公共卫生研究摘要 (2026-01-09)
共收录 53 篇研究文章
1. Pregnancy-Related Mortality Due to Infection: Maternal Mortality Review Committees in 29 U.S. States, 2017-2019.
期刊: Obstetrics and gynecology 发表日期: 2026-Jan-09 链接: PubMed
摘要
To describe demographic and clinical characteristics, preventability, Maternal Mortality Review Committee (MMRC)-determined contributing factors, and example recommendations for pregnancy-related deaths due to infection using data from MMRCs. We used pregnancy-related death data from MMRCs in 29 states occurring during 2017-2019 with MMRC-determined underlying cause of death of infection. We describe the distribution of demographic and clinical characteristics, present the most frequent contributing factor classes, and provide example MMRC prevention recommendations. Ninety-one pregnancy-related infection deaths were identified, and MMRCs determined that 86.4% of deaths were preventable among 88 deaths for which MMRCs determined preventability. Most deaths occurred within 42 days of delivery (69.3%). Additional clinical information was available for many deaths. Group A streptococci were the most frequently identified pathogen (34.0%, 18/53) and genital tract was the most frequently identified source (47.9%, 35/73) of the infection. The most frequent health care encounter before death was hospitalization (50.7%, 36/71). More than half of decedents (69.1%, 47/68) had a health care encounter less than 7 days before death. The five most frequent contributing factor classes were clinical skill/quality of care (18.6%), delay (10.1%), knowledge (10.1%), lack of continuity of care (9.6%), and lack of access/financial resources (7.8%). The MMRC prevention recommendations occur at multiple levels, addressing frequent contributing factor classes. Most pregnancy-related deaths due to infection are preventable. Example MMRC recommendations highlight prevention opportunities, including improving patient and clinician knowledge regarding clinical signs and symptoms of serious infections, implementing obstetric sepsis protocols, and enhancing care coordination within and across systems.
2. Three-dimensional insights into miniscrew-assisted rapid palatal expansion asymmetry: A novel cone-beam computed tomography-based analysis.
期刊: American journal of orthodontics and dentofacial orthopedics : official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics 发表日期: 2026-Jan-08 链接: PubMed
摘要
Miniscrew-assisted rapid palatal expansion (MARPE) is a predictable option for nongrowing patients with maxillary transverse deficiency manifesting as posterior crossbite. However, recent evidence suggests a high frequency of asymmetrical expansion as a complication of MARPE. Retrospective analysis of 9 patients (mean age: 21.7 years; 65% female; average Yonsei Transverse Index: -4.6 mm) included superimposition of pre (T1) and posttreatment (T2) cone-beam computed tomographies using a voxel-based technique on the anterior cranial base. T1 and T2 cone-beam computed tomographies were digitized in a common Cartesian plane, enabling linear and angular measurements using T1 landmarks as the reference to compare T2 landmarks. Geometric analyses included linear Euclidean left vs right and transverse distances, 3-dimensional (3D) angulation, and 3D matrix rotations to quantify asymmetry. Asymmetry thresholds were set at 2 mm or 2°. Stepwise regression was used to determine the association between potential explanatory variables and asymmetry. There was no statistically or clinically significant asymmetry of the ANS-PNS vector. Linear, angular, or zygomaticomaxillary roll of jugale, keyridge, or zygomaticofrontal suture around the ANS-PNS vector was found (P >0.05). Statistically but not clinically significant linear asymmetry of keyridge (0.9 ± 0.9 mm; P = 0.02) and first molar furcation (0.7 ± 0.8 mm; P = 0.02) was found. Stepwise regression did not find any potential explanatory variables explaining the keyridge and the first molar furcation linear asymmetry. Under the conditions of this study and 3D analyses, MARPE resulted in statistically significant linear asymmetry of the keyridge and the first molar furcation. Statistical significance does not equate clinical significance or relevance.
3. Pregnancy Test Use and Timing of Pregnancy Detection in a Prospective Cohort of Pregnancy Planners.
期刊: Obstetrics and gynecology 发表日期: 2026-Jan-08 链接: PubMed
摘要
To identify determinants of selected pregnancy testing behaviors among pregnancy planners and to elucidate the relationship between pregnancy testing and detection. In PRESTO (Pregnancy Study Online), a North American prepregnancy cohort study of pregnancy planners (2018-2024), participants reported day-specific information about pregnancy testing spanning 4 days before day of expected menstruation through 4 days after. We used generalized linear models to estimate the association between maternal attributes and pregnancy testing behavior, characterized as the timing of the first test and testing frequency. We used quantile regression to estimate the timing of pregnancy detection among participants who conceived by maternal characteristics and pregnancy testing behavior. We estimated the adjusted risk of having a negative test result and the probability of detecting a very early pregnancy loss by the timing of the pregnancy test. We analyzed data from 20,458 pregnancy tests across 6,569 unique participants. Of the participants, 40.7% of reported they engaged in very early testing, defined as testing more than 4 days before their expected period. We observed a range of pregnancy testing intensity, with some participants testing only once and others testing every day. Among participants who detected pregnancy, very early testers were more than 5 times more likely to have a negative test result before a positive test result than those who waited until the day of expected period to test (adjusted risk ratio [aRR[ 5.89; 95% CI, 4.73-7.33). Very early testers were more than 3 times more likely to have an initial positive test result followed by a negative test result, likely reflecting increased detection of very early pregnancy losses (aRR 3.80; 95% CI, 2.12-6.80). Patterns in home pregnancy testing varied widely among pregnancy planners. Early initiation of pregnancy testing was associated with slightly earlier pregnancy detection, but also a marked increase in risk of negative test results and detection of very early pregnancy losses.
4. Development and Initial Validation of a Brief, Online Version of the Center for Epidemiological Studies Depression Scale (CES-D): Psychometric Study.
期刊: JMIR formative research 发表日期: 2026-Jan-08 链接: PubMed
摘要
A growing volume of mental health research is conducted with participants recruited and responding online. However, to date, few psychometric scales have been specifically validated for online research. We aimed to devise a brief, 12-item version of the Center for Epidemiological Studies Depression Scale (CES-D) in which first order factors are sufficiently measured. We recruited 218 adults with depression and 226 comparison participants with no mental health history. Both groups completed the original 20-item CES-D and measures of social support, psychological distress, and sociodemographic information (eg, age, gender, and household income). Measurement of social support included online support, and psychological distress included symptoms of social media use disorder along with loneliness and life dissatisfaction. This brief, 12-item version of the CES-D was devised with persons with depression and replicated with comparison participants. For both, core sadness, somatic symptoms, interpersonal detachment, and absence of well-being each significantly contributed to measurement of a higher-order depression latent construct (P<.01). Structural equation modeling was performed to establish the construct validity of this 4-factor model in which depression is predicted by socioeconomic factors and depression predicts lower social support as well as greater psychological distress. Responses to this 12-item, online version of the CES-D demonstrate factorial and construct validity. Clinical research is required in future to ascertain whether scores greater than 11 (of 36) are suggestive of elevated depressive symptomology.
5. Considerations for Estimating Causal Effects of Informatively Timed Treatments.
期刊: Epidemiology (Cambridge, Mass.) 发表日期: 2026-Jan-08 链接: PubMed
摘要
Epidemiologic studies are often concerned with estimating causal effects of a sequence of treatment decisions on survival outcomes. In many settings, treatment decisions do not occur at fixed, prespecified follow-up times. Rather, timing varies across subjects in ways that may be informative of subsequent treatment decisions and potential outcomes. Awareness of the issue and potential solutions is lacking in the literature, which motivates this work. Here, we formalize the issue of informative timing, problems associated with ignoring it, and show how g-methods can be used to analyze sequential treatments that are informatively timed. As we describe, in such settings, the waiting times between successive treatment decisions may be properly viewed as time-varying confounders. Using synthetic examples, we illustrate how g-methods that do not adjust for these waiting times may be biased and how adjustment can be done in scenarios where patients may die or be censored in between treatments. Finally, we provide implementation guidance and examples using publicly available software. Our concluding message is that (1) considering timing is important for valid inference and (2) correcting for informative timing can be done with g-methods that adjust for waiting times between treatments as time-varying confounders.
6. Postoperative Weight-bearing Status Is Not Associated With Patient Mortality After Geriatric Distal Femur Fracture.
期刊: The Journal of the American Academy of Orthopaedic Surgeons 发表日期: 2026-Jan-08 链接: PubMed
摘要
To investigate the effect of immediate weight-bearing (WB) status on mortality in geriatric distal femur patients. Secondary aims included determining the effect of WB status on surgical complications and ambulatory ability at 90 days. This was a retrospective review of geriatric (age >60 years) patients with distal femur fracture (OTA/AO 33 A, 33C) from 9 level 1 trauma centers that underwent surgical fixation from 2012 to 2019. Mortality, ambulatory ability at 90 days, and surgical complications were compared between postoperative non-WB (NWB) versus WB (touch-down/partial/WB as tolerated) groups. A propensity-weighted regression model including demographics, tobacco-use, preinjury ambulatory status, injury mechanism, and American Society of Anesthesiologists classification was used to compare outcomes between the NWB and WB cohorts. Four hundred four patients were included where most of the patients (72%) underwent open reduction, internal fixation and most of the patients were NWB after surgery (63%). Most of the patients (328/404, 81%) were discharged to a nursing facility. Older patients, patients with ground-level fall, and American Society of Anesthesiologists I/II patients were more likely to be WB. Six-month mortality was 14%. Sixty-nine percentage of patients were able to ambulate without human assistance by 90 days. In the propensity-weighted analysis, there was no association with WB and mortality (hazard ratio [HR], 1.50; confidence interval [CI, 0.77, 2.92]; P = 0.24). No association was observed between WB and deep infections (HR, 2.86; [CI, 0.82, 9.93]; P = 0.10) or nonunion surgery (HR, 1.7; [CI, 0.71, 4.09]; P = 0.23). Finally, there was no association with WB and in ambulatory ability within 90 days (odds ratio [OR], 1.48; [CI, 0.65, 3.35]; P = 0.35). HRs/ORs >1 indicate higher risk/odds for the WB group. Based on this study, there was no association with prescribed postoperative WB and patient mortality, reoperations, or ambulatory ability within 90 days of surgery. III PROGNOSTIC.
7. Developing an AI-Assisted Tool That Identifies Patients With Multimorbidity and Complex Polypharmacy to Improve the Process of Medication Reviews: Qualitative Interview and Focus Group Study.
期刊: Journal of medical Internet research 发表日期: 2026-Jan-08 链接: PubMed
摘要
Structured medication reviews (SMRs) are an essential component of medication optimization, especially for patients with multimorbidity and polypharmacy. However, the process remains challenging due to the complexities of patient data, time constraints, and the need for coordination among health care professionals (HCPs). This study explores HCPs’ perspectives on the integration of artificial intelligence (AI)-assisted tools to enhance the SMR process, with a focus on the potential benefits of and barriers to adoption. This study aims to identify the key user requirements for AI-assisted tools to improve the efficiency and effectiveness of SMRs, specifically for patients with multimorbidity, complex polypharmacy, and frailty. A qualitative study was conducted involving focus groups and semistructured interviews with HCPs and patients in the United Kingdom. Participants included physicians, pharmacists, clinical pharmacologists, psychiatrists from primary and secondary care, a policy maker, and patients with multimorbidity. Data were analyzed using a hybrid inductive and deductive thematic analysis approach to identify themes related to AI-assisted tool functionality, workflow integration, user-interface visualization, and usability in the SMR process. Four major themes emerged from the analysis: innovative AI potential, optimizing electronic patient record visualization, functionality of the AI tool for SMRs, and facilitators of and barriers to AI tool implementation. HCPs identified the potential of AI to support patient identification and prioritizing those at risk of medication-related harm. AI-assisted tools were viewed as essential in detecting prescribing gaps, drug interactions, and patient risk trajectories over time. Participants emphasized the importance of presenting patient data in an intuitive format, with a patient interface for shared decision-making. Suggestions included color-coding blood results, highlighting critical medication reviews, and providing timelines of patient medical histories. HCPs stressed the need for AI tools to integrate seamlessly with existing electronic patient record systems and provide actionable insights without overwhelming users with excessive notifications or “pop-up” alerts. Factors influencing the uptake of AI-assisted tools included the need for user-friendly design, evidence of tool effectiveness (though some were skeptical about the predictive accuracy of AI models), and addressing concerns around digital exclusion. The findings highlight the potential for AI-assisted tools to streamline and optimize the SMR process, particularly for patients with multimorbidity and complex polypharmacy. However, successful implementation depends on addressing concerns related to workflow integration, user acceptance, and evidence of effectiveness. User-centered design is crucial to ensure that AI-assisted tools support HCPs in delivering high-quality, patient-centered care while minimizing cognitive overload and alert fatigue.
8. Assessment of injury severity and recovery trajectories in urban motorcycle crashes: An analysis of hospital data from Dhaka, Bangladesh.
期刊: Traffic injury prevention 发表日期: 2026-Jan-08 链接: PubMed
摘要
Motorcycle crashes, one of the major contributors to worldwide road traffic crashes (RTCs), remain a critical public health issue often in several low- and middle-income countries, where data limitations hinder comprehensive safety assessments. Existing studies have largely relied on police-reported data, which often underrepresents crash severity and lacks detail on post-crash recovery. To address the gap, this study aims to utilize hospital-based data for examining the distribution of patients across demographic, vehicular, situational and crash dynamics related factors; and to provide a severity-based assessment across several variables, such as patient’s age, impact speed, collision type, and impacted body region. Furthermore, it aims to evaluate severity-based post-crash outcomes, focusing on patient’s 30-day recovery status. The study used a questionnaire-based interview to collect data from 509 motorcycle crash victims admitted in two major hospitals, over a nine-month period in Dhaka, Bangladesh. The Abbreviated Injury Scale (AIS) was employed to provide a standardized assessment of injury severity, while the data summarization and visualization was achieved using R software package. Findings reveal a high frequency of motorcycle crashes among males in the 11-40 age bracket, middle-income individuals, and students or service-holders, with most incidents occurring at moderate speeds and head-on collisions on single-lane roads. Severity-based analysis highlights that injuries in AIS 2 (moderate) and 3 (serious) are predominant, with a trend of increasing proportion of injuries with severity of AIS 3 or above correlated with older age groups, high-speed crashes, and specific collision types like rear-end and head-on. Lower extremity, specially the legs, are the most susceptible body part to injuries across all severity categories. Moreover, recovery rates (proportion of injured patients who fully or partially recover from their injuries after 30-days) decrease with higher injury severity, with permanent disabilities being more common among severely injured patients. The data distribution reveals how crash frequency, and severity varies across several key factors while also divulging how injury severity impacts recovery trajectories. The results are expected to provide a foundation for future research and policy development toward reducing motorcycle crash risks and improving post-crash recoveries in similar urban settings.
9. Systems Theory Model to Understand the Barriers and Facilitators to Palliative Care Referral for Pediatric Oncology Patients in Canada.
期刊: JCO oncology practice 发表日期: 2026-Jan-08 链接: PubMed
摘要
To explore pediatric oncology and palliative care health care providers’ perspectives on the barriers and facilitators to pediatric palliative care (PPC) referral for children with cancer in Canada using a qualitative approach to inquiry. Sixty-six health care providers from four tertiary pediatric hospitals across Canada participated in semistructured interviews. Data analysis used the grounded theory method. Data collection and analysis occurred concurrently using an inductive, constant comparative approach. Line-by-line coding guided the development of themes. NVivo software supported data management and coding. Through iterative analysis of the data, a systems theory-informed model of PPC referral was developed. The PPC referral process was best understood as a dynamic system involving four primary agents: oncologists, interprofessional oncology teams, PPC teams, and the patient and family. Each agent’s readiness to initiate or accept referral was shaped by emotional, informational, cultural, skill-based, and environmental factors. We identified four distinct referral pathways, ranging from automatic referral at diagnosis to family-initiated referrals. Readiness for a referral emerged as a fluid, systemic state influenced by bidirectional interactions among all agents, rather than a static or solely clinical indicator. PPC referral is not a linear decision triggered by disease prognosis or progression alone, but rather a complex and evolving system shaped by interrelated human and organizational factors. Our systems theory model of PPC referral highlights the importance of fostering readiness across the health care team and integrating PPC as a relational and team-based process. These findings offer actionable insights to improve early PPC access and guide the design of interventions.
10. Enhancing Representation and Reporting of Body Mass Index in Cancer Randomized Clinical Trials.
期刊: Journal of clinical oncology : official journal of the American Society of Clinical Oncology 发表日期: 2026-Jan-08 链接: PubMed
摘要
11. Prescription Monitoring Program Mandates and Opioids Dispensed to Patients Dying of Cancer.
期刊: JCO oncology practice 发表日期: 2026-Jan-08 链接: PubMed
摘要
State legislations mandating prescriber use of Prescription Drug Monitoring Programs (PDMPs) may have the unintended consequence of restricting opioid analgesics to patients dying of cancer. This study aims to assess associations of comprehensive PDMP mandates with opioid-related outcomes for patients dying of cancer, overall and by decedent race and ethnicity. Study population were Medicare decedents who were age 66 years or older, diagnosed with breast, colorectal, lung, or prostate cancer, and died of cancer in 2011-2019. This cross-sectional study used SEER-Medicare data and a difference-in-differences design. Study sample included decedents from 10 states with an operating PDMP on January 1, 2011. Outcomes included the dichotomous event of having one or more opioid days, total and daily morphine milligram equivalents (MMEs) if having opioids, near the end of life. Generalized linear models were estimated for dichotomous (logit link function) and continuous (log) outcomes. This study included 115,256 decedents. Comprehensive PDMP mandates were associated with modest reductions in the rate of one or more opioid days (from 45.1% to 43.9%, difference = 0.011 [95% CI, -0.019 to -0.003]), total dose (from 1,600.6 to 1,521.0 MMEs, difference = 79.6 [95% CI, -131.5 to -27.6]), and daily dose from all opioids (from 75.7 to 72.9 MMEs, difference = 2.7 [95% CI, -5.1 to -0.4]). Compared with non-Hispanic White decedents, Black decedents experienced a four-fold reduction, and Asian/Pacific Islander decedents experienced a two-fold reduction, in the rate of one or more opioid days. Comprehensive PDMP mandates were associated with modest reductions in opioid analgesics dispensed to Medicare patients dying of cancer. Non-Hispanic Black and Asian/Pacific Islander decedents experienced larger reductions.
12. Reply to: Enhancing Representation and Reporting of Body Mass Index in Cancer Randomized Clinical Trials.
期刊: Journal of clinical oncology : official journal of the American Society of Clinical Oncology 发表日期: 2026-Jan-08 链接: PubMed
摘要
13. The Sexual Experiences of People Living with Sickle Cell Disease.
期刊: Journal of sex research 发表日期: 2026-Jan-08 链接: PubMed
摘要
Sickle cell disease (SCD) affects over 8 million people globally and 1 in 365 Black infants in the United States are born with SCD. Because of recent medical advances, people are living significantly longer with SCD, with opportunities to experience romantic and sexual relationships. However, people with SCD experience medical challenges, such as pain crises, which can occur during partnered sexual activities. This study sought to understand how SCD impacts a person’s sexual life. Using thematic analysis, 18 people, between 18 and 59 years old, gave an account of their experiences with solo masturbation and partnered sexual activities. Five themes were constructed: (1) Experiencing a Sex- or Orgasm-Induced Pain Crisis From Solo Masturbation and Partnered Sexual Activities; (2) Sexual Satisfaction and Orgasmic Pleasure; (3) Sickle Cell-Related Genital Pain With and Without Sexual Activity; (4) Intimate Connection With Sexual Partner; and (5) Communication About the Intersection of Sexuality and SCD. Overall, the participants described having satisfying experiences with solo masturbation and partnered sexual activities. However, a sex- or orgasm-induced pain crisis has impacted their sexual lives, including hospitalizations from said event. Additionally, participants experienced sickle cell-related genital pain with and without sexual activity.
14. Digital Interventions Targeting Healthy and Sustainable Eating Behavior: Systematic Review and Meta-Analysis.
期刊: Journal of medical Internet research 发表日期: 2026-Jan-08 链接: PubMed
摘要
Current food consumption patterns contribute to the rising prevalence of obesity and noncommunicable diseases and exacerbate environmental degradation. Digital media offer promising opportunities to promote healthier and more sustainable eating; yet, evidence regarding their effectiveness remains fragmented. The aim of this systematic review and meta-analysis is (1) to evaluate the effectiveness of digital interventions in improving healthy and sustainable food consumption and (2) to identify which participant and intervention characteristics are associated with greater effectiveness. A systematic search was conducted in January 2024 and repeated in September 2025 across Web of Science, Embase, and Scopus, supplemented with forward and backward reference searching. Eligible studies were those with a quasi-experimental or longitudinal design evaluating digital interventions targeting nonclinical populations, with the aim of increasing plant-based food consumption or reducing animal-based food intake. Risk of bias was assessed using the Cochrane risk-of-bias tool. Included interventions were coded for behavior change techniques using the Behavior Change Taxonomy version 1. A random-effects meta-analysis with robust variance estimation was performed, and moderator analyses were conducted with participant and intervention characteristics. Eligibility screening led to the inclusion of 52 papers published between 2004 and 2025, with 24,652 participants in total. The meta-analysis revealed a small but statistically significant positive effect of digital interventions on food consumption outcomes (d=0.33, 95% CI 0.25-0.42; P<.001). However, substantial heterogeneity (I2=86%, 95% prediction interval -0.21 to 0.87) indicates considerable variation in effectiveness across intervention characteristics. A moderator analysis showed no significant difference in effectiveness (P=.53) between interventions aimed at reducing meat consumption (d=0.38, 95% CI 0.20-0.57; P<.001) and those promoting plant-based eating (d=0.33, 95% CI 0.23-0.42; P<.001). Although digital interventions had the strongest effects among young adults (d=0.46, 95% CI 0.30-0.61; P<.001), age-related differences were not statistically significant. Intervention effectiveness differed significantly by platform (P=.03), with social media interventions (d=0.65, 95% CI 0.41-0.90; P<.001) yielding stronger effects than other modalities. Incorporating prompts or cues significantly enhanced effectiveness (d=0.58 vs d=0.30; P=.04). Although not statistically significant, interventions including social support or behavioral comparison (both d=0.39; P<.001) yielded larger effects. Few studies included adolescents or individuals from lower socioeconomic backgrounds. This review underscores the innovative potential of digital interventions in improving eating behavior, highlighting how effectiveness varies by intervention design. Social media emerge as particularly promising, likely due to their unique social and interactive features. By pinpointing the contexts and types of digital interventions that most effectively promote plant-based eating, this study provides timely guidance for researchers and practitioners in increasingly digitalized food environments. Nonetheless, more high-quality studies are needed to confirm these insights and address the critical gap among adolescents and low socioeconomic groups.
15. Toward an Environment and Transportation Framework of Mental Health Promotion: Secondary Analysis Via Health and City Planning Policy.
期刊: Issues in mental health nursing 发表日期: 2026-Jan-08 链接: PubMed
摘要
This study presents a targeted analysis of qualitative data under a parent study integrating the World Health Organization’s Age-Friendly Cities, Healthy Cities, and sustainable cities policy frameworks. To focus on implications for mental health promotion and nursing, data-analysis was performed mobilizing the Canada Health Act (CHA) as theoretical framework. Using data from 22 semi-structured interviews with community members (n = 17) and global policy stakeholders (n = 5), this analysis reveals how transportation may be a central factor through which environmental design influences accessibility to health care services, including mental healthcare. Thematic analysis revealed three interrelated factors-transportation cost, travel time, and travel risk-as central to understanding how city planning intersects with preexisting social marginalization to confound psychosocial outcomes. When viewed through the CHA’s framework, transportation barriers effectively render public healthcare systems functionally inaccessible for many, particularly individuals facing compounded challenges related to socioeconomic status, age, disability, and limited mobility. Overall, the sub-study suggests that the design of one’s physical environment can profoundly shape both access to care and one’s perceived ability to find respite from, cope with, or resolve mental health stressors. Conceptualizations of the “world,” in alignment with other mental health research, illuminate the ways in which transportation infrastructure and urban planning either expand or contract the scope of lived experience and autonomy to impact daily mental wellbeing. A preliminary framework of mental health nursing understood in terms of environmental and transportation planning concludes the study.
16. Environmental Exposure and Mental Health in Hong Kong: Protocol for a GPS- and Biosensor-Based Observational Study.
期刊: JMIR research protocols 发表日期: 2026-Jan-08 链接: PubMed
摘要
Environmental exposure, including green-blue space and walkability, may influence mental health through various physiological pathways. Traditional methods have limitations in capturing dynamic environmental exposure effects on mental health. This study aims to investigate the associations between minute-level environmental exposure and stress-related biomarkers using GPS-based measurements and wrist-worn biosensors in an urban population. In this prospective observational study, we will recruit 750 participants (aged 18-80 years) in Hong Kong from September 2024 to December 2026. This includes a pilot study supported by internal funds starting in September 2024 and external funding from the Health and Medical Research Fund by the Hong Kong Health Bureau in July 2025. Participants will undergo a 1-week experiment wearing biosensors and carrying GPS devices while completing daily surveys and entry and exit questionnaires. Primary outcomes include digital biomarkers (electrodermal activity, blood volume pulse, and skin temperature) from wrist-worn sensors and associations with the environmental exposures of air pollution, urban density, and green-blue space access. Secondary outcomes comprise questionnaire responses, physical activity metrics from accelerometer data, and environmental exposure assessments, including mobility barriers, land use mix, road accessibility, and thermal conditions. Focus groups will be conducted to refine study protocol and assess device-wearing experience. The study received ethical approval from the Human Ethic Research Committee (award numbers: EA240125 and EA240514). As of June 30, 2025, a total of 150 participants completed the pilot study (September 2024 onwards), achieving a 94% (141/150) completion rate with strong device compliance (141/150, 94% valid biosensor days; 137/150, 91% daily questionnaires). Protocol refinements based on participant feedback were implemented without altering core instruments. The main study supported by the Health and Medical Research Fund, commenced in July 2025, with 30 participants enrolled as of September 2025. Data collection for 750 participants will continue until December 2026. We are at an early stage of data cleaning and preprocessing for the pilot study. Data analysis is expected to be completed by June 2027, with results anticipated to be published in 2027 and 2028. This study’s innovative integration of continuous environmental monitoring and stress-related biomarker may provide new insights into environment-health relationships. Findings will inform public health initiatives for mental well-being promotion and urban planning interventions. DERR1-10.2196/84919.
17. Chinese Immune Multi-Omics Atlas.
期刊: Science (New York, N.Y.) 发表日期: 2026-Jan-08 链接: PubMed
摘要
Human peripheral blood exhibits molecular and cellular heterogeneity across populations, yet the underlying mechanisms remain unclear. We present the Chinese Immune Multi-Omics Atlas (CIMA), characterizing molecular variations linked to sex, age, and genetic variants through multi-omics analysis of more than 10 million circulating immune cells from 428 Chinese adults. CIMA established an enhancer-driven gene regulatory network comprising 237 robust regulons; identified 9600 eGenes and 52,361 caPeaks at cell type resolution; and revealed pleiotropic associations among immune-related disease risk loci, cis-expression quantitative trait loci (QTLs), and chromatin accessibility QTLs. Furthermore, the cell language model CIMA-CLM predicted chromatin accessibility and evaluated the effects of noncoding variants from chromatin sequences and gene expression. CIMA provides a comprehensive reference for immune-related disease research.
18. Mitochondrial control of fuel switching via carnitine biosynthesis.
期刊: Science (New York, N.Y.) 发表日期: 2026-Jan-08 链接: PubMed
摘要
Environmental adaptation often involves a shift in energy utilization toward mitochondrial fatty acid oxidation, which requires carnitine. Besides dietary sources of animal origin, carnitine biosynthesis from trimethyllysine (TML) is essential, particularly for those who consume plant-based diets; however, its molecular regulation and physiological role remain elusive. Here, we identify SLC25A45 as a mitochondrial TML carrier that controls carnitine biosynthesis and fuel switching. SLC25A45 deficiency decreased the carnitine pool and impaired mitochondrial fatty acid oxidation, shifting reliance to carbohydrate metabolism. Slc25a45-deficient mice were cold-intolerant and resistant to lipid mobilization by GLP1 receptor agonist (GLP-1RA), rendering them resistant to adipose tissue loss. Our study suggests that mitochondria serve as a regulatory checkpoint in fuel switching, with implications for metabolic adaptation and the efficacy of GLP-1RA-based anti-obesity therapy.
19. What Patients With Asthma Share When No One Listens: Multimethod Observational Study of Patient Narratives on Reddit.
期刊: Journal of medical Internet research 发表日期: 2026-Jan-08 链接: PubMed
摘要
The use of social media platforms, such as Reddit, to seek and share information about disease management and treatment strategies is increasingly common. In the context of asthma-a chronic condition characterized by limiting symptoms and exacerbations that require active patient engagement and adherence to treatment-there is a lack of research describing the content of Reddit posts and the specific topics of interest to patients. This study aimed to describe the topics discussed by users on the Reddit asthma forum and identify the sentiments and polarity of the language used in the posts. A retrospective observational study of public posts on the asthma subreddit forum (r/Asthma) over a 1-year period (October 2023-October 2024). All posts and related threads were included, subdivided into hot, news, and top, and those voted “up” or “down,” those that received “awards,” categorized as “golds.” The messages were reviewed manually and excluded if they were not related to asthma. A mixed methods analysis was conducted, comprising (1) analysis using text lemmatization, (2) structural topic modeling to identify topics based on word frequency, and (3) sentiment and polarity analysis. This approach aimed to identify the most frequently used topics on Reddit, detect positive and negative sentiments based on the words used, and acceptance or rejection (polarity) based on the language used in the asthma subreddit. Statistical analyses were performed using R software (version 4.1.3; R Foundation for Statistical Computing), with a significance threshold set at P<.05. After removing duplicates, 7806 posts were identified. The suitability of the chosen analysis model was confirmed, as it presented the best balance between exclusivity and semantic coherence. Clusters of 25 topics were identified and distributed according to their weight. The topics with the highest weight were Topic 7 (Symptoms and severity of asthma attacks) and Topic 18 (Causes of asthma). No significant differences were found in the evolution of emerging topics throughout the year except in Topic 20 (Seeking advice from people with asthma; P=.04), Topic 21 (Medical tests that should be reviewed periodically; P=.04), and Topic 22 (Times of year when attacks occur; P=.03). The proportion of feelings and emotions showed a stable trend throughout the year. Discrepancies in feelings and emotions were identified depending on the dictionaries used. Thus, a higher probability of positive feelings was confirmed in the AFINN lexicon. Meanwhile, negative feelings were significant in the Stanford Natural Language Processing, Bing, and National Research Council Canada lexicons. These results can serve as a guide to identify hidden patient needs and help professionals develop specific interventions on topics relevant to patients.
20. Preexisting Mental Health Disorders Are Associated With Acute Clinical Presentation and Longitudinal Recovery Trajectories in Adolescents With Concussion.
期刊: Journal of child neurology 发表日期: 2026-Jan-08 链接: PubMed
摘要
This secondary analysis examined the association between preexisting mental health conditions and clinical recovery trajectories in adolescents with concussion. Adolescents (13-17; n = 1238) completed clinical assessments (Post-Concussion Symptom Inventory [PCSI] ≤48 hours postinjury; PCSI/ Pediatric Quality of Life [PedsQL] for 3 months) and were categorized into control, anxiety, depression, or combined anxiety/depression groups. Acute outcomes were analyzed using analysis of variance or χ2, whereas linear and logistic regression analyzed recovery trajectories. A main effect of group was present for acute symptom scores (P = .03), but post-hoc testing revealed no significant comparisons. Main effects of group and time were observed for PCSI and PedsQL outcomes (P < .007), but interaction effects were nonsignificant. The combined anxiety/depression group reported more symptoms, worse quality of life, and had greater odds of experiencing persistent postconcussion symptoms (defined as ≥3 new/worse symptoms at 4 weeks; OR = 2.31, 95% CI = 1.18-4.67, P = .02) in univariate models. However, multivariable models found no association between preexisting mental health conditions and the presence of PPCS (P = .62). Preexisting mental health conditions were associated with similar longitudinal trajectories but higher symptom and lower quality of life scores overall, highlighting their importance in adolescent concussion management.
21. The relationship between different forms of childhood abuse and subsequent body dysmorphic disorder and complex PTSD symptoms among Israeli women.
期刊: The American journal of orthopsychiatry 发表日期: 2026-Jan-08 链接: PubMed
摘要
Body dysmorphic disorder (BDD) is common in childhood abuse survivors. Nonetheless, the relation between symptoms of BDD, posttraumatic stress disorder (PTSD), and complex PTSD, as well as the effects of different forms of childhood abuse in explaining these symptoms, remains unclear. This study explored (a) BDD scores as a function of childhood abuse; (b) the relationship between symptoms of BDD, PTSD, and disturbances in self-organization (DSO) in childhood abuse survivors; and (c) the effect of levels of different forms of childhood abuse on BDD, PTSD, and DSO symptoms. An online survey was conducted among a convenience sample of 404 Israeli adult women, of whom 53.7% (n = 217) were classified as having a history of childhood abuse. Background variables, BDD symptoms, and the classification and symptoms of PTSD and complex PTSD were assessed online via self-report measures. Results indicated elevated BDD scores in childhood abuse survivors and relationships between symptoms of BDD, PTSD, and DSO in childhood abuse survivors. Levels of emotional abuse served as a trans-diagnostic risk factor for PTSD, DSO, and BDD symptoms, whereas sexual abuse was associated with PTSD symptoms, and physical abuse had no significant effect. The strongest noncausal effect was found for PTSD and DSO symptoms, followed by BDD and DSO symptoms and BDD and PTSD symptoms. The present findings suggest that childhood abuse may be a risk factor for BDD and that trauma-related disorders and BDD are strongly associated in childhood abuse survivors. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
22. Frequency and predictive role of intestinal parasitic infections with irritable bowel syndrome in Egyptian patients: a case-control study.
期刊: Infection 发表日期: 2026-Jan-08 链接: PubMed
摘要
Irritable bowel syndrome (IBS) is a common disorder of gut-brain interaction with multifactorial pathophysiology, including post-infectious mechanisms. In endemic regions, intestinal parasitic infections remain highly frequent and may contribute to persistent gastrointestinal symptoms; however, their role in IBS is often under-recognized and insufficiently studied. This study aimed to compare the frequency and species distribution of intestinal parasitic infections among IBS patients and healthy controls and to evaluate their independent association with IBS in an endemic setting. A hospital-based case-control study was conducted in 2023, including 100 IBS patients diagnosed according to Rome IV criteria and 100 age-matched healthy controls. Stool samples were examined using World Health Organization-recommended parasitological techniques, including direct microscopy, concentration methods, staining, and culture. Multivariate logistic regression analysis was performed to assess factors independently associated with IBS. Intestinal parasitic infections were significantly more frequent among IBS patients compared with controls (P < 0.001), with Entamoeba histolytica and Giardia lamblia predominant. Parasitic infection showed a strong independent association with IBS, along with female sex and short sleep duration. Intestinal parasitic infections are significantly associated with IBS in endemic regions. These findings suggest that parasitological evaluation may warrant consideration during IBS assessment in selected settings.
23. A consensus of international experts on definition, sampling, treatment, and prevention of peripheral extracorporeal membrane oxygenation cannula-site infection obtained by the Delphi method: the SAVECMO study.
期刊: Intensive care medicine 发表日期: 2026-Jan-08 链接: PubMed
摘要
Nosocomial infections are common in patients receiving extracorporeal membrane oxygenation (ECMO), with ECMO cannula-site infections (ECMO-CSI) being the most frequent infections directly related to the ECMO run. These infections can significantly impact patient outcomes. Currently, no adult guidelines exist for the prevention, diagnosis, and/or treatment of peripheral ECMO-CSI, resulting in heterogeneity in both clinical practice and research findings. We conducted a Delphi study involving 39 international experts in ECMO management. The experts participated in four Delphi rounds to reach consensus on various aspects of ECMO-CSI complicating peripheral ECMO (central ECMO excluded), including definition, clinical suspicion, diagnostic methods, preventive measures, and treatment. Consensus was defined as ≥ 70% agreement among experts on each proposed item. The Delphi process established consensus on key aspects of ECMO-CSI. Experts agreed on clinical scenarios that warrant suspicion of ECMO-CSI, such as purulent discharge and local inflammatory signs. Standardized sampling techniques, including swabs and purulent drainage aspiration, were recommended, while others were rejected. Definitions were clarified, specifying that ECMO-CSI is defined by the isolation of a pathogen through local microbiological sampling and the presence of purulent discharge or local inflammatory signs. Among the preventive measures, the use of chlorhexidine-impregnated or semipermeable polyurethane dressings, unchanged for 7 days unless soiled or bleeding, was recommended, whereas systematic antibiotic prophylaxis, even for surgical ECMO, was not recommended. This study presents an international expert consensus focusing on peripheral ECMO-CSI, providing a standardized framework to improve clinical management and facilitate future research. The consensus aims to enhance patient outcomes and support evidence-based guidelines in this complex field.
24. Environmental Drivers of Dry Eye Disease: A Narrative Review of Pollutants, Climate, and Indoor Exposures with Practice Recommendations.
期刊: Ophthalmology and therapy 发表日期: 2026-Jan-08 链接: PubMed
摘要
Dry eye disease (DED) is a multifactorial and prevalent condition of the ocular surface that is associated with a wide range of risk factors. In the modern world, environmental conditions and pollution have become increasingly relevant contributors. Recent findings from the Tear Film & Ocular Surface Society Dry Eye Workshop III (TFOS DEWS III) highlight the contribution of oxidative stress, inflammatory cytokines, and neurosensory alterations to environmentally associated DED. This narrative, non-systematic review aims to synthesize current evidence on the impact of climate change and exposure to pollutants on the epidemiology, pathophysiology, and management of DED, with a particular emphasis on clinical practice. A targeted search of peer-reviewed literature was conducted in PubMed and Scopus, focusing on previous reviews and original human studies evaluating environmental exposures and DED, and findings were synthesized qualitatively due to heterogeneity in study design and diagnostic criteria. Environmental influences on the ocular surface encompass a wide range of factors, including climate conditions such as temperature, humidity, wind speed, altitude, dew point, ultraviolet radiation, and allergens, as well as exposure to air pollution from gases, particulate matter, volatile organic compounds, and other airborne contaminants. Individuals living in densely populated cities, industrial zones, and dry climates are at increased risk, and emerging challenges such as wildfires and desertification warrant increasing attention due to their rising global impact. Exposure to these agents may induce or exacerbate tear film instability, epithelial damage, immune dysregulation, and ocular surface inflammation. Although most available studies are cross-sectional or observational, and therefore limited in establishing causality, environmental exposures remain a key contributor to DED and can impair occupational performance, exacerbate pre-existing health conditions, and diminish overall quality of life. Comprehensive screening, environmental risk assessment, patient counseling, and personalized management strategies are essential to the prevention and management of DED in the face of accelerating environmental change.
25. Potential for integrated monitoring of tick-borne diseases: Indices of tick activity, citizen science, and tick-borne Lyme neuroborreliosis in Denmark from 2017 to 2024.
期刊: Ticks and tick-borne diseases 发表日期: 2026-Jan-07 链接: PubMed
摘要
Monitoring programs that track natural fluctuations in tick activity, human exposure, and disease incidence are limited in their ability to detect shifts in tick-borne disease (TBD) risk. We evaluated an integrated approach combining field-based tick surveillance, Google search trends, and national Lyme neuroborreliosis (LNB) records in Denmark from 2017-2024. Tick nymph activity was modelled using meteorological data from six forest sites and validated against independent 2024-2025 data. The model showed strong predictive performance (Pearson’s r = 0.76, normalised root-mean-square error = 0.16), with temperature, relative humidity, and precipitation significantly influencing activity. Predicted tick activity correlated strongly with Danish Google search terms for ticks (“Flåt” and “Tæge”) with a 1-month lag, and with “borrelia” searches without lag. Predicted activity preceded LNB incidence by one month, consistent with known delays in symptom onset and diagnosis. These findings suggest that digital search behaviour may reflect early public awareness and exposure, offering potential as an early warning signal. We adopted a bottom-up modelling approach, using predicted tick activity derived from meteorological data as a shared reference to explore weather-driven congruence across field surveillance, digital search behaviour, and disease records. The strong temporal alignment across data sources supports the feasibility of integrated TBD surveillance and indicates that the six field sites provide a representative signal of tick activity and can therefore act as effective sentinel sites. Combining weather data, sentinel site activity, digital behaviour, and health records offers a scalable, cost-effective complement to traditional monitoring and may improve confidence in detected trends, enabling earlier public health responses.
26. Middle school students' perceptions of peer bullying: A qualitative study.
期刊: Journal of pediatric nursing 发表日期: 2026-Jan-07 链接: PubMed
摘要
This study examined middle school students’ perceptions of peer bullying using qualitative methods. Peer bullying is a significant social problem that negatively affects children’s physical, emotional, and social development. While many studies have explored its prevalence and consequences, most rely on quantitative data. Qualitative research is needed to capture students’ lived experiences and to better understand the complex nature of bullying. A qualitative descriptive design supported by phenomenological elements was used with 27 middle school students between February and April 2025. Individual semi-structured interviews were conducted, and data were analyzed manually using thematic analysis. Four themes and 14 sub-themes were identified: Four themes and 14 sub-themes were identified: Types of Bullying (verbal, physical, psychological, and cyberbullying), Perceived Positive Meaning (academic achievement, social reputation, and empathy), Perceived Negative Meaning (impairment in social interaction, aggression, and feelings of revenge), and Coping with Bullying (raising awareness, peer support, collaboration with teachers, and sharing with family). Bullying occurred in verbal, psychological, physical, and cyber forms, causing negative effects such as social difficulties and aggression. Some students reported positive outcomes, including increased empathy and academic achievement. Awareness, teacher support, and family involvement were important in coping with bullying. School nurses and mental health professionals should take an active role in recognizing and preventing peer bullying. Implementing school-based awareness and support programs can strengthen students’ coping skills and promote safer school environments.
27. Hypertensive disorders of pregnancy and retinopathy of prematurity in extremely preterm infants: A causal mediation analysis.
期刊: Pregnancy hypertension 发表日期: 2026-Jan-07 链接: PubMed
摘要
Consensus has not been reached regarding the association between hypertensive disorders of pregnancy (HDP) and retinopathy of prematurity (ROP) in preterm infants. We aimed to clarify the effect of HDP on the risk of ROP based on causal mediation analysis using a population-based database from the Neonatal Research Network of Japan. A retrospective study was performed using clinical data of 11,798 infants born at less than 28 weeks of gestation between 2003 and 2017 (HDP group: n = 1,615, non-HDP group: n = 10,183). Causal mediation analysis was performed to decomposes the total effect into the mediated (indirect) and non-mediated (direct) effects of HDP on treated ROP and severe ROP after adjusting for covariates while evaluating fetal growth restriction (birthweight Z-score) as a mediator. The incidences of treated ROP and severe ROP in the HDP and non-HDP groups were 32.4% vs. 36.0% and 4.1% vs. 6.3%, respectively. The total, direct, and indirect effects of HDP on treated ROP, expressed as risk ratio with 95% confidence interval (CI), were 1.043, (95% CI 0.955-1.124), 0.913 (0.832-0.996), and 1.142 (1.102-1.183), respectively. The total, direct, and indirect effects of HDP on severe ROP were 0.845 (95% CI 0.645-1.086), 0.684 (0.511-0.892), and 1.234 (1.105-1.387), respectively. Maternal HDP has a direct protective effect against ROP in extremely preterm infants, whereas fetal growth restriction acts as a pathway that indirectly increases the risk of ROP. The overall effect of HDP on ROP appears to be neutral as these opposing effects offset each other.
28. Eating disorder symptom profiles and physical activity cognitions and motivations among emerging adults with physical activity intentions.
期刊: Eating behaviors 发表日期: 2026-Jan-05 链接: PubMed
摘要
Eating disorders (EDs) encompass maladaptive eating behaviors and body image concerns and often include unhealthy physical activity behaviors (e.g., driven and compulsive exercise). Despite exercise’s potential health benefits, its driven pursuit may exacerbate ED symptoms. This study used latent profile analysis in a non-clinical sample of emerging adults to identify classes of ED symptoms and their associations with physical activity cognitions and motivations (e.g., self-efficacy, identity, self-regulatory efforts). Emerging adults completed a baseline questionnaire of ED symptoms and measures of physical activity cognitions and motivations. Latent profile analysis was run with ED symptoms as indicators, including body dissatisfaction, overvaluation, dietary restraint, binge-eating frequency, and driven exercise frequency. Extracted groups were then compared on physical activity cognitions and motivations. Four distinct groups were identified: recurrent binge-eating symptoms (RBE), cognitive ED symptoms (COG), driven exercise symptoms (DE), and low ED symptoms (LED). These groups exhibited varying patterns of physical activity cognitions and motivations, with the DE group showing elevated adaptive cognitions and motivations (e.g., self-efficacy, self-regulation) and strong physical activity identity. Both the DE and COG groups reported higher guilt and shame regarding not exercising and reinforcing self-regulatory efforts. The RBE group displayed lower amotivation and less self-regulation for physical activity, suggesting challenges in incorporating exercise into their routines. These findings highlight similar and different physical activity cognitions and motivations that may underlie varying ED presentations and highlight the need for tailored interventions to promote healthy physical activity behaviors among individuals with EDs.
29. Racial Disparities in Psychoneurological Symptoms and Health-Promoting Behaviors Among Breast Cancer Survivors: A Two-Year Longitudinal Study.
期刊: Oncology nursing forum 发表日期: 2026-Jan-05 链接: PubMed
摘要
To examine racial disparities in psychoneurological (PN) symptom severity and health-promoting behaviors among breast cancer survivors (BCS) over time. BCS (N = 74) were assessed at baseline; the chemotherapy midpoint; and six months, one year, and two years postchemotherapy. A secondary analysis of a longitudinal, prospective study was conducted using linear mixed-effects models to examine trajectories of PN symptoms and health-promoting lifestyle behaviors. Black BCS experienced greater pain, fatigue, and cognitive impairment. White BCS reported significant changes in anxiety, sleep disturbance, fatigue, neurocognition, and leisure-time exercise, with symptoms worsening at the chemotherapy midpoint and improving thereafter. Black BCS exhibited no significant changes across time points. Culturally sensitive, tailored symptom management strategies and structural interventions are needed. Future research is warranted to identify the unique needs and preferences of Black BCS to improve their symptom experiences and encourage health-promoting lifestyle behaviors.
30. Strategies for forecasting long COVID in the active component U.S. military.
期刊: MSMR 发表日期: 2026-Jan-05 链接: PubMed
摘要
Long COVID, or post-acute coronavirus disease syndrome, represents a potentially serious threat to military readiness. Forecasts of future long COVID diagnoses could help prepare senior leaders for disruptions. Few studies predicting the incidence of long COVID have been published to date, however. Using existing COVID-19 and long COVID diagnoses, as well as demographic and outpatient encounter data, 1- to 6-month ahead and full 6-month forecasts were generated using time series and machine learning models trained on various covariate data. Forecasting models generated accurate predictions of long COVID diagnoses up to 6 months ahead of the forecasted date. Several model and covariate combinations were within 5% of the observed number of diagnoses over the full 6-month testing period, while monthly forecasts of long COVID diagnoses had median absolute percentage errors ranging from 3% to 10% for the best performing model combinations. Simple forecasting models and distribution-based forecasts that utilize existing clinical databases can provide accurate predictions of incident long COVID up to 6 months in advance and can be used to prepare for the burden of new long COVID diagnoses. Accurate predictions of long COVID cases over a 6-month period were achieved by utilizing existing COVID-19 case and outpatient encounter data from January 1, 2020, through December 31, 2022. Long COVID symptoms can cause disruptions to military readiness and prevent a healthy force, especially after surges in COVID-19 cases. The ability to use existing data sources to accurately predict future cases of long COVID allows senior leaders to anticipate and prepare for potential changes in the availability of service members.
31. Adverse pregnancy outcomes following COVID-19 infection or vaccination in active component U.S. military service women, 2021-2023.
期刊: MSMR 发表日期: 2026-Jan-05 链接: PubMed
摘要
Prior studies have found a higher risk of adverse pregnancy outcomes due to COVID-19 infection; however, recent literature documents few adverse impacts to younger and otherwise healthy populations, but with limited information about military members. The study population comprised active component service women with a singleton delivery between 2021 and 2023. Adverse pregnancy outcomes were evaluated by COVID-19 infection and vaccination history, as well as by demographics and pre-existing comorbidities. During the surveillance period, 39,355 active component U.S. service women had a singleton delivery. After controlling for potential confounders in the adjusted logistic regression analysis, COVID-19 infection during pregnancy was associated with eclampsia (OR 2.18, p<0.05) and antepartum hemorrhage (OR 1.11, p<0.05), and COVID-19 infection prior to the start of pregnancy was associated with antepartum hemorrhage (OR 1.18, p<0.05). In comparison, after adjustment, COVID-19 vaccination during pregnancy and prior to start of pregnancy was not associated with increased odds of any adverse pregnancy outcome in active component service women. COVID-19 vaccines are recommended for pregnant women by the American College of Obstetricians and Gynecologists and, previously, the U.S. Centers for Disease Control and Prevention. This analysis found no significant difference in adverse pregnancy outcomes among those who received a COVID-19 vaccine prior to delivery compared to women who did not, between 2021 and 2023. COVID-19 infection prior to start of pregnancy was associated with antepartum hemorrhage whereas COVID-19 infection during pregnancy was associated with eclampsia and antepartum hemorrhage. The findings from this analysis suggest there is a benefit to vaccinating pregnant active component service women against COVID-19. There was no increased risk of these adverse pregnancy outcomes associated with receipt of a COVID-19 vaccine in this study population. In contrast, COVID-19 infection may be associated with increased occurrence of some adverse pregnancy events.
32. The association between body mass index, physical fitness and COVID-19 hospitalization among male active duty U.S. Army soldiers, May 2020-November 2021.
期刊: MSMR 发表日期: 2026-Jan-05 链接: PubMed
摘要
Few studies have investigated body mass index (BMI) and physical fitness factors related to coronavirus disease (COVID)-19 hospitalizations among U.S. active duty service members. This investigation examined associations between measures of physical fitness, BMI, and Army physical fitness test (APFT) performance with COVID-19 hospitalizations of U.S. Army active duty soldiers. From May 2020 through November 2021, 13,074 male soldiers were diagnosed with COVID-19 (90 hospitalized, 12,984 non-hospitalized) who also had an APFT and BMI record no more than 9 months from the COVID-19 diagnosis date. Female soldiers were excluded due to insufficient numbers of COVID-19 hospitalizations. In adjusted logistic regression models controlling for race and ethnicity as well as comorbidities, and including age, BMI, and their interactions, both BMI (adjusted odds ratio [aOR] 1.07; 95% CI 1.01, 1.14; p=0.021), and the age and BMI interaction were statistically significant (aOR 1.01; 95% CI 1.00, 1.02; p=0.004). Each additional year of age amplified the odds of hospitalization by an additional 1% for every 1 unit increase in BMI. Development and maintenance of a healthy body weight may reduce likelihood of COVID-19 hospitalization and sustain individual and unit health and medical readiness. For male U.S. Army active duty soldiers, the association between having a higher BMI and COVID-19 hospitalization was amplified by age, indicating about a 1% increase in the odds of hospitalization per BMI unit for each additional year of age. Maintaining a healthy body weight may reduce the risk of COVID-19 related hospitalization for military personnel. The U.S. Army’s Holistic Health and Fitness Program is one example of a comprehensive health program established to simultaneously enhance several facets of military health and fitness.
33. We Need a Full Tank of High-Test Resilience.
期刊: Oncology nursing forum 发表日期: 2026-Jan-05 链接: PubMed
摘要
Preparation for older age allows us to withstand health challenges such as a cancer diagnosis or functional/cognitive decline. The same principle applies to nursing regarding professional reserve. We need a full fuel tank to.
34. Clinical and diagnostic characteristics of autoimmune, infectious, and cryptogenic central nervous system vasculitis at a tertiary care center.
期刊: Multiple sclerosis and related disorders 发表日期: 2026-Jan-04 链接: PubMed
摘要
Central nervous system (CNS) vasculitis is a rare, diagnostically challenging disorder involving inflammation of cerebral arteries. Differentiating infectious from autoimmune etiologies is difficult due to nonspecific presentations and limited tools. We characterized CNS vasculitis cases at a tertiary care center to identify distinguishing features by etiology. Patients admitted to Columbia University Irving Medical Center between 2020-2024 with an ICD diagnosis of CNS vasculitis were reviewed. Cases were classified as infectious, autoimmune, or cryptogenic based on clinical, laboratory, radiographic, and pathologic data. Demographics, symptoms, cerebrospinal fluid (CSF) findings, neuroimaging, treatments, and outcomes were analyzed with nonparametric testing. Of 43 included cases, the mean age was 45.7 years; 51.2 % male; 44.2 % immunocompromised; median symptom duration 7 days. Etiologies were infectious (14 %), autoimmune (30 %), and cryptogenic (56 %), with definitive diagnosis in 23.3 %. Headache, cognitive dysfunction, and motor symptoms were common. CSF parameters did not significantly differ across groups (median protein 53 mg/dL; glucose 79 mg/dL; RBC 60/µL; WBC 3/µL). Vessel narrowing occurred in 81.4 %; involvement of >2 vessels was more frequent in infectious (50 %) and cryptogenic (41.7 %) vs autoimmune (0 %) cases (p = 0.016). Cryptogenic cases more often showed ischemia (75 %), hemorrhage (25 %), and FLAIR hyperintensities (75 %) (p < 0.010). Biopsy was performed in 27.9 %. Steroids were given in 97.4 % and disease-modifying therapies in 25.6 %. Despite extensive testing, definitive diagnosis of CNS vasculitis remains difficult. While clinical and CSF features lacked discriminatory value, vascular and imaging patterns differed by etiology, highlighting the need for improved biomarkers and imaging strategies.
35. Possible tuberculous meningitis presenting with predominant voiding dysfunction in an elderly patient: A case report.
期刊: Journal of infection and public health 发表日期: 2026-Jan-02 链接: PubMed
摘要
Tuberculous meningitis (TBM) typically presents with neurological symptoms. Voiding dysfunction in TBM is usually attributed to spinal cord involvement. We report a rare case of possible TBM co-existing with possible prostatic tuberculosis, presenting primarily with urinary symptoms in the absence of spinal pathology. A 69-year-old male presented with a two-year history of progressive urinary retention, urgency, and frequency. Initial management for benign prostatic hyperplasia was ineffective. He subsequently developed fever, headache, and dizziness. Cerebrospinal fluid (CSF) analysis revealed lymphocytic pleocytosis and elevated protein. Despite extensive testing, including CSF culture, Xpert MTB/RIF, and metagenomic next-generation sequencing (mNGS), no pathogen was identified. However, a history of untreated testicular tuberculosis, pulmonary nodules on CT, and a prostatic nodule on MRI raised suspicion of disseminated tuberculosis. A clinical diagnosis of possible TBM was made based on a Marais score of 11. An intensive anti-tuberculosis regimen including moxifloxacin and linezolid led to complete resolution of neurological and urinary symptoms. This case suggests that voiding dysfunction in TBM patients may stem from concurrent genitourinary tuberculosis rather than spinal cord involvement. It highlights the importance of considering hematogenous dissemination from latent genitourinary foci in elderly patients and the utility of the Marais criteria for the diagnosis of TBM when microbiological evidence is elusive.
36. Public health impacts of increasing the minimum unit price for alcohol in Scotland: A model-based appraisal.
期刊: PLoS medicine 发表日期: 2026-Jan 链接: PubMed
摘要
Governments in several countries have introduced a minimum unit price (MUP) for alcohol. Evaluation studies suggest this has reduced alcohol-related harm, but MUPs must increase with inflation to remain effective. This paper estimates the impact of the impact of the Scottish Government’s decision to increase its MUP from £0.50 to £0.65 in September 2024 and, alternative options where the MUP changes to between £0.40 and £0.80. It examines impacts on alcohol consumption, spending, and related health outcomes, how impacts vary across the population with regard to deprivation, and how drinkers move between lighter and heavier alcohol consumption groups. Policy appraisal using the Sheffield Tobacco and Alcohol Policy Model, a dynamic microsimulation model that combines data on alcohol purchasing and consumption for 10 beverage types and 800 subgroups comprising adults in the Scottish population with price elasticities and an epidemiological model. Deprivation is measured using quintiles of the Scottish Index of Multiple Deprivation. Drinker group is categorised as moderate (<14 units/week, 1 UK unit = 8 g ethanol), hazardous (>14 to ≤35/ ≤50 units/week for women/men), and harmful (>35/50 units/week for women/men). The policy appraisal estimates that, compared to retaining Scotland’s MUP at £0.50, increasing the MUP to £0.65 leads to an estimated 12.0% decrease in alcohol consumption, 2.1% decrease in alcohol spending, 3,385 fewer deaths overall, and 2,578 fewer deaths wholly attributable to alcohol over 20 years. Estimated effects are largest in the quintile of the population living in the most deprived areas. Increasing the MUP to £0.65 is also estimated to reduce the proportion of drinkers consuming at harmful levels by 29.4% and the proportion consuming at hazardous levels by 8.0%. Key limitations of the study include relying on data on alcohol consumption and spending collected before the COVID-19 pandemic, synthesising consumption and spending data from separate datasets, and assuming no supply-side responses (e.g., price changes above the MUP threshold). Increasing the threshold of an established MUP can lead to additional reductions in alcohol consumption, related harm, and health inequalities. Benefits accrue particularly to the most deprived and heaviest drinkers.
37. Impact of a Reproductive Health Survivorship Care Plan on Fertility, Pregnancy Concerns, and Accessing Reproductive Healthcare Among Young Nulliparous Breast Cancer Survivors.
期刊: Cancer reports (Hoboken, N.J.) 发表日期: 2026-Jan 链接: PubMed
摘要
Young patients with breast cancer frequently receive chemotherapy and/or endocrine therapy that adversely affect ovarian function, leading to fertility, pregnancy, and other reproductive health concerns. Despite available evidence-based management strategies, dissemination to survivors and healthcare providers remains limited, resulting in substantial unmet informational and care needs. Web-based survivorship care plans may offer an effective approach to address these gaps. To evaluate the effect of a web-based Reproductive Health Survivorship Care Plan (SCP-R) on reproductive concerns and reproductive healthcare access among nulliparous young breast cancer survivors (YBCS). This is a secondary analysis of a 24-week randomized controlled trial on the effectiveness of a web-based SCP-R addressing unmet informational and clinical management needs for breast cancer survivors aged 18-50 years. The current analysis is restricted to nulliparous participants ages 18-40. The primary outcomes are improvement in fertility and pregnancy health concerns, as measured by the Reproductive Concerns After Cancer (RCAC) scale. The secondary outcome is fertility specialist access measured by referral, consultation, or treatment by a fertility specialist. Among 182 study participants from the parent trial, 47 met the inclusion criteria for the current study (17 in the intervention and 30 in the attention control). Mean age at diagnosis was 30.7 (SD = 3.5) years, and mean age at study participation was 34.0 (SD = 3.8) years. Fertility potential and pregnancy concerns improved in 35.3% of participants randomized to the intervention arm compared to 10.0% in the control arm (RR = 3.5, 95% CI = 1.01-12.34, p = 0.05). Intervention arm participants were significantly more likely to receive a fertility specialist referral, schedule a fertility consult, or undergo fertility treatment (37.5% in the intervention arm vs. 6.7% in the control arm; RR = 5.6, 95% CI = 1.28-24.73, p = 0.02). The web-based SCP-R intervention led to improvements in fertility potential and pregnancy concerns over time and resulted in more YBCS accessing fertility specialists, highlighting the importance of age- and parity-specific survivorship care interventions to address reproductive health concerns.
38. From source identification to preferential interventions: Determinants of a workplace mental health promotion program to control workplace stress among health care workers based on a qualitative study.
期刊: PloS one 发表日期: 2026 链接: PubMed
摘要
Occupational stress among healthcare workers (HCWs) is increasing due to the development of healthcare services and increased occupational sensitivity. The aim of this study was to identify the determinants of a workplace mental health promotion program for stress management among HCWs. Data for this qualitative study were obtained through semi-structured interviews and focus groups. Data analysis was conducted using a directed content analysis approach, grounded in the PRECEDE-PROCEED model (PPM) and the Job Demands-Resources (JD-R) model. It was found that workplace stress has both individual and environmental (mainly organizational) origins. In the second phase of the program, ten subcategories were identified as effective factors in reducing employee stress in three categories: predisposing, enabling, and reinforcing factors. In the final step, in order to create changes and implement interventions, it was revealed that there is a need to formulate or revise managerial and structural policies in the organization and empower employees to improve interpersonal skills and manage workplace stress. Also, Non- occupational factors, Cognitive factors, Supervisory function, Personality characteristics, and Personal context of the employee were identified as new subcategories in the PPM to investigate work stress. Workplace stress has different sources and dimensions. Therefore, it is necessary to consider a combined and multi-level approach, including individual, social, organizational, and educational factors, for the mental health promotion program in the workplace. In this regard, the conceptual model proposed in this study can be a roadmap for researchers and employers to control the stress of HCWs and other employees.
39. Effects of maternal BMI on early pregnancy endocrine-metabolic function and offspring development: Evidence from a retrospective cohort and animal model.
期刊: PloS one 发表日期: 2026 链接: PubMed
摘要
Abnormal body mass index (BMI) has been associated with pregnancy complications and adverse pregnancy outcomes; however, its clinical significance during early pregnancy remains unclear. This study aimed to investigate the relationships and underlying mechanisms between maternal BMI, reproductive endocrine parameters, and pregnancy outcomes, thereby providing a theoretical basis and clinical guidance for the management of pregnancies in women with abnormal BMI. A total of 353 pregnant women were enrolled in this study and categorized into four groups according to BMI: underweight (n = 45), normal weight (n = 229), overweight (n = 57), and obese (n = 22). At 6-8 weeks of gestation, pregnancy-related hormones, glucose and lipid metabolism parameters, and uterine artery blood flow indices were collected and analyzed. Pregnancy outcomes and neonatal birth information were also recorded. In addition, an obese mouse model was established to evaluate maternal weight changes during pregnancy and their effects on uterine and embryonic development. The expression of genes and proteins related to en[docrine metabolism, inflammatory regulation, and angiogenesis was assessed using RT-qPCR and Western blot techniques to further explore the potential mechanisms involved. During early pregnancy, pregnant women with low BMI exhibited significantly lower estradiol levels (P < 0.05). In contrast, women with high BMI had significantly reduced levels of human chorionic gonadotropin, estradiol, and progesterone, along with markedly elevated glucose and lipid metabolism parameters (P < 0.05). However, BMI had no significant impact on uterine artery blood flow indices, live birth rate, gestational age, or mode of delivery (P > 0.05). High BMI was associated with an increased risk of macrosomia in neonates (P < 0.05). In the animal experiments, obese pregnant mice exhibited significantly greater gestational weight gain compared to controls (P < 0.05), and their offspring showed a predisposition to obesity. RT-qPCR analysis revealed that, relative to the control group, mRNA expression levels of VEGFA, VEGFR-2, CD31, and SIRT1 were significantly decreased in the obese group (P < 0.001), whereas mRNA expression of GLUT1, HIF-1α, TNF-α, IL-6, HMGB1, and TLR4 was significantly upregulated (P < 0.01). Western blot results demonstrated that compared with controls, the obese group showed significantly lower expression levels of GLUT4 and phosphorylated IRS1 (P < 0.0001), while the expression of HIF-1α and TNF-α was significantly increased (P < 0.0001). Additionally, there were no significant differences in the protein expression levels of IRS1, SGK1, and NFκB p65 between the two groups (P > 0.05). Abnormal BMI affects hormonal profiles and glucose and lipid metabolism during early pregnancy. Although it does not significantly impact fetal survival rates, it markedly increases the risks of cesarean delivery, preterm birth, and abnormal neonatal birth weight. These alterations not only pose challenges for postpartum maternal and neonatal health management but may also exert adverse effects on the long-term health of the offspring. Maternal obesity may impair pregnancy outcomes by inhibiting insulin signaling, enhancing proinflammatory responses, inducing a hypoxic microenvironment in the decidual tissue, and suppressing angiogenesis, thereby disrupting maternal-fetal interface homeostasis.
40. Gender-transformative health promotion interventions for linking and retaining tuberculosis-diagnosed adult men in care in sub-Saharan Africa: A scoping review protocol.
期刊: PloS one 发表日期: 2026 链接: PubMed
摘要
Tuberculosis (TB) remains a leading cause of infectious disease mortality globally, with men in sub-Saharan Africa (SSA) disproportionately affected. Men experience higher TB incidence, delayed care-seeking, poorer treatment adherence, and elevated mortality compared to women. Gender-transformative health promotion interventions that challenge harmful masculine norms, enhance health system responsiveness, and foster positive health behaviours show promise for improving linkage to and retention in TB care. However, evidence on their design, implementation, and effectiveness in SSA is limited. Following the Arksey and O’Malley framework, refined by Levac et al., this scoping review will map evidence on gender-transformative health promotion interventions targeting adult men (≥18 years) diagnosed with any form of TB in SSA. We will search PubMed via MEDLINE, the Cochrane Library, Embase.com, Global Health, Web of Science, PsycINFO, Google Scholar, Africa-Wide Information, and the WHO Library, and screen reference lists of included studies. Eligibility will follow the Population-Concept-Context (PCC) framework, focusing on interventions supporting linkage to care, treatment initiation, adherence, or retention in care. Data will be charted using a standardized extraction tool, quality appraised using the Mixed Methods Appraisal Tool, and narratively synthesized using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework. Stakeholder consultations will inform the interpretation of findings. As a protocol, no results are reported. The review will identify intervention characteristics, implementation strategies, barriers, facilitators, and outcomes across SSA contexts. Findings will guide the development of culturally sensitive, gender-responsive TB interventions aligned with the Sustainable Development Goal 3 to improve linkage and retention among men diagnosed with TB in SSA.
41. Prevalence and risk factors of diarrhea among young children in Kenya's drylands: A longitudinal study.
期刊: PLOS global public health 发表日期: 2026 链接: PubMed
摘要
Diarrhea is the third leading cause of malnutrition and mortality among children under five globally. Environmental and socioeconomic conditions in the drylands of sub-Saharan Africa may increase the risk of diarrhea, yet few studies have examined the factors in these settings. We therefore aimed to estimate the prevalence of diarrhea and identify potential risk factors among young children in Kenya drylands. Data are from a longitudinal population-based study conducted in Turkana County, Kenya. Surveys were implemented across six waves (May 2021 to September 2023) among 1211 households with children under 36 months at baseline. Caregivers reported on household conditions and episodes of diarrhea in the prior two weeks. Prevalence trends were examined by survey zone, livelihood zone, and child age and sex. Multivariable logistic regressions with generalized estimating equations were used to access distal, intermediate, proximal, and immediate risk factors and reported adjusted odds ratio (AOR) together with the associated 95% confidence interval (CI). Diarrhea prevalence declined significantly over time, from 32.1% at baseline to 8.7% at end of the study. Factors associated with higher odds of diarrhea included caregiver alcohol consumption [AOR = 1.28, 95% CI: 1.02-1.60], child malnutrition (wasting: AOR = 1.20, 95% CI: 1.04-1.39; stunting: AOR = 1.40 95% CI: 1.19-1.65; underweight: AOR = 1.29, 95% CI: 1.11-1.49), household shocks (biological: AOR = 1.37, 95% CI: 1.20-1.57; climatic: AOR = 1.18, 95% CI: 0.93-1.50; conflict: AOR = 1.60, 95% CI: 1.40-1.83), and moderate (AOR = 1.25, 95% CI: 1.04-1.50) or high-water insecurity (AOR = 1.46, 95% CI: 1.19-1.81) relative to no-to-marginal household water insecurity. Protective factors included greater child age (AOR = 0.97, 95% CI: 0.96-0.98), receipt of vitamin A supplementation (AOR = 0.77, 95% CI: 0.66-0.89), deworming (AOR = 0.88, 95% CI: 0.75-1.02), and caregiver handwashing after toilet use (AOR = 0.83, 95% CI: 0.70-0.98). These findings highlight the multifactorial drivers of childhood diarrhea in drylands and underscore the need for integrated interventions that improve water security, strengthen nutrition, support hygiene practices, and enhance resilience to household shocks.
42. Longitudinal analysis of the risk factors for onset and change in tinnitus in the Busselton Healthy Ageing Study.
期刊: PloS one 发表日期: 2026 链接: PubMed
摘要
Effective prevention and intervention strategies for tinnitus rely on identifying risk factors and understanding its progression over time. However, longitudinal data on these aspects are limited. This study therefore aimed to (1) assess the incidence of tinnitus and identify risk factors associated with tinnitus development, and (2) assess the impact of tinnitus and change in impact over time and identify factors associated with this change. Data from the Busselton Healthy Ageing Study, a population-based cohort of individuals born between 1946-1964, were used. Information on tinnitus presence and impact, general health, ear-related health and mental health was collected from 3863 participants through questionnaires and physical measurements at two time points with a six-year interval. Logistic regression analysis was used to examine risk factors for tinnitus development. Multinomial logistic regression analysis was used to examine factors associated with changes in impact. The 6-year incidence of tinnitus was 12.1%. Statistically significant risk factors for developing tinnitus included male gender, higher BMI, larger waist circumference, fair subjective health, hearing loss, occupational noise exposure with occasional use of hearing protection, hyperacusis, migraine, and diagnosed anxiety disorder. Among participants with pre-existing tinnitus, 21.4% reported an increase in tinnitus impact over time, while 16.5% experienced a decrease. Changes in impact were influenced by general health and ear-related health factors. The high incidence of tinnitus and its notable impact on daily life emphasize the importance of gaining a better understanding of the broad range of identified risk factors for developing tinnitus and change in impact. The multifaceted nature of these factors, comprising hearing-related issues, general health conditions and psychological aspects, underscore the complexity of tinnitus etiology and impact. By gaining more insight into these factors, we can inform future research efforts aimed at developing targeted prevention and intervention strategies tailored to specific demographic groups.
43. Relationship between the Rate of Perceived Stability, electrodermal activity and task performance during balance challenges in chronic stroke.
期刊: PloS one 发表日期: 2026 链接: PubMed
摘要
In addition to sensorimotor impairments following stroke, decreased self-efficacy regarding walking balance may lead to self-imposed limitations on community level mobility, especially among women. The Rate of Perceived Stability (RPS) is a self-efficacy measure used to assess individual perception of balance ability when standing or walking balance is challenged. Measurement of electrodermal activation (EDA), modulated by the autonomic nervous system, during perturbations to standing balance reflects the physiological arousal (‘fight or flight’) response of the individual as they maintain or recover their balance. Repeat performance of a balance task has been shown to result in habituation of EDA within a single session; however, studies have yet to test whether similar habituation occurs when the same balance tasks are repeated across different days. This study aims to examine the relationships between EDA, task performance ability, and RPS in individuals with chronic stroke performing walking balance challenges. Further, the study explores how sex and repeat exposure (repeat performance of task) moderate these relationships. Over two testing days, participants with chronic stroke (>1 year) were assessed on walking balance task performance with the Community Balance and Mobility Scale (CB&M) and rated their perceived stability using the RPS. EDA measured the physiological arousal during task performance. Linear mixed models were used to assess: 1) the relationship between CB&M task performance and RPS and whether sex or repeat exposure moderates this relationship, 2) the relationship between the physiological arousal response and RPS and whether sex or repeat exposure moderates this relationship, and 3) whether physiological arousal response mediates the relationship between CB&M task performance and RPS. Thirty individuals with chronic stroke, with moderate severity lower extremity impairment (Chedoke McMaster Stroke Assessment score 4-5/7) participated in the study, including 15 males (mean age: 65.1 ± 10.2 years; time since stroke: 9.4 ± 4.7 years) and 15 females (mean age: 65.5 ± 9.7 years; time since stroke: 7.6 ± 5.9 years). CB&M scores, indicating balance performance, explained 20.3% of the variability in the RPS. As CB&M task performance improved, RPS scores decreased by 2.69 (95% CI [-3.28 - -2.10]) to 3.67 (95% CI [-4.32 - -3.02]) points, indicating improved perceived stability. Physiological arousal significantly predicted RPS scores, however only explained 1.6% of the variability in the RPS. Physiological arousal was not found to be a significant mediator of the relationship between the CB&M task performance scores and RPS. Participant-specific random effects accounted for more variance in the RPS than the fixed effects of task performance and physiological arousal, explaining 46% of variance in RPS. Repeat exposure and sex did not moderate the relationships between the predictors (physiological arousal and task performance) and RPS. Ability to perform a walking balance task (CB&M task performance score) and the underlying physiological arousal response (EDA) are independent predictors of perception of balance in people with chronic stroke as measured by the RPS. However, individual characteristics not captured in this study account for a greater proportion of the variability of the self-reported perception of balance during tasks performed. Potential characteristics may include constructs such as fall history and level of physical activity highlighting the complexity of perception of balance ability post-stroke.
44. Suboptimal primaquine adherence in Plasmodium vivax malaria: Evidence from high-burden tribal districts in Odisha.
期刊: Journal of infection and public health 发表日期: 2025-Dec-30 链接: PubMed
摘要
Eliminating Plasmodium vivax malaria in India’s tribal regions is challenging, mainly due to poor adherence to primaquine, the only hypnozoiticidal drug for radical cure under national policy. Incomplete adherence to the 14-day primaquine regimen leads to relapse, treatment failure, ongoing transmission, and may contribute to antimalarial resistance. This study quantified primaquine adherence, and explored behavioral factors influencing non-adherence in high-burden tribal districts of Odisha. This prospective cohort study conducted from January to December 2024 in two high-burden tribal districts (Malkangiri, Koraput) enrolled 269 laboratory-confirmed P. vivax patients aged over one year. Structured questionnaires collected demographic, clinical, and treatment data. Adherence to the 14-day primaquine regimen was assessed on days 7 and 14 via self-report, pill counts, and blister pack inspection. Uni- and multivariable analyses identified predictors of non-adherence. Adherence to chloroquine (3 days) and artesunate-SP (mixed infections) exceeded 93 %, while only 58.7 % (95 % CI: 52.6-64.9) completed the 14-day primaquine course. Healthcare workers dispensed drugs according to guidelines. Treatment discontinuation was mainly due to symptom resolution (61.9 %) and forgetfulness (21.4 %); only one patient discontinued primaquine due to an adverse event. Older age and household malaria history were associated with better adherence. Suboptimal primaquine adherence delays P. vivax elimination despite adequate drug supply and correct dosing. Addressing behavioral drivers of early treatment cessation is critical to interrupt relapse transmission. Programmatic focus should include intensified social behavior change communication, targeted directly observed therapy, and evaluation of shorter primaquine or single-dose tafenoquine treatments with G6PD testing to enhance radical cure and accelerate India’s 2030 malaria elimination goal.
45. Epstein-Barr virus in multiple sclerosis pathogenesis: The path towards mechanistically faithful models.
期刊: Multiple sclerosis and related disorders 发表日期: 2025-Dec-30 链接: PubMed
摘要
Multiple Sclerosis (MS) is a chronic, disabling autoimmune disease of the central nervous system (CNS). While its aetiology is multifactorial, compelling evidence now implicates Epstein-Barr virus (EBV) as a primary aetiological agent. This review summarises the extensive epidemiological and mechanistic data supporting a causal link between EBV infection and MS. Epidemiological studies demonstrate that EBV infection confers >30-fold increased risk for MS, with seroconversion preceding the onset of neuroaxonal damage. The leading proposed mechanism is molecular mimicry, where antibodies and T cells targeting the EBV nuclear antigen 1 (EBNA1) cross-react with CNS proteins, such as GlialCAM, initiating autoimmune-mediated demyelination. This process is modulated by synergistic interactions with genetic risk factors, and environmental factors like smoking and adolescent obesity. A critical evaluation of the experimental models used to investigate this connection is presented. In vitro systems using patient-derived cells have confirmed dysregulated immune responses to EBV antigens, while in vivo models - ranging from murine experimental autoimmune encephalomyelitis (EAE) and humanised mice to non-human primate models with homologous γ-herpesviruses - have been instrumental in demonstrating the role of EBV in breaking immune tolerance and driving neuroinflammation. Despite their utility, each model possesses limitations, underscoring the need for next-generation model systems that more accurately recapitulate the complex interplay between the virus, host genetics, and the CNS environment. Future research focused on refining these models is crucial for developing targeted EBV-based therapeutics, such as vaccines or antiviral agents, to prevent or treat MS.
46. Machine learning-based short-term forecasting of COVID-19 hospital admissions using routine hospital patient data.
期刊: Epidemics 发表日期: 2025-Dec-18 链接: PubMed
摘要
During the COVID-19 pandemic, the field of infectious disease modeling advanced rapidly, with forecasting tools developed to track trends in transmission dynamics and anticipate potential shortages of critical resources such as hospital capacity. In this study, we compared short-term forecasting approaches for COVID-19 hospital admissions that generate forecasts one to five weeks ahead, using retrospective electronic health records. We extracted different features (e.g., daily emergency department visits) from an individual-level patient dataset covering six hospitals located in the region of Bern, Switzerland, from February 2020 to June 2023. We then applied five methods - last-observation carried forward (baseline), linear regression, XGBoost and two types of neural networks - to time series using a leave-future-out training scheme with multiple cutting points and optimized hyperparameters. Performance was evaluated using the root mean square error between forecasts and observations. Generally, we found that XGBoost outperformed the other methods in predicting future hospital admissions. Our results also show that adding features such as the number of hospital admissions with fever and augmenting hospital data with measurements of viral concentration in wastewater improves forecast accuracy. This study offers a thorough and systematic comparison of methods applicable to routine hospital data for real-time epidemic forecasting. With the increasing availability and volume of electronic health records, improved forecasting methods will contribute to more precise and timely information during epidemic waves of COVID-19 and other respiratory viruses, thereby strengthening evidence-based public health decision-making.
47. Comparing ChatGPT and DeepSeek for ultra-processed food classification: AI models for nutritional research and dietary assessment.
期刊: Nutrition (Burbank, Los Angeles County, Calif.) 发表日期: 2025-Dec-11 链接: PubMed
摘要
There is growing evidence linking the consumption of ultra-processed foods (UPFs) to adverse health outcomes. Accurate classification of foods according to the extent and purpose of industrial processing is therefore essential for improving dietary assessment and public health strategies. This study aimed to evaluate and compare the performance of two large language models (LLMs), DeepSeek-R1 and ChatGPT o1, in classifying foods according to the NOVA classification system. Both LLMs were tasked with categorizing a standardized list of 1,168 food items obtained from the Brazilian Food Composition Table (TBCA, version 7.0). The classifications generated by the models were compared with a reference list manually classified by a trained researcher. Quantitative analyses included the calculation of unweighted Cohen’s kappa between the LLMs, as well as accuracy, sensitivity, specificity, precision, and F1 score for each model. Qualitative analyses were conducted to explore discrepancies in food classification. ChatGPT o1 demonstrated superior performance across all evaluated metrics, achieving an accuracy of 98.0%, sensitivity of 94.7%, specificity of 99.0%, and an F1 score of 95.6%. In comparison, DeepSeek-R1 achieved an accuracy of 92.6%, sensitivity of 69.8%, specificity of 99.3%, and an F1 score of 81.1%. ChatGPT o1 also produced substantially fewer misclassifications than DeepSeek-R1 (23 versus 86, respectively). The findings highlight the potential of large language models to support dietary assessment and nutrition research. The development of an automated tool based on the NOVA food classification framework is recommended to assist nutritionists and researchers, enabling faster and more consistent food classification in both clinical and research settings.
48. Acute-phase Geriatric Nutritional Risk Index is associated with swallowing function after convalescent rehabilitation in older patients with ischemic stroke: A retrospective cohort study.
期刊: Nutrition (Burbank, Los Angeles County, Calif.) 发表日期: 2025-Dec-11 链接: PubMed
摘要
Post‑stroke dysphagia and malnutrition both compromise recovery. Whether the Geriatric Nutritional Risk Index (GNRI) measured on acute admission predicts swallowing function after convalescent rehabilitation remains unclear. This study retrospectively analyzed 254 with ischemic stroke patients aged ≥ 65 y (median age 79.3 y; 141 men) who were admitted within 7 d of stroke onset and subsequently transferred to convalescent rehabilitation hospitals. GNRI was calculated within 3 d of acute admission. Swallowing function was assessed with the Functional Oral Intake Scale (FOIS). Multivariate linear regression analyses with FOIS on convalescent discharge included acute-phase GNRI, age, sex, brainstem lesion, premorbid modified Rankin Scale, National Instituted of Health Stroke Scale, hemoglobin, C-reactive protein, Functional Independence Measure, days to speech therapy initiation, and baseline FOIS, which were assessed at the time of admission to the acute hospital. Fifty-one (20.1%) had malnutrition for GNRI < 92 on acute admission. Patients with malnutrition were lower FOIS on acute admission (P = 0.002) and convalescent discharge (P < 0.001) than patients without malnutrition. Multivariate linear regression analyses revealed that acute-phase GNRI (β = 0.151; P = 0.019), premorbid modified Rankin Scale (β = -0.149; P = 0.009), C-reactive protein (β = 0.138; P = 0.024), days to speech therapy initiation (β = -0.116; P = 0.031), and baseline FOIS (β = 0.37; P < 0.001) were significantly associated with FOIS on convalescent discharge. Acute‑phase GNRI may predict swallowing function after convalescent rehabilitation in older patients with ischemic stroke.
49. Use of oral nutritional supplements in Greece: Examining the effect of the level of knowledge of health care professionals on their use in clinical practice.
期刊: Nutrition (Burbank, Los Angeles County, Calif.) 发表日期: 2025-Dec-06 链接: PubMed
摘要
Nutrition therapy can improve patients’ health outcomes and reduce health care cost. The undergraduate curriculum is often considered inadequate with respect to medical nutrition therapy, resulting in insufficient knowledge of medical nutrition therapy methodology among health care professionals (HCPs). The aim of this study was to evaluate the level of knowledge among HCPs regarding the use of oral nutritional supplements (ONS) in clinical practice. An online survey was performed with the use of a validated questionnaire consisting of 33 questions (11 on demographic characteristics and 22 on the use of ONS). HCPs working in Greece with a recognized bachelor’s degree and a professional licensewere included in the study. A total of 159 HCPs (49.1% dietitians - nutritionists, 32.7% physicians, 15.7% nurses and 2.5% pharmacists; 66.0% women; mean age: 40.5 ± 9.5 years) were analyzed. The mean number of correct responses on the use of ONS was 11.4 ± 3.0, with a higher level of knowledge being observed for questions about the principles of ONS administration in relation to their use in specific conditions. The lowest success rates were recorded for questions relating to pressure ulcers (8.2%), hip fracture surgery (13.2%), chronic kidney disease (CKD) (15.1%) and older adult patients (24.5%). Moreover, a knowledge deficit was found to be associated with younger age, role as physician, nurse, or pharmacist, limited working experience, and a lack of interest/experience in clinical nutrition (p < .05). The results of our study support the need to improve clinical nutrition education, especially for younger HCPs, those with limited experience, physicians, nurses, and pharmacists.
50. Biomarkers.
期刊: Alzheimer’s & dementia : the journal of the Alzheimer’s Association 发表日期: 2025-Dec 链接: PubMed
摘要
Higher plasma p-tau217 levels have been related to cognitive decline in predominantly European American and European adult samples. Some studies suggest cardiovascular disease (CVD) and kidney disease, comorbidities more common in African American (AA) adults, are associated with cognitive dysfunction and elevated p-tau217; consequently, these comorbidities may confound associations between p-tau217 and cognition. Using p-tau217 thresholds for amyloid (A) and tau (T) positive status, we examined if AT status associated with cognitive decline in an AA sample and if significant associations persisted when adjusting for comorbidities also identified as significant predictors of worsening cognition. N = 199 African Americans Fighting Alzheimer’s in Midlife (AA-FAIM) study participants, without baseline dementia, had cognitive data and plasma (EDTA) p-tau217 (AlzPath, Inc.) for analysis (Table 1). N = 130 had baseline estimated-glomerular-filtration-rate (eGFR) to assess kidney function. CVD was defined as baseline history of myocardial-infarction, congestive-heart-failure, or stroke. p-tau217 thresholds for amyloid- and tau-positive status (A+>.35pg/mL; T+>.556pg/mL) were derived from previous receiver-operating-characteristic-curve analyses of AA-FAIM amyloid- and tau-PET data. Separate mixed effects models tested whether AT status (A+T+, A+T-, A-T-[reference]), eGFR, 3-level kidney function variable (mild-to-severe, mild, normal[reference]), and CVD moderated relationships between age and decline in: Rey-auditory-verbal-learning-test (RAVLT: immediate- and delayed-recall), log-transformed Trails A and B, semantic fluency, and preclinical-Alzheimer’s-cognitive-composite. If AT status, CVD and/or kidney-function were significantly related to same cognitive outcome, the association between AT status and cognition was re-tested adjusting for the comorbidity and age*comorbidity interaction. See Table 2 for covariates. A+T+ status was related to greater decline in log-transformed Trails B and RAVLT immediate-recall; CVD predicted greater decline in log-transformed Trails B; association between mild-to-severely decreased kidney function and decline in RAVLT immediate-recall was not significant (p = .10) (Table 2). AT status and comorbidities were not associated with other cognitive outcomes. A+T+ status was associated with greater declines in log-transformed Trails B and RAVLT immediate-recall when adjusting, respectively, CVD and impaired kidney function and their interactions with age (Table 2; Figure 1). In AA-FAIM, plasma p-tau217 A+T+ status was related to greater decline in executive function and immediate-recall, even following comorbidity adjustment. Replication is needed in samples having larger proportions with medical comorbidities.
51. Biomarkers.
期刊: Alzheimer’s & dementia : the journal of the Alzheimer’s Association 发表日期: 2025-Dec 链接: PubMed
摘要
The Lumipulse®G pTau217 assay is among the highest performing plasma assays available for detecting amyloid pathology. Recently, Fujirebio has submitted the Lumipulse® G pTau 217/β-Amyloid 1-42 Plasma Ratio to the FDA. The aim of the current study was to assess the utility of these assays for classifying amyloid and tau PET status in a risk-enriched preclinical Alzheimer’s disease cohort. 190 plasma samples from the Wisconsin Registry for Alzheimer’s Prevention and the Wisconsin Alzheimer’s Disease Research Center were selected and analyzed using the Lumipulse®G pTau 217 Plasma assay. Another set of 451 plasma samples were selected and analyzed using the Lumipulse® G pTau 217/β-Amyloid 1-42 Plasma Ratio. 38 samples were analyzed using both assays. Amyloid and tau positivity were determined based on visual reads of [C-11]PiB and [F-18]Florquinitau PET scans, respectively. We used ROC analyses to assess the amyloid and tau classification performance of the biomarkers. We used Spearman correlations to compare plasma pTau217 levels in the samples that were analyzed using both assays. All analyses were cross-sectional and the maximum time difference between plasma and PET assessment was two years. Sample characteristics for both the Lumipulse®G pTau 217 and Lumipulse® G pTau 217/β-Amyloid 1-42 Plasma Ratio data subsets are provided in Table 1. The ROC AUC of pTau217 was .93 for amyloid PET (95% CI .89-.98, accuracy 86%) and .93 for tau PET (95% CI .87-.99, accuracy 88%; Figure 1). The ROC AUC of the pTau217/Abeta 42 ratio was .93 for amyloid PET (95% CI .89 - .97, accuracy 90%) and .90 for tau PET (95% CI .83-.96, accuracy 68%; Figure 2). The Spearman correlation between plasma pTau217 levels was .92. Both the Lumipulse®G pTau 217 Plasma assay and the Lumipulse® G pTau 217/β-Amyloid 1-42 Plasma Ratio accurately classified amyloid and tau status in this largely cognitively unimpaired, preclinical cohort.
52. Biomarkers.
期刊: Alzheimer’s & dementia : the journal of the Alzheimer’s Association 发表日期: 2025-Dec 链接: PubMed
摘要
Alzheimer’s disease (AD), a leading cause of dementia, poses a global health challenge as aging populations expand. Traditionally, practitioners rely on symptom-based identification, often miss the critical window for early intervention, limiting opportunities for improved clinical outcomes. Molecular You (MY) has developed an innovative, two-sided platform to address this gap. The platform i) quantifies 280 high-value plasma metabolites and proteins with absolute quantification and ii) through its algorithms ranks health risks and provides insights across more than 20 biological systems and pathways with an average predictive value of 88%. This study demonstrates the value of applying the MY platform in identifying AD risk and associated co-morbidities early, stratifying patients into endotype-specific mechanisms that inform customized care plans. Plasma samples from 74 patients, including 5 diagnosed with AD, were collected after an overnight fast, rapidly frozen, and shipped to MY for analysis. Each specimen underwent quantitative metabolomic (143 metabolites) and proteomic (140 proteins) assays using well-established LC-MS/MS methods. The resulting data were processed through the MY platform to identify health risks and map key biological pathways. Four of the five patients diagnosed with AD were confirmed, while one patient’s profile was more aligned with vascular dementia. Additionally, 36 patients were identified at moderate to high risk for AD. Analysis of the biological pathways revealed several distinct endotypes for AD risk: dyslipidemia/ abnormal lipid metabolism, metabolic aberrations, inflammation and oxidative stress driving neuroinflammation and neurodegeneration, and neurotransmitter dysfunction leading to excitotoxicity and synaptic dysfunction. Several co-morbidities were identified in the population, including metabolic health issues such as diabetes, kidney health, liver health, immune health, cardiovascular disease, and inflammatory bowel disease. Personalized care plans were developed based on these findings, incorporating targeted dietary, lifestyle, and clinical interventions. The MY platform demonstrates the feasibility of multi-omic analysis of blood to enhance the early detection of AD before clinical symptoms manifest, identify emerging co-morbidities, stratify patients into AD endotypes enabling precision preventative and personalized care. By monitoring patients longitudinally using the MY platform it will be possible to objectively quantify treatment efficacy, safety and overall patient outcomes.
53. Biomarkers.
期刊: Alzheimer’s & dementia : the journal of the Alzheimer’s Association 发表日期: 2025-Dec 链接: PubMed
摘要
Air pollution is a key risk factor for dementia and negatively affects respiratory, cardiovascular, and cognitive health. Older adults are particularly vulnerable due to age-related changes and cumulative exposure over their lifespan. Limited mobility in older age may lead to more consistent but still harmful exposure. However, personal exposure data in this population, especially at high temporal and spatial resolution, remain scarce. We analyzed PM2.5 data from the Atmotube Pro air quality sensor worn by older adults enrolled in the Einstein Aging Study (P01AG003949; N = 209, Mean Age = 77.4, SD = 7.85; 68% female, 14% Hispanic or Latino, 24% MCI). Sensors measure particulate matter (PM1, PM2.5, PM10), VOCs, and meteorological factors every 5 minutes for 14 days annually over five years. This analysis focuses on Year 1 data available so far (January 2025 release), evaluating PM2.5 levels and variability as a function of age and cognitive status (Clinical Dementia Rating, CDR; Mild Cognitive Impairment, MCI). The raw time-series data were aggregated at the participant, hour, and day-of-week level using median PM2.5 values. These metrics were then summarized by participant demographics and cognitive characteristics (e.g., age, MCI status) to calculate the mean and standard deviation of hourly medians. Group differences in air pollution exposure (mean and variability) are reported in Table 1 below. Median pollution levels and variability were slightly lower in older groups, those with higher CDR scores, and those with MCI, but not significantly. This study provides high-resolution air pollution exposure data in older adults, revealing substantial variability not captured by regional monitoring. These findings hint at age-graded and cognitive-status graded effects on exposure, and highlight the need to further investigate cognitive effects through neuropsychological testing and smartphone-based data collection, and for wearable monitoring to improve exposure assessments and inform policies.