公共卫生研究摘要 (2026-01-11)

共收录 59 篇研究文章

1. The association between serum iodine concentration in the first trimester and foetal ultrasound biometric parameters and birth size among Chinese pregnant women.

期刊: Annals of medicine 发表日期: 2026-Dec 链接: PubMed

摘要

To investigate the relationship between first-trimester maternal serum iodine concentration (SIC) and foetal ultrasound biometric parameters as well as neonatal size at birth in Chinese pregnant women. A birth cohort study of 1881 women from 2022 to 2024 in Zhejiang Province, China, was conducted. SIC in the first trimester was measured using inductively coupled plasma mass spectrometry. Foetal biometric parameters in mid-pregnancy were measured using ultrasound scanning techniques. Neonatal anthropometric measurements were obtained immediately after delivery. Linear regression models were used to explore the association between maternal SIC and both foetal ultrasound biometric parameters as well as birth size indicators. Log-transformed maternal SIC showed a significant positive association with biparietal diameter (BPD) (β = 0.102, 95% CI: 0.029, 0.174), but significant negative associations with birth length (β = -0.337, 95% CI: -0.608, -0.066) and birth weight (β = -0.091, 95% CI: -0.171, -0.012). Further sex-stratified analysis revealed that among male foetuses, SIC was significantly positively associated with BPD (β = 0.158, 95% CI: 0.053, 0.263), head circumference (HC) (β = 0.414, 95% CI: 0.074, 0.754) and abdominal circumference (AC) (β = 0.490, 95% CI: 0.111, 0.870). but negatively associated with neonatal length (β = -0.402, 95% CI: -0.742, -0.062) and birth weight (β = -0.120, 95% CI: -0.234, -0.005). These associations were attenuated and non-significant in female foetuses. Maternal age stratification showed significantly stronger positive associations between SIC and foetal BPD in women aged <29 years (β = 0.150, 95% CI: 0.036, 0.265) compared to those ≥29 years. Our findings suggest that first-trimester maternal SIC shows a positive association with foetal BPD but a potential negative association with neonatal anthropometric measures, with these relationships appearing stronger in male foetuses and younger mothers.

2. Impact of a Care Pathway for Older Patients Undergoing Emergency Abdominal Surgery: A Before-and-After Study.

期刊: Acta anaesthesiologica Scandinavica 发表日期: 2026-Feb 链接: PubMed

摘要

Older patients undergoing emergency abdominal surgery face high risks of mortality and complications. Investigate whether a care pathway designed for older patients improves surgical outcomes. This single-centre study investigated the effect of a care pathway for older patients undergoing emergency abdominal surgery, including preoperative frailty assessment, optimised perioperative care, and structured decision-making for severely frail patients. Following implementation of the pathway, patients aged ≥ 75 years were prospectively enrolled in the ‘after’ cohort (1 January 2020-16 April 2021) and compared with a historical ‘before’ cohort of patients (1 January 2016-31 December 2017). The primary outcome was the Comprehensive Complication Index (CCI), a composite measure encompassing 30-day mortality and postoperative complications. Secondary outcomes included 30-day postoperative mortality, the number of palliative patients, mortality at 1 and 3 years and postoperative complications. Among 154 patients in the ‘after’ cohort (median age 82 years [Q1-Q3: 78-86], 54% women, 53% frail), the primary outcome did not differ significantly from that of the 170 patients in the ‘before’ cohort (CCI mean [95% CI]: 44 [39-48] vs. 50 [46-55]; p = 0.15). Postoperative 30-day mortality was significantly reduced (22% vs. 13%, p = 0.04). During the intervention, severely frail patients triaged to palliation (n = 12) were excluded from the study and received palliative care. High postoperative mortality was observed at 1 (31%) and 3 years (49%). Pulmonary (44% vs. 69%, p < 0.001) and gastrointestinal complications (39% vs. 52%; p = 0.02) were significantly reduced. In this ‘before-and-after’ study a care pathway designed for older patients undergoing emergency abdominal surgery had no significant impact on the composite outcome of postoperative mortality and complications. Postoperative 30-day mortality, pulmonary and gastrointestinal complications were significantly reduced, while long-term mortality remained high. Although the results should be interpreted with caution, they highlight the importance of careful preoperative evaluation. In this study, outcomes of elderly patients undergoing emergency abdominal surgery were compared before and after implementation of a care pathway for elderly patients in a moderately sized single centre. Overall it is noted that implementation of this care pathway resulted in a decision to offer palliation instead of surgery to several patients. While the primary outcome of comprehensive complication index did not differ between the before-and after groups, several secondary outcomes were improved in the after group. It should be noted however that multiple confounders could explain the difference, including selection bias of a more robust population offered surgery. The one-and three year mortality of both groups was very high, stressing the importance of a careful and critical assessment of preoperative comorbidity and frailty, as well as the importance of ensuring that the treatment offered aligns with the overall goals of care for the individual patient.

3. The Determinants to Effective Diagnosis and Management of Otitis Media in Aboriginal Children in Primary Care From the Perspective of Health Care Practitioners.

期刊: The Australian journal of rural health 发表日期: 2026-Feb 链接: PubMed

摘要

To identify the barriers and facilitators for timely detection and optimal management of otitis media (OM) in Aboriginal children in a primary care setting from the perspective of Health Care Providers (HCPs). A large regional town in the Kimberley region of Western Australia. Thirty HCPs to Aboriginal children. A qualitative, aboriginal co-designed, participatory action research study with semi-structured interviews and focus groups. Barriers were identified throughout the child’s presentation and management and included challenges with paediatric ear examinations, earwax obstructing the view of the tympanic membrane, unfamiliarity with diagnostic tools, multiple guidelines with varying recommendations, and confusion with accessing ENT specialists. Multiple facilitators were identified and included training HCPs in paediatric examination techniques and wax removal, a single best practice guideline, and system changes to facilitate access to ENT specialist support if required. Importantly, an expanded clinical role of Aboriginal Health Practitioners (AHPs) was identified to augment efficient and effective clinical OM assessment and management in children presenting to clinic. All barriers could potentially be overcome through a programme that enhances theoretical knowledge and practical skills in paediatric ear examination, otoscopy, and safe, timely removal of earwax, improved communication with ENT specialists, and an expanded clinical role for AHPs. Our findings carry important implications for managing OM in primary care services across Australia.

4. Exploratory Evaluation of Self-Reported Periodontitis Among Adult Population From Comitán Chiapas, Mexico.

期刊: Clinical and experimental dental research 发表日期: 2026-Feb 链接: PubMed

摘要

We assessed the reliability and validity of a self-report instrument to ascertain periodontitis risk. A cross-sectional population-based study was conducted in 2013 involving 454 adult people. The instrument included items on periodontal status such as self-perception of gum health, bleeding and gingival infection, halitosis, tooth mobility, and tooth loss. The periodontal clinical condition was assessed using the Periodontal Screening and Recording Index. Construct validity was evaluated by exploratory factor analysis (EFA). Sensitivity, specificity, and area under the receiver operating characteristic curve (AUC-ROC) were calculated as well. Reliability was assessed using Cronbach’s alpha. The prevalence of clinically evaluated moderate (MP) and severe (SP) periodontitis was 49.3% and 28.9%, respectively. Two factors for both types of periodontitis were identified using EFA. The combination of self-report items and risk factors for periodontitis showed an AUC-ROC of 0.660 (sensitivity 97.3%, specificity 3%) for MP and 0.804 (sensitivity 96.9%, specificity 28.3%) for SP. EFA showed two factors that accounted for the baseline and outcome stage of periodontitis and better predicted the risk of SP. This instrument can be an alternative for monitoring this disease at the population level.

5. Proteomic and Lipidomic Profiling of Immune Cell-Derived Subpopulations of Extracellular Vesicles.

期刊: Proteomics 发表日期: 2026-Jan-10 链接: PubMed

摘要

Extracellular vesicles (EVs) are heterogeneous and play important roles in intercellular communication, contributing to physiological and pathological processes. Since few markers currently exist to differentiate subtypes of EVs, this study aimed to determine proteomic and lipidomic differences among four EV subpopulations. Large and small EVs (L-EVs and S-EVs) were isolated from human mast cells (HMC-1) and monocytes (THP-1) by differential ultracentrifugation and then further separated by density cushions into two different densities [low-density (LD) and high-density (HD)]. L-EVs were pelleted at 16,500 × g, and S-EVs were pelleted at 118,000 × g. LD EVs were collected at 1.079-1.146 g/mL, while HD EVs were collected at 1.146-1.185 g/mL. The morphology, size and yield of EVs were determined by TEM and western blot. The proteome and lipidome of the EV subpopulations were determined with mass spectrometry. A total of 5364 proteins were quantified, and L-EVs LD were enriched in mitochondrial proteins such as TIMM/TOMM and MICOS proteins, while L-EVs HD were enriched in cytoskeleton- and cytokinesis-associated proteins, such as KIF proteins. S-EVs LD were enriched in tetraspanins, ADAM10 and ESCRT machinery proteins, while S-EVs HD were enriched in proteins commonly viewed as contaminants, such as histones, complement factors and collagen. Proteins involved in membrane trafficking between the plasma membrane and organelles, such as adaptor protein complexes, the conserved oligomeric Golgi complex, the trafficking protein particle complex, sortin-nexins, TBC1 domain proteins and coatomer subunits, were expressed at similar levels across all EV subtypes. Furthermore, 107 lipids were quantified, and phosphatidylethanolamine (PE) was less abundant in L-EVs LD as compared to the other EV subtypes, while ceramides were enriched in L-EVs as compared to S-EVs.This study demonstrates that there is a core proteome and lipidome that is similar across all four EV subtypes, but importantly, it also shows that a portion of the proteome and lipidome differs in EV subpopulations separated based on size and density. We suggest that these could be important markers in future EV studies and that they may reflect a different biogenesis and EV function.

6. Honokiol Inhibits Stemness in Pancreatic Cancer via Downregulating c-Met Expression.

期刊: Phytotherapy research : PTR 发表日期: 2026-Jan-10 链接: PubMed

摘要

Due to its high recurrence and metastasis rates, the prognosis of pancreatic cancer (PC) patients is extremely poor. Cancer stem cells (CSCs) are the major source of occurrence and progression of PC, suggesting that targeting pancreatic CSC stemness may provide therapeutic benefits. This study aims to clarify the mechanisms by which Honokiol (HNK) inhibits the stemness of pancreatic cancer. The expression of c-Met and downstream molecules was investigated based on public databases and also confirmed by the immunohistochemistry (IHC) staining of human tissues. Colony formation assay and sphere formation assay were conducted to verify the effect of HNK on the proliferation and stemness of PC cells. A subcutaneous transplanted tumor model of BALB/c nude mice was established to explore the effect of HNK on modulating the tumor growth of PC in vivo. c-Met expression was significantly elevated in PC tissues versus normal pancreas tissues, and the high level of c-Met was positively correlated with poor prognosis of PC patients. Overexpression of c-Met significantly enhanced the proliferation and stemness of cancer cells, whereas HNK treatment reversed these effects. Critically, HNK suppressed tumor growth in vivo by downregulating c-Met. Our study reveals that HNK reduced the proliferation and stemness of PC cells via suppressing the c-Met overexpression. These findings provide a potential therapeutic method for PC, offering new hope for improving patients’ outcomes.

7. Optimal approach to standardized documentation in epilepsy clinics: A scoping review.

期刊: Epilepsia 发表日期: 2026-Jan-10 链接: PubMed

摘要

Clear documentation and transfer of information between health care providers is key to ensuring the delivery of high-quality patient care. Our aim was to determine how to optimize and standardize physician documentation in outpatient epilepsy clinics as well as to highlight challenges and barriers to their implementation. We conducted a scoping review of studies implementing standardization and optimization of physician documentation within outpatient epilepsy clinics. The study is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. The following databases were searched from inception to March 2025: MEDLINE, Embase, APA PsycInfo, CINAHL, and Cochrane Library. All abstracts, full texts, and data charting were completed in duplicate. The search yielded 10 268 studies, of which 16 met eligibility criteria. Studies were primarily from the United States (n = 12, 75.0%) and focused on adult practices (n = 9, 56.25%). Studies were quality improvement framework/consensus guideline investigations (n = 9, 56.3%), observational audits/cross-sectional designs (n = 2, 12.5%), and retrospective cohort/chart reviews (n = 2, 12.5%), followed by several mixed-methods development, observational field study, and observational toolkit implementation designs (n = 1, 6.25% each). Most clinical notes were in electronic medical records (n = 14, 87.5%) using free-text fields (n = 4, 25.0%), structured fields (n = 2, 12.5%), or hybrid approaches (n = 7, 43.8%). Common Data Elements included seizure information and treatment counseling information. Outcomes associated with standardized note implementation included reduced epilepsy-related adverse events, better seizure control, and more consistent documentation of pertinent patient information. Highlighted challenges to implementation included workflow disruptions, hesitation to initial uptake, and cost-related barriers such as information technology support. Implementation of standardized documentation was associated with fewer adverse events and better seizure control. Future efforts should prioritize inclusive design, have expanded quality indicators, be easy to use at point of care, and have robust evaluation metrics to optimize their utility for epilepsy care.

8. Trajectory of Neurocognitive Functioning in Children Treated for Acute Lymphoblastic Leukemia (ALL): Dana-Farber Cancer Institute ALL Consortium Study 16-001.

期刊: Pediatric blood & cancer 发表日期: 2026-Jan-10 链接: PubMed

摘要

Children treated for acute lymphoblastic leukemia (ALL) are at risk of neurocognitive deficits in attention-concentration, working memory, executive function, and psychomotor speed. This study evaluated longitudinal trajectories and medical/demographic associations with neurocognitive outcomes during treatment of newly diagnosed ALL. Patients ages 3-21 treated on DFCI 16-001 (NCT03020030) across eight North American sites (2017-2022) were evaluated using Cogstate across four timepoints from diagnosis through maintenance phase. Linear mixed models estimated trajectories and interactions with clinical factors over time, incorporating random effects for patients and sites. Among 298 patients (median age 7.9 years, 53% male), performance changed significantly over time in varying directions for executive functioning, attention, visual learning, and working memory-accuracy (all p < 0.001). There was a significant interaction overall between age and time for psychomotor function (interaction p = 0.01) and working memory-accuracy (interaction p < 0.001). Older age was associated with worse performance on working memory-speed (β = -0.04) and attention (β = -0.05). Female sex was associated with worse performance on psychomotor function (β = -0.27) and working memory-accuracy (β = -0.50), but better on visual learning (β = 0.47) and working memory-speed (β = 0.30). A greater-than-expected proportion of participants performed below -1.5 SD on tests of attention, executive functioning, and psychomotor functioning at multiple timepoints. While most patients demonstrated normal neurocognitive functioning, including variable trajectories, a subgroup performed poorly on attention, executive functioning, and psychomotor functioning. Risk factors include older age at diagnosis and female sex, which may provide insight into groups warranting early intervention.

9. Audio-guided exercise at home: Preliminary findings from a pilot study on physical activity for people with low vision.

期刊: PM & R : the journal of injury, function, and rehabilitation 发表日期: 2026-Jan-10 链接: PubMed

摘要

Individuals with severe visual impairments frequently refrain from regular physical activity due to multiple barriers, including transportation difficulties, financial constraints, and limited availability of exercise programs tailored to their needs. These factors often contribute to a gradual decline in mobility and independence. To evaluate the feasibility of a self-administered, audio-guided training protocol designed to improve mobility in people with severe visual impairments. Nonrandomized controlled clinical trial (number: NCT05956730). Nineteen adults (55.5 ± 14.8 years, 52% females) with severe low vision or blindness, met the inclusion criteria and completed all the assessments. Interventions: Participants were assigned to an audio-guided (AUD) group performing a 3-month home-based training or a supervised (SUP) group performing identical training in a gym. Mobility assessment, including Timed Up and Go Low Vision version (TUG-LV), 1-minute sit-to-stand (1-MSTS), the 3-minute step (3-MSTEP), and Sit and Reach (SR) tests, was conducted every 4 weeks. Physical activity level, satisfaction profile, visual functioning, and caregiver burden were recorded. Participants reported no injuries or physical issues, and adherence was >95%. Both AUD and SUP showed enhancements in TUG-LV, 1-MSTS, 3-MSTEP, and SR (time, p <.001), with differences between groups in 1-MSTS and 3-MSTEP (time × group, p = .04). Physical activity level and satisfaction in physical functioning increased over time (p = .002; p = .03), with no time per group interaction (p = .76; p = .37). No significant changes were noted in visual functioning or caregiver burden. Although supervised training showed slightly greater improvements in some outcomes, audio-guided training is feasible, offering a valuable alternative to enhance mobility when supervision is not viable.

10. Beyond the faculty-student dyad: Disentangling the hidden factors shaping graduate HPE advising success.

期刊: Medical teacher 发表日期: 2026-Jan-10 链接: PubMed

摘要

Advising is essential for student success in graduate health professions education (HPE). Advising does not happen in a vacuum, yet most research focuses narrowly on advisor-advisee relationships. To address this gap, this study examines how institutional structures, policies, and programmatic dynamics influence the effectiveness of advising in graduate HPE. We conducted semi-structured interviews with 15 HPE program leaders across six WHO regions. Using framework analysis guided by Activity Theory and the concept of knotworking, we analyzed how institutional systems shape advising practices. Five institutional factors were identified: (1) strategic advisor recruitment, (2) supportive advising cultures, (3) bureaucratic and resource constraints, (4) advisor training and evaluation, and (5) recognition and support for advisors. Leaders described advising as an adaptive, cross-system process shaped by institutional complexity and evolving student needs. Advising in graduate HPE operates beyond dyadic relationships. It is embedded within institutional activity systems and requires ongoing negotiation across structural boundaries. Programs must adopt systemic strategies, such as faculty development, workload alignment, and policy reform, to support effective advising networks.

11. Optimal Site of the Reference Electrode for Recording the Compound Muscle Action Potential of the Deltoid Muscle.

期刊: Muscle & nerve 发表日期: 2026-Jan-10 链接: PubMed

摘要

For recording the compound muscle action potential (CMAP) of the deltoid muscle, the reference electrode over the acromion (Ac) has been used to avoid contamination of responses from other arm muscles to the distal tendon (DT). A recent article recommended the sternum (St) as the reference electrode. In this study, we aimed to find the appropriate reference site for the deltoid CMAP. Subjects were 12 healthy volunteers. The deltoid CMAP was recorded using Ac, St and DT references. CMAPs of the biceps brachii (BB) and triceps brachii (TB) were also recorded. In addition to stimulation at Erb’s point, selective stimulations of the axillary, musculocutaneous, or radial nerve were attempted at the axilla. The deltoid CMAPs with Ac reference had similar shapes following Erb’s point (proximal) stimulation and axillary plus radial (distal) stimulation at the axilla. In contrast, CMAP using St reference was considerably smaller following proximal than distal stimulation. This difference was derived from the Ac-St lead, to which proximal muscles such as pectoralis major are supposed to contribute only following the proximal stimulation. Such a contribution can be explained by the far-field potential (FFP) theory, which suggests that the Ac-St lead can record FFPs from muscles situated between the Ac and St electrodes. Consistency between proximal and distal stimulations is preferred for motor nerve conduction studies. We propose that Ac reference that enables selective recording from the deltoid muscle is the most appropriate way to record deltoid CMAP to date.

12. Influence of Surgical and Prosthetic Factors on Peri-Implant Health or Disease. Clinical Recommendations From a Spanish Society of Periodontology (SEPA) Expert Consensus.

期刊: Journal of esthetic and restorative dentistry : official publication of the American Academy of Esthetic Dentistry … [et al.] 发表日期: 2026-Jan-10 链接: PubMed

摘要

To examine which prosthetic factors, including design, materials, and cleansability, may influence the onset of peri-implant diseases. The Spanish Society of Periodontology (SEPA) convened a group of experienced periodontists, prosthodontists, and laboratory technicians to develop clinical recommendations based on expert consensus. Emerging evidence highlights the importance of prosthetic design, implant positioning, and material selection in mitigating biological complications. Notably, access for self-performed oral hygiene is a significant predictor of peri-implant health, and designs that facilitate cleaning and prosthetic configurations that minimize plaque accumulation are favored. Additionally, the use of less porous materials, such as zirconia, has been shown to improve soft tissue integration and plaque control. Other critical considerations include minimizing prosthetic manipulation and ensuring optimal implant-abutment connections to prevent bone loss. This review presents clinical recommendations on prosthetic design, material selection, and implant placement in order to reduce the risk of peri-implant diseases. Future research should focus on refining these strategies and evaluating the long-term effectiveness of digital manufacturing techniques in improving prosthetic accuracy and reducing the incidence of disease. Peri-implant diseases, including peri-implantitis, are major concerns in implant dentistry, often linked to suboptimal prosthetic designs and maintenance. This review underscores the importance of prosthetic design in preventing such diseases. Clinicians should prioritize prosthetic configurations that enhance accessibility for self-performed oral hygiene. Furthermore, proper implant positioning in a 3D prosthetically driven position is essential for preventing peri-implant complications. Additionally, the choice of materials, such as ceramic-based and zirconia prostheses, can influence plaque accumulation and soft tissue health. Regular follow-ups and patient education on maintaining good oral hygiene are critical for the prevention of peri-implant diseases. Finally, the increasing use of digital technologies in implant placement and prosthesis manufacturing offers the potential for improving accuracy and minimizing prosthetic misfits, which may further reduce the risk of disease. Future research is needed to explore the impact of digital tools on peri-implant health and to refine best practices in prosthetic design and material selection.

13. Investigating the role of indoor plants in reducing (absorbing) BTEX compounds from indoor air: a systematic review.

期刊: International journal of phytoremediation 发表日期: 2026-Jan-10 链接: PubMed

摘要

BTEX compounds (Benzene, Toluene, Ethylbenzene, and Xylene) are hazardous indoor air pollutants known for their carcinogenic properties and adverse effects on respiratory health. This systematic review, conducted in accordance with PRISMA guidelines, investigates the potential of indoor plants to reduce or remove BTEX from indoor air. A comprehensive search across Scopus, PubMed, and Web of Science yielded 687 articles, with 43 studies meeting inclusion criteria after rigorous screening. The findings indicate that removal efficiencies vary widely, ranging from -25% to 100%, with phytoremediation (82.4%) and microbial degradation (17.5%) identified as the primary removal mechanisms. Commonly studied species included Ficus benjamina, Zamioculcas zamiifolia, and Aglaonema brevispathum. However, practical application remains constrained by the limited effect size per plant, often necessitating large quantities for meaningful pollutant reduction. While indoor plants offer a natural, sustainable, and cost-effective approach to improving indoor air quality, challenges related to cost, maintenance, and scalability must be addressed. Future research should prioritize cost-benefit analyses, pollutant-specific plant selection, and standardized experimental metrics such as mg/h/m² to facilitate real-world implementation. This study conducts the first comprehensive systematic review on potted plants’ ability to remove BTEX pollutants from indoor spaces, providing a quantitative analysis to update current knowledge and fill a 5-year research gap, aiming to establish a robust evidence base for using potted plants as a sustainable solution for indoor air pollution.

14. Associations between sensory processing, social skills, and participation in kindergarten children: A cross-sectional study.

期刊: Applied neuropsychology. Child 发表日期: 2026-Jan-10 链接: PubMed

摘要

Sensory processing plays a critical role in children’s ability to engage in social interactions and participate in daily activities. This study examines the associations between sensory processing skills, social skills, and participation in kindergarten children. A total of 88 children aged 4-7 years were included. The Sensory Processing Measure (SPM), Social Skills Scale (SSS), and Child and Adolescent Participation Scale (CASP) were completed by parents. The SPM total score was significantly negatively correlated with social cooperation (r = -.45, p < .001), self-regulation (r = -.51, p < .001), and assertion (r = -.42, p < .001). Similarly, significant negative correlations were observed between SPM and CASP in home (r = -.55, p < .001), community (r = -.43, p < .001), and school (r = -.44, p < .001) settings, as well as with home and community living activities (r = -.34, p = .001). Regression analysis showed that both sensory processing (β = -.37, p < .001) and social skills (β = .39, p < .001) were statistically significant predictors of participation, explaining 43.4% of the variance (R2 = 0.434, F = 30.318, p < .001). These findings highlight the importance of early identification and intervention for addressing sensory processing issues, thereby enhancing participation and social development in early childhood.

15. Assessing the impact of targeted interventions on access to self-managed abortion care in Zambia.

期刊: International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 发表日期: 2026-Jan-09 链接: PubMed

摘要

This study evaluates the effectiveness of targeted interventions implemented in Zambia from June 2023 to May 2024 in improving access to self-managed medical abortion (SMA) care, following the identification of barriers among providers and community through a baseline assessment and subsequent endline survey. A pre- and post-survey using quantitative method focused on barriers for healthcare providers and community, including Access and Physical Environment; Guidelines and Documents; Equipment and Supplies; Provision and Staff Training; and Financial Aspects. Interventions included improving access, provider training, commodity strengthening, and community sensitization. Participants included healthcare providers, community members, and peer educators across 30 health facilities. STATA was used for descriptive analysis and McNemar’s test. Our study revealed notable improvements in the provision of SMA services across the 30 participating facilities. Facilities offering SMA services increased from 25.3% at baseline to 44% at endline, while the proportion of facilities with adequate sticks of combipacks and misoprostol increased significantly. There was also a documented rise in hospital leadership support and a reduction in charges for SMA services. Access to telemedicine services also improved, increasing from 5.3% to 20.9%. Among community health volunteers, social acceptance of SMA care increased from 54.7% to 79.3%. There was also a greater preference for home administration of SMA medication and self-assessment of effectiveness. Facilities with trained community health volunteers delivering SMA education rose markedly from 25.3% to 93.1%. The findings demonstrated significant improvements from baseline to endline, highlighting that SMA interventions were effective in improving access to safe abortion care in Zambia.

16. Defining Life Stages and Mapping Care Trajectories: A Narrative Review of Life-Course Theories, Models and Frameworks.

期刊: Journal of advanced nursing 发表日期: 2026-Jan-09 链接: PubMed

摘要

To review how life-course theories, models and frameworks define and classify life stages and transitions; how they characterise trajectories of care needs and care provision; and to consider how these insights might inform future developments of care-focused life-course frameworks. Narrative review using a theory synthesis approach. The review synthesised 56 theories, models and frameworks, drawn from 90 articles published up to 2024, using a three-stage process: extraction and summarisation of conceptual content; comparison to identify convergence and divergence; and interpretive synthesis to generate an overarching account of how frameworks conceptualise life-course development, care transitions and care trajectories. Earlier life-course perspectives emphasise normative, age-graded stages, while more recent approaches highlight transitional junctures, relational contexts and structural influences on care trajectories. Life stages were defined variably, encompassing developmental phases, chronological age bands, major life transitions, historical and cultural perspectives and diverse lived experiences. Trajectories of care needs and provision were shaped by social networks, socioeconomic conditions, timing of transitions, transgenerational relationships and interdependencies, and intersectionality. Findings suggest that care needs and care provision fluctuate across time and are best understood as interrelated, dynamic processes influenced by life-course biographies, as well as broader social, economic and policy environments at individual (micro), relational (meso) and structural (macro) levels. Life-course frameworks are shifting from age-based models towards personalised, context-sensitive perspectives that better capture the complexity and diversity of care trajectories. Care planning should incorporate not only developmental stage but also individual, relational and structural factors influencing care needs, care provision and care trajectories over time. Applying a personalised, multilevel life-course perspective may improve assessment accuracy, coordination of resources and equity in care delivery. This narrative review did not involve patients or the public.

17. Strategies for overcoming challenges in implementing simulation in medical education: A qualitative leadership perspective.

期刊: Medicine 发表日期: 2026-Jan-09 链接: PubMed

摘要

Implementing simulation-based education in medical curricula presents distinct challenges, especially for educators newly assuming leadership roles. This study aimed to explore the lived experiences of medical educators who are simulation center leaders to understand the nature of the challenges they encountered and to offer strategic insights for other leaders navigating similar transitions. A qualitative, phenomenological research design was employed. Data were collected from 4 simulation leaders through semi-structured interviews, reflective writings, and institutional documents. Interpretative phenomenological analysis was used to explore how participants made sense of their experiences. An external qualitative expert contributed to the coding and analysis process to ensure trustworthiness. Three major themes emerged: First, the role of the medical educator as a leader: participants reported shifting from being content experts to reflective leaders, emphasizing strategic vision, emotional intelligence, and educational theory. Second, team spirit: the presence of a dedicated team and shared moral purpose supported resilience and collaboration. Communication strategies and informal advocacy strengthened engagement. Third, understanding the challenges: faculty resistance, institutional inertia, and limited resources were viewed through an empathetic lens. Participants addressed resistance via faculty development, research collaboration, and ongoing feedback mechanisms. Finally, institutional support and leadership alignment: administrative support was pivotal in legitimizing efforts and sustaining initiatives. Leadership continuity, policy alignment, and access to decision-making platforms shaped the success of simulation integration. Leadership in health professions education, particularly in simulation-based implementation, requires more than subject expertise; it demands emotional resilience, strategic communication, and relationship-building. Findings suggest that simulation-based change requires not only technical knowledge but also adaptive leadership grounded in context and collaboration. Leaders navigated resistance not as defiance, but as a sign of systemic gaps in understanding and preparation. The study emphasizes the importance of aligning simulation efforts with institutional structures and culture to achieve lasting transformation in medical education.

18. Elevated Risk of Herpes Zoster in Vitiligo Patients: A Nationwide Population-Based Cohort Study of Taiwan.

期刊: The Journal of dermatology 发表日期: 2026-Jan-09 链接: PubMed

摘要

Emerging therapies for vitiligo, such as Janus kinase (JAK) inhibitors, have raised concerns about an increased risk of herpes zoster (HZ), emphasizing the need to clarify the baseline HZ risk in patients with vitiligo. This study aimed to determine whether vitiligo itself is associated with a higher risk of HZ and to identify potential modifying factors, including systemic treatments. Using Taiwan’s Longitudinal Health Insurance Database from 2010 to 2022, a retrospective nationwide cohort study was conducted. Patients with vitiligo were identified through diagnostic codes and matched in a 1:4 ratio with non-vitiligo controls by age, gender, index date, and comorbidities using propensity score matching. Subgroup analyses evaluated HZ risk among patients receiving systemic treatments, including phototherapy and immunosuppressants. A total of 79 910 individuals were included after matching. During the study period, the incidence of herpes zoster was significantly higher in patients with vitiligo than in controls (7.78% vs. 2.72%, p < 0.001). After adjusting for potential confounders, vitiligo remained independently associated with an increased risk of HZ (adjusted hazard ratio [aHR]: 1.532). The risk of HZ increased with age and was higher among female patients. Subgroup analysis further revealed that vitiligo patients receiving systemic therapy had the greatest susceptibility to HZ, especially those treated with cyclosporine (aHR: 1.891), methotrexate (aHR: 1.981), and systemic corticosteroids (aHR: 1.474). In conclusion, this large population-based study demonstrates that vitiligo is an independent risk factor for herpes zoster, and systemic immunosuppressive therapies further augment this risk. Clinicians should be aware of the potentially increased vulnerability to HZ among patients with vitiligo, particularly in older or female individuals. These findings may help inform general clinical considerations regarding preventive strategies, including herpes zoster vaccination, to reduce the risk of infection-related complications in this population.

19. Evaluating the causal connections between sleep duration and disease prevalence: A comprehensive systematic review and meta-analysis of Mendelian randomization studies.

期刊: Medicine 发表日期: 2026-Jan-09 链接: PubMed

摘要

The causal link between sleep duration and diverse health conditions remains unconfirmed. This meta-analysis aimed to clarify these relationships by synthesizing Mendelian randomization (MR) study evidence. PubMed was systematically searched up to February 15, 2024, for MR studies exploring genetic predispositions to sleep duration/insomnia (short/long/overall sleep duration, insomnia) and associations with circulatory, digestive, neurodegenerative, metabolic diseases, and cancers. Eligible effect estimates were meta-analyzed. Fifty-one MR studies were included. Genetic variations in sleep traits were strongly linked to elevated risk of 12 cardiovascular diseases, obesity-related metrics (Type 2 diabetes, fasting glucose/insulin, HbA1c), neurological disorders (Alzheimer, amyotrophic lateral sclerosis, Parkinson disease), mental health conditions (attention-deficit/hyperactivity disorder, autism, bipolar disorder, major depressive disorder, schizophrenia), inflammatory bowel disease, and lung cancer. Genetic evidence confirms causal associations between sleep characteristics and multiple diseases, emphasizing sleep’s key role in health promotion and supporting personalized sleep management to reduce disease risk.

20. Type 2 diabetes after gestational diabetes, a cross-sectional study-DIVINE-NSW.

期刊: Diabetic medicine : a journal of the British Diabetic Association 发表日期: 2026-Jan-09 链接: PubMed

摘要

Gestational diabetes mellitus (GDM) is a well-established independent risk factor for type 2 diabetes mellitus (T2DM) and cardiovascular disease. As risks emerge within the first decade following childbirth, early intervention is required. However, competing postpartum priorities and limited time inhibit many women from prioritising their post-GDM health. Therefore, the study aimed to: (1) Measure dysglycaemia prevalence and identify predictors among Australian women with recent GDM and (2) understand women’s views regarding their risk of future T2DM and approach to potential preventive strategies, including post-GDM preventive pharmacotherapy. Cross-sectional study of women with recent (within 5 years) GDM, including an online questionnaire and oral glucose tolerance test completion by participants. Participants (n = 505) had a mean age of 37.3 ± 4.9 years, body mass index (BMI) of 27.5 ± 6.4 kg/m2 and were 2.9 ± 1.4 years postpartum. Of the 248 (49.1%) participants completing an oral glucose tolerance test, 4% had T2DM and 11% had pre-diabetes. Each 1 kg/m2 increase in BMI was associated with 10% greater odds of dysglycaemia (p = 0.03). On a 10-point scale (10 = highest), the median self-reported 5-year risk of developing T2DM was 5 [IQR: 3-7], and concern about developing T2DM was 7 [5-9]. Women strongly agreed (10 [8-10]) that preventing or delaying T2DM onset was important. Women reported being very likely to adopt lifestyle changes (4 [4-5] out of 5), and somewhat likely to take medication for T2DM prevention (3 [1-4] out of 5). Women consider preventing or delaying the onset of diabetes very important. Hence, studies evaluating adjunct therapies, such as pharmacotherapy, are needed to reduce their long-term risk.

21. Universal Cytomegalovirus Screening in the First Trimester of Pregnancy: The Multicentre Observational Cohort Study in the Area of Barcelona (CITEMB Study).

期刊: BJOG : an international journal of obstetrics and gynaecology 发表日期: 2026-Jan-09 链接: PubMed

摘要

To determine the CMV seroprevalence among pregnant women and assess the rate of primary CMV infections during the first trimester. Prospective multicentre observational cohort study. Four primary care centres (ASSIRs) and two tertiary hospitals in Barcelona and its metropolitan area. Pregnant women attending first-trimester antenatal visits between October 2022 and September 2024. All participants underwent CMV IgG and IgM serological testing at the first antenatal visit. Women with positive IgM and low or intermediate IgG avidity were diagnosed with primary CMV infection and managed according to local protocols, including treatment with valaciclovir and fetal follow-up. CMV screening acceptance rate, seroprevalence, rate of primary infection, fetal infection, and neonatal outcomes up to one year of age. Of 3 677 pregnant women recruited, 3 357 were included in the final analysis. CMV screening acceptance was high. Seroprevalence was 77.7% (95% CI 76.2%-79.1%), and 743 women (22.1%, 95% CI 20.7%-23.6%) were seronegative. Five cases (0.15%, 95% CI 0.05%-0.37%) of primary CMV infection were identified and treated. No fetal infections were detected by amniocentesis. One newborn tested positive for CMV but remained asymptomatic at birth and at 6 months. Women who were seronegative were generally older, of European origin, and had higher education and employment rates. Universal first-trimester CMV screening is feasible and well accepted in a public healthcare setting. While the rate of primary infection was low, early identification of seronegative women offers opportunities for preventive counselling and targeted follow-up.

22. Genomic comparisons shed light on the adaptive basis of brain size plasticity and chromosomal instability in the Eurasian common shrew.

期刊: Molecular biology and evolution 发表日期: 2026-Jan-09 链接: PubMed

摘要

Sorex araneus, the Eurasian common shrew, has seasonal brain size plasticity (Dehnel’s phenomenon) and abundant intraspecific chromosomal rearrangements. Genomic contributions to these traits, however, remain unknown. We couple a chromosome-scale genome assembly with seasonal brain transcriptomes to discover relationships between molecular changes and both traits. While positively selected genes enriched the Fanconi anemia DNA repair pathway (FANCI, FAAP100), which is likely involved in chromosomal rearrangements by preventing the accumulation of chromosomal aberrations, genes under positive selection or showing seasonal differential expression in the brain implicate neurogenesis (PCDHA6, SOX9, Notch signaling) and metabolic regulation (VEGFA, SPHK2) as key mechanisms underlying Dehnel’s phenomenon. We also find that both positively selected and differentially expressed genes in the hippocampus are overrepresented near Sor. araneus evolutionary breakpoints. This relates both positive selection and differential expression to accessible chromatin configuration, suggesting that chromosomal rearrangements are integral to adaptive evolution and the regulation of brain size plasticity.

23. Photocatalytic performance of Co-MOF-derived Co3O4 nanoparticles for degradation of herbal cigarette detritus and industrial dyes in wastewater.

期刊: Journal of environmental science and health. Part. B, Pesticides, food contaminants, and agricultural wastes 发表日期: 2026-Jan-09 链接: PubMed

摘要

In the present work, Co3O4 nanoparticles (Co3O4 NPs) were prepared by calcination of a hydrothermally synthesized Co-MOF precursor. The X-ray diffraction (XRD) analysis results confirmed the formation of Co3O4 NPs with well-defined cubic spinel oxide (Fd-3m phase) with an average crystallite size of ∼22 nm, while Fourier transform-infrared (FTIR) spectra supported the presence of Co-O bonding through prominent vibrational modes at 562 and 663 cm-1. The SEM images demonstrated that the Co3O4 NPs possess porous flower-like morphology, and EDAX confirmed the existence of cobalt and oxygen atoms. The PL analysis reveals prominent defect-related emissions in Co3O4 nanoparticles, confirming abundant defect states that can enhance their photocatalytic activity. The vibrating sample magnetometry (VSM) analysis demonstrated antiferromagnetic behavior, which was consistent with nanoscale Co3O4 NPs. The prepared Co3O4 NPs displayed superior photocatalytic activity toward the degradation of emerging wastewater pollutants. The experimental results demonstrated that about 96% degradation of herbal cigarette detritus in 160 min, and almost complete degradation of industrial dyes, namely Janus Green B, Methyl Violet 2B, and Congo Red in 30, 60, and 40 min, respectively, under UV-light irradiation.

24. The impact of experience quality on revisit intention: The chain mediation effect of tourist satisfaction and place attachment.

期刊: Medicine 发表日期: 2026-Jan-09 链接: PubMed

摘要

Outdoor camping tourism, a nature-based leisure activity that promotes health, fosters social connections, and enhances environmental awareness, has experienced rapid growth in popularity. However, limited research has explored how tourists’ experience quality (EQ) shapes their behavioral intentions through psychological mechanisms. This study aimed to investigate the impact of EQ on revisit intention (RI) and to explore the mediating roles of tourist satisfaction (TS) and place attachment (PA) within the stimulus-organism-response theoretical framework. A structured questionnaire survey was conducted on a sample of 600 outdoor camping tourists in Guangdong Province, China. Partial least squares structural equation modeling was employed to test the hypothesized relationships and mediating effects. EQ significantly influenced RI (β = 0.236, P < .001) and indirectly affected RI through TS and PA. TS significantly enhanced PA (β = 0.473, P < .001), and the 2 variables jointly produced a chained mediating effect between EQ and RI (variance accounted for = 41.5%). Research confirms that high-quality experiences not only directly enhance tourists’ RIs but also cultivate satisfaction and PA, further enhancing loyalty to camping destinations. These findings enrich the application of stimulus-organism-response theory in tourism behavior studies, providing practical guidance for tourism managers to enhance EQ, strengthen emotional bonds, and promote the sustainable development of destinations.

25. Lifetime occupational physical demand and risk of hip fracture in older adults: A retrospective cohort study.

期刊: Medicine 发表日期: 2026-Jan-09 链接: PubMed

摘要

Hip fractures in the elderly, especially among the Chinese population, are among the most serious complications of osteoporosis. As age increases, the incidence of these fractures rises. In this study, we seek to identify a range of lifetime occupational physical-demand factors that may serve as potential indicators of hip-fracture risk in Chinese individuals aged 65 years and older. Our aim is to inform preventive strategies and occupational health policies by enhancing understanding of how long-term physical work demands contribute to fracture risk across the aging population. This study employed a retrospective cohort design and was conducted at the Affiliated Hospital of Yan’an University. We included patients who underwent surgical treatment for intertrochanteric fractures or femoral neck fractures between January 2017 and December 2021. The study followed the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines to enhance transparency and methodological reporting. A total of 434 patients were included in this study, comprising 95 with light, 297 with moderate, and 42 with heavy occupational physical demand. Unadjusted multivariate logistic analysis revealed that moderate occupational physical demand was associated with a decreased risk of hip fracture (OR = 3.57, 95% CI: 2.01-6.33, P <.0001; compared to heavy occupational physical demand). Adjusted multivariate logistic model Ⅰ showed that moderate occupational physical demand (OR = 3.35, 95% CI: 1.75-6.44. P = .0003; compared to heavy occupational physical demand) remained associated with hip fracture. Fully adjusted multivariate logistic model Ⅱ also showed that moderate occupational physical demand (OR = 2.83, 95% CI: 1.51-5.97, P = .0032; compared to heavy occupational physical demand) remained associated with hip fracture. Compared to heavy physical demand, moderate occupational physical demand might be associated with a higher risk of hip fracture among older adults.

26. Perioperative immunonutrition and outcomes in head and neck cancer surgery - a randomized clinical trial: Effects of perioperative immunonutrition in patients with head and neck cancer.

期刊: Medicine 发表日期: 2026-Jan-09 链接: PubMed

摘要

This study aimed to evaluate the impact of perioperative immunonutrition (IN) versus standard enteral nutrition (EN) on short-term postoperative outcomes in patients with head and neck cancer (HNC). A prospective randomized controlled trial was conducted with 34 HNC patients (17 in the intervention group and 17 in the control group). Five days before surgery, the intervention group received 3 sachets of IN (arginine, omega 3, nucleotide), whereas the control group received 3 boxes of a standard EN product. Postoperatively, both groups continued their respective nutritional regimens for 10 days from the (nasogastric) tube. Measurements included body composition, food consumption, nutritional risk score (NRS)-2002, quality of life, biochemical parameters, complications, antibiotic use, and length of hospital stay (LOS). There were no significant changes in anthropometric measurements or NRS-2002 scores. Albumin levels in both groups decreased on the 10th postoperative day compared with the preoperative period (P < .05). While the C-reactive protein levels of all patients increased on the 10th postoperative day (P = .002), they decreased on the 40th postoperative day (P = .045). There were no significant differences between the groups in terms of complications or LOS (P > .05). The functional scales and physical, occupational, and cognitive function scores of the intervention group were higher than those of the control group (P < .05) on postoperative 40th day. Perioperative IN support did not differ significantly from standard EN in terms of anthropometric measurements, biochemical findings, LOS, or complication rates. Nutritional counseling by a dietitian is essential for patients with HNC.

27. Aesthetic Rehabilitation of Patients with Central and Peripheral Facial Palsy with Injectables (BNT-A, HA-Fillers and CaHa).

期刊: Journal of clinical medicine 发表日期: 2026-Jan-05 链接: PubMed

摘要

Background: Facial palsy constitutes a profoundly disabling condition, often leading to marked functional deficits and a decline in facial appearance, which substantially reduces the patient’s quality of life. A combined therapy of botulinum toxin (BoNTA), hyaluronic acid (HA) and calcium hydroxylapatite (CaHA) appears promising in the pharmacological approach of these patients. Methods: We reported our single center experience of patients with facial palsy, either of central or peripheral etiology who were treated with the combination of BoNTA, HA and CaHA, during a 6-month period (January 2025-June 2025). Results: Eight consecutive adult patients [mean age: 49.50 ± 7.95 years, 6 (75%) female] with facial palsy, either of central (4 patients) or peripheral (4 patients) etiology, received the combination of BoNTA, HA and CaHA. No serious adverse reactions were documented. Localized bruising and swelling at injection sites resolved without requiring any additional intervention. Facial Disability Index (FDI) was assessed both prior to and following treatment. The functional subscale increased from 65.63 ± 16.13 to 80.63 ± 10.50 (improvement rate = 24.4%, p-value = 0.002), while the psychosocial subscale increased from 63.00 ± 17.34 to 74.50 ± 10.89 (improvement rate = 18.3%, p-value = 0.004). Consequently, the total FDI score improved from 128.63 ± 28.92 to 155.13 ± 17.96 (overall improvement = 20.6%, p-value = 0.001). Conclusions: The present case series underscores the potential therapeutic role of CaHA as an adjunct to BoNTA and HA injections in patients with central or peripheral facial palsy.

28. Oral Health-Related Quality of Life and Self-Reported Oral Health Status Are Associated with Change in Self-Reported Depression Status: A Cohort Study.

期刊: Journal of clinical medicine 发表日期: 2026-Jan-04 链接: PubMed

摘要

Background/Objectives: Oral health-related quality of life (OHRQoL) may influence mental health outcomes, yet longitudinal evidence on its association with depression remains limited. This study aimed to examine whether oral health status and OHRQoL are associated with a change in self-reported depression status among adults in Japan. Methods: We analyzed data from the Japan COVID-19 and Society Internet Survey (JACSIS), conducted in 2022 and 2023. A total of 15,068 participants aged ≥20 years without depression at baseline were included. Depression status was identified by self-reported measures between the two survey waves. Logistic regression models estimated odds ratios (ORs) and 95% confidence intervals (CIs) for change in self-reported depression status in relation to OHRQoL and oral health status, adjusting for sociodemographic and behavioral factors. Results: During follow-up, 218 participants (1.45%) reported a change in self-reported depression status. Poorer OHRQoL was significantly associated with a change in self-reported depression status (OR: 1.018; 95% CI: 1.001-1.036; p = 0.039). Additional risk factors included younger age (OR: 0.974; 95% CI: 0.964-0.985), participation in hobbies and cultural activities (OR: 2.224; 95% CI: 1.498-3.302), habitual use of sleeping pills or anxiolytics (current use OR: 3.512; 95% CI: 2.267-5.442), increased loneliness (OR: 1.217; 95% CI: 1.140-1.299), lower life satisfaction (OR: 0.900; 95% CI: 0.836-0.969), and poor self-rated health (OR: 2.921; 95% CI: 1.810-4.715). Conclusions: Impaired OHRQoL was associated with a change in self-reported depression status, potentially through psychosocial mechanisms. These findings suggest that oral health and OHRQoL may be relevant factors to consider in integrated oral and mental health approaches in clinical practice.

29. Corporate Profits and the Health of Americans.

期刊: Healthcare (Basel, Switzerland) 发表日期: 2026-Jan-04 链接: PubMed

摘要

A large and growing empirical literature documents that privatization, deregulation, financialization, and under-regulation of harmful industries are associated with adverse health outcomes in the United States. However, this evidence remains fragmented across sectors and rarely articulates a unifying causal framework. This paper advances the literature by integrating findings across health care, harmful-product industries, and economic and social policy to demonstrate that corporate profit maximization functions as a cross-cutting driver of health disparities and premature mortality in the United States. We synthesize evidence showing that profit-driven incentives shape insurance markets, hospital and physician practice ownership, pharmaceutical marketing, and the aggressive promotion of tobacco, alcohol, ultra-processed foods, opioids, firearms, and fossil fuels-together contributing to more than one million deaths annually. We further document how corporate influence over public policy has increased poverty, economic inequality, and discrimination, all of which are powerful social determinants of health. In contrast to sector-specific analyses, this paper presents a unified, systems-level account of how profit-first governance undermines population health. We conclude by describing how a social movement to achieve a single payer system that provides Medicare for All would not only vastly improve public health, it would be a catalyst for numerous other reforms that enhance the general wellbeing.

30. Cross-National Analysis of Consumer Preferences for Organic Food in Portugal, Spain, and Greece: Socio-Demographic Drivers and Attribute Importance.

期刊: Foods (Basel, Switzerland) 发表日期: 2026-Jan-03 链接: PubMed

摘要

Consumer demand for organic products has grown substantially in Southern Europe, driven by health, environmental, and ethical concerns. Understanding cross-country differences in attribute preferences and sociodemographic influences is critical to inform marketing strategies and policy interventions targeting organic food consumption. To perform a comparative study across Portugal, Spain, and Greece, regular organic consumers were surveyed (250 per country) using a culturally adapted Best-Worst Scaling questionnaire. Socio-demographic variables and ten organic food attributes were analysed using MANOVA, Kruskal-Wallis tests, PCA, and cluster analysis. Spanish and Portuguese consumers prioritised health, environmental impact, absence of GMOs, and certification, while Greeks emphasised price, appearance, taste expectation, and nutrition. Age, gender, and education influenced attribute importance differently across countries, revealing distinct national consumption patterns and preferences. Findings highlight substantial heterogeneity: health and environmental attributes dominate in Portugal and Spain, reflecting strong certification and sustainability awareness, whereas Greek consumers focus on value, sensory qualities, and nutrition, indicating lower organic uptake and stronger price sensitivity. Older and more educated consumers valued certification and provenance, women emphasised health and environmental benefits, and men responded more to convenience and status cues. These patterns suggest that marketing and policy strategies should combine universal motivators with tailored approaches addressing national, demographic, and cultural differences to enhance organic consumption. Cross-country differences reveal the need for context-specific interventions promoting organic food while leveraging common health and sustainability drivers.

31. Impact of the Eras Protocols on Costs and Benefits in Two Italian Second-Level Healthcare Centers According to the National Waiting List Management Plan (PNGLA).

期刊: Journal of clinical medicine 发表日期: 2026-Jan-02 链接: PubMed

摘要

Background/Objectives: To analyze the financial impact of the ERAS program in two major surgical procedures (colon resection for cancer and hip replacement) in two second-level healthcare centers. Methods: A cost-benefit analysis was carried out on four hypothetical scenarios, based on the rate of compliance with the ERAS program, focusing on the additional costs and the additional benefits deriving from the decrease in hospital stay caused by the application of the ERAS protocol, with particular regard to the interventions envisaged by the National Waiting List Management Plan (PNGLA). Results: In the most optimistic scenario, with a coefficient of application of ERAS of 100% and a number of 800 days of hospitalization gained per year, the revenue-cost ratio was equal to 2.92. In the least favorable scenario, with a coefficient of application of ERAS of 50% and a number of 400 days of hospitalization gained per year, the revenue-cost ratio was equal to 1.11. Conclusions: In all the scenarios, the revenue-cost ratio was higher than 1. Implementation of the ERAS program is feasible also in second-level centers with the costs for additional healthcare professionals. Application of the ERAS program leads to a more sustainable health policy with an improvement in the number of treated patients per year and an advantage in the waiting list.

32. Understanding Monkeypox Virus Evolution, Host-Pathogen Interactions, and Therapeutic Advances.

期刊: Reviews in medical virology 发表日期: 2026-Jan 链接: PubMed

摘要

The recent outbreak of the Monkeypox (Mpox) virus has raised significant concerns. First identified in 1958, Monkeypox virus (MPXV) belongs to the Orthopoxvirus genus, sharing similarities with the Smallpox virus. It is a zoonotic disease mainly harboured by rodents and transmitted through direct interaction with infected animals, respiratory droplets, contaminated materials, or body fluids and from mother to child during pregnancy. The MPXV has a brick-shaped lipoprotein envelope, usually containing conserved genes essential for viral replication and variable genes that influence pathogenicity. The virus exists in two genetic clades: West African (Clade II) with lower mortality (∼1%) and Central African (Clade I) with higher mortality (∼10%). The spread of Mpox was primarily limited to Congo Basin (West Africa), which eventually increased globally. In the year 2022, World Health Organisation (WHO) declared Mpox an ‘International Public Health Emergency Concern’, indicating vital need to develop robust strategies to combat Mpox. As per 2022 outbreak, 40% patients required medical treatment (antiviral, antibacterials, and pain killer), 1%-13% patients required hospitalisation and 0.1% cases ended in fatality. The contemporary pre- and post-prophylactic therapies, include non-replicating modified vaccinia Ankara vaccination, are not yet available in endemic countries in Africa. Moreover, since January 1, 2024, there have been 812 deaths reported linked to the clade Ib Mpox outbreak in Central Africa, mostly in the Democratic Republic of the Congo. This corresponds to a case-fatality rate of about 3% among the nearly 29,000 assumed cases by September 2024. Hence, this review outlines routes of Mpox transmission and early and chronic symptoms of infection. The mechanisms employed by the virus for immune evasion or immune suppression to promote viral survival inside the host are discussed in detail. The review illustrates Mpox therapeutics and medications, including anti-viral drugs that help to treat symptoms, prevent complications, and support recovery, particularly in the immunocompromised patients. In addition, we discuss recent advancements in the development of prophylactic vaccine for Mpox, including ACAM2000, LC16m8, JYNNEOS (MVA), and others. Future research directions include exploiting the conserved Mpox antigens to develop safer and more broadly protective vaccines. There is also an urgent need for international collaborations in surveillance, rapid response systems and comprehensive OMICS studies for understanding the viral evolution and mutations, which will greatly aid vaccine design and therapeutic strategies to combat Mpox.

33. Patients Suffering From Post-COVID-19 Syndrome Feature Enhanced Antibody Reactivity Towards Specific Linear Epitopes Within EBV EBNA1.

期刊: Scandinavian journal of immunology 发表日期: 2026-Jan 链接: PubMed

摘要

Post-COVID-19 syndrome (PCS; also known as post-acute sequelae of COVID-19, PASC and Long COVID) manifests with various clinical symptoms of unclear aetiology that persist or develop months after acute infection with SARS-CoV-2. Potential triggers for PCS include reactivation of latent viruses and autoimmune reactions. In our retrospective cross-sectional and explorative study we compared 48 PCS patients with 48 individuals that recovered fully from COVID-19 (convalescents, CC). We focused on characterising humoral immunity by recording IgG antibody reactivity patterns against Epstein-Barr virus (EBV) EBNA1 antigen using peptide microarray and ELISA methodology as well as determining the presence of autoantibodies. The overall binding landscape of IgG antibodies for the EBV EBNA1 protein was similar for the patients with sequelae versus the convalescents. However, the PCS patients displayed stronger reactivity for epitopes contained within the glycine-alanine repeat region of EBNA1, in particular residues 90-325, and within the central part, amino acids 393-420. Intriguingly, in the latter case, the EBNA1 peptide (residues 405-419) that discriminated the PCS and CC cohorts was localised in a different segment C-terminal from the sequence proposed to be mechanistically associated with multiple sclerosis. The screening for autoantibodies against nuclear/cytoplasmic antigens in HEp-2 cells and against CRYAB, cardiolipin, beta-2-glycoprotein I, IFN-alpha2, IFN-omega, and IL-15 antigens did neither reveal higher prevalence nor increased reactivity in the PCS patients compared to the convalescents. In conclusion, elevated antibody levels against linear peptides derived from residues 90-325 and 405-419 of EBV EBNA1 were the most distinctive characteristics in our cohort of post-COVID-19 syndrome patients.

34. Assessing Biological Mortality Bias From Deciduous Tooth Emergence.

期刊: American journal of biological anthropology 发表日期: 2026-Jan 链接: PubMed

摘要

Traits found in a skeletal sample are frequently used to infer qualities of the living population from which the skeletons were drawn. However, traits observed in a mortality sample may exhibit biological mortality bias in that they may not accurately represent the same traits in the living sample. The purpose of this research was to assess biological mortality bias in deciduous tooth emergence, a trait that is used to estimate chronological age in skeletal samples. Data on clinical tooth emergence were collected from longitudinal studies of Javanese, Guatemalan, and Bangladeshi children that included a living sample (those who survived through the study) and a mortality sample (those who died during the study). Parametric hazards analysis was used to test for differences in the timing of tooth emergence between the living and mortality samples. There were no significant differences between the living and mortality samples for Bangladesh and Java, although there was a trend toward delayed emergence in the Bangladesh mortality sample. The Guatemalan mortality sample exhibited advanced emergence of the posterior dentition for the mortality sample. No evidence of biological mortality bias was found in pooled analyses of the Bangladesh and Java samples or pooled analyses of all three samples. We found limited evidence that deciduous tooth emergence in a mortality sample (e.g., a skeletal series) would differ from the timing of emergence in the living population from which the mortality sample was drawn.

35. Proteomic Signatures Over Age Reveal Significant Changes From Infancy Till Late Adulthood.

期刊: Advanced biology 发表日期: 2026-Jan 链接: PubMed

摘要

Biomarkers are essential in drug development and diagnostics, aiding patient selection and disease monitoring. The lack of age-specific protein references complicates tracking patterns related to chronic disease or treatment. This exploratory, proof-of-concept study explores age-related changes in the serum proteome across the full human lifespan. Using proximity extension assays (Olink), we measured the Immuno-oncology panel in serum from 264 healthy individuals, another panel in a subgroup of 109, all without significant disease at blood draw, aged 0 days to 88 years. Cluster analysis of the Immuno-oncology panel revealed two clusters: cluster 1 included samples from children ≤11 days, cluster 2 encompassing samples with an age range from 2 months till 88 years old. Weighted correlation network analysis identified five protein modules, with four showing enrichment in specific pathways. The Organ-Damage panel showed similar age-related protein variations. Finally, we identified four protein patterns over age: constant, increasing, decreasing, or U-shaped and defined age-specific normal expression ranges. Altogether, our findings suggest that healthy aging across the entire lifespan involves alterations in protein expressions and distinct protein profiles exist in newborns, children, adults and older adults. We provide valuable reference data for the different protein patterns observed across the entire lifespan.

36. Characterisation of Antifungal Prophylaxis and Therapy Among Inpatients With Haematological Malignancies in Non-Research Clinical Setting: A Multicentre Italian Experience.

期刊: Mycoses 发表日期: 2026-Jan 链接: PubMed

摘要

Invasive fungal infections (IFI) are a prominent cause of morbidity and mortality among patients with haematological malignancies (HMs). Diagnostic work-up excluding IFI is mandatory in case of persistent fever while antifungal treatment (AFT) is started. We aimed to describe antifungal prophylaxis (AFP) and AFT among haematological patients with IFI managed in clinical practice, focusing on microbiological and radiological characteristics, 30-day outcome and therapeutic options after AFT failure. We enrolled 461 consecutive adult and paediatric patients with HMs, in which an intravenous AFT was started from September 2019 to December 2021. After serum galactomannan (GM) and chest CT scan, they were stratified as presenting with proven, probable, and possible IFI according to 2008 EORTC-MSG criteria. Fungal isolates were detected from culture tests in 17.5% and from biopsy in 1.5% of patients. Mould active and non-active AFP was used in 42.3% and 16.5% of cases, respectively. Use of AFP significantly impact on serum GM negativity (p < 0.001 for mould active and p = 0.04 for mould non active, respectively). Use of mould non-active prophylaxis significantly correlates with radiological imaging (typical p = 0.0037, IC (0.370-0.825) and negative -p = 0.0031, IC (0.241-0.750)). Toxicity, progression, and drug interaction were responsible for therapy change in 58 (12%) patients: 18 patients with proven/probable IFI needed multiple courses of AFT. At 30 days from starting AFT, overall mortality with IFI was 23/461 (5%). In this observational study, we recorded an impact of AFP on serum GM results and radiological imaging. Need of AFT should be carefully evaluated, as diagnostic work-up might be affected not only by specific disease risk but also by previous AFP.

37. Influenza Surveillance in the Central African Republic From 2015 to 2018 to Inform Vaccination and Treatment Strategies.

期刊: Influenza and other respiratory viruses 发表日期: 2026-Jan 链接: PubMed

摘要

Surveillance of influenza infections and virus characterisation are essential to guide prevention strategies. In the Central African Republic (CAR), data on influenza viruses are patchy and poorly documented. To study the clinical, seasonal, genetic and phenotypic characteristics of influenza viruses circulating in the CAR population. From January 2015 to December 2018, the presence of influenza A and B viruses in patients presenting with influenza-like illness (ILI) symptoms or severe acute respiratory infections (SARI) was investigated by RT-qPCR. Influenza genetic diversity was evaluated by phylogenetic analyses, and antigenic properties were investigated by haemagglutination inhibition assays, whereas reduced susceptibility to neuraminidase inhibitors was assessed through the presence of known genetic markers and neuraminidase assay. The relationship between patients’ clinical characteristics and infection status was investigated using statistical analyses. Over the surveillance period influenza viruses were detected in 9.7% of samples (n = 6134), with the highest intensity of circulation occurring in 2016 (15.8%), attributed mainly to A(H3N2). Periods of increased influenza transmission (June to October) generally coincided with rainy seasons; however, variations in terms of monthly distribution of cases between years were evident. Hospitalisation rates (SARI) were most frequent in infants (0-11 months, 37.9%) and young children (1-4 years, 24.8%), whereas influenza prevalences were highest in the 15-49 (12.0%) and ≥ 50 (15.2%) years old categories. A new A(H1N1)pdm09 6B.1 hemagglutinin subgroup characterised by amino acid substitutions S84N, S162N and I216T was detected in 2015, with associated antigenic drift, and subsequently, two of these viruses showed highly reduced inhibition by oseltamivir. This study showcases the value of local influenza sentinel networks to specifically inform vaccination strategies and highlights the need for improved strain characterisation in tropical regions.

38. Multifunctional Edible Amaranths: A Review of Nutritional Benefits, Anti-Nutritional Factors, and Potential in Sustainable Food Systems.

期刊: Foods (Basel, Switzerland) 发表日期: 2026-Jan-01 链接: PubMed

摘要

In recent decades, species within the genus Amaranthus L. (amaranth) have garnered growing global interest due to their exceptional nutritional value, functional properties, and agricultural versatility. Traditionally consumed as leafy vegetables or pseudo-cereals, several Amaranthus species are now receiving renewed attention in the context of the development of modern functional foods. This review evaluates the data on nutritional composition, health-promoting properties, and potential applications of Amaranthus spp. in sustainable food systems in peer-reviewed publications from the last 25 years. Amaranth is rich in high-quality proteins, essential amino acids, dietary fibre, vitamins, and minerals, positioning it as a significant factor in addressing malnutrition and enhancing food security. Furthermore, its bioactive compounds, such as flavonoids, phenolic acids, and peptides, exhibit antioxidant, anti-inflammatory, and hypocholesterolemic activities, suggesting its potential as a part of healthy diets, alleviating the risk of non-communicable diseases. The presence of anti-nutritional factors, including saponins, phytates, and oxalates, has also been explored, with implications for nutrient bioavailability and overall health effects. In addition to its nutritional advantages, Amaranthus spp. demonstrate strong adaptability to diverse climatic conditions, thus performing as a crop resilient under climate stress. Their olfactory and sensory attributes are also considered important for consumers’ acceptance and market integration. By synthesising traditional knowledge and contemporary scientific research, this review underscores the potential of Amaranthus spp. as a multifunctional food source that could support health promotion, climate resilience, and agricultural sustainability.

39. Advancing global dementia research through equity and inclusion.

期刊: Alzheimer’s & dementia : the journal of the Alzheimer’s Association 发表日期: 2026-Jan 链接: PubMed

摘要

Despite the global burden of dementia, research remains dominated by high-income, Western populations, limiting the generalizability and equity of findings. In this Perspective, we highlight the importance of diversity and inclusion in dementia research, not only in study participants but also in the researchers, study design, and funding priorities. We describe how the lack of representation creates knowledge gaps and delays progress in prevention, diagnosis, and treatment. We also present examples of initiatives that are working to change this, including the Alzheimer’s Disease Data Initiative and the William H. Gates Sr. Fellowship program, which supports open science, international collaboration, and early-career researchers from underrepresented regions. These efforts demonstrate that diversity is not only an ethical goal, but a scientific need. More inclusive and global research could lead to discoveries that are more generalizable, more globally applicable, and better able to inform strategies to address dementia across all communities. HIGHLIGHTS: Prioritize representation in datasets across ethnicity, geography, sex/gender, and socio-economic status. Support early-career researchers from underrepresented regions with long-term funding and mentorship. Standardize and adapt tools (cognitive, clinical, genomic) across cultural and linguistic contexts. Promote open science through equitable, federated data sharing platforms, and embed community engagement from research design to dissemination. Value diversity as a driver of discovery, not as a confounder.

40. Vaccination in the Age of Memes: An Exploration of Digital Health Communication.

期刊: Nursing inquiry 发表日期: 2026-Jan 链接: PubMed

摘要

This study explores how internet memes serve as digital communication tools in public health discourse, influencing public perceptions by spreading both accurate and misleading health information. Utilizing a dual qualitative approach, Qualitative Content Analysis (QCA) and Reflexive Thematic Analysis (RTA), this study examined 99 vaccine-related memes shared online during the 2019 and 2025 measles outbreaks and the 2020 COVID-19 pandemic. QCA analyzed rhetorical tones (pathos, ethos, and logos) and vaccine stances (pro, anti, and neutral), while RTA identified key themes. Memes were sampled from Google Images using broad vaccine-related search terms (e.g., “vaccine meme,” “vaccination meme”), allowing inclusion of memes related to a wide range of vaccine-preventable diseases rather than limiting the dataset to any single condition. While memes predominantly targeted emotional appeals (pathos), emergent themes include increased use of logical appeals (logos), political polarization, and anti-vaccine sentiments. Nurses and other public health communicators must counter misinformation and foster evidence-based dialogue to shape digital health literacy. Rhetorical patterns (e.g., humor, emotional resonance, and appeals to credibility) are communication strategies that transcend national boundaries. These findings, therefore, provide a foundation for understanding how similar dynamics might appear in other linguistic and cultural settings, while highlighting the need for ongoing research.

41. From Synaptic Plasticity and Critical Periods to Social Behavior and Stress: Getting to, and Staying in, CA2.

期刊: Hippocampus 发表日期: 2026-Jan 链接: PubMed

摘要

Hippocampal Area CA2, with some exceptions, had long been neglected in in vivo studies, due largely to its small size, and in in vitro studies because of its general similarity to CA3 and CA1. Increasing evidence showing that CA2 was molecularly distinct led to the increased appreciation of CA2 as a separate region, and as such, that it likely had functions that were dissimilar from its neighboring CA subfields that were worth studying. Indeed, it was the molecules that are enriched in CA2 that provided inspiration for many of the functional studies. In this article, I provide a personal account of how I got interested in CA2 and describe how I viewed our discoveries in the context of the others in the field. As it happened, much of my earlier work on synaptic plasticity in hippocampus and visual cortex had everything to do with why I felt compelled to ask the question, “are CA2 synapses resistant to long-term potentiation?.” In fact, we are a product of our training and our environment when we are considering research directions.

42. Global Incidence and Prevalence of Trigeminal Neuralgia, 1945-2024: A Systematic Review and Meta-Regression Analysis.

期刊: Journal of clinical neurology (Seoul, Korea) 发表日期: 2026-Jan 链接: PubMed

摘要

Although trigeminal neuralgia (TN) imposes a substantial burden on quality of life and mental health, epidemiological estimates of its incidence and prevalence remain limited. Thus, we aimed to comprehensively assess the epidemiological and clinical features of TN from 1945 to 2024. A comprehensive literature search was performed using PubMed/MEDLINE, Embase, CINAHL, and Google Scholar databases up to January 22, 2025, with search terms related to “trigeminal neuralgia.” TN was defined according to the International Classification of Headache Disorders (ICHD)-1, Rushton and Olafson criteria, and International Classification of Diseases (ICD) codes prior to 2004, which primarily relied on clinical features for diagnosis, whereas the ICHD-2, ICHD-3, Read codes, and ICD codes after 2004 were grouped together, as these criteria incorporated imaging modalities into the diagnostic process. A random-effects model was applied to calculate pooled estimates with 95% confidence intervals (CIs) for the incidence, prevalence and lifetime prevalence of TN. In addition, meta-regression models were also fitted using inverse-variance weighting. A total of 17 eligible studies, comprising over 170 million participants and 109,070 patients with TN, were included in the analysis. Global pooled incidence of TN was estimated at 25.33 cases per 100,000 person-years (95% CI, 11.87-54.02), while the global pooled annual prevalence was 45.38 cases per 100,000 inhabitants (15.41-133.61), and the global pooled lifetime prevalence was 108.43 cases per 100,000 inhabitants (30.54-384.18). Incidence and prevalence estimates tended to be higher in females than in males, more often right-sided, and more frequent in the maxillary and mandibular divisions than in the ophthalmic division; however, the certainty of these subgroup differences was low. Lastly, the incorporation of imaging modalities into diagnostic criteria may have contributed to the increased prevalence of TN. This study highlights substantial global variations in TN incidence and prevalence, with how the evolving diagnostic criteria affects the epidemiological features of TN.

43. The Oral Microbiome in Amyotrophic Lateral Sclerosis Shows Differentially Abundant Organisms in Limb Versus Bulbar Onset Disease: A Binational Study.

期刊: Journal of clinical neurology (Seoul, Korea) 发表日期: 2026-Jan 链接: PubMed

摘要

Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease of upper and lower motor neurons leading to progressive disability and death. Approximately 10% of cases are caused by single-gene disorders with the remaining 90% of cases presumed to be caused by a combination of environmental and genetic factors. The microbiome (the ensemble of microorganisms that colonize body surfaces and organs) was recently identified for its importance in the pathogenesis of ALS. In this study, we recruited 100 participants from two ethnically and geographically distinct sites (71 from Calgary, Canada, and 29 from Seoul, Republic of Korea) which included 59 ALS participants and 41 controls. All participants provided saliva samples for oral microbial analysis using 16S rRNA sequencing. Basic demographic information was collected from all participants, and ALS participants provided additional clinical information including site of disease onset, disease duration, and ALS Functional Rating Scale - Revised score. Significant differences in beta diversity of the oral microbiomes were seen between limb- and bulbar-onset ALS participants. Two bacterial genera were differentially abundant between these groups, Bifidobacteriaceae Bifidobacterium was enriched in bulbar-onset cases, while Pasteurellaceae Haemophilus was enriched in limb-onset cases. No significant differences were found between ALS participants and controls, but there were significant differences when comparing participants from different sites of recruitment. Amongst household pairs (n=35 pairs), ALS participants differed from control participants at the Seoul site. Despite the cohort and household effects, our study identified differentially abundant organisms that may be important to the phenotypic variability of ALS and should be considered for future study. Our study provides novel insights into design for future multi-site microbiome research in ALS.

44. Mixed Infectious-Immune Pneumonitis Associated with PD-L1 Blockade: A Case of Durvalumab-Induced Lung Injury Complicated by Human Metapneumovirus Infection.

期刊: Journal of clinical medicine 发表日期: 2025-Dec-29 链接: PubMed

摘要

Background: Durvalumab, a PD-L1 inhibitor used as consolidation therapy after chemoradiation in unresectable stage III non-small cell lung cancer (NSCLC), can induce immune-related adverse events, among which immune-mediated pneumonitis represents one of the most severe. Differentiating checkpoint inhibitor pneumonitis (CIP) from infectious pneumonia is challenging due to overlapping clinical and radiologic findings. Case presentation: We describe a 67-year-old woman with stage III lung adenocarcinoma treated with chemotherapy, radiotherapy, and durvalumab, who presented with progressive dyspnea and extensive bilateral ground-glass opacities on CT imaging. Laboratory tests revealed leukopenia and elevated inflammatory markers. Despite broad-spectrum antibiotic and antiviral therapy, her condition worsened, requiring high-flow nasal cannula oxygen therapy. Multiplex molecular testing on sputum identified human metapneumovirus (HMPV), while blood cultures and urinary antigens for Streptococcus pneumoniae and Legionella pneumophila were negative. A pulmonology consultation raised suspicion for severe durvalumab-induced pneumonitis exacerbated by viral infection. High-dose methylprednisolone (2 mg/kg/day) followed by a four-week taper led to gradual clinical and radiologic resolution. Durvalumab was permanently discontinued. Discussion: To our knowledge, this is the first reported case of HMPV-associated pneumonitis in a patient receiving durvalumab. This case highlights the potential synergistic interplay between viral infection and immune checkpoint blockade, resulting in severe lung injury. Comprehensive microbiologic evaluation, including molecular diagnostics, is essential to guide therapy and distinguish infectious from immune-mediated causes. Conclusions: Early recognition of mixed infectious and immune-mediated pneumonitis, and timely corticosteroid therapy are critical to achieving favorable outcomes and preventing irreversible pulmonary damage.

45. Economic Evaluation of Direct Oral Anticoagulants Versus Low-Molecular Weight Heparin for Cancer-Associated Thrombosis in a Thai University-Affiliated Hospital.

期刊: Journal of clinical medicine 发表日期: 2025-Dec-27 链接: PubMed

摘要

Background/Objectives: Venous thromboembolism (VTE) is an important global health concern associated with considerable morbidity and mortality. Despite established guidelines for VTE treatment, there is a gap between clinical recommendations and their implementation in practice because of limited accessibility, particularly in low- and middle-income countries and among patients with cancer. This study aimed to assess the cost-effectiveness of direct oral anticoagulants (DOACs) on VTE in patients with cancer at a Thai university-affiliated hospital. Methods: A cost-utility analysis using a Markov model was developed to estimate costs and quality-adjusted life-years (QALYs) of DOACs and low-molecular weight heparin (LWMH) in Thai patients with cancer aged over 60 years. The model with eight health states, including CAT on treatment, pulmonary embolism (PE), deep vein thrombosis (DVT), clinically relevant nonmajor bleeding (CRNMB), non-intracranial hemorrhage major bleeding (non-ICH MB), intracranial hemorrhage (ICH), off treatment, and any death, was developed with a one-month cycle length and used to estimate costs and health outcomes from a societal perspective with a lifetime horizon. The efficacy and safety of DOACs compared to LMWH were obtained from a network meta-analysis, while the costs were based on a Thai university hospital database. All costs and outcomes were discounted at 3%, and the Thai societal willingness-to-pay (WTP) threshold (THB 160,000 per QALY gained) was applied. The incremental cost-effectiveness ratio (ICER) was calculated to compare costs and QALYs of the interventions. Results: The total lifetime cost of LMWH was THB 70,928 (USD 2,163), while for apixaban, dabigatran, edoxaban, and rivaroxaban, the costs were THB 26,323 (USD 803), THB 33,667 (USD 1,027), THB 29,570 (USD 902), and THB 22,310 (USD 680), respectively. The QALYs for LMWH, apixaban, dabigatran, edoxaban, and rivaroxaban were 0.771, 0.775, 0.746, 0.759, and 0.770 QALYs, respectively. Compared to LMWH, apixaban provided 0.004 additional QALYs, with a decreased cost of THB 44,605 (USD 1,360), resulting in reduced expenses. On the other hand, dabigatran, edoxaban, and rivaroxaban were also associated with lower lifetime costs but reduced life-years and QALYs when compared with LMWH. Conclusions: This study revealed that apixaban is likely to be the preferred option for treating patients with CAT. However, policy decision-making process should take into account the uncertainties related to the implementation of this practice.

46. Lanadelumab in Hereditary Angioedema: Real-World Outcomes and Implications for Access Practices in Europe.

期刊: Journal of clinical medicine 发表日期: 2025-Dec-26 链接: PubMed

摘要

Background/Objectives: Lanadelumab is approved in the EU for long-term HAE prevention in patients aged ≥2 years. While trials show high efficacy, real-world data on reimbursement and outcomes are limited. This study presents real-world clinical results in Poland and compares reimbursement criteria across European countries, assessing how effectiveness influences access restrictions. Methods: This retrospective analysis examined patients in the Polish drug program for lanadelumab. It collected demographics, disease features, attack frequency, and rescue medication use before and after at least six months of treatment. Additionally, a review of European reimbursement policies was conducted using health technology assessments, policy documents, and literature. Results: The data of 72 patients with HAE with C1 inhibitor deficiency were analyzed. The median follow-up was 20.0 months (IQR 15.0-25.0). The median baseline attack frequency was 15 over 6 months. After 6 months of lanadelumab, attacks dropped to 0 (IQR 0.0-0.0; p < 0.001), with 77.8% achieving >90% reduction. Most remained attack-free beyond 6 months; on-demand medication use decreased from 16 to 0 doses (p < 0.001). Outcomes persisted beyond 6 months. No demographic or baseline variables predicted response. No discontinuations due to adverse events. Reimbursement criteria across Europe vary, from broad access to restrictions based on attack frequency or treatment response, with differences in care settings. Conclusions: Data from Poland confirm lanadelumab nearly eliminates severe HAE attacks in practice, regardless of attack frequency. Some European reimbursement models may exclude patients who could benefit. Using real-world effectiveness evidence in policies could improve access and outcomes for HAE patients.

47. One Health Approaches to Ethical, Secure, and Sustainable Food Systems and Ecosystems: Plant-Based Diets and Livestock in the African Context.

期刊: Foods (Basel, Switzerland) 发表日期: 2025-Dec-26 链接: PubMed

摘要

The contribution of members of the agri-food system to achieving the Sustainable Development Goals is a key element in the global transition to sustainable development. The use of sustainable management systems supports the development of an integrated approach with a spirit of continuous improvement. Such organization is based on risk-management tools that are applied to multiple stakeholders, e.g., those responsible for product quality, occupational health and safety, and environmental impact, thus enabling better global performance. In this review, the term “ethical food systems” is used in our discussion of the concrete methods that can be used to endorse fairness and concern across the food chain. This comprises safeguarding equitable access to nutritious foods, defending animal welfare, assisting ecologically accountable production, and addressing social and labor justice within supply chains. Ethical factors also include transparency, cultural respect, and intergenerational responsibility. Consequently, the objective of this review is to address how these ethical values can be implemented within a One Health framework, predominantly by assimilating plant-based diets, developing governance tools, and resolving nutritional insecurity. Within the One Health framework, decoding ethical principles into practice necessitates a set of concrete interventions: (i) raising awareness of animal rights; (ii) distributing nutritional and environmental knowledge; (iii) endorsing plant-based food research, commercialization, and consumption; (iv) development of social inclusion and positive recognition of vegan/vegetarian identity. At the same time, it should be noted that this perspective represents only one side of the coin, as many populations continue to consume meat and rely on animal proteins for their nutritional value; thus, the role and benefits of meat and other animal-derived foods must also be recognized and discussed. This operational definition provides a foundation for asking how ethical perspectives can be applied. A case study from Africa shows the implementation of a sustainable and healthy future through the One Health approach.

48. The Prevalence of Microorganisms on Vegetables and Fruit from Wet Markets in Chiang Mai Province, Northern Thailand.

期刊: Foods (Basel, Switzerland) 发表日期: 2025-Dec-26 链接: PubMed

摘要

Foodborne diseases remain a public health issue worldwide. Inadequate attention to food safety and hygiene increases the risk of opportunistic pathogens and resistant bacteria spreading to people through the food chain, leading to foodborne diseases. To investigate food safety in our region, this study aims to measure the prevalence of microorganisms on raw food materials randomly purchased from wet markets in Chiang Mai province, Northern Thailand. In this study, microbial cultures, identified by MALDITOF-MS techniques, were used to determine the microflora and antibiotic-resistance organisms on raw vegetables and fruit. Consequently, to confirm antibiotic resistance, the antimicrobial susceptibility techniques were performed. The results found no Salmonella enterica was detected on the overall food samples. For Proteus spp. detection, P. mirabilis were detected at 3.23% in cabbage, 3.57% in Chinese cabbage, and 6.67% in lettuce, while P. vulgaris were detected at 7.14% in Chinese cabbage and 3.57% in peppermint. No Proteus spp. was detected in basils, tomatoes and grapes. In addition, for antibiotic-resistance detection, only ESBL-producing Klebsiella oxytoca was detected in the raw tomato sample (3.57%). According to the study’s findings, people who participate in the food process should be aware of their food safety and hygiene.

49. Predictors of PTSD Symptom Reduction in a Secondary Analysis of a Randomized Controlled Clinical Trial.

期刊: Journal of clinical medicine 发表日期: 2025-Dec-23 链接: PubMed

摘要

Objective: In a secondary analysis of a randomized, sham-controlled trial, we prospectively investigated baseline comorbidities, demographics, and intervention as predictors of clinically meaningful (≥15-point) CAPS-5 reduction in PTSD symptom reduction. Methods: This four-year (2018-2022), two-arm, parallel-group, prospective randomized placebo controlled clinical trial was conducted at the Long Beach VA Healthcare System among 71 treatment-seeking 18-55-year-old Veterans with chronic combat-related PTSD. Hierarchical and backward multivariable logistic regression models were conducted to compare the predictive capabilities of discriminating between 15-point reduction or more in CAPS-5 at follow-up. Results: Hierarchical multivariable logistic modeling found demographic variables alone provided a nearly acceptable prediction of 15-point reduction (c-statistic = 0.69) while clinical assessments alone provided an acceptable prediction (c-statistic = 0.75). Together, the baseline demographic and clinical variables indicated strong prediction (c-statistic = 0.92) and the addition of the group intervention variable increased the prediction (c-statistic = 0.94). In a backwards stepwise regression retaining variables with an alpha = 0.10 significance, females (adjusted odds ratio (AOR) = 14.7), and those receiving acupuncture (AOR = 4.17), indicating better physical health (AOR = 1.14) and less pain (AOR = 0.95), were statistically more likely to result in a 15-point CAPS-5 reduction at follow-up after controlling for other variables in the model. Conclusions: In this small sample, demographic and baseline clinical variables were independently predictive of symptom reduction and, together with the acupuncture intervention, presented a near perfect prediction of PTSD symptom reduction, though further validation is warranted. Patient characteristics that may indicate a more favorable response for PTSD symptom reduction include less baseline pain, better physical functioning, females, increasing age, and sociodemographic variables including higher income and not employed.

50. Multimorbidity in Focus: Emerging Patterns, Medication Appropriateness and Clinical Innovation.

期刊: Journal of clinical medicine 发表日期: 2025-Dec-23 链接: PubMed

摘要

Chronic conditions and multimorbidity are significantly altering the landscape of modern clinical care […].

51. "Demanding, but Worth It": The Parental Experience of Home-Based Vojta Therapy for Children Presenting Global Developmental Delay-A Qualitative Study Using Photo-Elicitation.

期刊: Journal of clinical medicine 发表日期: 2025-Dec-21 链接: PubMed

摘要

Background/Objectives: Introducing a demanding home-based program (HBP) of Vojta therapy (VT) into their daily activities is a life-altering event for parents of children with global developmental delay (GDD). This study aims to document the experiences of parents of children with GDD administering a HBP of VT. Methods: A multicentre study with a qualitative case design based on an interpretative approach is presented. Interviews were conducted with 10 parents using photo-elicitation (PE). Inductive and thematic analyses were used. Results: Four common experiential themes were identified. Firstly, crying was identified as the most significant barrier to administering therapy (despite parents accepting that crying was not pain-related). Secondly, parents described the intense and variable emotional impact of being responsible for the therapy and its effects on their child. Thirdly, parents unanimously felt that their involvement was worthwhile, with the developmental results they perceived outweighing the emotional, physical and time demands of administering the VT. Finally, parents developed a narrative of hope stemming from the therapy and its observed effects. Conclusions: The physical, emotional and time demands on parents when administering a HBP of VT are very significant. The main barriers to adherence to the program are identified as the child’s crying during therapy and time management. Intense emotional experiences, both positive and negative, arise while administering a HBP of VT. Parents are not only able to overcome all emotional and logistical challenges when they recognize improvements in their child, but they also begin to hope for further improvement. Implications for the professional design of HBPs of VT include the following: advanced warning that crying is normal, part of the therapy and not pain-related; training and ongoing support from a qualified therapist; training in recognising developmental improvement; and psychological support to deal with the emotional journey.

52. The Impact of Public Health Interventions on the Frequency and Duration of Hospitalisations Among Seniors in Poland-An Analysis Covering the Years 2017-2018.

期刊: Journal of clinical medicine 发表日期: 2025-Dec-20 链接: PubMed

摘要

Background/Objectives: Public health programmes for older adults aim to reduce hospital admissions and improve health outcomes. However, the effects of these programmes on the length of hospital stays for seniors remain unclear. This study aimed to examine the link between the number and type of public health initiatives implemented between 2017 and 2018, and the number of hospitalisations, as well as the duration of hospital stays in 2019 and 2020, among seniors with heart, digestive, and musculoskeletal diseases. Methods: A correlation analysis was conducted to explore the relationship between the number of public health programmes and activities, and the number and length of hospitalisations among older adults. Statistical significance was set at p < 0.05 and p < 0.01. Results: The analysis revealed positive correlations between the number of completed public health tasks and the length of hospital stay across the three disease groups. For heart disease, hospital stay length was correlated with the total number of programmes (r = 0.501, p < 0.05) and those specifically supporting medical services (r = 0.574, p < 0.05). In cases of digestive diseases, correlations were observed with the overall number of programmes (r = 0.623, p < 0.01), as well as programmes in the “general” category and ones supporting medical services (r = 0.544-0.601, p < 0.05). Regarding musculoskeletal diseases, the strongest correlation occurred with programmes that support medical services (r = 0.700, p < 0.01). Conclusions: Our results indicate that increased public health interventions may be associated with longer hospital stays among seniors, likely reflecting the emergence of more complex health needs and increased diagnostic intensity. At the same time, analysis based on ecological data does not allow for the establishment of causal relationships, emphasizing the need for further, more advanced research that controls for confounding factors.

53. Association Between Lipid-Lowering Therapy and Differences in the Distribution of LDL-C, apoB and non-HDL-C.

期刊: Journal of clinical medicine 发表日期: 2025-Dec-20 链接: PubMed

摘要

Background: The diagnosis of hypercholesterolemia relies on the laboratory assessment of lipid parameters. This study aimed to evaluate differences in the distribution of low-density lipoprotein cholesterol (LDL-C), non-high-density lipoprotein cholesterol (non-HDL-C), and apolipoprotein B (apoB) concentrations according to the presence and type of lipid-lowering therapy (LLT). Methods: This retrospective analysis included consecutive patients who had at least one measurement of LDL-C, apoB, and non-HDL-C between March and November 2024 in a high-volume tertiary hospital. All lipid fractions were expressed as the percentages of measurements above or below cut-off values established by the recent ESC guidelines. Subgroup analysis based on LLT type was performed, with patients categorized as receiving either single or combined LLT. Results: A total of 5048 patients were included in the analysis. Among patients receiving LLT, most were on statin monotherapy (77.3%), predominantly atorvastatin. Combined therapy, primarily statin plus ezetimibe, was used in 22.7% of treated patients. Discordance between on-target apoB levels and elevated LDL-C concentrations occurred in 26.6% of untreated and 13.6% of all treated patients, and in 15.1% and 8.6% of single and combined-LLT patients, respectively. Similarly, discordance between on-target non-HDL-C and elevated LDL-C levels was observed in 13.5% of untreated and 7.5% of all treated patients, and in 8.4% and 4.8% of single and combined-LLT patients, respectively. Conclusions: Classification of hyperlipidemia based on LDL-C, non-HDL-C, and apoB concentrations reveals significant discrepancies between these markers, especially between LDL-C and apoB. LLT reduces these discrepancies with combined LLT being particularly effective.

54. Biomarkers.

期刊: Alzheimer’s & dementia : the journal of the Alzheimer’s Association 发表日期: 2025-Dec 链接: PubMed

摘要

Aging is associated with a decline in specific cognitive abilities and increased variability of dynamic functional connectivity (v-dFC; Jauny et al., 2022), across the whole brain (Yang et al., 2023) and in the default network (Douw et al., 2016; Madhyastha & Grabowski, 2014). We investigated the extent to which age-related changes in v-dFC would be mitigated by an intervention to enhance physical activity in older adults at risk for Alzheimer’s disease (AD) and whether the changes in v-dFC were related to cognitive improvements. 50 participants from the PREVENT-AD longitudinal cohort (Tremblay-Mercier et al., 2021) with a family history of AD were assigned to the intervention (N = 21; Mage=69.8 years) or the active control group (N = 29; Mage=70.3 years) for a four-week randomized controlled trial. Multi-echo gradient-echo EPI sequence was used to acquire resting-state functional MRI data at baseline and post-intervention. Using Schaefer’s 200 parcellation across Yeo’s 17 networks, the dFC matrices were constructed with the Multiplication of Temporal Derivatives method (Shine et al., 2015; 10 TR overlapping windows). Modularity, system segregation (Chan et al., 2014), within-network and between-network FC of the DefaultA/B/C and ControlA/B/C networks were calculated for each dFC matrix. V-dFC was defined as the standard deviation of these measures. Group by time interactions effects on v-dFC were estimated after controlling for age, education, sex, motion and APOE4 carriership status. Change scores in v-dFC measures were correlated with changes in cognitive performance on digit span and digit symbol matching tasks. The intervention group showed decreased modularity and maintained system segregation within-DefaultC, between DefaultC-ControlC v-dFC, compared to the control group who showed increased v-dFC (Figure 1) after the intervention period relative to baseline. The baseline to post-intervention decrease in v-dFC of modularity was related to concurrent improvement in digit symbol matching task performance (Figure 2). An intervention to enhance physical activity mitigated age-related increases in v-dFC network segregation and connectivity of the DefaultC subnetwork. DefaultC corresponds to the medial temporal lobe subsystem (Andrews-Hanna et al., 2010), including the parahippocampal, retrosplenial and inferior parietal regions, which are highly vulnerable to AD pathology (Buckner et al., 2005).

55. 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) is marked by neuroinflammation and immune system changes, yet the role of peripheral immune cells remains unclear. Immune function varies by ancestry, influencing disease progression and treatment responses. This study applies high-resolution immune cell deconvolution of whole blood RNA-seq data from a multi-ancestry cohort to characterize AD-associated immune alterations and ancestry-specific differences. Whole blood RNA-seq data were generated from non-Hispanic White (NHW), African-American (AA), and Hispanic participants, balanced between AD cases and controls. Immune cell proportions were estimated using CIBERSORTx Hi-Res. The propeller R package tested for immune cell differences between AD cases and controls using a main-effects model adjusted for age, sex, and ancestry. An interaction model assessed ancestry-specific immune alterations. The main-effects model revealed peripheral immune dysregulation in AD, characterized by increased pro-inflammatory cells and weakened adaptive immunity. AD cases had elevated classical monocytes, cytotoxic monocytes, activated mast cells, M0 macrophages, and neutrophils, along with reductions in non-classical monocytes, naïve B cells, memory CD8 T cells, resting mast cells, and plasma cells. The interaction model revealed ancestry-specific immune alterations. NHW AD cases showed reduced naïve B cells and helper CD4 T cells, with increased cytotoxic monocytes, indicating a pro-inflammatory shift. Hispanic AD cases exhibited the strongest inflammatory response, with heightened classical monocytes and naïve CD4 T cells but reduced memory CD8 T cells and regulatory CD4 T cells, suggesting excessive innate immune activation and impaired regulation. AA AD cases displayed significant depletion of naïve B cells and an increase in M0 macrophages, indicating adaptive immune deficiencies. Classical monocyte increases were most pronounced in Hispanic AD cases, while regulatory CD4 T cell reductions were more severe in this group than in NHW or AA cases. This study reveals ancestry-specific immune dysregulation in AD, emphasizing the role of monocytes and mast cells in disease pathology. The identification of HRH4-expressing mast cells suggests potential novel inflammatory pathways in AD. These findings highlight varying immune system responses to AD, which may point to different underlying disease processes.

56. 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) neuropathology involves the extracellular formation of senile β-amyloid (βA) plaques and intraneuronal tau phosphorylation, leading to neurofibrillary tangles. βA burden can be detected using biomarkers from cerebrospinal fluid or positron emission tomography (PET) quantification using [18F]Florbetaben (FBB) or [11C]PiB. βA PET quantification can use standard uptake values (SUVR) or the Centiloid (CL) values, which are anchored from 0 to 100, classifying individuals with low βA burden (<20 CL), intermediate (>20 CL and <50 CL) and high (>50 CL). This study aims to analyze the distribution of CL values in FBB PET images acquired in individuals under cognitive decline investigation. A standard processing pipeline was validated using the PMOD PNEURO tool with the GAAIN dataset. After validation, we retrospectively evaluated 266 FBB PET images from individuals under cognitive decline investigation on a GE Discovery D600 PET/CT. Images were reconstructed using iterative VuePointHD, with attenuation, scatter, and random corrections. T1-weighted magnetic resonance (MR) images were acquired on a 3T GE Signa HDxT with 3DBRAVO® sequence. MR and FBB PET images were co-registered and normalized to the MNI space. The CL atlas was used to quantify the global cortical and whole cerebellar regions, categorizing the population βA burden groups. Individuals were also binary classified as βA positive (SUVR > 1.42, CL > 64) or negative. 33.4% of participants were classified as having a low βA burden, 15.8% as intermediate, and 50.8% as high. Demographics are presented in Table 1 and Figure 1. Figure 2 shows the groups using the CL-based βA deposition. The binary classification resulted in 40% false negatives in individuals with intermediate and high βA deposition identified by their CL values. The CL scale provides a precise and reliable method for quantifying βA deposition. It is an objective measure that supports visual assessment and minimizes false-negative or false-positive binary classifications. Reporting βA PET results with the CL scale enables normalization across different radiotracers, thereby increasing its usefulness in evaluating disease progression and treatment response. Further investigation is underway to compare the cohort’s CL values with visual readings and their correlation with neuropsychological and other laboratory testing.

57. Biomarkers.

期刊: Alzheimer’s & dementia : the journal of the Alzheimer’s Association 发表日期: 2025-Dec 链接: PubMed

摘要

Apolipoprotein E (APOE) and ethnicity were proved to have strong effect on Alzheimer’s disease. However, study on APOE effect on amyloid-PET in East Asians was limited. Here, we assess the effects of APOE and race/ethnicity interaction effects on amyloid-positivity and amyloid-PET among East Asian and Not Hispanic and Latino White people. Linear regression model was used to estimate the APOE and APOE/ethnicity interaction on amyloid-PET among East Asians (N = 1529) and Not Hispanic and Latino White (ADNI, N = 1259). Logistic generalized estimating equations were used to estimate the APOE/ethnicity interaction effect on frequency of amyloid-positivity (using cohort-specific visual check). For estimation of APOE and APOE/ethnicity effect, the APOE ε3/ε3 was used as reference group. Both models were adjusted for age, sex and years of education. APOE ε4 alleles were ascociated with higher risk amyloid deposition compared with ε3/ε3 group (ε2/ε4: β=37.68, p <0.001, ε3/ε4: β=20.96, p <0.001, ε4/ε4: β=36.27, p <0.001) among East Asians. However, ε2 alleles showed no protective effect on amyloid deposition in East Asians. For APOE/ethnicity interaction effect (Figure 2), ε4 alleles in East Asians were associated with less amyloid deposition and amyloid positivity risk than Not Hispanic and Latino White population. In contrast, ε2 alleles were associated with higher risk of amyloid deposition and positivity in East Asians than Not Hispanic and Latino White people. Moreover, APOE ε2/ε4 showed similar effect between East Asians and White people on amyloid deposition and positivity. Through recent advances in AD-related genetic cohorts, this study provided the largest-to-date overview of the association of APOE with amyloid-PET risk in East Asians. APOE ε4 alleles were associated with less amyloid deposition risk and APOE ε2 alleles were associated with higher risk than White people. These novel insights are critical to guide AD clinical trial design and research.

58. Biomarkers.

期刊: Alzheimer’s & dementia : the journal of the Alzheimer’s Association 发表日期: 2025-Dec 链接: PubMed

摘要

Mitochondrial dysfunction in Alzheimer’s Disease (AD) is characterized by impaired energy production, oxidative stress, and disrupted calcium homeostasis, which collectively contribute to neuronal damage, synaptic dysfunction, and the progression of AD pathology. A significant knowledge gap in studying mitochondrial dysfunction in Alzheimer’s Disease (AD) lies in understanding the precise molecular mechanisms linking mitochondrial metabolic alterations to neuronal damage, particularly how sex-specific and cell-type-specific mitochondrial processes contribute to the progression of AD pathology. This study integrates multiple datasets, post-mortem brain RNAseq from ROSMAP, Mayo Clinic brain bank and Mount Sinai Brain Bank cohort data available via AD Knowledge Portal hosted by Sage Bionetworks), Human Protein Atlas (HPA), MitoCarta3, genome-scale human metabolic reconstruction, mitochondriome analysis, and brain & blood metabolomics data (data generated by the Alzheimer’s Disease Metabolomics Consortium (ADMC)) to identify mitochondrial genes associated with disrupted metabolism in AD. Additionally, biodomain analysis was used to identify key processes associated with pathology. A total of 62 common genes were identified across these approaches, highlighting their potential significance in mitochondrial processes. We also developed the framework to perform metabolite-gene correlation analyses revealing key mitochondrial-metabolic interactions (eg. homocysteine and MTHFR gene; acetyl-CoA and PDHA1 gene). Integrated in silico metabolic analysis identified reaction fluxes, uncovering sex-specific differences in mitochondrial transport and tricarboxylic acid (TCA) cycle subsystems, with notable alterations in females. Biodomain enrichment analysis focused on mitochondrial processes, identifying disruptions in pathways critical for energy production and redox homeostasis. Additionally, we analyzed datasets related to metformin and complex I inhibitors, linking mitochondrial complex I modulation with metabolic alterations in AD. This analysis identified druggable targets and potential therapeutic candidates for mitochondrial metabolic pathways. Our findings integrate multiple data sources to provide a systems-level understanding of mitochondrial metabolism in AD. Sex-specific differences associated with mitochondrial dysfunction in AD were identified. We identify important mitochondrial transport proteins and metabolites that could potentially be used as druggable targets in AD.

59. Return to work with fatigue after stroke: A complex occupational adaptation process.

期刊: Scandinavian journal of occupational therapy 发表日期: 2025-Jan 链接: PubMed

摘要

Return to work after stroke is a key goal in rehabilitation for people of working age. However, post-stroke fatigue is a common and complex symptom, and how it affects sustainable return-to-work and everyday life remains insufficiently explored. To describe how persons of working age who experience fatigue after stroke perceive their prerequisites for sustainable return-to-work in the context of everyday life. Forty-eight working-age individuals with stroke participated. Data were collected via the Worker Role Interview (WRI) and a survey. WRI data were analysed using qualitative abductive content analysis and descriptive statistical analysis were conducted. Upon returning to work, participants found themselves in an everyday life where fatigue affected their work ability. The process was marked by uncertainty, ongoing challenges handling work demands under reduced capacity, and inconsistent support. The stroke marked the beginning of a complex, emotionally charged process as participants sought to navigate their new self and redefine their occupational identity. Sustainable return-to-work when experiencing post-stroke fatigue requires person-centred rehabilitation that integrates work and everyday life. Flexible work environments are essential, along with close employer collaboration to ensure understanding of the work situation.