases in two large cohorts, independent of genetic susceptibility and mediated by biological aging acceleration. It also accelerates progression from digestive disease to death, leading to severe outcomes and higher surgical need. Our findings help the identification of high-risk individuals and highlight the importance of preventing tobacco exposure during early life to mitigate digestive disease risk and mortality, and associated surgical burden.
53. Global, regional, and national burden of fractures in the elderly, 1990-2021: a systematic analysis based on GBD 2021.
期刊: International journal of surgery (London, England) 发表日期: 2025-Nov-14 链接: PubMed
摘要
With the intensification of global population aging, fractures in the elderly have become a significant public health concern. Although the incidence of fractures has declined in some regions, the overall global burden of fractures among the elderly continues to rise. We described the number of incident cases, prevalent cases, years lived with disability (YLDs), and their age-standardized rates of fractures among the elderly from 1990 to 2021, and assessed long-term trends using the estimated annual percentage change (EAPC). The study also analyzed the age and regional distribution characteristics of fractures by anatomical site and evaluated sex differences in disease burden. From 1990 to 2021, the number of new fracture cases in the elderly worldwide increased by 134.5%, prevalent cases rose by 95.8%, and YLDs grew by 90.9%. Although the incidence rate slightly increased, both prevalence and YLD rates showed a downward trend. Hip fractures were the most common type of incident fracture among older adults, while fractures of the patella, tibia, fibula, and ankle had the most significant health impact. The major contributors to fracture burden in older adults are falls, road-related trauma, and exposure to mechanical forces. The incidence of fractures among older women was significantly higher than that of men, with pronounced sex differences. The burden of fractures in older adults showed a decreasing trend in high-income countries, whereas incidence rates continued to rise in low- and middle-income countries. As of 2021, Andorra had the highest age-standardized burden of fractures among older adults. Furthermore, from 1990 to 2021, Qatar and the United Arab Emirates exhibited the fastest growth in incident and prevalent fracture cases, as well as YLDs. Although some regions have implemented effective fracture prevention and treatment measures, the global burden of fractures among the elderly continues to rise, particularly in low- and middle-income countries.
54. Chronic Recurrent Multifocal Osteomyelitis: A Review of 80 Cases in Chinese Children.
期刊: Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases 发表日期: 2025-Nov-13 链接: PubMed
摘要
To analyze the clinical characteristics, treatment approaches, and prognosis of chronic recurrent multifocal osteomyelitis (CRMO) in Chinese pediatric patients. We conducted a retrospective analysis of 5 cases of CRMO at Children’s Hospital Affiliated to Shandong University. These data were compared with the clinical characteristics of 75 pediatric cases reported in China up to December 2024. The medical journal search engines utilized for this study included Wanfang Data and Science China for Chinese literature, while PubMed was employed for foreign language medical journals. No gender differences were observed in the incidence of CRMO. The diagnostic process may be protracted, with a delay of up to 7 years being observed. A significant majority of patients, specifically 92.5%, presented with bone pain, while fever, arthritis, or rash were noted in 57.5%, 23.8%, and 13.8% of cases, respectively. Laboratory tests conducted on children diagnosed with CRMO indicated elevated levels of C-reactive protein or sedimentation rates. The most frequently affected skeletal sites included the tibia (70.0%), femur (65.0%), fibula (42.5%), foot (36.3%), and pelvis (32.5%). Clinical manifestations of CRMO in Chinese children are predominantly marked by bone pain and fever, which, due to their nonspecific nature, often lead to delayed diagnosis. Clinicians should closely monitor children presenting with both symptoms to prevent misdiagnosis. In addition, a rigorous long-term follow-up protocol for children with CRMO is essential to accurately evaluate the disease remission rate.
55. Culturally Responsive Mental Health Care for Asian Americans: A Call to Action.
期刊: Harvard review of psychiatry 发表日期: 2025-Nov-01 链接: PubMed
摘要
Though Asian Americans (AAs) are the fastest growing racially minoritized group in the United States, their mental health care needs have not received adequate attention. AAs are less likely to seek mental health care than other minoritized groups. When they do, they often present more acutely, a trend exacerbated by events amidst the COVID-19 pandemic. During the pandemic, AAs experienced increased discrimination and anti-Asian hate crimes that still persist today. One in five AAs who has encountered racism has suffered psychological and emotional effects as a result. Recent studies have shown an increased risk of depression associated with anti-Asian crime rates. Although the psychological toll of COVID-19-related racism has led to increased prevalence of overall mental health symptoms, the likelihood that AAs seek care still remains low. This column highlights the specific challenges faced by AAs and the critical need for culturally responsive mental health initiatives and resources to better serve the unique needs of this community.
56. From Code Stroke to Cultural Formulation: A Case of Postpartum Functional Neurologic Disorder.
期刊: Harvard review of psychiatry 发表日期: 2025-Nov-01 链接: PubMed
摘要
Functional neurologic disorder (FND) is an underrecognized but important cause of acute neurological presentations in the postpartum period, particularly among culturally diverse patient populations. We present the case of a female Nepali immigrant (G5P3023 [fifth pregnancy, three term births, zero preterm births, two pregnancies that ended before 20 weeks, three living children]) in her late 30s with no prior medical or psychiatric history. She developed sudden neurological deficits on postoperative Day 0 following an uncomplicated Cesarean delivery. Approximately 11 hours after delivery, the patient became dizzy, pale, and diaphoretic, then developed right-upper and bilateral-lower extremity paralysis with impaired eye and mouth opening. A code stroke was initiated. Extensive workup (including computed tomography head, computed tomography angiography head/neck, and magnetic resonance imaging brain) was unremarkable. Neurological deficits resolved within hours after ammonia inhalant stimulation. The patient was ultimately diagnosed with postpartum FND. This case highlights key diagnostic and management challenges in distinguishing FND from stroke, catatonia, and dissociative states in medically complex postpartum patients. It also underscores the importance of trauma-informed, culturally sensitive approaches to diagnosis and care. Our discussion explores the limited but evolving literature on postpartum FND-potentially inclusive of sensory-motor mismatch, loss of agency, hormonal shifts, and psychosocial stressors-while also exploring strategies for culturally grounded psychoeducation. Clinicians must vigilantly watch for functional presentations postpartum to avoid unnecessary interventions and promote holistic recovery. Cross-disciplinary collaboration among psychiatry, neurology, and obstetrics is essential for optimal care.
57. The Relationship Between Neutrophil-to-Lymphocyte Ratio and the Prevalence and Clinical Outcomes of Depressive Disorders: A Systematic Review and Meta-Analysis.
期刊: Harvard review of psychiatry 发表日期: 2025-Nov-01 链接: PubMed
摘要
The pathophysiology of depressive disorder (DD) has been linked to the inflammatory process, and neutrophil-to-lymphocyte ratio (NLR) is considered a marker of systemic inflammation. Increasing research suggests a potential correlation between NLR and DD onset and prognosis. Current literature, however, presents conflicting results, highlighting a need for further investigation. A systematic literature search was performed in PubMed, Embase, Web of Science, and the Cochrane Library, from inception to September 4, 2024, to identify studies evaluating the relationship between NLR and DD. The primary outcomes pointed to DD prevalence and suicide risk in individuals with DD. Sensitivity and subgroup analyses were conducted to explore the heterogeneity and robustness of results. Meta-analyses were executed using STATA 15.0 and Review Manager 5.4.1. A total of 37 studies comprising 88,019 participants were included. Categorical analyses showed that high NLR was significantly associated with presence of DD (odds ratio [OR]: 1.57, 95% confidence interval [CI]: 1.28, 1.93). Continuous analyses revealed elevated NLR levels in individuals diagnosed with DD (standardized mean difference [SMD]: 0.73, 95% CI: 0.51, 0.94). Furthermore, increased NLR was associated with heightened suicide risk among those with DD (categorical outcome OR: 1.56, 95% CI: 1.26, 1.94; continuous outcome SMD: 0.42, 95% CI: 0.23, 0.61). Elevated NLR is associated with higher prevalence of DD and increased suicide risk in this patient population. NLR may serve as a promising biomarker for diagnosing and assessing individuals with DD.
58. Assessment of long COVID-19 symptoms and functional status: insights from a cross-sectional study.
期刊: Frontiers in medicine 发表日期: 2025 链接: PubMed
摘要
This cross-sectional study examines the functional limitations of Long COVID (LC) in a clinically confirmed cohort (n = 220). We collected sociodemographic, clinical, and lifestyle data via a structured electronic form and assessed daily limitations using the Post-COVID-19 Functional Status (PCFS) scale. Linear models were used to evaluate the association between symptom burden and functional limitations and to identify symptom-specific predictors of impairment. Participants had a mean age of 44.8 years, and 80.5% were women. A dose-response pattern linked higher symptom counts with worse PCFS grades in the multivariable-adjusted model (β = 0.17; 95% CI 0.10-0.25; p < 0.001). In hierarchical models, fatigue, dizziness, and memory loss were independent predictors of greater functional limitations (crude β: fatigue 1.56; 95% CI 1.22-1.90; dizziness 1.08; 95% CI 0.81-1.34; and memory loss 1.26; 95% CI 0.97-1.55), cumulatively explaining 51.3% of the variance in functional limitations. In contrast, other common LC symptoms did not retain independent associations after adjustment. These findings highlight the value of simple symptom counts and targeted symptom profiles for risk stratification in primary care and occupational health and for planning rehabilitation and work ability assessment. Prospective studies should validate these indicators over time and explore the mechanisms linking neurocognitive and fatigue phenotypes with persistent disability.