公共卫生研究摘要 (2026-01-13)
共收录 58 篇研究文章
1. Development of a Prognostic Model for Poststroke Dementia Using Multiple International Cohorts: A STROKOG Collaboration Study.
期刊: Neurology 发表日期: 2026-Feb-10 链接: PubMed
摘要
Dementia risk prediction models developed for the general population perform poorly in stroke cohorts. Existing stroke-specific models are few and limited by short prediction horizons or reliance on neuroimaging. The aim of this study was to develop a clinically practical model for predicting 5-year dementia risk after stroke using commonly available variables and individual participant data from the Stroke and Cognition Consortium (STROKOG). Data were pooled from 12 studies across 10 countries. Dementia was diagnosed mainly by expert panel consensus and algorithmic classification. Fine-Gray subdistribution hazard models estimated dementia probability, accounting for death as a competing event. Candidate predictors included routinely collected baseline clinical and stroke-related variables, selected through backward stepwise elimination. Model performance was evaluated using discrimination (C-index) and calibration for prediction up to 5 years after stroke. Internal-external cross-validation (IECV) assessed generalizability across studies, regions, and study periods. A total of 2,663 participants (mean age 67.0 years [SD 11.1]; 40% female) were followed for a median of 2.0 years (IQR 1.0-5.0), during which 655 developed dementia (8.7 per 100 person-years). The final model included age, sex, education, history of previous stroke, diabetes, stroke severity, 2 interactions (age × sex; age × stroke severity), and study-level variables including national current health expenditure. An Excel-based risk calculator is available in the Supplement (eAppendix 1). The model demonstrated strong discrimination (C-index: 0.81; 95% CI 0.75-0.87) and excellent calibration in the full data set used for development. In IECV, discrimination was acceptable across individual studies (pooled C-index: 0.70 [0.67-0.73]) and higher in recent (post-2010; 0.79 [0.76-0.82]) and European (0.74 [0.71-0.78]) cohorts. Risks were slightly overestimated in Asian cohorts. Case numbers were too small for reliable assessment in other regions. We developed and internally-externally validated a 5-year dementia risk model for stroke survivors using routinely available clinical variables. The model showed strong performance in the full development data set and generalized well to recent and European cohorts, although external validation in diverse populations is needed. This tool can help identify high-risk individuals for targeted cognitive monitoring and follow-up. By informing clinical decision making and resource planning, it offers a practical means to improve long-term outcomes.
2. An ecological cascade links climatic variability to avian irruptions and zoonotic salmonellosis outbreaks.
期刊: Proceedings of the National Academy of Sciences of the United States of America 发表日期: 2026-Jan-20 链接: PubMed
摘要
Salmonellosis is a common bacterial infection that can lead to severe illness and death in humans as well as domesticated and wild animals. In bird populations, salmonellosis outbreaks are temporally irregular but occur simultaneously across large spatial extents, frequently leading to widespread avian mortality with occasional spillover to humans. Here, we test the hypothesis that avian salmonellosis epidemics result from a cascade of ecological processes triggered by climate variability in coniferous forests. Building on well-evidenced ecological mechanisms, we find strong evidence for multiyear causal links between temperature cues that drive substantial “boom-bust” cycles in tree cone production across North America, the subsequent irruptions of seed-eating birds, and, finally, the eventual occurrence and severity of avian salmonellosis outbreaks in the United States. By using an integrated, multilevel Bayesian statistical model as a predictive tool to forecast future bird irruptions and disease outbreaks, we demonstrate that our methods can be employed as an early warning system for future epidemics, potentially mitigating outbreak severity among birds and lowering the risk of zoonotic spillover events by encouraging measures such as the temporary cessation of bird feeding ahead of high-risk periods.
3. Less NOx emission reductions are a potential cause for low effectiveness of sulfate aerosol reductions in China.
期刊: Proceedings of the National Academy of Sciences of the United States of America 发表日期: 2026-Jan-20 链接: PubMed
摘要
4. "Difficult Patients," Persistent Symptoms, and the Biopsychosocial Model.
期刊: Annals of internal medicine 发表日期: 2026-Jan-13 链接: PubMed
摘要
5. Impact of 4 Weeks or More Immersive Virtual Reality on Quality of Life and Physical Activity in Older Adults: Systematic Review and Meta-Analysis.
期刊: JMIR aging 发表日期: 2026-Jan-12 链接: PubMed
摘要
Population aging poses significant public health challenges. Older adults often face multimorbidity, functional decline, and diminished quality of life. While physical activity can mitigate these effects, adherence remains low. Immersive virtual reality (IVR) has emerged as a promising, engaging tool to promote physical and cognitive health in this population. The review aims to evaluate the effectiveness of IVR interventions lasting 4 weeks or more on quality of life, physical activity, pain, perceived effort, and adverse events in older adults. A systematic review and meta-analysis were conducted following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and Cochrane guidelines. Literature was searched across PubMed, Web of Science, PEDro, and Scopus, as well as sources of gray literature. Eligible studies included randomized controlled trials involving participants aged >60 years, using IVR via head-mounted display. Outcomes assessed included quality of life, physical activity, pain, perceived effort, and adverse events. Risk of bias and evidence certainty were assessed using Risk of Bias 2.0 and GRADE (Grades of Recommendation Assessment Development and Evaluation), respectively. A total of 14 studies with 839 participants were included in the qualitative synthesis, of which 8 were eligible for quantitative meta-analysis. The pooled analysis showed a statistically significant moderate effect of IVR on quality of life (standardized mean difference [SMD]=0.48, 95% CI 0.1-0.8; P=.007), particularly in interventions lasting 10 to 12 weeks or involving more than 600 minutes of exposure. For physical activity, no significant differences were found between IVR and control groups (SMD=-0.2, 95% CI -0.7 to 0.4; P=.50). Evidence for secondary outcomes (pain, perceived exertion, and adverse events) was limited and largely qualitative, with inconsistent findings. Pain outcomes, assessed in 2 studies, indicated reductions in the IVR group, especially when multimodal approaches were used. Perceived effort was not systematically measured. Adverse events were generally mild, with cybersickness being the most reported issue. IVR interventions of 4 weeks or more appear to moderately improve quality of life in older adults, especially those with clinical vulnerabilities or in institutional settings. Although effects on physical activity were not significant, trends suggest potential with appropriate program design. Preliminary findings support IVR’s use in pain reduction, particularly when incorporating emotional and multisensory elements. The low incidence of adverse events suggests good tolerability. Overall, IVR is a promising and safe tool to support healthy aging, though further high-quality studies are needed to confirm these findings and assess long-term outcomes.
6. Evaluating Spanish Translations of Emergency Department Discharge Instructions by a Large Language Model: Tool Validation and Reliability Study.
期刊: JMIR formative research 发表日期: 2026-Jan-12 链接: PubMed
摘要
When given a sample of 100 emergency department discharge instructions, Claude Sonnet, a large language model, produced accurate Spanish translations as evaluated by Spanish-speaking physicians and medical interpreters.
7. Exploring Risk Factors and Neurophysiological Mechanisms Underlying the Development of Chronic Postsurgical Pain After Thoracic Surgery: Protocol for an Observational Feasibility Study.
期刊: JMIR research protocols 发表日期: 2026-Jan-12 链接: PubMed
摘要
Chronic postsurgical pain (CPSP) is a debilitating chronic pain condition that particularly impacts patients undergoing thoracic surgery, with incidence rates of up to 50%. The current understanding of risk factors is limited, and preoperative neurophysiological risk factors that may predict the development of CPSP have not yet been explored. Additionally, the specific neural mechanisms underlying the transition to CPSP are not well characterized. As a novel approach, we propose the use of transcranial magnetic stimulation and electroencephalography, along with other patient and surgical factors, to understand the neurophysiological mechanisms underlying the onset of CPSP after thoracic surgery. The primary objective of this study is to evaluate the feasibility of our study design to inform a larger observational cohort study. Secondary objectives include exploring preoperative neurophysiological markers along with clinical characteristics associated with a higher risk of developing CPSP, as well as exploring postoperative differences in cortical function between patients who undergo thoracic surgery and develop CPSP compared with those who do not develop CPSP. A total of 30 participants undergoing video-assisted thoracic surgery or a robotic-assisted thoracic lobectomy, wedge resection, segmental section, or minimally invasive esophagectomy, will be recruited to take part in 2 assessment sessions. The first assessment will take place 2 to 3 weeks before surgery, and the second assessment will take place 3 months after surgery, during which the CPSP diagnosis of each participant will be assessed by the experimenter using a validated definition. Feasibility outcomes include recruitment and retention rates of study participants. The secondary objectives include exploring factors associated with the development of CPSP, as well as examining postoperative differences in neurophysiological measures between patients with and without CPSP. We will consider the following neurophysiological measures for these objectives: transcranial magnetic stimulation measures of short-latency intracortical inhibition, cortical silent period, and motor evoked potentials; electroencephalography measures of resting band activity, event-related desynchronization, and corticomuscular coherence; and quantitative sensory testing of mechanical detection threshold and pressure pain threshold. This is an ethics-approved, ongoing study. Initial funding for this study was provided in March 2023. Recruitment for the study began in January 2025. A total of 22 participants have been recruited for the study. We anticipate completing data collection for this study by April 2026, with data analysis to follow. This protocol details our study design for a feasibility study exploring the neurophysiological markers and patient characteristics associated with the development of CPSP. Demonstration of feasibility is expected to lead to a larger study. Improved understanding of the risk factors and mechanisms underlying CPSP may inform the delivery of targeted therapies and preventive measures to reduce the incidence of CPSP after thoracic surgery. DERR1-10.2196/81042.
8. GPT-4o and OpenAI o1 Performance on the 2024 Spanish Competitive Medical Specialty Access Examination: Cross-Sectional Quantitative Evaluation Study.
期刊: JMIR medical education 发表日期: 2026-Jan-12 链接: PubMed
摘要
In recent years, generative artificial intelligence and large language models (LLMs) have rapidly advanced, offering significant potential to transform medical education. Several studies have evaluated the performance of chatbots on multiple-choice medical examinations. The study aims to assess the performance of two LLMs-GPT-4o and OpenAI o1-on the Médico Interno Residente (MIR) 2024 examination, the Spanish national medical test that determines eligibility for competitive medical specialist training positions. A total of 176 questions from the MIR 2024 examination were analyzed. Each question was presented individually to the chatbots to ensure independence and prevent memory retention bias. No additional prompts were introduced to minimize potential bias. For each LLM, response consistency under verification prompting was assessed by systematically asking, “Are you sure?” after each response. Accuracy was defined as the percentage of correct responses compared to the official answers provided by the Spanish Ministry of Health. It was assessed for GPT-4o, OpenAI o1, and, as a benchmark, for a consensus of medical specialists and for the average MIR candidate. Subanalyses included performance across different medical subjects, question difficulty (quintiles based on the percentage of examinees correctly answering each question), and question types (clinical cases vs theoretical questions; positive vs negative questions). Overall accuracy was 89.8% (158/176) for GPT-4o and 90% (160/176) after verification prompting, 92.6% (163/176) for OpenAI o1 and 93.2% (164/176) after verification prompting, 94.3% (166/176) for the consensus of medical specialists, and 56.6% (100/176) for the average MIR candidate. Both LLMs and the consensus of medical specialists outperformed the average MIR candidate across all 20 medical subjects analyzed, with ≥80% LLMs’ accuracy in most domains. A performance gradient was observed: LLMs’ accuracy gradually declined as question difficulty increased. Slightly higher accuracy was observed for clinical cases compared to theoretical questions, as well as for positive questions compared to negative ones. Both models demonstrated high response consistency, with near-perfect agreement between initial responses and those after the verification prompting. These findings highlight the excellent performance of GPT-4o and OpenAI o1 on the MIR 2024 examination, demonstrating consistent accuracy across medical subjects and question types. The integration of LLMs into medical education presents promising opportunities and is likely to reshape how students prepare for licensing examinations and change our understanding of medical education. Further research should explore how the wording, language, prompting techniques, and image-based questions can influence LLMs’ accuracy, as well as evaluate the performance of emerging artificial intelligence models in similar assessments.
9. Translation and Validation of the User Version of the Mobile Application Rating Scale Into the Polish Language: Cross-Sectional Methodological Study.
期刊: JMIR formative research 发表日期: 2026-Jan-12 链接: PubMed
摘要
Mobile health (mHealth) apps can innovatively diagnose, prevent, and treat many diseases. The increasing use of mHealth apps necessitates an appropriate assessment standard. This study aimed to translate the User Version of the Mobile Application Rating Scale (uMARS) into Polish, followed by validation, cultural adaptation, and examination of its reliability and validity. The Polish version of uMARS was adapted, translated, and validated based on the free STOP COVID ProteGO Safe app available for Android and iOS platforms. A total of 117 participants rated the app using the translated scale and rerated it 1 week later. The conceptual equivalence of all items and subscales of the original uMARS and its Polish version was confirmed. The translated uMARS scale exhibited high reliability (Cronbach α=0.95). The perceived test-retest reliability and total influence score were acceptable, with intraclass correlation coefficient values of 0.59 and 0.65, respectively. The translated scale matched the reliability of the original scale. It can help users choose the best mHealth apps available in Poland and report their quality. The Polish version of uMARS was cross-culturally validated and was found to be as reliable as the original uMARS. The translated and validated uMARS tool can be used to evaluate mHealth apps in various aspects. App developers can reliably assess app components and determine areas that require further improvement and development to deliver higher-quality apps. The Polish version of the uMARS can become a standard tool for evaluating the quality of mHealth apps in Poland.
10. Digital Exclusion Among People Experiencing Homelessness and Residents of Urban Communities in Brazil: Cross-Sectional Study.
期刊: JMIR public health and surveillance 发表日期: 2026-Jan-12 链接: PubMed
摘要
The COVID-19 pandemic amplified digital divides in Brazil, restricting vulnerable groups’ online access to health information and preventive guidance, with limited intersectional analyses of these inequities. This study aimed to investigate inequalities in digital exclusion and access to online COVID-19 information among people experiencing homelessness and residents of urban communities in Brazil by using an intersectional multilevel analysis. A cross-sectional study (2021-2023) involving 2652 participants (n=1353, 51% experiencing homelessness and n=1299, 49% from urban communities across 26 state capitals) was conducted using the adapted COVID-19 Social Thermometer questionnaire administered via face-to-face interviews. Multilevel analysis of individual heterogeneity and discriminatory accuracy examined 115 intersectional strata (gender, race and ethnicity, schooling, income, and Brazilian Unified Health System use) with online COVID-19 information seeking as the binary outcome; multilevel logistic models estimated additive effects and between-strata variance. Most participants were men (1600/2652, 60.3%), self-identified as Black or Brown individuals (1942/2652, 73.2%), and were Unified Health System users (2433/2652, 91.7%) without private insurance (2469/2652, 93.1%). Over one-third (905/2652, 34.1%) had no formal schooling; 62.4% (1655/2652) reported low income. A total of 39.2% (1040/2652) sought online COVID-19 information. Being a woman (odds ratio [OR] 1.49, 95% CI 1.13-1.97), higher schooling (OR 1.78-5.59, 95% CI 3.52-8.88), and higher income (OR 2.37-4.54, 95% CI 2.59-7.93) showed a stronger association with online COVID-19 information seeking; public health system use was not associated with the outcome (OR 0.92, 95% CI 0.64-1.33). Predicted probabilities ranged between 14% and 85% across 115 strata, with the lowest among Black or Brown men (no schooling or low income) and the highest among women and higher schooling or income. The intersectional analysis (n=2405) null model showed 24% between-strata variance; the full additive model reduced it to 1% (proportional change in variance=97%). Intersectional analysis reveals structural informational exclusion driven by additive disadvantages in schooling, income, and gender among participants, calling for digital inclusion policies, critical health literacy programs, and equitable multichannel communication strategies to address persistent COVID-19 information seeking disparities.
11. Acceptability of and Implementation Supports for Video Directly Observed Treatment to Enhance Methadone Dosing Flexibility in a Multisite Opioid Treatment Program: Qualitative Rapid Needs Assessment Study.
期刊: JMIR formative research 发表日期: 2026-Jan-12 链接: PubMed
摘要
Methadone is a first-line treatment for opioid use disorder, which is delivered in federally regulated opioid treatment programs (OTPs). Federal policies require directly observed dosing of methadone followed by graduated provision of nonobserved doses to take at home (ie, “take-home” dosing) after demonstrated stability is achieved. Policy changes since the COVID-19 pandemic have greatly expanded take-home dosing. Video directly observed treatment (video DOT) is an approach in which patients submit videos of themselves taking medications, which are asynchronously reviewed to verify adherence. In preparation for an implementation trial evaluating the adoption of video DOT in OTP settings, we conducted a rapid needs assessment with multidisciplinary stakeholders to assess acceptability, perceived benefits, and needed support for video DOT to monitor take-home methadone dosing. In our rapid needs assessment, we explored perspectives of multidisciplinary stakeholders (N=20) at 3 clinical sites within a single OTP in western Washington state. Trained qualitative researchers took ethnographic field notes during meetings with organizational leadership and in-person site visits with clinical and administrative staff. Field notes were analyzed via a team-based rapid assessment process using coding templates informed by the Consolidated Framework for Implementation Research. Summaries of qualitative data were iteratively reviewed by the study team and further confirmed with site stakeholders. Stakeholders included leadership (n=6, 30%), medical providers (n=4, 20%), substance use disorder counselors (n=7, 35%), and clinic managers and support staff (n=3, 15%). Stakeholders perceived that video DOT could lessen the barriers patients face, including travel burden (eg, time and cost) and stigma. They also identified that video DOT could have important impacts on early care retention, given expansions of take-home dosing. However, stakeholders anticipated an added burden for clinical staff and emphasized the need for implementation supports that would limit burden, such as additional staff support for video submission review and clear communication pathways when video submissions require additional clinical input. A rapid needs assessment of OTP sites for a future implementation study suggested that stakeholders saw potential benefits for patients receiving video DOT, but there were concerns that this would add to their work burden. Learnings informed the subsequent tailoring of clinical use cases and implementation supports.
12. Liverrisk score (LRS) predicts long-term liver-related outcomes in a cohort of veterans without evidence of liver disease.
期刊: Hepatology (Baltimore, Md.) 发表日期: 2026-Jan-12 链接: PubMed
摘要
Metabolic dysfunction-associated steatotic liver disease (MASLD) is increasing and disproportionately affects Hispanics. The LiverRisk Score (LRS), a non-invasive stratification tool, could enhance early identification of patients at risk for liver disease; however, it has not been validated in a large U.S. Veteran cohort with sufficient liver-related outcomes. We conducted a retrospective cohort study of Veterans Health Administration (VHA) patients from 1999-2023. Individuals with chronic liver disease, viral hepatitis, or missing LRS values were excluded using laboratory and ICD-10 data. Patients were classified into minimal (LRS <6), low (6-<10), medium (10-<15), and high-risk (≥15) categories. Outcomes included liver-related events, mortality, hepatocellular carcinoma (HCC), and C-statistics. Analyses used parametric/non-parametric methods and Cox proportional hazard models with competing risks, adjusting for missing data. Among 170,998 Veterans (93% male; median age 60; 63% White), 71%, 26%, 2%, and 0.5% were classified as minimal, low, medium, and high-risk, respectively. Over 13.5 years median follow-up, 15,463 (9%) developed a liver-related event, 6,219 (3.6%) died of liver causes, and 640 (0.5%) developed HCC. C-statistics were 0.61 for events, 0.70 for mortality, and 0.71 for HCC. Accuracy was highest among Hispanic/Latino Veterans (mortality 0.77, 95% CI 0.73-0.81; HCC 0.82, 95% CI 0.75-0.90) versus non-Hispanic Whites (mortality 0.62, 95% CI 0.61-0.62). LRS effectively predicted liver-related events, mortality, and HCC in Veterans. Its integration into clinical alerts and lab reports could support proactive patient care and liver disease prevention.
13. Reply: Placebo drift, dose heterogeneity and the winner's curse - re-evaluating the hierarchy of MASH therapeutics.
期刊: Hepatology (Baltimore, Md.) 发表日期: 2026-Jan-12 链接: PubMed
摘要
14. Barriers to mental health help-seeking intentions among Black college students: examining the role of discrimination.
期刊: Journal of American college health : J of ACH 发表日期: 2026-Jan-12 链接: PubMed
摘要
Objective: To determine the association between six barriers of mental health counseling and intention to seek mental health help as well as to understand the moderating role of racial discrimination. Methods: We conducted a secondary data analysis of Black students (n = 367), aged 18-25 recruited from a large southeastern university. Participants previously completed an online survey originally conducted to understand student mental health needs and resources on campus. Results: Negative perceived value and discomfort with emotions barriers were negatively associated with intention to seek mental health help. Suicidal behavior was associated with lower help-seeking intention. Racial discrimination did not significantly moderate the association between barriers and intention to seek help for mental health concerns. Conclusions: Findings suggest that contextualizing individual-level barriers through a cultural and contextual lens may be impactful for increasing help-seeking intentions in this population. Further, Black college students may be a critical group to receive suicide prevention interventions.
15. Exploring Factors Associated With the Stalled Implementation of a Ground-Up Electronic Health Record System in South Africa: Qualitative Insights From the E-Tick Case Study Using the Consolidated Framework for Implementation Research (CFIR).
期刊: JMIR medical informatics 发表日期: 2026-Jan-12 链接: PubMed
摘要
Electronic health records (EHRs) have the potential to improve service delivery through record keeping and monitoring health outcomes. As countries move toward universal health coverage, digital health tools such as EHRs are essential for achieving this goal. However, EHR implementation in middle-income countries like South Africa faces obstacles. This study explores the reasons behind a stalled implementation of the electronic tick register (E-tick) system (an electronic version of a paper primary health care register to record services provided), using the Consolidated Framework for Implementation Research. Using a qualitative design, in-depth interviews were conducted with 38 participants to explore their perceptions and experiences, and the factors surrounding the success and stalling of E-ticks. Participants included managers, stakeholders, implementers, and end users from the 3 implementation clinics. Data was collected using semistructured interview guides. The Thematic and Consolidated Framework for Implementation Research framework analysis (innovation, inner setting, individual characteristics, implementation process, and outer setting) was applied. The E-tick system was designed to improve data quality in paper health registers, addressing inaccuracies in reporting to district and provincial health departments (Innovation domain). Implementers iteratively developed the system through user input from managers and clinicians, and stakeholder engagement of software developers, funders, health managers, and decision-makers from the provincial health department (individual characteristics). Although the system was initially well adopted by end users, it stalled primarily due to outer setting factors, which included a change of developers, funding cuts, and limited support at the provincial health department level due to capacity gaps, political appointments, and mistrust stemming from corruption and abuse of the tender system. Moreover, resistance to leveraging lessons from locally developed small-scale systems further constrained institutional support for the E-tick. Although successful implementation of EHRs can be facilitated by strong user engagement and co-design, outer setting factors such as governance, funding, and policy alignment can pose significant threats to sustainability. This underscores the importance of effective synergy between top-down and bottom-up processes for successful implementation.
16. Global Coastline Plastic Emissions into the Oceans.
期刊: Environmental science & technology 发表日期: 2026-Jan-12 链接: PubMed
摘要
Global marine plastic pollution has become a major concern for its negative effect on marine life and potential human health. However, research on the distribution and quantification of coastal sources remains limited, hindering the formulation of effective mitigation strategies. Here, we developed a machine learning-based framework using 25,892 data points from 3468 coastal sampling sites, incorporating 38 features including socioeconomic factors, plastic waste sectors, and types. The framework further integrates coastal geomorphological and tidal characteristics to account for the regulating effects of natural processes on plastic emissions. To systematically characterize pollution severity, we proposed the Coastal Plastic Pollution Index (CPPI), which classifies coastal input sites into four levels (I-IV) based on estimated emission. The model estimated global coastal plastic emission in 2019 between 15.32 and 59.18 Kt, with per capita values ranging from 2.17 to 8.38 g. Mismanaged plastic waste (MPW), plastic waste generation (PWG), consumer and institutional products (CIP), packaging (PAC) PET, and PP play dominant roles in coastal emissions. After clustering the sampling data using unsupervised learning, we found a high degree of consistency in CPPI distribution among countries within the same cluster. Our findings offer robust scientific support for both national and international policy actions.
17. Crowdsourcing Cancer Survivors' Perspectives on the Use of Artificial Intelligence and Automation in Financial Hardship Interventions.
期刊: JCO oncology practice 发表日期: 2026-Jan-12 链接: PubMed
摘要
The use of artificial intelligence (AI) or automation in financial hardship (FH) interventions has the potential to increase reach and address implementation challenges. However, cancer survivor perceptions of how AI or automation could be used in FH interventions are understudied. Eligibility for an online crowdsourcing study included being ≥18 years of age, a cancer survivor, and living in the United States. The survey asked open-ended crowdsourcing questions about how survivors thought AI/automation could have improved their experience with financial assistance and health insurance. A qualitative content analysis was conducted that consisted of two cycles of coding including the use of ChatGPT-5 to generate the preliminary codebook. A total of N = 198 cancer survivors participated and were on average age 50.3 years (standard deviation [SD], 14.3) and age 40.1 years at diagnosis (SD, 16.2), most commonly non-Hispanic/Latine (89.9%), White (86.9%), cisgender women (69.2%), and heterosexual (70.2%). Qualitative analysis revealed seven subcategories within the financial assistance category: (1) efficient search and personalized resource matching, (2) application support and process navigation, (3) insurance and billing support, (4) conversational and interactive tools, (5) connecting to human support, (6) emotional support, and (7) concerns and lack of applicability. Furthermore, five subcategories were identified within the health insurance support category: (1) health insurance education tools and decision support, (2) health insurance navigation, (3) system simplification or automation, (4) connecting to resources and human support, and (5) concerns and lack of applicability. Overall, cancer survivors generated a variety of ideas focused on reducing the administrative burden of seeking out financial assistance and dealing with health insurance. Findings demonstrate that cancer survivors could imagine AI or automation being used in FH interventions.
18. Searching for a therapist from the community and in-network: A qualitative exploration of gay and bisexual men's mental health care navigation.
期刊: Psychological services 发表日期: 2026-Jan-12 链接: PubMed
摘要
Gay and bisexual men experience disproportionate rates mental health challenges including for depression, suicidality and substance use disorders. At the same time, they may face unique barriers to seeking mental health care that is lesbian, gay, bisexual, transgender and queer+ (LGBTQ)-affirming. In this study, we describe and analyze gay and bisexual men’s mental health care navigation, with a focus on identifying challenges that arose when seeking care. Between July and September of 2023, 24 individuals participated in in-depth interviews via video-conferencing software. Interviews were transcribed and analyzed using a reflexive thematic approach. Participants reported challenges navigating insurance networks, which often engendered frustration and emotional upset. Participants desired mental health providers that could provide affirming and culturally tailored care, with a preference for providers from the LGBTQ+ community and from their racial or ethnic background. Such needs were complicated by narrow provider networks, limited resources and provider directories replete with inaccuracies and unavailable providers. Participants also highlighted cost-related challenges, including high out-of-pocket costs associated with care and treatment limitations that restricted access to care. Finally, participants reported programing and resources that helped bridge the payment gap or made accessing care more convenient, including community and employer-offered mental health programming, primary care provider-delivered care and telehealth utilization. Our findings support that gay and bisexual men experience challenges when seeking mental health care that also affect the broader population, but may be magnified for this population, particularly for men of color seeking care from a smaller subset of providers prepared to deliver culturally tailored and affirming care to LGBTQ+ individuals. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
19. Assessing Health Literacy in Patients With Heart Failure and Potential Impact on Readmissions: A Quality Improvement Project.
期刊: Professional case management 发表日期: 2026-Jan-12 链接: PubMed
摘要
This quality improvement project was designed to close a gap in capturing health literacy in adult patients with heart failure discharged from a hospital system. An opportunity existed to investigate if health literacy levels contribute to individuals’ social factors and overall health. A priority focus was evident across healthcare organizations to address the social determinants of health (SDOH) for the populations served. Throughout the literature, limited health literacy is associated with higher hospital readmission rates. Pre-implementation data included 2023 heart failure readmission rate (19.02%) and baseline SDOH screenings (9,500) which noted housing, food insecurities, and transportation as greatest needs. There was no prior data analysis of how social factors may have impacted readmissions. Patients with recent hospitalization in Acute Care Hospitals with a known heart failure diagnosis; received health literacy screenings by the Registered Nurse (RN) Transitional Care Managers (TCMs) during their post-hospital discharge follow-up calls. Pre-implementation period began in August 2024. Project launched in November 2024 with RN TCMs conducting assessments using the BRIEF (Health Literacy Screening Tool) during post-hospital discharge calls. Additional follow-up calls were required as the intervention for patients with limited literacy during their 30-day post-hospitalization transition period. Data collection occurred from November 2024 through June 2025. The 8-month period included 1,543 high-risk hospital discharges, among them 580 patients with heart failure screened for health literacy; 517 patients had adequate health literacy, 44 had marginal health literacy, and 19 had limited health literacy. The intervention of additional follow-up calls for patients with limited health literacy achieved statistical significance in reducing readmissions. By implementing the BRIEF screening tool within an existing RN TCM workflow, it allowed for RN TCMs to interview patients with important questions during a vulnerable time for patients - transitioning from hospital to home. Expansion of health literacy assessments is vital for patients with any chronic condition, not just heart failure. RN TCMs identify the necessary interventions needed to support their patients and develop care plans. It is especially important to understand the needs specifically for patients with limited health literacy. Care management plays a pivotal role in patient advocacy by providing education and coordinating directly with providers to support patients’ journey to better health.
20. Impact of childhood adversity on suicidality among children in the United States: Does race and ethnicity moderate the association?
期刊: The American journal of orthopsychiatry 发表日期: 2026-Jan-12 链接: PubMed
摘要
Because suicide-related outcome risk is higher among individuals experiencing adverse childhood experiences (ACEs), and individuals of minoritized race and ethnicity experience greater ACEs, differences by race and ethnicity in ACE exposure and/or response may help explain racial and ethnic disparities in suicide-related outcomes. We aimed to describe ACE prevalence by race and ethnicity, estimate associations between ACEs and suicidality, and explore moderation by race and ethnicity. Supported by the stress sensitization hypothesis, we hypothesized that associations between ACEs and suicidality would be stronger among non-Hispanic Black and Hispanic children than non-Hispanic White children. We utilized an Adolescent Brain Cognitive Development study subsample (n = 5,469; Mage = 119.3 months [SD = 7.5 months]; Hispanic: 20.8%; non-Hispanic Black: 14.8%; non-Hispanic White: 64.4%). We estimated associations between ACEs (cumulative ACE score and three subdomains: family-centered adversity, interpersonal adversity, and life events) and suicidality (any child-reported suicidal thoughts or behaviors) using generalized linear mixed models and included an interaction term between ACEs and race and ethnicity to examine potential moderation. ACE prevalence differed by race and ethnicity and was highest among non-Hispanic Black children, although household mental illness prevalence was highest among non-Hispanic White children. Cumulative ACE score (OR = 1.17, 95% CI [1.12, 1.23]), family-centered adversity (OR = 1.89, 95% CI [1.54, 2.32]), and interpersonal adversity (OR = 1.62, 95% CI [1.35, 1.94]) were positively associated with suicidality; the associations were not moderated by race and ethnicity. Differential ACE exposure by race and ethnicity may help explain suicide-related disparities. ACE prevention and interventions, particularly among children of minoritized race and ethnicity, are vital. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
21. Advancing drug development for the prevention of spontaneous preterm birth.
期刊: Journal of neonatal-perinatal medicine 发表日期: 2026-Jan-12 链接: PubMed
摘要
In the United States, one in 10 pregnancies results in preterm birth (PTB), making it the leading cause of infant morbidity and mortality. Following the 2023 withdrawal of Makena (hydroxy progesterone caproate) for lack of efficacy, clinicians currently lack FDA-approved options for women at risk of recurrent spontaneous PTB. Researchers and pharmaceutical companies may be hesitant to commit resources to develop therapies for PTB. This report summarizes a Food and Drug Administration-Duke Margolis Institute for Health Policy public workshop held in January 2024 to discuss challenges and opportunities for advancing drug development for the prevention of PTB. Participants-researchers, clinicians, industry representatives, families, and regulators-highlighted challenges that hinder the development of PTB therapies, including the limited understanding of PTB causes, ethical concerns for trials, and lack of consensus on appropriate outcome measures. A few of the emerging recommendations suggest that supporting basic science research to address knowledge gaps, such as elucidating the biological drivers and underlying mechanisms of spontaneous preterm birth (sPTB), as well as improving data quality and evidence and focusing on gestational age-specific clinical outcome endpoints could help move the needle forward in this area. Meeting participants also shared perspectives on research priorities, discussed optimizing study design for dose-finding, and strategized about funding and investments. Key recommendations included pursuing greater regulatory flexibility, innovative trial designs, expanding federal and philanthropic funding incentives to de-risk early-stage development, and strengthening data-sharing and research collaborations to accelerate translation of discoveries into therapies.
22. Evaluating the Acceptability of Using Virtual Reality to Promote Physical Activity Among Latino, Latina, and Latine Adults With Cardiometabolic Risk Factors and Obesity in Underresourced Settings: Protocol for a Qualitative Focus Group Study.
期刊: JMIR research protocols 发表日期: 2026-Jan-12 链接: PubMed
摘要
Obesity represents a significant public health challenge in the United States, particularly among Latino, Latina, and Latine communities and those in underresourced settings. Virtual reality (VR) is a new and innovative technology that can promote physical activity and has the potential to overcome some structural barriers. However, there are few studies that explore the acceptability of using this new technology among high-risk groups in underresourced settings. We outline a community-informed protocol for conducting focus groups with Latino, Latina, and Latine adults who have cardiometabolic risk factors and obesity residing in underresourced communities. The focus groups will assess the acceptability of a culturally aligned VR program to promote physical activity. Using a community-engaged approach informed by community health workers and a community advisory board, we delivered an immersive VR dance experience to Latino, Latina, and Latine adult participants with cardiometabolic risk factors and obesity. Following the VR experience, we conducted semistructured focus group interviews to assess acceptability guided by the theoretical framework of acceptability. Data collection included a baseline demographic survey and focus group discussions to evaluate participant experiences and the VR program’s acceptability. As of April 2025, we have completed 7 focus groups with 44 participants across 3 age groups: 18 to 29 years, 30 to 49 years, and 50 to 70 years. Data collection was completed in May 2025, and study findings are expected to be published in February 2026. The fully analyzed data from this study will offer insights into leveraging VR as an innovative tool for promoting physical activity in underserved populations, contributing to the broader literature on digital health equity and obesity prevention.
23. Impact of biological age versus chronological age on clinical outcomes in patients with atrial fibrillation: insights from the COOL-AF registry.
期刊: Journal of thrombosis and thrombolysis 发表日期: 2026-Jan-12 链接: PubMed
摘要
Because patients with atrial fibrillation (AF) often exhibit heterogeneous risks that are not fully captured by traditional clinical factors, identifying a more accurate measure of physiological ageing could improve risk stratification and clinical management compared to chronological aging.This study aimed to determine the clinical outcome in relation to biological ageing in patients with AF. We used the data from the COOL-AF registry which is a multicentre nationwide registry of AF patients. The enrolment period was 2014-2017. Patients were followed-up for 3 years. Biological ageing was calculated from the Klemera-Doubal method (KDM) is a based on chronological age and blood chemistry and body function factors. The main outcome of this study was the composite of all-cause death, major bleeding, ischemic stroke/systemic embolism (SSE), and heart failure. We included total of 3405 patients, with a mean chronological age of 67.8 ± 11.3 years, and 1424 (41.8%) were female. During the median follow-up duration of 35.9 (IQR 34.8, 36.0) months, the composite outcomes, death, major bleeding, SSE, and heart failure developed in 726 (21.3%), 380 (11.2%), 199 (5.8%), 134 (3.9%), and 247 (7.3%) patients, respectively. Restricted cubic spline analysis showed that KDM bioage had higher hazard ratios compared to chronological age, with the adjusted Hazard ratios and 95% confidence interval (CI) of Quartile 4 (Q4) KDM for the composite outcomes, death, major bleeding, SSE, and heart failure were 2.11 (1.82-2.45), 2.53 (2.06-3.11), 2.12 (1.60-2.83), 1.96 (1.37-2.78), and 1.83 (1.42-2.38), respectively (all p < 0.001). In conclusion, KDM bioage is an independent predictor for clinical outcome and performs better than chronological age. These findings highlight the clinical value of incorporating biological ageing metrics into AF risk assessment models and suggest that KDM bioage may enhance personalized prognostication beyond conventional age-based evaluation.
24. AI for screening in healthcare: promise and challenges.
期刊: Abdominal radiology (New York) 发表日期: 2026-Jan-12 链接: PubMed
摘要
Artificial intelligence (AI) is reshaping population screening, yet the translation from laboratory performance to population benefit remains limited. This narrative review describes current uses of AI across major screening pathways. Prospective trials in mammography demonstrate non‑inferior cancer detection with large reductions in radiologist workload. In diabetic retinopathy, the first FDA‑authorized autonomous system extends specialist‑level screening into primary care and improves uptake. During colonoscopy, real‑time computer vision improves adenoma detection without increasing removal of non‑neoplastic tissue. Emerging multimodal approaches, including transformer‑based and large language model-enabled systems, integrate images, clinical variables, and molecular signals and underpin multi‑cancer early detection tests. Despite these gains, three constraints currently limit impact: the base‑rate problem in low‑prevalence cohorts, which magnifies the burden of false positives; limited generalizability and potential bias across institutions and populations; and practical barriers in workflow, regulation, and trust. Opportunities ahead include foundation models pre‑trained on diverse data, uncertainty‑aware “decision referral,” federated learning, larger representative datasets, and prospective trials that track interval cancers, stage shift, and cost‑effectiveness. The overarching conclusion is cautious optimism: when validated and invisibly integrated, AI augments physicians, expands access, and improves efficiency; realizing durable public‑health benefits will depend on equity‑focused design, rigorous evaluation, and sustained human oversight.
25. Understanding the Complexities of Peripartum Mood and Anxiety Disorders: A Qualitative Assessment of Current Issues in Management and Treatment.
期刊: Maternal and child health journal 发表日期: 2026-Jan-12 链接: PubMed
摘要
Perinatal Mood and Anxiety Disorders (PMADs) are an important public health issue that can have detrimental consequences to both the woman and the child. Despite our extensive understanding about the consequences and the availability of treatments, only 3% individuals with PMADs are treated to remission. Our aim was to understand the community’s needs, barriers to accessing care for PMADs, and obtain feedback on current services. In this study, we carried out qualitative interviews with 32 relevant individuals from varied backgrounds to understand the complexities related to PMADs and barriers to help-seeking. These narratives were transcribed, and an inductive thematic analysis approach was used to identify codes which were used in an iterative manner until data saturation was reached. Three broad themes were identified related to the key questions including prevalence, barriers to care and finally, service needs and home visiting programs. All participants acknowledged the high prevalence of PMADs, particularly during and after the COVID-19 pandemic. They identified multiple barriers related to individual attitudes, knowledge, and stigma; health systems knowledge, attitude and access; and social determinants including poverty, race, geography, childcare and insurance. They also identified societal and cultural attitudes and the role of social support systems in help-seeking. All participants acknowledged the importance of home-visiting programs in addressing the needs of peripartum individuals. Our findings provide an in-depth insight into the complex underpinnings of PMADs, particularly barriers to accessing care. This information, along with the positive feedback on home-visiting programs, can contribute to the development of innovative programs.
26. Strengthening Collaboration Between Community-Based Organizations, State Title V Agencies, and Funders by Uplifting Community-Rooted Evidence: A Qualitative Research Study.
期刊: Maternal and child health journal 发表日期: 2026-Jan-12 链接: PubMed
摘要
What is considered ‘evidence’ in maternal and child health (MCH) has major implications for which organizations and initiatives receive funding. Despite growing recognition of the importance of community-rooted work, state and jurisdictional MCH agencies, (Title V) operate from an evidence framework that typically prioritizes empirical research and large-scale evaluations over community-rooted evidence (CRE). This study sought to examine how CRE informs decision-making within Title V agencies, understand capacity-building needs of community-based organizations (CBOs), and explore strengthening relationships between CBOs and Title V. This qualitative study interviewed Title V and CBO staff to explore current CRE perceptions and funder/CBO relationships. 16 CBO and 11 Title V staff participated in compensated interviews from February to July 2024. Interviews were conducted, transcribed, coded, and analyzed using a thematic analysis approach. CBO interviewees stressed the need to reimagine misaligned funder and CBO relationships to be rooted in trust, allow CBOs agency to define metrics of success for their work, recognize the credibility of CRE including qualitative data and storytelling, and introduce more flexibility into funding opportunities and reporting structures. Title V respondents expressed capacity building needs around how to operationalize CRE in their work and decision-making practices, as well as build CBO capacity. Funders including Title V can support tailored, innovative, and community-driven solutions to MCH challenges through uplifting CRE in evidence frameworks, investing in trust-based relationships with CBOs, and supporting CBO capacity building. Recommendations for how Title V can operationalize CRE in their work are also provided.
27. Association of Public and Private Insurance with Having a Usual Source of Care in Adolescence: Race/Ethnicity and Immigrant Differences.
期刊: Journal of racial and ethnic health disparities 发表日期: 2026-Jan-12 链接: PubMed
摘要
Adolescents with a usual source of care (USC) are less likely to have unmet health needs. Insurance coverage may enable having a USC by reducing some barriers to care, but unique challenges of public insurance (e.g., limited number of providers) and private insurance (limited no-cost services) suggest that the impact of insurance may not be universal. Groups such as immigrants and racial and ethnic minorities face additional barriers to receiving health care and may be differentially impacted by type of insurance coverage. This study examined the relationship between insurance type and having no USC in adolescence overall and by race and ethnicity and whether parents are immigrants. We analyzed nationally representative cross-sectional data from the 2018-2021 Medical Expenditure Panel Survey Household Component using multivariable logistic regression adjusting for other explanatory variables. Analyses were conducted for the full sample, by race and ethnicity, and by parents’ immigrant designation (US-born, mixed immigrant type, and foreign-born). Although adolescents with public insurance were less likely to be without USC than adolescents with private insurance, in the subsample analyses, this finding was only significant for Non-Hispanic Black adolescents and those with US-born parents. Additional work is needed to ensure all insurance plans address the unique barriers to care experienced by adolescents of different races, ethnicities, and immigrant designations.
28. Applying Innovative Methods to Develop Health Education Text Messages in Cancer Survivorship.
期刊: Journal of cancer education : the official journal of the American Association for Cancer Education 发表日期: 2026-Jan-12 链接: PubMed
摘要
Dietary quality, physical activity, and sleep hygiene are interrelated behaviors that have been associated with health outcomes among cancer survivors and caregivers. The purpose of this study was to develop health promotion short message service (SMS) content related to these three behaviors using generative artificial intelligence (AI) as part of a health promotion intervention development process. Generative AI was first used to develop English-language SMS drafts for each of the three health behaviors using ChatGPT 3.5 (OpenAI, 2023). SMS drafts were then refined by humans to produce usable messages and approved by content experts. Each SMS was translated to Spanish by a native bilingual/bicultural speaker, with assistance from an AI translator (IXL Learning, 2023). This work demonstrated that AI can be an effective tool for generating new health education SMS content; however, expert human review and revision are critical for ensuring both the accuracy of content and appropriateness of language. Lessons learned and recommendations for incorporating GenAI into future SMS intervention development are discussed.
29. The Lived Experiences of Children Who Have Undergone Kidney Replacement Therapy and Their Families: Protocol for a Qualitative Systematic Review.
期刊: JMIR research protocols 发表日期: 2026-Jan-12 链接: PubMed
摘要
In many high-income countries, 5 to 10 children per million of the age-related population start kidney replacement therapy (KRT), which includes both dialysis (peritoneal dialysis and hemodialysis) and kidney transplantation (KT) for end-stage kidney disease. After peritoneal dialysis is introduced, or after KT, self-care at home typically becomes the main focus. Providing support for each developmental stage and transition period in the treatment process from dialysis to KT is an urgent issue. This review aims to synthesize the lived experiences of children undergoing KRT and their families. We will use identified themes to develop a self-care program aimed at solving the life tasks of children and their families. A search strategy will follow the Joanna Briggs Institute methodology and will be conducted in 3 steps: an initial limited search, a comprehensive database search, and a reference search of the included articles. MEDLINE (EBSCO), CINAHL Plus, and PsycINFO will be searched with no restriction on language or publication dates. The study selection, critical appraisal, data extraction, and data synthesis will be performed according to Joanna Briggs Institute guidelines for systematic reviews of qualitative research. Final synthesis will be assessed using the ConQual (confidence in the output of qualitative research synthesis) approach. The review will include studies focusing on the experiences of children with KRT and their families. These experiences include physical, mental, and social issues, hygiene care, diet, fluid intake, medication, strict infection prevention, delays in growth and development, restrictions on social life, and a lack of social resources. This is an important issue because after starting dialysis, or after KT, many children are treated at home and experience these issues in their local communities and homes. As of May 2025, the authors have conducted 2 pilot searches to test and refine keywords of results with the help of the librarian and have identified 1003 studies for screening in MEDLINE. This systematic review is scheduled to be completed by April 2026. This systematic review synthesizes qualitative evidence regarding the daily life experiences of children and their families after initiating KRT, contributing to the development of a self-care program that enhances their quality of life.
30. Molecular detection of Orientia tsutsugamushi infection in bats from the China-Myanmar border.
期刊: PLoS neglected tropical diseases 发表日期: 2026-Jan-12 链接: PubMed
摘要
Orientia tsutsugamushi (Ot), the causative agent of tsutsugamushi disease (TD), has been detected in Muridae, Soricidae, Cricetidae, Canidae, Artiodactyla, and birds, as well as in its trombiculid mite vectors. However, to date, scarce reports have documented Ot infection in bats. TD is an ancient zoonotic disease transmitted through the bite of infected trombiculid mites. The global disease burden of TD, particularly in impoverished regions, warrants renewed attention and a reevaluation of public health strategies. In this study, we analyzed bat samples for Ot using nested PCR (nPCR) and real-time quantitative PCR (qPCR) for both qualitative and quantitative detection. Genetic evolution and divergence time of the detected Ot sequences were assessed using bioinformatics tools, including BioAider, Clustal X2, MEGA-X, and BEAST. Ot was detected in 7.32% (44/601) of bat samples by qPCR. At least three genotypes, including Karp, Gilliam, and Kato, were identified in both insectivorous bats (Hipposideros larvatus and Hipposideros armiger) and frugivorous bats (Rousettus amplexicaudatus and Cynopterus sphinx). Ot DNA was detected in multiple tissues, including heart, kidney, spleen, lung, rectum, liver, and brain, with median copy numbers ranging from 28.60 to 1069.76 copies/μL. Notably, divergence analysis suggests that Ot isolated from bats emerged around 126 AD, later than its appearance in rodents, humans, and chiggers (approximately 4140 BC), indicating that Ot infection in bats may originate from other animals or vectors. Our findings recommend ongoing monitoring of Ot in bats and their ectoparasites, which will provide a basis for risk assessment and guide strategies for the prevention and control of scrub typhus.
31. Lumpy skin disease virus protein LSDV122 impairs IFN-I receptor complex formation to evade host innate immunity.
期刊: PLoS pathogens 发表日期: 2026-Jan-12 链接: PubMed
摘要
Lumpy skin disease virus (LSDV) is a pathogenic poxvirus that causes systemic disease in cattle. Although LSDV encodes multiple proteins that are predicted to regulate host defense, the underlying mechanisms of its immune evasion strategies remain largely elusive. Here we identify the LSDV-encoded protein LSDV122 as an antagonist of type I interferon (IFN-I)-mediated innate immunity. LSDV122 interacts with both subunits of the IFN-I receptor, IFNAR1 and IFNAR2, disrupting their proper assembly and preventing the recruitment of the downstream kinases JAK1 and TYK2, leading to impairment of IFN-β-mediated JAK-STAT signaling and induction of antiviral IFN-stimulated genes (ISGs). Deletion of the LSDV122 gene (LSDVΔ122) led to stronger antiviral response by restoring IFN-β-induced signaling in vitro and in a mouse model. Our study suggests that LSDV122 plays a critical role in antagonizing IFN-I signaling and is essential for efficient viral immune evasion, offering new insights into the rational design of live-attenuated LSDV vaccines.
32. Temporal trends in physical activity and diet quality among Korean adults (2018-2021).
期刊: Nutrition and health 发表日期: 2026-Jan-12 链接: PubMed
摘要
BackgroundPhysical activity and diet quality are key determinants of chronic disease prevention and overall health. However, their population-level time trends and between-year differences in cross-sectional associations remain underexplored.AimsThis study examined secular trends in physical activity and diet quality among Korean adults from 2018 to 2021 and assessed whether the cross-sectional association between adherence to WHO physical activity guidelines and diet quality varied across survey years.MethodsData were drawn from 18,976 adults aged 19-79 years participating in the Korea National Health and Nutrition Examination Survey. Physical activity was assessed using the Korean version of the International Physical Activity Questionnaire-Short Form and classified according to the WHO guideline (≥150 min/week). Diet quality was measured using the Korean Healthy Eating Index (KHEI). Logistic regression was used to examine the association between physical activity adherence and higher diet quality, adjusting for age, gender, smoking, alcohol use, and body mass index. Meta-regression evaluated the between-year variation in the cross-sectional association.ResultsPhysical activity levels remained stable across survey years, whereas diet quality significantly declined (Plinear = 0.04), particularly among women, non-smokers, alcohol consumers, and individuals with underweight or overweight. In year-specific cross-sectional models, meeting the physical activity recommendation was associated with 31% higher odds of higher diet quality (OR = 1.31, 95% CI = 1.16-2.48, p < 0.001). This association did not significantly change over time.ConclusionsFrom 2018 to 2021, diet quality declined among Korean adults despite stable physical activity levels. Although physical activity adherence was consistently associated with higher diet quality, no significant temporal trends were observed in this relationship.
33. "There are still ways to live a fulfilling life in this incredibly messed up world": Community advice for clinicians working with transgender, nonbinary, and gender-expansive Black, Indigenous, and other people of color with experiences of suicidal ideation.
期刊: Journal of counseling psychology 发表日期: 2026-Jan-12 链接: PubMed
摘要
Transgender, nonbinary, and gender-expansive (TNGE) Black, Indigenous, and other people of color (BIPOC) communities tend to experience alarmingly disparate levels of suicidal ideation and attempts. Such levels of suicidal thoughts and behaviors are exacerbated by systemic exclusion within medical systems and a limited interest within scientific research to center community narratives. To better understand potential avenues of effective crisis intervention and suicide prevention, the present study surveyed 110 TNGE BIPOC participants about their advice to mental health professionals who work with community members experiencing suicidal ideation. Given that much of the extant suicidology literature about TNGE BIPOC tends to be deficit-based, the overarching motive of this study was to recenter information regarding suicide prevention to include the perspectives of TNGE BIPOC community members. A conventional content analysis approach resulted in four major themes and 16 subthemes to guide mental health professionals in the work of self-education, systemic change, clinical intervention, and community. Contributions to counseling in suicide prevention include (a) engaging with self-education as an ongoing process, (b) conceptualizing the clinical role as one of systemic change with therapeutic support that is contextualized within resistance to oppressive systems, and (c) valuing community connection as an integral psychological resource. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
34. Minor influence of climbing hall characteristics on rubber-derived compound contamination highlights a need for material-level solutions.
期刊: Environmental science. Processes & impacts 发表日期: 2026-Jan-12 链接: PubMed
摘要
Climbing shoe abrasion generates fine rubber particles, leading to elevated concentrations of rubber-derived compounds (RDCs) in airborne particulate matter and settled dust of indoor climbing halls, in some cases comparable to levels measured near high-traffic roads. Indoor climbing halls therefore represent a hotspot of RDC exposure for visitors and employees. While the health implications remain uncertain, several RDCs present in climbing halls have demonstrated toxicity in vitro and in animal studies. Previous work, limited to a small number of facilities, left open whether climbing hall characteristics can mitigate RDC contamination. Here, we analyzed more than 200 samples of settled dust and foothold powder (abrasion material) collected from 41 climbing halls across 10 countries. RDCs were detected in every sample, confirming their ubiquity. Unsupervised analyses (hierarchical clustering, principal component analysis) revealed distinct patterns in concentrations and profiles, but supervised approaches (redundancy analysis, partial least squares, univariate correlations) showed only weak associations with hall characteristics. These results demonstrate that hall design and operation exert only a minor influence on RDC levels, underscoring that effective mitigation will require material-level solutions, specifically safe and sustainable-by-design (SSbD) innovations in the material used in climbing shoe soles to replace substances of concern with safer alternatives.
35. Comparative genomics of Borrelia lusitaniae.
期刊: G3 (Bethesda, Md.) 发表日期: 2026-Jan-12 链接: PubMed
摘要
Human Lyme disease is a frequent tick-borne human disease that is caused by several species in the Borrelia burgdorferi sensu lato (BBSL) clade of the bacterial spirochete genus Borrelia. Although Borrelia lusitaniae does not appear to be a major cause of this disease, it has been isolated from human patients. This Borrelia species is unusual in that its vertebrate reservoir includes reptiles in Europe and North Africa. We describe here the complete genome sequences of three B. lusitaniae isolates, PotiB2T (the species type strain) and PotiB3 that represent a Southern Portugal-North African lineage and PoHL1 that represents a Northern Portugal-Central Europe lineage. Like other members of this genus, their genomes include linear chromosomes as well as numerous circular and linear plasmids. Their total genomes contain 1,202,579 bp (PotiB2T), 1,171,499 bp (PotiB3), 1,155,617 bp (PoHL1), and they carry eight (PotiB2T and PotiB3) or six (PoHL1) plasmids. We discuss the differences and similarities of these genomes with other members of the BBSL species group. A most unusual feature of the B. lusitaniae genomes is that their important cp26 plasmids are partially degraded dimers of the cp26 plasmid that is present in all other BBSL isolates analyzed to date. The cp26 plasmid has been shown to be essential for growth of B. burgdorferi sensu stricto B31T. The B. lusitaniae dimer cp26 plasmids carry multiple ospC genes of different types, which is unique to this species. OspC is an important protein that is required for the establishment of mammalian infection by B. burgdorferi B31T and tick salivary gland infection in B. afzelii. It remains unclear how genes of more than one OspC type in one strain might affect the infection process.
36. A new perspective on wastewater phytoremediation: pH-driven cadmium removal by Atriplex halimus L.
期刊: International journal of phytoremediation 发表日期: 2026-Jan-12 链接: PubMed
摘要
Phytoremediation using halophytes provides a sustainable, low-cost method for removing heavy metals from saline-contaminated water. However, the influence of pH on cadmium (Cd) uptake is unclear. This study investigates the combined effects of pH and salinity on Cd uptake and phytoremediation efficiency in the halophyte Atriplex halimus L. A hydroponic experiment was conducted with three pH levels (5.5, 7.0, and 8.5) and two irrigation types (tap and saline water at 20 dS m-1), using 40 µg Cd L-1. Results showed that saline irrigation enhanced plant growth, root development, and Cd accumulation, especially under acidic conditions. The highest Cd removal (39.1%), shoot Cd uptake (10.53 μg plant-1), bioconcentration factor (4.88), and translocation factor (1.18) were observed under saline-acidic conditions, indicating enhanced Cd uptake and efficient translocation to shoots. In contrast, alkaline pH reduced Cd uptake, likely due to decreased exudation of low molecular weight organic acids (citrate, malate, oxalate). Physiological responses, including increased proline and reduced chlorophyll, reflected stress induced by Cd and salinity effects. These findings highlight the importance of pH and root exudates in enhancing halophyte-based phytoremediation and support the use of A. halimus in treating saline wastewater and reclaiming marginal water resources. The results of this study expand on the current understanding of Atriplex halimus as a halophytic phytoremediator by specifically examining its cadmium (Cd) uptake, translocation, and accumulation under a range of pH conditions in both saline and non-saline environments. While previous research has focused on the species’ general tolerance to salinity and heavy metals, this study uniquely evaluates how pH-driven changes in Cd bioavailability and root exudation patterns influence phytoremediation efficiency. It further investigates the interactive effects of salinity and pH on A. halimus physiology to uncover the underlying mechanisms controlling its phytoremediation potential in wastewater-impacted, saline-alkaline or acidic environments.
37. Take control: A two-study evaluation of a self-regulation intervention with randomized controlled trials.
期刊: Journal of occupational health psychology 发表日期: 2026-Jan-12 链接: PubMed
摘要
The way in which people work is changing, with workplaces characterized by greater variations in where, when, and how people work. Across two studies, we evaluated a web-based intervention introducing self-regulation strategies based on Action Regulation Theory to enable workers in hybrid working environments to organize their workday effectively, to manage work and private life demands, and thus to improve work performance (indicated by task performance and proactivity), occupational self-efficacy, and psychological detachment and reduce work-life conflict. In two randomized controlled trials, participants were assigned to an intervention group or a waitlist control group, filling out questionnaires before and after the intervention. In Study 1, using a randomized controlled trial with a convenience sample of 128 German employees (intervention group: n = 65; control group: n = 64) with baseline and two follow-up measurement points, multilevel analyses revealed positive effects on occupational self-efficacy, task performance, and proactivity. Moreover, we found a delayed effect on both work-life conflict and detachment after 2 weeks. In Study 2, in a randomized controlled trial with a sample of 125 Irish employees from one organization (intervention group: n = 59; control group: n = 66), we found positive effects directly after the intervention on occupational self-efficacy and work-life conflict. The results of both studies converge to support the effectiveness of the developed self-regulation intervention. Findings suggest that the intervention is an effective tool for promoting certain aspects of work performance. Furthermore, training self-regulation in the work context can improve occupational self-efficacy and reduce work-life conflict. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
38. Design and validation of the Intervention and Multiphase Training Transfer Assessment Questionnaire (IMTTAQ) for individual, group, and leader occupational health psychology training interventions.
期刊: Journal of occupational health psychology 发表日期: 2026-Jan-12 链接: PubMed
摘要
Training transfer represents a crucial mechanism for understanding how occupational health psychology training interventions achieve their effects, yet no validated instruments exist to systematically assess the implementation process surrounding transfer within well-being-focused contexts. This study develops and validates the Intervention and Multiphase Training Transfer Assessment Questionnaire, designed specifically to capture contextual elements, transfer mechanisms, and behavioral outcomes across the implementation phases of occupational health psychology training interventions. We tested the Intervention and Multiphase Training Transfer Assessment Questionnaire’s psychometric properties, convergent and discriminant validity, and predictive validity using data from a large multinational, multiwave study across 10 organizations (N = 1,966 at T1) in five European countries, with data collected over six time points. Results demonstrated (a) strong psychometric properties, including robust factor structure and temporal reliability, (b) convergent and discriminant validity with expected relationships between subscales, and (c) predictive validity showing that pretraining contextual constructs and training experiences predicted posttraining integration and well-being outcomes. The Intervention and Multiphase Training Transfer Assessment Questionnaire provides a validated tool for systematically assessing training transfer across temporal phases (pretraining, during training, and posttraining integration), enabling researchers and practitioners to evaluate the contextual constructs and mechanisms that facilitate successful workplace learning integration in occupational health psychology interventions. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
39. Factor analysis on the Pittsburgh Sleep Quality Index and the Chalder Fatigue Scale sample of critical care nurses in Saudi Arabia.
期刊: Nutrition and health 发表日期: 2026-Jan-12 链接: PubMed
摘要
BackgroundFatigue and Sleep disturbance are common among healthcare professionals, particularly nurses working in high-acuity clinical environments. Poor sleep quality can lead to cognitive impairment, decreased work efficiency, and compromised patient care. The Pittsburgh Sleep Quality Index (PSQI) is widely utilized to assess sleep quality, and the Chalder Fatigue Scale (CFS) is used to determine fatigue. However, their psychometric properties need validation within specific cultural and occupational contexts.AimThis study aimed to validate the PSQI and CFS among critical care nurses in Saudi Arabia through factor analysis.MethodsAn exploratory and confirmatory factor analysis was conducted using data from a cross-sectional study involving 173 critical care nurses in Saudi Arabia.ResultsThe results of the CFS showed that the Average Variance Extracted values were 0.58 and 0.55, respectively, and all outer loadings of all items for the two components were greater than 0.5. The Kaiser-Meyer-Olkin measure of sampling adequacy for PSQI was 0.675, meeting the minimum threshold (≥0.6). Parallel analysis identified a three-factor structure, explaining 54.9% of the total variance. The total variance explained by the three components of CFS was 54.9%, which exceeded the recommended value of 50% as a general rule.ConclusionThe PSQI and CFS demonstrated validity and reliability among Saudi Arabian critical care nurses, validating their use in assessing fatigue and sleep quality. These steps can help develop policies and interventions that enhance nurses’ health and productivity in high-acuity settings.
40. Clinical assessment of a Near-Infrared spectroscopy device for rapid triage in traumatic brain injury.
期刊: Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia 发表日期: 2026-Jan-11 链接: PubMed
摘要
Traumatic Brain Injury (TBI) poses a significant public health challenge in India, with nearly 2 million cases annually and limited CT availability causing delays in diagnosis. This study evaluated CEREBO®, a machine learning-enhanced near-infrared spectroscopy (mNIRS) device, as a rapid, non-invasive triage tool for TBI. A prospective quasi-experimental study was conducted at AIIMS, New Delhi, enrolling 202 suspected TBI patients. Participants were divided into control (standard care) and experimental (standard care + CEREBO®) groups. CEREBO® findings were compared with CT as the gold standard. Diagnostic performance (sensitivity, specificity, accuracy), time to preliminary diagnosis, and potential of impact on triage decisions were assessed. CEREBO® demonstrated high diagnostic performance with 98% sensitivity, 90% specificity, and 93.9% accuracy for detecting intracranial pathology. In a post-hoc exploratory simulation, using CEREBO®’s negative result as a hypothetical criterion for deferring CT suggested that CT imaging could have been potentially avoided in 82.1% of red (critical condition) cases and 80.6% of yellow (stable but urgent) cases. These simulations also indicated that CEREBO® may help identify patients whose urgency of care could be underestimated by initial triage classification. The NIRS device demonstrated rapid, non-invasive assessment capability across a broad patient population, supporting its potential utility as an adjunct screening tool in resource-limited trauma settings. These findings suggest that the device may help streamline triage, optimize CT utilization, and improve workflow efficiency in high-volume emergency environments.
41. The blue Un/Commons: Tracing new directions in research on outdoor swimming, health and place.
期刊: Health & place 发表日期: 2026-Jan-11 链接: PubMed
摘要
This discussion provides an introduction to our special issue, The Blue Un/Commons: Tracing new directions in research on outdoor swimming, health and place. This introduction provides a rationale and overview of the social and research contexts the special issue is immersed in, including the growing multi-disciplinary literature on the established health and wellbeing swimming benefits of swimming. Our aim is to extend this ‘health and wellbeing’ focus and develop a new research agenda that reflects positive connections, while simultaneously considering critical dimensions of feminist, anticolonial, environmental, posthuman, and inclusionary research. The main sections examine the literature around four core themes; access, risk, the blue commons, and more-than-human water. Access is considered as both a material and affectual component that is shaped by varied permissions/allowances. Risk is considered in terms of relational immersions between bodies and waters that have personal, societal, environmental and cultural dimensions. The idea of a blue (un)commons is critically described in relation to key inclusions and exclusions, recognising wider existential threats around ownership and sustainability. The final theme considers the more-than-human water itself, in terms of nature and mood, cultural and practical knowledges and ecological allyship. The final section of the article identifies significant potential for research about outdoor swimming, health and wellbeing and specifically engages with the potential of future work on diverse swimming bodies, relational swimming spaces, swimming practices, cultures and knowledges, innovative methodological possibilities and swimming as a lifelong health-promoting practice. Uncovering new immersive connections with water promotes the idea of a blue spatial justice as a productive co-collaboration that supports not just human but also planetary wellbeing.
42. Risk of testicular cancer and exposure to welding fumes.
期刊: European journal of public health 发表日期: 2026-Jan-10 链接: PubMed
摘要
The incidence of germ-cell testicular cancer (TC) has increased in recent decades. Current evidence does not indicate a unanimous association between occupational exposure to welding fumes and TC risk. However, most publications do not provide information on exposure levels to welding fumes. We investigated the association between occupational exposure to welding fumes and the risk of TC in a German case-control study (268 cases and 797 control subjects). A measurement-based welding-exposure matrix was used to estimate year-specific exposure values which were linked to job-task descriptions. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated via logistic regression, conditional on study area and 5-year age groups. ORs were adjusted for a history of cryptorchidism, a family history of TC, and ever exposure to metal-working fluids (MWF). Regular welding was associated with an elevated TC risk (OR: 2.26, CI: 0.92-5.53) compared to occasional welding (OR: 1.14, CI: 0.78-1.69). For non-seminoma, there was an indication of a strong association among regular welders (OR: 3.71, CI: 1.08-12.80) and for non-welders using MWFs (OR: 3.39, CI: 1.21-9.53). However, these estimates were based on few exposed cases. We did not observe dose-effect relationships with increasing lifetime exposure to welding fumes, duration, or average intensity. We found an association between regular welding and TC risk based on standardized job-task descriptions, but not when using the year-specific exposure values.
43. Associations of internal exposure to organophosphate esters and their metabolites with cognitive functions in middle-aged and elderly people: the mediating effects of inflammation.
期刊: Environment international 发表日期: 2026-Jan-08 链接: PubMed
摘要
Organophosphate esters (OPEs) are widely used chemicals, whereas the environmental contamination caused by OPEs and their metabolites (mOPEs) leads to human exposure and health risks. In this study, a cross-sectional analysis was conducted to investigate the serum levels of twelve OPEs and six mOPEs in middle-aged and elderly individuals residing in Beijing, China. The association between serum levels of OPEs/mOPEs and cognitive functions, as well as the mediating effect of inflammation, was explored. OPEs and mOPEs were widely detected in serum from 1,061 participants, and median concentrations of ΣOPEs + mOPEs, ΣOPEs, and ΣmOPEs were 48.73, 20.22, and 21.78 pmol/L, respectively. Serum levels of nine OPEs and mOPEs were negatively associated with cognitive scores in the whole population. For these compounds, for every increase of one quartile in their serum levels, cognitive scores reduced by 0.01-0.42 points. Stratified analysis showed that female participants are more sensitive to OPE/mOPE exposure than males. Moreover, educational level, age, and body mass index (BMI) may affect the associations between OPE/mOPE exposure and cognitive function. Two inflammation-related biomarkers, 5-hydroxytryptamine (5-HT) and plasma toll-like receptor 2 (TLR2), showed significant mediating effects in the influence of OPEs/mOPEs on cognitive function. The exposure of some OPEs and mOPEs can reduce cognitive scores by influencing 5-HT and TLR2, with mediating effect ratios to the total effect ranging from 5.4 % to 53.3 %. These findings provide evidence for understanding the impact of OPEs/mOPEs on cognitive function in the aging population.
44. The impact of cannabis co-use and cannabis use disorder on interest in and barriers to tobacco cessation.
期刊: Addictive behaviors 发表日期: 2026-Jan-08 链接: PubMed
摘要
Co-use of cannabis and tobacco is increasing, but its impact on smoking cessation is not completely understood. It is unclear whether any cannabis use, or only problematic use such as cannabis use disorder (CUD), impacts smoking cessation. In 2023, we conducted an online, national survey of US adults (n = 2,271) currently smoking cigarettes. We examined the association of past 30-day cannabis use (divided into three groups: co-use with CUD, co-use without CUD, and no cannabis use) with outcomes that can impact smoking cessation: self-rated importance, readiness, and confidence in quitting, barriers to cessation (Barriers to Cessation Scale, score range 0 to 57), and specific types of barriers (Addiction, Internal, and External barriers subscales). Interest in quitting smoking and self-rated importance was lowest in those with co-use without CUD, but self-rated readiness and confidence did not significantly differ among the three groups. Those with CUD reported the highest levels of barriers overall (total score of 20.3 for co-use with CUD, 15.2 for co-use use without CUD, and 16.4 for no cannabis use) and across all subscales. Adjusted subscale scores were higher for adults with CUD vs. cannabis use without CUD (Addiction: p = 0.03, External: p= 0<.001, Internal: <.001) and vs. no cannabis use (Addiction: p = 0.03, External: p = 0.02, Internal: p < 0.001). Adults who smoke cigarettes and use cannabis (vs. those smoking without cannabis co-use) report similar levels of readiness and confidence in quitting smoking. However, interest in and importance of quitting smoking was lowest in those reporting co-use without CUD and barriers were greatest in those reporting co-use with CUD. These populations may benefit from targeted interventions to address their unique challenges and improve smoking cessation.
45. Epigallocatechin gallate (EGCG) partially prevents elastase-induced mechanical and microstructural changes in the mouse ascending aorta in vitro.
期刊: Journal of the mechanical behavior of biomedical materials 发表日期: 2026-Jan-08 链接: PubMed
摘要
Elastic fibers are critical for proper mechanical function of large arteries such as the aorta. Fragmentation, degradation, or reduced amounts of elastic fibers are associated with aortic diseases such as stiffening-induced hypertension and aneurysms. Epigallocatechin gallate (EGCG) is a plant-based polyphenol that has been shown to increase elastic fiber synthesis, preventing stiffening-induced hypertension and alleviating abdominal aortic aneurysms. EGCG is similar in structure to another polyphenol, pentagalloyl glucose, that has been shown to increase elastic fiber synthesis and prevent elastic fiber degradation. The effects of EGCG on elastic fiber degradation have not been previously investigated. In this study, elastase (ELA) was used to degrade elastic fibers in the mouse ascending aorta and the preventative and restorative potential of EGCG was determined by characterizing the passive, circumferential mechanical behavior and microstructural organization of the aortic wall. EGCG treatment alone had no effect on the mechanical behavior or microstructural organization of the aortic wall. ELA treatment alone resulted in increased aortic diameter, altered aortic compliance, reduced low modulus, increased high modulus, and decreased density of the elastic fiber layers in the wall. EGCG as a preventative treatment before ELA partially prevented the changes in mechanical behavior and wall structure observed with ELA. EGCG as a restorative treatment after ELA did not prevent the changes in mechanical behavior and wall structure associated with ELA. These results suggest that EGCG may be an effective preventative pharmaceutical treatment option for cardiovascular diseases that are characterized by elastic fiber degradation.
46. Synergistic removal of drugs in wastewater from traditional Chinese medicine processing using industrial-scale ozone cavitation.
期刊: Ultrasonics sonochemistry 发表日期: 2026-Jan-07 链接: PubMed
摘要
Traditional Chinese medicine (TCM) production generates wastewater containing high level of morphine, codeine, and other opioids. Our field investigations at TCM factories revealed that existing activated sludge systems, though may be compliant for other chemicals, exhibit limited removal efficiency for these recalcitrant contaminants. Consecutive daily monitoring of effluent showed morphine persistently at concentrations ranging from 37,029-301,623 ng/L due to incomplete biodegradation, posing a significant disruption to aquatic environment and its further wastewater-based surveillance in public security. To address this challenge, we developed an advanced hydrodynamic cavitation-ozonation system (HC/O3), incorporating a novel negative-pressure reactor configuration. Under optimized conditions (1.5 L/min ozone inflow, 4 mg/L ozone concentration), the system achieved 94% removal of morphine within one hour, with a synergy index of 1.46 demonstrating remarkable process enhancement. Distinct from prior laboratory-scale investigations limited to model pollutants, this work validated HC/O3 performance treating six psychoactive substances in compositionally variable TCM wastewater, demonstrating scalability and robustness under real-world operating conditions. Over a 5-day continuous trial with variable influent compositions, the HC/O3 system demonstrated robust adaptability, consistently achieving 99.9% removal of morphine and thebaine within 3 h, specifically at 94% removal for morphine-specific reduction within first hour. The operational costs of 5.38 USD/m3 and energy efficiency reflected in a 1.11 × 10-7 mg/J cavitational yield. This result indicates potential economic viability and technical robustness of this integrated solution for industrial implementation, under the tested conditions. The HC/O3 process establishes a new approach for treating pharmaceutical-laden wastewater, simultaneously reducing environmental risks for aquatic ecosystems and potentially improving the reliability ofwastewater-based surveillance.
47. An Implementation Roadmap to Accelerate Academic Clinical Cancer Research in Portugal: A Multistakeholder Perspective.
期刊: Acta medica portuguesa 发表日期: 2026-Jan-02 链接: PubMed
摘要
48. Feasibility trial of a transdiagnostic individual lifestyle evaluation and intervention (Lev-i) for health behavior change.
期刊: PloS one 发表日期: 2026 链接: PubMed
摘要
Individuals with disabilities face challenges in adopting and maintaining healthy behaviors. Existing interventions are often diagnosis-specific, profession-bound, and limited to single health behaviors, restricting a broader applicability. This study evaluated the feasibility and acceptability of Lev-individual (Lev-i), a transdiagnostic and interprofessional intervention designed to promote health behaviors among individuals with disabilities. This feasibility study was conducted in an outpatient disability healthcare setting, involving 25 adult participants with long-term disabilities. Lev-i consists of three structured sessions focusing on goal setting, motivational strategies, and behavior change techniques that can be used across ten health domains. Data on treatment completion, acceptability and secondary outcomes was collected through self-reports for participants and professionals before, during, and after the intervention. The treatment completion rate was 23 out of 25 (92%), with high treatment satisfaction (M = 3.61 out of maximum 4). Participants reported significant increases in treatment credibility and expectancy of change (6.93 pre, 8.27 post, p < .01), as well as high treatment satisfaction. Professionals rated the intervention as relevant and feasible, though many comments indicated a need for simplification of the study protocol and clearer intervention materials. No serious adverse events were reported. For secondary outcomes, goal attainment scores indicated that participants on average reached their goals. Also, there was a significant improvement in dietary habits (p < .05, d = 0.55), and a non-significant trend toward increased physical activity (d = 0.39). Findings suggest that Lev-i is a feasible and acceptable intervention for promoting health behaviors among individuals with disabilities. However, further refinements may enhance feasibility for both patients and professionals before conducting a randomized controlled trial. ClinicalTrials.gov (NCT05889936).
49. Crowdsourcing is Acceptable to Develop Pre-Exposure Prophylaxis Promotions in Alabama: A Qualitative Study with Sexual Minority Men and Sexual Health Providers.
期刊: Journal of the International Association of Providers of AIDS Care 发表日期: 2026 链接: PubMed
摘要
IntroductionCrowdsourcing engages the community to create and share solutions; this participatory method could be used to create effective pre-exposure prophylaxis (PrEP) promotions. We explored acceptability of using crowdsourcing to develop PrEP promotions among sexual minority men (SMM) and sexual health providers in Alabama.MethodsWe conducted focus group discussions (FGDs) with SMM and interviews with sexual health providers with guides grounded in the Theoretical Framework of Acceptability. We employed thematic analysis through deductive and inductive coding.ResultsTen SMM (60% Black, 50% younger than 30 years) participated in FGDs, and six providers completed interviews. We found four themes: 1) Personal identity and background inform the participation and products of crowdsourcing, 2) SMM and providers are motivated to participate in crowdsourcing, 3) Crowdsourcing participants require resources to effectively engage, and 4) Logistic and social factors are barriers to crowdsourcing participation.DiscussionCrowdsourcing as a strategy to create PrEP promotions in the Southern United states would be acceptable and feasible in the correct context. These formative, yet novel, findings demonstrate that SMM and sexual health providers would be willing to participate in crowdsourcing events and also provide key insight to design crowdsourcing events. Crowdsourcing to Create PrEP Promotions is Acceptable by Gay, Bisexual, and Other Men Who Have Sex with Men and Sexual Health Providers in AlabamaPlain Language SummaryCrowdsourcing is a way to engage community members to participate in solving problems and sharing the solutions back with the community. Pre-exposure prophylaxis (PrEP) effectively prevents HIV. Crowdsourcing to promote PrEP may be a way to better communicate about PrEP to community members, but we do not know how acceptable this would be the community. This study explores how gay, bisexual, and other men who have sex with men and sexual health providers would feel about using crowdsourcing to promote PrEP. To determine this, we conducted FGDs and interviews with participants. We audio-recorded, transcribed, and studied their answers to understand what were the most important aspects. We found that 1) a person’s background influences their participation, 2) community members would be motivated to participate, 3) community members would need resources, like funding or time, to participate, and 4) shame related to sexual health, HIV, LGBTQ+ identity as well as other barriers may prevent some community members from being able to participate. Overall, we found that community members and sexual health providers feel that crowdsourcing could be a good idea to better promote PrEP in the community.
50. Determinants of Non-Adherence to the Mediterranean Diet Among Healthcare Workers: A cross-sectional study.
期刊: La Clinica terapeutica 发表日期: 2026 链接: PubMed
摘要
Healthy eating habits are a key determinant of physical and mental well-being, particularly in the workplace, where individuals spend most of their daily lives. In hospital settings, the intense pace, shift work, and stressful environments often hinder the ability to maintain a balanced diet. Despite the recognized health benefits of the Mediterranean diet, adherence among healthcare workers remains suboptimal, revealing the need to explore the barriers behind this phenomenon. This study aimed to identify the main factors leading to non-adherence to the Mediterranean diet among healthcare workers and to assess the impact of organizational, psychological, and social variables on dietary behaviour. A cross-sectional study was carried out among overweight and obese employees of the Policlinico Umberto I Teaching Hospital and Sapienza University of Rome. Participants, who had previously discontinued a Mediterranean diet program, completed an ad hoc semi-structured questionnaire exploring four domains: dietary management, stress and motivation, professional support, and social context. Data were analysed to identify variables significantly associated with non-adherence. Thirty-eight workers participated in the study. Non-adherence was significantly correlated with work-related stress (p<0.013), unrealistic goals (p<0.014), and a hectic lifestyle (p<0.035). Social isolation during lunch breaks also reduced motivation (p<0.049), while dietary rigidity was not perceived as a barrier. Adherence to the Mediterranean diet among healthcare workers is mainly influenced by psychosocial and organizational factors rather than by the diet itself. Integrated interventions combining nutritional education, stress management, and supportive workplace environments are essential to promote lasting healthy behaviours and overall well-being.
51. The role of probiotics in modulating the gut microbiota as a potential inhibitor of diabetic kidney disease progression.
期刊: Jornal brasileiro de nefrologia 发表日期: 2026 链接: PubMed
摘要
Gut dysbiosis is commonly observed in patients with diabetic kidney disease (DKD) and may contribute to its pathogenesis. Among microbial metabolites, butyrate plays a key role in regulating antioxidant proteins in type 2 diabetes mellitus (T2DM). Based on this, we hypothesized that the administering probiotics to diabetic rats modulates redox status and thereby attenuates renal disease progression. An in vivo study was performed using 15 male Wistar rats (8 weeks old, 250-300 g) randomized into three groups (n = 5/group): Control (vehicles: 0.9% saline and 0.1 M citrate, pH 4.2, i.p., on day 1), T2DM (nicotinamide 100 mg/kg, i.p., followed by streptozotocin 60 mg/kg, i.p., in 0.1 M citrate buffer, pH 4.2), and T2DM + Prob (T2DM protocol plus a multistrain probiotic-Bifidobacterium longum, Bifidobacterium bifidum, and Lactobacillus rhamnosus-1010 CFU/mL by gavage for 6 weeks). The parameters evaluated were: serum creatinine, inulin clearance, microalbuminuria, urinary and lipid peroxides, glutathione, and nuclear factor erythroid 2-related factor 2 (Nrf2). Probiotic treatment significantly increased Nrf2 expression and glutathione levels, reduced urinary and lipid peroxidation, and-beyond attenuating oxidative stress-improved renal function, with lower serum creatinine and microalbuminuria and higher inulin clearance. These findings indicate that probiotics prevented DKD progression, likely by modulating oxidative stress via the gut microbiota. These results suggest that probiotics may serve as renoprotective agents, potentially reducing DKD morbidity in T2DM.
52. Tuberculosis screening and care delivery in pregnant and postpartum persons living with HIV in Botswana.
期刊: PLOS global public health 发表日期: 2026 链接: PubMed
摘要
Tuberculosis (TB) disease during pregnancy, particularly in persons living with HIV (PLHIV), is associated with poor maternal and neonatal outcomes. There are barriers to TB screening and care for PLHIV in the pregnant and postpartum period given atypical clinical presentation and service delivery challenges. Our objective was to understand barriers and facilitators to TB screening and care delivery during routine antenatal and postpartum care in Botswana government health centers among PLHIV and healthcare providers. In this mixed methods study conducted between April 2022 and November 2023, quantitative data was collected from PLHIV on frequency of TB screening at their antenatal and postpartum government health center visits. At a 2-month postpartum study visit, PLHIV were screened for TB symptoms by study staff, using the World Health Organization TB symptom screen, and referred to their local government health center if positive. Qualitative data was obtained from semi-structured interviews with maternal participants, who screened positive for TB and were referred to government clinics for evaluation, and medical staff from referral clinics. Ninety-five pregnant and postpartum PLHIV consented to study participation. Of the 95 pregnant PLHIV, 9 participants were referred to their local government health facility after screening positive for TB symptoms; 8 of these participants participated in qualitative interviews, along with 9 medical staff. TB screening and care facilitators and barriers for maternal and medical staff participants were identified according to the environmental and population level guided by Andersen’s Behavioral Model. Facilitators to TB screening and care included HIV diagnosis, pregnancy, and proximity to clinics. Barriers included challenges with diagnostic workup, resource limitations, and knowledge gaps. Our findings highlight challenges of TB screening and care for pregnant and postpartum PLHIV. Further studies are needed to evaluate interventions to improve and support TB screening and care delivery for pregnant and postpartum PLHIV.
53. Developing a rehabilitation intervention difficulty index: A mixed-methods study using NASA-TLX and Borg RPE in a tertiary clinical setting.
期刊: PloS one 发表日期: 2026 链接: PubMed
摘要
Rehabilitation difficulty varies substantially across clinical areas and intervention types, yet few brief, standardised measures exist to quantify difficulty from the therapist’s perspective. Understanding rehabilitation difficulty is important for workforce planning, resource allocation, and identifying contexts where therapist support is most needed. To develop and preliminarily evaluate the Rehabilitation Intervention Difficulty Index (RIDI), a mixed-methods measure combining cognitive/affective and physiological dimensions of rehabilitation difficulty, and to identify contextual factors associated with high difficulty. Quantitative component: 441 rehabilitation sessions from 28 therapists across 12 clinical areas were assessed using the NASA Task Load Index (NASA-TLX; four items: mental demand, temporal demand, effort, frustration) and Borg Rating of Perceived Exertion (RPE). The RIDI was constructed as the mean of the NASA composite score and normalised Borg RPE (0-10 scale). Psychometric properties were evaluated using Cronbach’s alpha and exploratory factor analysis. Descriptive statistics, one-way ANOVA, Pearson correlations, and intervention-level summaries were performed. Qualitative component: Semi-structured interviews and focus groups with 20 therapists (10 individual interviews, 10 focus-group participants; 11 physiotherapists, 9 occupational therapists) were conducted across selected clinical areas in the same hospital. Thematic analysis identified key sources of rehabilitation difficulty. Qualitative and quantitative findings were integrated through joint display analysis. Quantitative findings: RIDI showed good internal consistency for the NASA items (α = 0.80, 95% CI [0.77, 0.83]) and acceptable consistency for the five-item set (α = 0.75, 95% CI [0.72, 0.78]), with a unidimensional factor structure explaining 52% of the variance. RIDI scores differed significantly across clinical areas (F = 9.18, p < 0.001, η² = 0.19), with higher scores in neurorehabilitation and acute neuro settings (both 5.80) and lower scores in outpatient physical therapy (3.63). Among frequently used interventions (n ≥ 5), transfer training and splinting had the highest RIDI scores (6.78 and 6.71), while passive range of motion had the lowest (2.68). RIDI was moderately correlated with session duration (r = 0.28, p < 0.001) but not with therapist experience (r = 0.01, p = 0.78).Qualitative findings: Six themes described sources of difficulty: time demands (78 coded segments, 18 participants), cognitive demands (72, 18), physical demands (65, 17), patient-related factors (57, 16), environmental constraints (44, 15), and coping strategies (33, 14). No substantially new themes were identified after approximately 70% of the data, suggesting thematic saturation.Mixed-methods integration: High RIDI scores in neuro and acute inpatient areas converged with qualitative descriptions of heavy time, cognitive, and physical demands. Coping strategies were discussed much less often in high-RIDI areas (8 segments) than in lower-RIDI areas (23 segments), suggesting that in the most demanding contexts therapists may have fewer opportunities to apply deliberate coping strategies. RIDI showed acceptable reliability and preliminary evidence of construct validity as a therapist-reported measure of rehabilitation difficulty that captures both cognitive/affective and physiological aspects of workload. Variation in RIDI scores across clinical areas and interventions was consistent with meaningful differences in perceived difficulty. The under-representation of coping strategies in high-RIDI contexts suggests that high rehabilitation difficulty may require structural and organisational responses-such as staffing, workflow redesign, and environmental modifications-rather than relying primarily on individual coping. RIDI may provide a practical tool for identifying high-demand areas, informing workforce planning, and targeting support where it is most needed.
54. Hyperbaric oxygen therapy in alleviating cerebral ischemia-reperfusion injury via the BMP6/Smad-hepcidin pathway.
期刊: PloS one 发表日期: 2026 链接: PubMed
摘要
Cerebral ischemia-reperfusion injury (CCI) is a cause of neurological damage. Hyperbaric oxygen therapy (HBOT) can improve recovery in CCI in relation to iron metabolism and ferroptosis, but the precise mechanisms remain unclear. This study aims to explore the neuroprotective effects of HBOT in CCI and its regulator of iron homeostasis via BMP6/Smad-Hepcidin signaling pathway. Male Wistar rats were divided into Control (CT), Ischemia-Reperfusion (GM), Ischemia-Reperfusion + Normobaric Hyperoxia (NH), and Ischemia-Reperfusion + HBOT (HO) groups. The CCI model was induced by four-vessel occlusion. HBOT was administered at 2.5 ATA for 120 minutes daily for 5 days. Neurological function was assessed using the modified neurological severity score, light-dark box, and Morris Water Maze test. Histopathological analysis, transmission electron microscopy, Nissl and TUNEL staining, oxidative stress markers, Western blotting and qPCR were used to assess neuronal damage, mitochondrial integrity, necrosis, apoptosis, oxidative stress, iron metabolism and BMP6/Smad-Hepcidin mRNA expression and protein concentrations. HBOT significantly improved neurological function, reduced neuronal damage, and preserved mitochondrial integrity compared to untreated animals. Oxidative stress markers, including malondialdehyde and antioxidant enzyme activities were significantly restored. HBOT also downregulated the BMP6/Smad-Hepcidin pathway, leading to decreased hepcidin levels. Western blot and qPCR analysis confirmed the suppression of ferroptosis-related markers in the HBOT group. HBOT significantly reduces neurological deficits, neuronal damage, and oxidative stress in CCI injury. Its neuroprotective effects are likely mediated by the regulation of the BMP6/Smad-Hepcidin pathway and the suppression of ferroptosis. These findings suggest that HBOT is a promising therapeutic strategy for treating CCI.
55. Attitudes, needs and expectations regarding the application of AI in occupational healthcare: a multiple stakeholder perspective.
期刊: Journal of occupational and environmental medicine 发表日期: 2025-Dec-05 链接: PubMed
摘要
To explore attitudes, needs, and expectations of employees, employers, and occupational health professionals regarding the application of AI in occupational healthcare. 23 semi-structured interviews were conducted between May and December 2024. Data were analysed using thematic analysis. Five themes were identified: scepticism about the feasibility of using AI, perceived benefits of using AI, chances for improving quality of care, unfamiliarity leading to more reserved attitudes, and need for clarity about actionable perspectives. There is an urgent need from all stakeholders for clear, actionable perspectives on AI-outcomes, such as predictions of future sick leave. Future research should explore these actionable perspectives, ensuring they are acceptable to all stakeholders and maximize occupational health benefits. Due to unfamiliarity, a longer period of co-creation with stakeholders is recommended when developing AI tools for occupational healthcare.
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
Data accessibility and interoperability across the U.S. Alzheimer’s Disease Research Centers (ADRCs) provides necessary resources and data access to enable novel hypothesis testing without additional data collection and will allow end users to rapidly advance our understanding of multiple pathologies or multiple chronic conditions on disease progression within Alzheimer’s disease and related diseases. The aim of the current study was to integrate plasma data from the National Centralized Repository for Alzheimer’s Disease and Related Dementia’s (NCRAD) with ADRC neuroimaging data from the SCAN initiative and National Alzheimer’s Coordinating Center Uniform Data Set (NACC UDS) demographic data, all publicly available through the NACC Data Platform and Data Front Door. We provide sample descriptives and present the results of initial data explorations. The NACC and NCRAD data request procedures were completed to gain access to the data. We focused on the subset of participants for whom Quanterix Simoa HD-X Alzpath plasma pTau217 data was available (NCRAD). Amyloid pathology was defined based on centiloid values (cut-off >= 20; SCAN initiative). Demographic information was available for all participants (NACC UDS). We integrated data using the NACC identifier and visit age where available. We used Spearman correlations to assess the association between plasma pTau217 and centiloid values and we used ROC analyses to assess amyloid classification performance. Plasma pTau217 data was available for 927 participants (sample descriptives in Table 1). Figure 1 shows the distribution of plasma pTau217 levels across diagnostic groups. In the subset of participants for whom amyloid PET was available (n = 170, Table 1), the Spearman correlation between plasma pTau217 levels and centiloid values was 0.59. Quanterix pTau217 accurately classified amyloid status with a ROC AUC of .92 (95%CI 0.89-0.97; accuracy 85%; Figure 2). Tau PET was available for 135 participants with plasma pTau217 data and 114 participants with both plasma pTau217 and amyloid PET data. Combining the SCAN PET and NCRAD plasma results in a promising resource, already with 36% demographic diversity. Sample sizes will increase through ongoing efforts as part of the SCAN initiative and the ADRC Consortium for Clarity in ADRD Research Through Imaging (CLARiTI).
57. Night shift work and breast cancer risk in healthcare workers: a systematic review and meta-analysis.
期刊: Occupational medicine (Oxford, England) 发表日期: 2025-Dec-01 链接: PubMed
摘要
Healthcare workers (HCWs) are often exposed to night shift work, which may increase cancer risk. We conducted a systematic review and meta-analysis on night shift work and breast cancer risk in HCWs. We systematically searched PubMed/Embase, evaluated the risk of bias (RoB) of the included studies, and estimated pooled relative risks (RR) using random-effects models. Twelve studies were included (12 132 breast cancer cases); 60% of these were rated as ‘definitely’ or ‘probably’ high RoB in the exposure characterization domain. Compared to never exposure, pooled RRs were 1.05 (95% confidence interval [CI] 0.96-1.14, 12 studies, I2 = 39%) for ever, and 1.11 (95% CI 0.96-1.28, 9 studies, I2 = 62%) for ≥10 years, 1.25 (95% CI 1.01-1.55, 7 studies, I2 = 59%) for ≥20 years, and 1.68 (95% CI 0.77-3.65, 3 studies, I2 = 79%) for ≥30 years of night shift work. Pooled RRs were higher in case-control/nested studies and studies assessing lifetime occupational history. The RR for ≥20 years of exposure lost statistical significance in influence analysis and approached unity after correction for possible publication bias. Long-term night shift work may increase breast cancer risk in HCWs, but the association is far from established. If this association were real, night shift work would be responsible for a substantial number of breast cancers in HCWs.
58. Reframing Stress Management Competency in the Hybrid Era: Time for Multisource Validation and Cultural Adaptability.
期刊: Occupational medicine (Oxford, England) 发表日期: 2025-Dec-01 链接: PubMed