公共卫生研究摘要 (2026-01-15)
共收录 57 篇研究文章
1. Deregulation is Terrorism.
期刊: New solutions : a journal of environmental and occupational health policy : NS 发表日期: 2026-Feb 链接: PubMed
摘要
2. Piezo1 dictates K+ homeostasis through coordinated regulation of the ubiquitin ligase Kelch-like 3 in RBCs and the kidney.
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
The maintenance of potassium (K+) balance is a fundamental biological process involving multiple tissues. However, the roles of intertissue crosstalk in K+ homeostasis remain poorly understood. Here, we demonstrate that the mechanosensor Piezo1 dictates extracellular K+ homeostasis by orchestrating the ubiquitin ligase Kelch-like 3 (KLHL3) activity in red blood cells (RBCs; erythrocytes) and the kidney. Genetic variants within KLHL3 with expression quantitative trait locus effects are associated with altered RBC parameters, and CRISPR-generated KLHL3 knock-in (KLHL3-KI) mice carrying a nonphosphorylatable Ala substitution at its activation site (Ser433) reveal that KLHL3 regulates erythrocyte volume by modulating with-no-lysine 1 (WNK1). In wild-type, but not in KLHL3-KI, erythrocytes, Piezo1 activates KLHL3 through Ser433 dephosphorylation, reducing WNK1 abundance and intracellular K+ content-a physiologically adaptive response to hypo-osmotic stress. KLHL3-KI mice exhibit hyperkalemia and reduced fractional K+ excretion, accompanied by elevated WNK levels and reduced renal outer medullary K+ (ROMK) abundance in collecting ducts of the kidney. Single-cell transcriptomics confirm coexpression of Piezo1 and KLHL3 in these segments, where Piezo1 regulates WNK abundance through KLHL3-Ser433 dephosphorylation. In human genetic studies of 200,367 UK Biobank participants, the PIEZO1 missense variant rs563555492 (p.L2277M) is independently associated with lower urinary K+. Piezo1-mediated WNK1 regulation is abolished in human kidney cells expressing Piezo1L2277M. Causal role of Piezo1 in regulating K+ excretion and ROMK was confirmed in vivo. These findings identify Piezo1-KLHL3 interaction as a key intertissue signaling mechanism between erythrocytes and the kidney that governs K+ homeostasis, and suggest this pathway as a therapeutic target for dyskalemia.
3. Negative feedback regulation of alcohol ingestion through the FGF21-PVH oxytocin-VTA dopamine system.
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
Alcohol has a notable negative impact on global health. Understanding its physiological regulation is crucial to addressing alcohol use. Here, we show that FGF21-oxytocin neurons in the paraventricular nucleus of the hypothalamus (PVHOXT)-dopamine neurons in the ventral tegmental area (VTADA) negatively regulate the drive to drink alcohol. Alcohol induces FGF21 signaling, which activates PVHOXT and induces oxytocin release in the VTA. The VTADA neurons are activated hours after alcohol ingestion, which reduces the drive to drink alcohol, extends the interdrink interval, and thereby reduces alcohol consumption. The system is downregulated in a mouse model of alcohol dependence, and activating the system with FGF21-inducing sugars reduces alcohol ingestion and prevents binge drinking and alcohol dependence. Therefore, FGF21-inducing nutraceuticals can substitute for alcohol by supplementing the FGF21-PVHOXT-VTADA negative feedback signal to attenuate alcohol-related behaviors in mice.
4. Changes in pulmonary function and airway mechanics with increased serum osmolality.
期刊: Journal of applied physiology (Bethesda, Md. : 1985) 发表日期: 2026-Jan-14 链接: PubMed
摘要
Dehydration and associated increases in plasma osmolality have been shown to decrease pulmonary function. The suggested mechanism is a decline in small airway function and premature airway closure caused by increased osmolality, but this has not been directly tested. The purpose of this study was to measure pulmonary function, closing capacity, and maximal flow-static recoil curves pre- and post-infusion of isotonic and hypertonic saline in men (n = 7) and women (n = 7) with an exploratory comparison between sexes. We found that the hypertonic saline infusion significantly increased serum osmolality (287 ± 3 vs. 311 ± 17 mOsm/kg H2O; p < 0.001) leading to decreases in forced vital capacity and forced expired volume in 1 second (4.6 ± 1.1 and 3.9 ± 0.9 L, respectively) compared to pre-infusion (4.8 ± 1.1 and 4.1 ± 0.9 L, respectively; p = 0.002 - 0.02) with no effect of sex (p = 0.06 - 0.39). There was a significant main effect of time for residual volume, closing volume, and closing capacity such that following both isotonic and hypertonic saline these values were increased compared to pre-infusion (p = 0.001 - 0.033). Additionally, maximal flow for a given lung recoil pressure was decreased following hypertonic saline infusion. Thus, pulmonary function decreased following increased serum osmolality and this change may be caused by small airway dysfunction and premature airway compression and closure.
5. Expectations vs Reality of an Intraoperative Artificial Intelligence Intervention.
期刊: JAMA surgery 发表日期: 2026-Jan-14 链接: PubMed
摘要
Having significant gaps between the expectations and reality of artificial intelligence-based programs can be a major barrier to successful implementation. This is the first multisite implementation assessment of gaps between surgeon expectations and real-world effects of the Operating Room Black Box, a novel intervention that leverages artificial intelligence to improve surgical outcomes. To identify barriers and facilitators to implementing artificial intelligence-based interventions that improve intra- and postoperative care. This qualitative study was conducted at 3 large academic centers via semistructured interviews with surgeons and implementation leaders of the AI intervention to identify areas where expectations of the technology misaligned with their experiences. Thirty surgeons and 17 implementation leaders from 3 centers that implemented the AI intervention were interviewed. Data were collected and analyzed between 2021 and 2024. Implementation of the AI intervention. The primary outcome was areas of misalignment between participant expectations of the AI intervention technology and actual program deliverables. Of 30 surgeons and 17 implementation leaders interviewed, most surgeons (17 [57%]) were between the ages of 35 and 50 years, and implementation leaders were older, typically between 51 and 80 years old (6 [35%]). Eight surgeons (27%) and 4 implementation leaders (24%) were female. Most surgeons (17 [57%]) had neutral views of the technology, 11 (37%) expressed positive views, and 2 (7%) had negative views. Interviewees identified the following 4 major themes that highlighted misalignment between user expectations and the experience of using the technology: (1) the artificial intelligence model needed considerable additional training to be usable; (2) accessing data on surgical cases was difficult and time consuming; (3) the program showed limited ability to predict postoperative complications; and (4) the program generated few academic deliverables. Per the results of this multisite qualitative study, successfully implementing interventions based on artificial intelligence may require deliberate efforts to minimize gaps between what surgeons expect from the interventions and what they can deliver. Our evaluation of this study’s AI intervention offers lessons for addressing this critical barrier to implementation.
6. Mental Disorders as a Risk Factor of Acute Coronary Syndrome: A Systematic Review and Meta-Analysis.
期刊: JAMA psychiatry 发表日期: 2026-Jan-14 链接: PubMed
摘要
Mental disorders have been associated with traditional cardiovascular risk factors that may mediate the risk of acute coronary syndrome (ACS). To estimate the association of ACS among patients with mental disorders, as compared with patients without mental disorders. MEDLINE, Embase, and PubMed were searched for studies between July 1, 2025, and date of database inception. Study screening was performed in duplicates with conflicts resolved upon consensus. Inclusion criteria were as follows: (1) observational or randomized study, (2) measured association with ACS (incident events, risk ratio, odds ratio, hazard ratio [HR]), and (3) investigated any clinical mental disorder (based on DSM and International Classification of Diseases) before ACS events. This systematic review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. Data extraction was performed in duplicate and resolved on consensus. Data were quantitatively synthesized through random-effects meta-analysis. The National Institutes of Health Study Quality Assessment Tools were used to assess the quality of included studies. Studies were analyzed from January 1966 to October 2021. Association and/or risk of ACS. Among 3616 initially identified studies, 25 full-text articles met inclusion criteria with 22 048 504 participants of median (IQR) age 48.0 (34.5-56.1) years, with 13 019 897 males (59.1%). Depressive disorder (HR, 1.40; 95% CI, 1.11-1.78; P = .01; Grading of Recommendations Assessment, Development, and Evaluation [GRADE] certainty = very low), anxiety disorder (HR, 1.63; 95% CI, 1.40-1.89; P < .001; GRADE certainty = low), sleep disorder (HR, 1.60; 95% CI, 1.22-2.10; P < .001; GRADE certainty = low), and posttraumatic stress disorder (PTSD; HR, 2.73; 95% CI, 1.94-3.84; P < .001; GRADE certainty = moderate) were associated with increased risk of ACS. Bipolar (HR, 1.48; 95% CI, 0.47-4.61; P = .28; GRADE certainty = very low) and psychotic (HR, 0.97; 95% CI, 0.01-178.30; P = .06; GRADE certainty = very low) disorders were not significantly associated with increased risk of acute myocardial infarction, although they had similar point estimates to some other mental disorders. Results of this systematic review and meta-analysis suggest that depressive disorders, anxiety disorders, PTSD, and sleep disorders were associated with an increased risk of ACS. Particularly, PTSD and sleep disorders emerged as significant risk factors for ACS, indicating the potential impact of sleep quality on cardiovascular outcomes. Future research addressing these limitations could provide more nuanced insights into the association between mental health and ACS.
7. Trends in County-Level Childhood Vaccination Exemptions in the US.
期刊: JAMA 发表日期: 2026-Jan-14 链接: PubMed
摘要
This study examines US county-level trends in nonmedical and medical exemptions to childhood vaccination requirements.
8. A novel approach to characterise the energy cost of human cool-seeking behaviour and its individual variability during heat stress.
期刊: American journal of physiology. Regulatory, integrative and comparative physiology 发表日期: 2026-Jan-14 链接: PubMed
摘要
Behavioural thermoregulation (e.g. cool-seeking) is thought to proceed autonomic heat-loss responses (e.g. sweating), due to energy-conservation requirements. However, the energy cost of cool-seeking behaviours in humans has been rarely quantified. Here we present a novel approach to characterise the energy cost of a common human cool-seeking behaviour (i.e. manual fanning) and its individual variability during heat stress. Ten healthy males (20±1y) participated in two 60-min trials (CONTROL and FAN) consisting of resting exposure to 37(±0.4)°C and 44(±6)% RH. During FAN, participants freely used a hand-held fan instrumented with an accelerometer, to offset thermal discomfort. During CONTROL, no fan was provided. We measured energy expenditure (breath-by-breath gas analysis), core temperature (Tc), mean skin temperature (T¯sk), forehead Tsk, microclimate (next-to-skin) relative humidity (RH¯sk), heart rate (HR), and thermal discomfort during both trials; and used FAN accelerometery data to characterise cool-seeking behaviour’s onset, duration, bout frequency, and work rate. Seven participants engaged with self-fanning, which varied individually in onset time (mean: 12:30 mm:ss [range: 00:49-30:19]), total duration (05:54 mm:ss [01:04-17:53]), and bouts (6 [1-17]), but not work rate (308±51 strokes·min-1). Energy expenditure did not differ between FAN vs. CONTROL in those who fanned (433±28 vs. 447±64 KJ; p=0.993), nor time-dependent changes in Tc, T¯sk, RH¯sk, and HR. Our results indicate that our novel approach, which combine accelerometery (to quantify movement patterns) and indirect calorimetry (to measure associated energy expenditure), is both feasible and effective in quantifying the energetic cost of voluntary, behaviourally mediated thermoregulatory actions, and their individual variability during heat stress.
9. Prediabetes, Subclinical Myocardial Injury or Stress, and Heart Failure Risk for Adults With Hypertension.
期刊: JAMA cardiology 发表日期: 2026-Jan-14 链接: PubMed
摘要
It is unclear whether and the extent to which subclinical myocardial injury or stress coexisting with prediabetes is associated with the risk of heart failure (HF). To evaluate the joint associations of prediabetes and subclinical myocardial injury or stress with incident HF risk. This post hoc prospective cohort study analyzed data from the Systolic Blood Pressure Intervention Trial (SPRINT). Two analytic samples were used: (1) adults with hypertension without diabetes or prior HF for the baseline biomarkers analysis and (2) participants with biomarker measurements at both baseline and 12 months for the longitudinal biomarkers’ change. Prediabetes was defined as a fasting plasma glucose level of 100 to 125 mg/dL. Subclinical myocardial injury was defined as a high-sensitivity cardiac troponin I (hs-cTnI) level of 6 ng/L or higher in men and 4 ng/L or higher in women and subclinical myocardial stress defined as an N-terminal pro-B-type natriuretic peptide (NT-proBNP) level of 125 pg/mL or higher. A 25% or greater increase in any biomarker concentration from baseline to 12 months defined longitudinal change. Data were analyzed between January 1 and May 31, 2025. The primary outcome was adjudicated incident HF. Cox proportional hazards models were used to estimate hazard ratios (HRs) for HF across joint categories of prediabetes and biomarker elevation. Of 8234 participants (mean [SD] age, 68 [9] years; 37.1% women), 3271 (39.7%) had prediabetes, 2942 (35.7%) had subclinical myocardial injury, and 3593 (43.6%) had subclinical myocardial stress. Over a median follow-up of 3.2 years (IQR, 2.8-3.8 years), 122 participants developed HF. Compared with normoglycemia and no myocardial injury, those with both prediabetes and injury had the highest HF risk (HR, 4.20; 95% CI, 2.31-7.63); similar findings were observed for myocardial stress (HR, 5.20; 95% CI, 2.52-10.70). In the longitudinal analysis (median follow-up, 2.3 years [IQR, 1.9-2-8 years]), 7449 participants with both prediabetes and a 25% or greater increase in hs-cTnI or NT-proBNP level had the highest risk of HF (for hs-cTnI: HR, 3.05; 95% CI, 1.58-5.88; for NT-proBNP: HR, 2.39; 95% CI, 1.28-4.46). These findings suggest that among adults with hypertension, prediabetes in combination with subclinical myocardial injury or stress is associated with a significantly elevated risk for HF. These findings support the integration of glycemic status and cardiac biomarkers profiling to improve HF risk stratification and guide prevention.
10. Soluble Urokinase Plasminogen Activator Receptor (suPAR) Mediates the Impact of Diabetes on Adverse Outcomes in Coronary Artery Disease.
期刊: Diabetes care 发表日期: 2026-Jan-14 链接: PubMed
摘要
Type 2 diabetes (T2D) is a significant risk factor for adverse outcomes in coronary heart disease (CHD). We investigated whether inflammation and immune dysregulation, measured using soluble urokinase plasminogen activator receptor (suPAR) and high-sensitivity C-reactive protein (hs-CRP) levels, mediate this risk. Patients with and without CHD enrolled in the Emory Cardiovascular Biobank had suPAR (ViroGates, Denmark) and hs-CRP levels measured and were followed for 1) cardiovascular death, 2) a composite of incident myocardial infarction and cardiovascular death, and 3) all-cause death. Fine and Gray or Cox proportional hazards models adjusted for demographic, clinical, and treatment variables were used. Regression-based causal mediation analyses were performed. A total of 4,324 participants (mean [SD] age 64 [11.9] years, 36% women, 31.8% with T2D) were followed for a median of 6.9 years. SuPAR levels were higher in those with T2D (median [interquartile range] 3,260 [2,503-4,463] vs. 2,792 [2,217-3,600] pg/mL). T2D was associated with a higher adjusted risk (hazard ratio [HR] 1.38; 95% CI 1.16, 1.63; P < 0.001) of cardiovascular death that was greatly attenuated (HR 1.18; 95% CI 0.99, 1.40; P = 0.1) after adjustment for suPAR, but not hs-CRP, levels. Similar findings were observed for the other outcomes. SuPAR, but not hs-CRP, levels mediated >50% of the effect of T2D on adverse outcomes. The impact of T2D on adverse outcomes is significantly mediated through chronic inflammation and immune dysregulation, estimated using suPAR levels. Whether novel therapies for reducing suPAR levels will impact CHD risk in T2D warrants further investigation.
11. Tracking the Pulse of Suicidology in Southeast Asia: A Bibliometric Analysis.
期刊: Omega 发表日期: 2026-Jan-14 链接: PubMed
摘要
This study presents the first comprehensive bibliometric analysis of suicidology research in Southeast Asia, examining 255 documents retrieved from the Scopus database spanning 1954 to 2025. The analysis explores publication trends, key authors, institutions, countries, journals, keyword patterns, and citation metrics. Findings indicate a notable surge in suicidology research between 2022 and 2024, likely driven by the mental health aftermath of the COVID-19 pandemic. Malaysia emerged as the most productive country, followed by Singapore and Thailand. Keyword analysis revealed “suicide”, “adult”, “adolescent”, “suicidal ideation”, and “suicide attempt” as dominant terms, reflecting both epidemiological priorities and ethical feasibility in research. Further, regional advancements such as the decriminalisation of attempted suicide in Singapore and Malaysia contributed to a more supportive research environment. This analysis provides valuable insights into the regional research landscape and offers strategic guidance for future studies, collaborations, and policy development tailored to Southeast Asia’s unique socio-cultural and mental health contexts.
12. Implications of Eliminating Medicare's Inpatient Only List.
期刊: JAMA surgery 发表日期: 2026-Jan-14 链接: PubMed
摘要
This Viewpoint describes the safety, access, and financial risks of eliminating Medicare’s Inpatient Only list and proposes that the Centers for Medicare & Medicaid Services instead strengthen their review process.
13. Understanding the Impact of Psychosocial Barriers on Colorectal Cancer Knowledge in Emerging Adult Black Men.
期刊: Journal of cancer education : the official journal of the American Association for Cancer Education 发表日期: 2026-Jan-14 链接: PubMed
摘要
In the United States, Colorectal Cancer (CRC) is one of the most commonly diagnosed cancers and the third leading cause of death among non-Hispanic African American/Black (henceforth Black) men. Inadequate CRC knowledge leads to missing early warning signs, delaying prevention and increasing risk. Emerging adulthood (18-25) is a key period for building healthy behaviors and addressing barriers to CRC knowledge in addition to understanding attitudes and practices to CRC screening. Psychosocial barriers - including social support, medical mistrust, and perceived racial discrimination - contribute to the lack of CRC knowledge among older Black men, yet emerging adult Black men remain understudied. The present study examined psychosocial barriers to CRC knowledge among emerging adult Black men. Additionally, although not screening eligible, a secondary aim was to examine how these psychosocial barriers play a role CRC attitudes and preventive practices. One hundred sixty-eight men (Mage = 20.4, SD = 1.73) were recruited in Petersburg, Virginia. Participants completed a survey assessing social support, medical mistrust, and perceived racial discrimination, CRC knowledge, and CRC practice items. Data was analyzed using SPSS v.29. A hierarchical regression, controlling for age, public assistance status, and masculinity, examined social support, medical mistrust, and perceived racial discrimination. Contrary to hypothesis, higher medical mistrust predicted greater CRC knowledge, p = 0.003, while increased social support also predicted greater CRC knowledge, p < .001. Perceived racial discrimination did not significantly predict CRC knowledge. Logistic regressions showed that higher masculinity health problem minimization and perceived racial discrimination predicted significantly lower odds of considering early CRC screening. No variables significantly predicted early detection. Findings provide critical understanding of barriers and facilitators of CRC knowledge among emerging adult Black men. Addressing barriers during emerging adulthood may encourage healthier behaviors and foster motivation to seek CRC knowledge, ultimately supporting prevention in this high-risk population. Results are critical for informing culturally age-tailored prevention strategies.
14. A Method for Comparing Health Inequality Impact Magnitudes, with an Illustration for Hypothetical Treatments of 1336 Diseases.
期刊: PharmacoEconomics 发表日期: 2026-Jan-14 链接: PubMed
摘要
We aimed to facilitate the comparison and communication of magnitudes of health inequality impact across interventions for different diseases, and to indicate the potential range of such impacts. We propose rescaling the slope index of inequality to measure the health inequality impact as the change in the gap in total predicted quality-adjusted life-years between the least and most socially disadvantaged groups, with linear regression predictions used to account for effects on intermediate groups. We suggest reporting the inequality impact relative to the total health opportunity cost to facilitate comparison across interventions varying in scale and unit costs. We illustrated the approach with aggregate distributional cost-effectiveness analyses of hypothetical treatments for 1336 diseases in England. We approximated benefit shares for neighbourhood deprivation quintile groups using disease-specific hospital admissions. We tested between-group equality using generalised linear regression and constructed uncertainty intervals using Monte Carlo simulation. We assumed an equal total health opportunity cost and benefit-cost ratio of one, with alternative scenarios in a sensitivity analysis. Health inequality impacts of hypothetical treatments ranged from - 33.1% of the total health opportunity cost (inequality increasing) to + 45.3% (inequality decreasing), and were ≤ - 5% for 1.6% of diseases, ≥ + 5% for 41.8% and ≥ + 20% for 1.6%. The impact was positively associated with the benefit-cost ratio and decreased when more deprived groups were assumed to incur proportionately more total health opportunity costs. Health inequality impacts can be compared using the change in the total predicted quality-adjusted life-year gap between the least and most socially disadvantaged groups as a proportion of the total health opportunity cost.
15. Machine learning in the development and application of patient-reported outcome measures (PROMs) for surgical patients: a systematic review.
期刊: Journal of patient-reported outcomes 发表日期: 2026-Jan-14 链接: PubMed
摘要
Artificial intelligence (AI) and machine learning (ML) are increasingly integrated into healthcare, offering potential advancements in patient-reported outcome measures (PROMs) for surgical populations. Improved PROMs can enhance patient-centered care by accurately capturing patient experiences with minimal burden. In the context of surgery, where recovery trajectories vary widely, this study aims to systematically review the use of AI and ML in the development, application, and prediction capabilities of PROMs in surgical populations, with a focus on psychometric properties and the predictive accuracy of post-surgical outcomes. A comprehensive search of the PubMed database was conducted from inception until August 2024. Studies were included if they utilized AI or ML in the development, application, or predicting PROMs for surgical patients. Methodological quality was assessed using COSMIN and PROBAST tools, depending on study design. A qualitative synthesis of findings was performed. Twenty-two studies met the inclusion criteria, with 19 rated as high quality. Six studies focused on developing computer adaptive tests (CAT) PROMs, seven on evaluating psychometric properties, and five on ML for post-surgical outcome prediction. CAT PROMs showed comparable measurement accuracy to traditional PROMs, good to excellent construct validity, and significantly reduced patient burden by reducing the length of questionnaires. ML algorithms, such as logistic regression, random forests, extreme gradient boosting, and neural networks, achieved similar predictive accuracy for post-surgical outcomes, with no single model demonstrating consistent superiority. AI and ML have the potential to improve PROM utilization in surgical care by enhancing efficiency and personalization while maintaining data quality. Clinicians can use AI-driven PROMs to reduce patient burden and integrate ML models for accurate post-surgical outcome prediction, thereby optimizing patient-centered care.
16. Moving forward, leaving the patients behind? A multilevel assessment framework for evaluating patient-centred, integrated care quality.
期刊: Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation 发表日期: 2026-Jan-14 链接: PubMed
摘要
Many current care assessment frameworks prioritise clinical and organisational outcomes over patient perspectives. This study aimed to identify gaps in existing patient-centred assessment methods and to develop a multilevel framework aligning quality evaluation with patient-defined priorities across macro (policy), meso (organisational), and micro (individual) levels, and technological levels. We used a primarily qualitative design, conducting a literature review of patient-centred integrated care assessment studies and integrating these findings with a longitudinal case study that examined how the patient’s perspectives were documented across multiple health information systems, synthesising evidence on existing practices with insights into how patient perspectives are integrated and represented for a comprehensive understanding. In total, 32 studies were included. The review revealed ongoing misalignment between systemic evaluation practices and patient-defined outcomes, particularly for individuals with complex physical and mental health needs. Minimal patient involvement in developing evaluation criteria reflected a disconnect between policy-level targets and individual patient well-being. This misalignment was echoed in the case study, which underscored that personal goals and non-clinical needs were often unrecorded, highlighting the gap between evaluation metrics and genuinely patient-centred care. Integrated care quality assessment remains misaligned with patient-defined outcomes. We propose Patient-Reported Integrated Measures (PRIMs) as a conceptual contribution. PRIMs complement existing Patient-Reported Outcome Measures (PROM) and Patient-Reported Experience Measures (PREM) by capturing multidimensional outcomes that matter to patients and ensuring evaluation aligns with their goals. Integrating PRIMs into health information systems and research agendas can realign care evaluation with evolving patient priorities, thereby reducing the risk of leaving patients behind in future healthcare reforms.
17. Estimation of 'spectrum value': A discrete choice experiment to investigate the willingness-to-pay for narrow-spectrum based on other antimicrobial characteristics.
期刊: Applied health economics and health policy 发表日期: 2026-Jan-14 链接: PubMed
摘要
Narrow-spectrum antimicrobials are likely to drive fewer antimicrobial resistances. However, they may be more expensive than broad-spectrum alternatives. To determine the preferences of antimicrobial stewardship (AMS) experts regarding antimicrobial choice relative to relevant pharmacological and economic attributes, and how those attributes impact their willingness-to-pay for narrow-spectrum of activity. Two discrete choice experiments (DCEs), consisting of six pharmacological and economic attributes, were administered via an online survey to Australian infectious disease physicians, clinical microbiologists and hospital AMS pharmacists. Respondents were asked to complete each DCE from a public hospital perspective, assuming 100 or 1000 patients would be treated each year, respectively. A conditional logit model was used to analyse the DCE data. 155 respondents participated in one or both DCEs. Antimicrobial price, spectrum of activity, administration route, and public funding significantly affected drug choice in both scenarios (p < 0.001). Whether the antimicrobial was a novel class did not significantly impact choice. As the price of a narrow-spectrum antimicrobial increased, it became less preferred compared to a broad-spectrum cheaper alternative. With all other attributes being equal, participants were willing to pay an additional AU$862 for the narrow-spectrum option (95% CI $726-$998). While narrow-spectrum antimicrobials are preferred for targeted therapy by health practitioners with AMS expertise, price significantly influenced drug choice. Willingness-to-pay values reflect the knowledge and experience of AMS experts who are best-placed to gauge the opportunity costs of paying more for narrow-spectrum antimicrobials. These findings can inform the quantification of spectrum-value for health-system funding decisions.
18. Examining the effectiveness of the PAX-GOOD BEHAVIOUR GAME in improving the mental health and academic outcomes of FIRST NATIONS children in Canada: a clustered randomized controlled trial using administrative data.
期刊: Social psychiatry and psychiatric epidemiology 发表日期: 2026-Jan-14 链接: PubMed
摘要
PAX Good Behaviour Game (PAX-GBG), a school-based mental health promotion approach, has been shown to improve children’s mental health and academic outcomes. Given that these effects have yet to be shown in Indigenous populations, a partnership with First Nations communities was created to evaluate PAX-GBG’s effectiveness among First Nations children living in Canada. In this clustered randomized controlled trial, we used population-based administrative data that allowed de-identified individual-level linkages. Our cohort from 20 First Nations schools was assigned to PAX-GBG (n = 468) or wait-list control (n = 255). We used multi-level regression modeling and propensity score weighting to estimate group differences in mental health and academic outcomes over time (2011-2020). PAX-GBG group children had significantly greater decreases in conduct problems (β:-1.08, standard error(se):0.2505, p < .0001), hyperactivity-inattention (β:-1.13, se:0.3617, p = .0018), and peer problems (β:-1.10, se:0.3043, p = .0003) and a greater increase in prosocial scores (β:2.68, se:0.4139, p < .0001) than control group children. The percentage of PAX-GBG group children meeting academic expectations was higher than control group children. However, only third-grade numeracy (odds ratio (OR):4.30, confidence interval (CI):1.34 - 13.77) and eighth-grade reading and writing (OR:2.78, CI:1.01 - 7.67) were statistically significant. We found no evidence that PAX-GBG was associated with less emotional problems, diagnosed mental disorders, or greater student engagement or mathematics. These findings suggest that PAX-GBG is a promising intervention in improving First Nations children’s mental health and academic outcomes. What remains unclear is whether these findings are generalizable to all First Nations and how adding supports for program implementation would influence these findings.
19. [Rethinking patient-centered care through an intersectional lens: pathways to health equity].
期刊: Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz 发表日期: 2026-Jan-14 链接: PubMed
摘要
Patient-centered care takes into account the individual needs of patients and promotes participatory decision-making. In order for this concept to be implemented, it must recognize the diversity of social realities. This is countered by discrimination based on assumptions and exclusion, which affects the healthcare system at the personal, structural, and institutional levels. Discrimination impedes equitable care, for example with regard to gender, sexual orientation, language barriers, legal access, or social status. An individually oriented patient-centered approach must have an intersectional understanding of experiences of discrimination in order to recognize barriers and address them in care. Discrimination is not only an ethical problem, but also generates avoidable costs. International and national approaches are increasingly calling for marginalized groups to be placed at the center of patient-centered care and for inequities in care to be taken into account. There are already numerous initiatives that incorporate the knowledge and experiences of marginalized groups into the design, methodology, and implementation of health-related interventions. It is also important to professionalize the healthcare staff and, thus, also the structural competence in the institutions. The routine collection of data on health inequities and experiences of discrimination supports the development and implementation of concrete strategies. Research, healthcare, and health policy are three central fields of action to which concrete changes must be linked in order to enable equal patient-centered care. HINTERGRUND: Patientenzentrierung berücksichtigt individuelle Bedürfnisse der Patient*innen und fördert partizipative Entscheidungen. Damit dieses Konzept umgesetzt werden kann, muss es die Vielfalt gesellschaftlicher Lebensrealitäten anerkennen. Dem steht Diskriminierung, die auf Zuschreibungen und Ausgrenzungen basiert und im Gesundheitswesen auf personaler, struktureller und institutioneller Ebene wirkt, entgegen. Versorgungsungerechtigkeit wird durch Diskriminierung verhindert, zum Beispiel in Hinblick auf Geschlecht, sexuelle Orientierung, Sprachbarrieren, den rechtlichen Zugang oder sozialen Status. Eine individuell orientierte Patientenzentrierung muss ein intersektionales Verständnis für die Diskriminierungserfahrungen mitbringen, um Barrieren zu erkennen und diese in der Versorgung adressieren zu können. Diskriminierung ist zudem nicht nur ein ethisches Problem, sondern produziert vermeidbare Kosten. Internationale und nationale Ansätze fordern zunehmend, marginalisierte Gruppen in den Fokus der Patientenzentrierung zu rücken und (soziale) Ungleichheiten in der Versorgung zu berücksichtigen. Es gibt bereits zahlreiche Initiativen, die das Wissen und die Erfahrungen von marginalisierten Gruppen in die Konzeption, Methodik und Umsetzung gesundheitsbezogener Interventionen einbeziehen. Zudem ist es wichtig, das Fachpersonal und damit auch die strukturelle Kompetenz in den Institutionen zu professionalisieren. Die routinemäßige Erfassung von Daten zu gesundheitlichen Ungleichheiten und Diskriminierungserfahrungen unterstützen die Entwicklung und Umsetzung von konkreten Maßnahmen. Wissenschaft, Gesundheitsversorgung und Politik sind drei zentrale Handlungsfelder, an die konkrete Veränderungen zu knüpfen sind, um eine gleichberechtigte Patientenzentrierung zu ermöglichen.
20. Private equity in ophthalmology: geographic trends reveal urban-rural disparities in acquisitions and satellite expansion.
期刊: Graefe’s archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie 发表日期: 2026-Jan-14 链接: PubMed
摘要
To investigate post-pandemic private equity (PE) acquisition trends among U.S. ophthalmology and optometry practices from 2022 to 2024, emphasizing rural versus urban distribution and subspecialty services. Retrospective cross-sectional study. A total of 550 PE-backed acquisitions of ophthalmology and optometry practices from 2011 to 2024 were identified in the Pitchbook database. All practices were categorized using the Rural-Urban Commuting Area (RUCA) system, with codes 1-3 defined as urban and 4-10 as rural. Subspecialties (e.g., retina, optometry, oculoplastic, etc.) were assigned based on company websites. Data collection included primary practice locations, last financing dates, and any satellite practices linked to acquired companies. Statistical analysis including linear regression and analysis of variance for comparison of variables was performed to assess acquisition trends, subspecialty distribution, and geographic expansion patterns with a significance level of a P value < 0.05. Annual acquisition counts, urban vs. rural classification, and subspecialty coverage. Between 2011 and 2024, 85% of all PE acquisitions targeted urban practices, and acquisitions grew markedly from 2016 to 2021 before peaking in 2021. After that peak, acquisitions declined from 71 in 2022 to 27 in 2024; 96% of the 2022-2024 acquisitions were urban. Geographic analysis showed the Southern region received the highest proportion of recent acquisitions (50%) during 2022-2024, while the Midwest, West, and Northeast received 16%, 19%, and 15% respectively (P = 0.19). Subspecialty distribution indicated that retina, oculoplastic, cataract, and optometry services were most offered by acquired practices, particularly in urban areas. Satellite expansions further demonstrated a strong urban focus, resulting in a threefold higher number of urban satellites compared with rural ones (P = 0.03). Private equity activity continues to favor urban, subspecialty-rich practices, while rural investments remain limited. As overall deal volume has declined since 2021-likely influenced by rising interest rates and pandemic-related economic factors-further research is needed to clarify how PE ownership affects care quality, patient outcomes, and practice sustainability. Addressing rural-urban disparities in ophthalmic and optometric care delivery may require targeted policy interventions to ensure equitable access for all patients. WHAT IS KNOWN? : Prior to 2021, private equity acquisitions of ophthalmology and optometry practices grew rapidly, predominantly targeting urban, subspecialty-rich practices under historically low interest rates. Geographic and specialty-based patterns in PE acquisitions have previously favored high-volume, multispecialty urban practices. WHAT IS NEW? : From 2022-2024, PE acquisitions declined sharply, yet most of those deals remained urban, with rural acquisitions remaining stagnant. The southern U.S. accounted for 50% of all post-pandemic acquisitions, while optometry, retina, and oculoplastic practices continued to dominate PE interest.
21. Scoping review of regulatory transparency in AI-based radiology software: analysis of PMDA-approved SaMD products.
期刊: Japanese journal of radiology 发表日期: 2026-Jan-14 链接: PubMed
摘要
22. DMOG Enhances hUC-MSCs Paracrine Activity to Promote Endometrial Epithelial Cells Reconstitution Via VSELs Formation in Ovariectomized Mice.
期刊: Stem cell reviews and reports 发表日期: 2026-Jan-14 链接: PubMed
摘要
Estrogen deficiency-induced uterine atrophy is a major cause of menstrual disorders and infertility in postmenopausal women and patients with premature ovarian failure. However, current hormone replacement therapies carry long-term risks and fail to achieve physiological endometrial regeneration. It has been demonstrated that dimethyloxalylglycine (DMOG) can augment the therapeutic effects of mesenchymal stem cells (MSCs), but the effects of DMOG-pretreated MSCs on Estrogen deficiency-induced uterine atrophy remain unclear. This study aimed to explore whether DMOG-pretreated human umbilical cord MSCs (hUC-MSCs) could repair estrogen deficiency-induced uterine atrophy. The results showed that compared with the MSCs group, the DM group significantly improved the disordered estrous cycle of ovariectomy (OVX) mice, increased serum estradiol (E2) levels, and restored uterine morphology and index, and facilitated the recovery of endometrial thickness and gland number. Masson staining confirmed that the DM group had a more significant reduction in endometrial fibrosis. Immunofluorescence demonstrated enhanced expression of Oct-4 and Nanog in the DM group, which suggests that DMOG-pretreated hUC-MSCs may exert paracrine effects to promote the formation of VSELs, thereby facilitating the remodeling of endometrial epithelial structure. This provides a novel and effective strategy for the treatment of estrogen deficiency-related uterine atrophy.
23. Ten-year changes in risk factors for requiring treatment of retinopathy of prematurity in extremely low birth weight infants: a multicenter study in Tokyo.
期刊: Japanese journal of ophthalmology 发表日期: 2026-Jan-14 链接: PubMed
摘要
To investigate 10-year changes in risk factors associated with treatment required for retinopathy of prematurity (ROP) in extremely low birth weight infants. Retrospective cohort study. Data for extremely low birth weight infants born in 2011 (Group 1) and those born in 2020-2021 (Group 2) were extracted from the Neonatal Research Network of Japan, with a total of 564 cases. The frequency of ROP treatment-related risk factors and results of multivariate analyses were compared between the two groups. Missing data in covariates were handled using multiple imputation. Group 2 had a significantly lower birth weight (p=0.038), gestational age (p=0.037), and Apgar scores (p<0.001), than Group 1. The frequencies of resuscitation with intubation (p=0.030), oxygen therapy beyond 36 weeks’ postmenstrual age (p<0.001), chronic lung disease (p=0.012), gastrointestinal perforation (p=0.030), and red blood cell transfusion (p=0.018) were higher in Group 2 than in Group 1. However, the incidence and treatment rate of ROP decreased over time. The multivariate analysis shows that mechanical ventilation for 60 days or more is a strong independent risk factor for ROP treatment in Group 1, but this effect disappeared in Group 2. Birth weight and gestational age of extremely low birth weight infants born in Tokyo have decreased significantly compared with 10 years previously, and the severity of ROP has not increased. Advances in respiratory management may have contributed to reducing the risk of developing severe ROP.
24. Mobilizing community-led health promotion: Evidence-informed co-development of the Live Well PEI community mobilization platform and integrated granting program.
期刊: Canadian journal of public health = Revue canadienne de sante publique 发表日期: 2026-Jan-14 链接: PubMed
摘要
Live Well PEI provides individuals and organizations in PEI with information and tools to support healthy behaviours. This paper describes the development of the Live Well PEI community-mobilization intervention, consisting of a website and integrated community granting program for health promotion initiatives. (1) What is an effective design of a web-based community-mobilization intervention for community-led health promotion and (2) what lessons can be learned and shared for community-engaged, evidence-informed public health intervention development? Intervention development followed the Six Steps in Quality Intervention Development (6SQuID) process. Through literature reviews, jurisdictional scans, expert consultations, and community engagement, evidence for conditions that foster community mobilization was gathered and used to inform development of intervention components. The intervention was refined through iterative expert and community consultations. Four conditions that foster community-led health promotion were identified: accessibility of grant funding, availability of community data, resources to enhance capacity, and community collaboration. These conditions informed outputs of a Theory of Change. Intervention design that supports these conditions included website elements such as collections of evidence-informed health promotion interventions, stories of prior community-led projects, and community health status and needs information. The granting program integrates research and community feedback on project eligibility, grant administration and support for awardees. Findings from an evaluability assessment support pilot-testing implementation of the intervention. Development of the community-mobilization intervention provides a prime case example of evidence-informed, community-engaged public health intervention co-design. Learnings are applicable to community-focused health promotion initiatives across Canada. RéSUMé: INTERVENTION: Mieux vivre Î.-P.-É. fournit aux particuliers et aux organisations de l’Île-du-Prince-Édouard des informations et des outils pour favoriser des comportements sains. L’article décrit l’élaboration de l’intervention de mobilisation communautaire qu’est Mieux vivre Î.-P.-É., qui comprend un site web et un programme intégré de subventions communautaires pour des initiatives de promotion de la santé. QUESTIONS à L’éTUDE: 1) Qu’est-ce qu’une conception efficace d’intervention de mobilisation communautaire en ligne pour la promotion de la santé menée par les communautés? 2) Quels enseignements peuvent être tirés et partagés pour l’élaboration d’interventions de santé publique fondées sur des données probantes et impliquant les communautés? MéTHODES: L’élaboration de l’intervention a suivi le processus en six étapes pour l’élaboration d’interventions de qualité (6SQuID). Grâce à des analyses documentaires, des analyses de ce qui se fait ailleurs, des consultations d’experts et la participation des communautés, des données probantes sur les conditions favorables à la mobilisation communautaire ont été recueillies et utilisées pour éclairer l’élaboration des composantes de l’intervention. L’intervention a été affinée grâce à des consultations itératives avec des experts et les communautés. RéSULTATS: Quatre conditions favorisant la promotion communautaire de la santé ont été établies: l’accessibilité de subventions, la disponibilité de données communautaires, des ressources pour accroître la capacité et la collaboration communautaire. Ces conditions ont étayé les extrants d’une théorie du changement. Le concept d’intervention appuyant ces conditions comprenait des éléments du site Web, comme des interventions de promotion de la santé fondées sur des données probantes, des résumés de projets communautaires antérieurs et des renseignements sur la santé communautaire et les besoins. Le programme de subvention intègre la rétroaction de scientifiques et de communautés sur l’admissibilité des projets, l’administration des subventions, et le soutien aux personnes ou entités subventionnées. Les constatations d’une évaluation de l’évaluabilité appuient la mise en œuvre d’un essai pilote de l’intervention. CONCLUSION: La conception de l’intervention de mobilisation communautaire fournit un exemple type de conception d’intervention en santé publique sollicitant les communautés et fondée sur des données probantes. Les leçons tirées s’appliquent à des initiatives de promotion communautaire de la santé partout au Canada.
25. HRS Degradation-Induced Nicotinamide Deficiency in Placental Extracellular Vesicles Triggers Preeclampsia by Disrupting Maternal-Fetal Immune Homeostasis.
期刊: Advanced science (Weinheim, Baden-Wurttemberg, Germany) 发表日期: 2026-Jan-14 链接: PubMed
摘要
Preeclampsia (PE) is closely associated with alterations in placental extracellular vesicles (pEVs), but the mechanisms and their role in PE pathogenesis remain unclear. This study reveals that nicotinamide (NAM) levels in PE-derived pEVs (PE-EVs) are lower than in pEVs from normal pregnancies, correlating with disease severity. Functionally, NAM in pEVs inhibits Th1 differentiation via SIRT1 suppression and Th17 differentiation via macrophages. NAM-deficient pEVs exhibit reduced capacity to inhibit Th1 and Th17 cell differentiation both in vitro and in vivo, leading to PE-like symptoms. NAM is enriched in pEVs compared to placental villous tissue and maternal serum. The lower NAM in PE-EVs is due to decreased hepatocyte growth factor-regulated tyrosine kinase substrate (HRS) expression in trophoblasts, which loads NAM into the cargo of multivesicular bodies (MVBs) via binding to the tryptophan-115 residue of HRS. Furthermore, the reduction of HRS in PE trophoblasts results from ubiquitination and degradation by elevated HSP27. Collectively, these findings indicate that elevated HSP27 in PE trophoblasts leads to the degradation of HRS, a reduction in pEV NAM levels, and diminished Th1 and Th17 inhibitory effects, thereby contributing to the development of PE.
26. Secreted exosomes induce filopodia formation.
期刊: eLife 发表日期: 2026-Jan-14 链接: PubMed
摘要
Filopodia are dynamic adhesive cytoskeletal structures that are critical for directional sensing, polarization, cell-cell adhesion, and migration of diverse cell types. Filopodia are also critical for neuronal synapse formation. While dynamic rearrangement of the actin cytoskeleton is known to be critical for filopodia biogenesis, little is known about the upstream extracellular signals. Here, we identify secreted exosomes as potent regulators of filopodia formation. Inhibition of exosome secretion inhibited the formation and stabilization of filopodia in both cancer cells and neurons and inhibited subsequent synapse formation by neurons. Rescue experiments with purified small and large extracellular vesicles (EVs) identified exosome-enriched small EVs (SEVs) as having potent filopodia-inducing activity. Proteomic analyses of cancer cell-derived SEVs identified the TGF-β family coreceptor endoglin as a key SEV-enriched cargo that regulates filopodia. Cancer cell endoglin levels also affected filopodia-dependent behaviors, including metastasis of cancer cells in chick embryos and 3D migration in collagen gels. As neurons do not express endoglin, we performed a second proteomics experiment to identify SEV cargoes regulated by endoglin that might promote filopodia in both cell types. We discovered a single SEV cargo that was altered in endoglin-KD cancer SEVs, the transmembrane protein Thrombospondin Type 1 Domain Containing 7A (THSD7A). We further found that both cancer cell and neuronal SEVs carry THSD7A and that add-back of purified THSD7A is sufficient to rescue filopodia defects of both endoglin-KD cancer cells and exosome-inhibited neurons. We also find that THSD7A induces filopodia formation through activation of the Rho GTPase, Cdc42. These findings suggest a new model for filopodia formation, triggered by exosomes carrying THSD7A. Cell migration is a crucial process that underpins both healthy functions – such as organ and blood vessel development, and the formation of synaptic connections between neurons – and pathological events like cancer metastasis. For cells to migrate, they must reorganize their cytoskeleton to form specialized structures that support their movement. This reorganization includes filopodia, which are slender protrusions that play key roles in sensing directional cues at the leading edge of migrating cells and initiating contact with other cells. The extracellular signals that trigger the formation of filopodia remain poorly understood, but recent research suggests that extracellular vesicles may be involved in this process. Also known as exosomes, these vesicles are membrane-enclosed particles that carry proteins, lipids, and nucleic acids between cells, representing an alternative mode of cellular communication. McAtee et al. aimed to determine whether exosomes could also promote filopodia formation. They studied two distinct systems: cancer cells, where filopodia facilitate metastasis, and rat neurons, where they promote synapse formation. In both contexts, exosomes emerged as potent, general regulators of filopodia formation, indicating a broad role in controlling this fundamental cellular behavior. Using genetic inhibition of exosome secretion, combined with add-back of extracellular vesicles, McAtee et al. demonstrated a direct causal relationship between exosomes and filopodia formation. In neurons, filopodia matured into dendritic spines – critical structures for synaptic connectivity between neurons. A quantitative analysis of neurons confirmed that exosomes indeed promoted the formation of dendritic spines and synapses. They also identified the exosomal protein THSD7A as key in driving filopodia formation in both neurons and cancer cells. Moreover, in cancer cells, the secretion of THSD7A-containing exosomes, filopodia formation, cell migration, and metastatic colony formation were regulated by a growth factor receptor known as endoglin. The study by McAtee et al. highlights a novel role for extracellular vesicles in filopodia formation, enhancing our understanding of how cells migrate in health and disease. Interestingly, both molecules identified as cargoes of filopodia-regulating exosomes are associated with disease: endoglin with hereditary hemorrhagic telangiectasia, and THSD7A with a kidney disease called secondary membranous nephropathy. This suggests that dysregulation of filopodia may occur in these conditions. Furthermore, endoglin and/or THSD7A could serve as potential targets for anti-cancer therapies. Indeed, some promising investigations have already employed anti-endoglin antibodies to inhibit metastasis.
27. Intravitreal Administration of a Selective HDAC6 Inhibitor Prevents Retinal Damage Progression in the Acute Ocular Toxoplasmosis Model.
期刊: ACS infectious diseases 发表日期: 2026-Jan-14 链接: PubMed
摘要
Ocular toxoplasmosis (OT), caused by Toxoplasma gondii, is the leading cause of retinochoroiditis worldwide, with particularly severe cases in Brazil. The treatment used for OT is the combination of cotrimoxazole and corticosteroids. However, this therapy includes prolonged treatment, resistance to circulating strains, and cytotoxic effects for patients. The intensification of the inflammatory response against T. gondii can exacerbate retinal tissue damage. In this study, the HDAC6 inhibitor Tubastatin A was evaluated by intravitreal injection in the murine ocular toxoplasmosis model. Tubastatin A has presented anti-T. gondii activity and an interesting potential for immunoregulation in the approach to eye disease. The inhibition of HDAC6 interferes with the establishment of infection by blocking the recruitment of the host cell cytoskeleton, which is necessary for the active entry of tachyzoites. After 5 days of treatment, Tubastatin A prevented the progression of lesions in the infected retina from the 10th postinfection day. Tubastatin A restored retinal tissue barriers and regulated the HDAC6-Hsp90 pathway, leading to decreased VEGF and HSF1 expression, which may help prevent neovascularization observed in OT patients. A single intravitreal dose of Tubastatin A established an anti-inflammatory microenvironment that supported retinal tissue homeostasis. Tubastatin regulated micro- and macroglial activation, reduced immunolabeling of Iba1 and GFAP (glial fibrillary acidic), and decreased the secretion of IL-12, IL-4, and IL-17A, key cytokines associated with OT pathology. The combination of Tubastatin A with antifolates may be a viable new treatment regimen to protect retinal tissue and prevent blindness in patients.
28. Diacetyl-induced occupational lung disease: insights from two cases.
期刊: Clinical toxicology (Philadelphia, Pa.) 发表日期: 2026-Jan-14 链接: PubMed
摘要
Occupational exposure to diacetyl may cause severe respiratory diseases, including bronchiolitis obliterans. Research has focused on diacetyl vapor exposure, but the risk from diacetyl-containing powder may also be problematic. We investigated two cases of occupational lung disease in workers at a flavor manufacturing facility. Two cases of occupational lung disease caused by diacetyl exposure were identified in workers at a flavor manufacturing plant in China, including one case of bronchiolitis obliterans. Both workers developed severe obstructive lung disease after short-term exposure to diacetyl-containing flavoring powder. The two patients and existing literature show that workers exposed to diacetyl-containing flavoring powder are at higher risk of occupational lung disease, particularly obliterative bronchiolitis, compared to unexposed workers. Case study findings suggest the lung damage from powder exposure may be underestimated. The likely mechanism involves hydrated particles releasing diacetyl directly onto bronchiolar epithelial cells, triggering local inflammation and abnormal fibrosis. Key knowledge gaps include validating particle-mediated release in vivo, characterizing aerosol properties beyond size and quantifying diacetyl in powder. Inhalation of diacetyl-containing flavoring powder may play a more critical role in occupational lung disease than exposure to diacetyl vapor alone, but the underlying injury mechanisms remain poorly understood.
29. Cellular and Molecular Signals of Cardiac Wound Healing After Myocardial Infarction.
期刊: American journal of physiology. Heart and circulatory physiology 发表日期: 2026-Jan-14 链接: PubMed
摘要
Wound healing after myocardial infarction (MI) is a dynamic and multifaceted process that links the molecular alterations induced by or in response to prolonged ischemia with structural and physiological changes to the damaged myocardium. Changes, at the tissue level, are driven by a complex intersection of cellular and molecular mechanisms that operate along a classic wound healing paradigm as an attempt to repair the damaged myocardium and restore cardiac physiology. Maladaptive healing prevents a return to the original homeostasis, rather yielding a myocardium reset to a new homeostatic status that can lead to heart failure due to compromised contractility, increased chamber dilation, and cardiac fibrosis or due to sudden cardiac death resulting from arrhythmias. This review summarizes our current knowledge of how key inflammatory drivers in the myocardium (cardiomyocytes, neutrophils, monocytes/macrophages, fibroblasts, and vascular endothelial cells) respond to molecular signals including cytokines, growth factors, and proteases to coordinate the wound healing process in the mouse model of MI. We also identify knowledge gaps that remain in our understanding of cardiac remodeling that are opportunities for future examinations.
30. Therapeutic Efficacy of Mesenchymal Stem Cells (MSCs) on Alzheimer's Disease: Review of Clinical Results.
期刊: Tissue engineering and regenerative medicine 发表日期: 2026-Jan-14 链接: PubMed
摘要
Alzheimer’s disease (AD) presents significant unmet medical needs with no effective therapeutic options. Current pharmacological treatments provide only symptomatic relief and do not prevent the ongoing neurodegeneration. Cell therapies using mesenchymal stem cells (MSCs) are being widely investigated for its potential in treating AD but remain unverified. This review aimed to evaluate therapeutic effects of MSCs on AD patients through a review of clinical trial literatures. Publications and registered clinical trials from January 2011 to June 2025 were collected from the international databases (ClinicalTrials.gov, PubMed, Web of Science, SCOPUS) using the keywords of “Alzheimer’s disease”, “mesenchymal stem cells”, and “clinical trials”. After initial screening and sorting, 17 clinical trials and 4 related papers were finally selected for in-depth analysis. The 17 clinical trials were mostly early stages with 4 phase 1 (23.5%), 9 phases 1/2 (52.9%), 3 phase 2 (17.7%), and 1 pilot phase (5.9%). The source of MSCs included allogeneic umbilical cord blood (UCB) in 5 trials (29.4%), autologous adipose tissue in 4 (23.5%), allogeneic umbilical cord (UC) in 3 (17.6%), allogeneic bone marrow (BM) in 3 (17.6%), allogeneic placenta in 1 (5.9%) and 1 unknown (5.9%). Administration routes were primarily intravenous (IV) infusion in 12 trials (70.6%), intracerebroventricular (ICV) infusion via Ommaya reservoir in 3 (17.6%), and stereotactic brain injection (SBI) in 2 (11.8%). Among the 17 clinical trials, outcome data of 7 trials have been reported in 4 clinical papers and 1 clinical results posted in ClincalTrials.gov: 4 trials using UCB MSCs (NEUROSTEM-AD) in 2 papers, 2 trials using BM MSCs (Lomecel-B) in 2 papers and 1 trial using adipose MSCs (AstroStem) in ClinicalTrials.gov. All 5 reports using different cell types, administration routes or dosages claimed the safety of MSCs administration. As for the therapeutic efficacy, 2 reports using Lomecel-B reported meaningful improvement in AD pathophysiology or cognitive functions, while the other 3 reports using NEUROSTEM-AD or AstroStem failed to show statistically significant efficacy. The analysis of 17 clinical trials and 5 relevant clinical outcomes showed that MSCs therapy if feasible and generally safe in AD patients. There are indications of potential therapeutic benefits such as improved cognitive function or quality of life measures in some AD patients. However, its therapeutic efficacy has not been proven definitely due to small size of subjects, variations in dosage, MSCs source, and administration scheme (route, timing, and frequency). Larger subject sizes and well-controlled trials are needed to provide more conclusive evidence.
31. Indigestible carbohydrates suppress colorectal cancer through IRF6/TRAF3/IFNα pathway.
期刊: Discover oncology 发表日期: 2026-Jan-14 链接: PubMed
摘要
32. Antibiotics in the first week of life and the association with atopic diseases at ages 9-12: a prospective cohort study.
期刊: European journal of pediatrics 发表日期: 2026-Jan-14 链接: PubMed
摘要
Dysbiosis in early life has been associated with the development of atopic diseases. In the INCA study, antibiotic treatment in the first week of life was associated with wheezing at 1 year and food allergies at 4-6 years. This follow-up study investigates whether these associations persist at age 9-12, and whether new associations with other atopic diseases have developed. The INCA cohort consisted of 436 children included in 2012-2015 to investigate the long-term effects of antibiotic treatment in the first week of life. Term-born infants from four Dutch hospitals were included, of which 151 received intravenous antibiotics in their first week of life due to suspected early-onset sepsis (AB+), and 285 were unexposed infants (AB-). In the 9-12-year follow-up study, parents and children filled out questionnaires on atopic diseases. Furthermore, general practitioners’ diagnoses were collected. The follow-up questionnaire was completed by 314 participants. Parental-reported and test-confirmed food allergies were more prevalent in AB+ children compared to AB- (unadjusted odds ratio (OR) 3.52, 95% confidence interval (CI) 1.50-8.25 and OR 6.6, 95% CI 1.3-32, respectively). However, no significant differences existed between AB+ and AB- in the incidence of asthma (OR 0.73, 95% CI 0.25-2.1) or inhalant allergies (OR 1.03, 95% CI 0.554-1.91). The “any allergy” diagnosis by general practitioners was more prevalent in AB+ than AB- (OR 3.0, 95% CI 1.2-7.6). Antibiotic treatment in the first week of life is associated with food allergies at ages 9-12, but not with asthma, inhalant allergies, or eczema. • Correlations have been observed between early life antibiotics exposure (< 2 years of age) and the development of atopic diseases such as asthma, eczema, and allergies. • Antibiotics exposure specifically in the first week of life has been associated with an increased risk of wheezing at age 1 and food allergies at ages 4-6. • Antibiotics in the first week of life are still associated with food allergies at ages 9-12, but not with airway atopy (asthma, hay fever, or inhalant allergies). • The results of this study suggest that there may be different mechanisms involved in the development of food vs. inhalant allergies, and further research is needed to determine how these diseases develop and how to prevent this.
33. Simulated poultry-house PM2.5 exposure reveals a gut-lung axis mechanism of microbial propionate in protecting against pneumonia.
期刊: Applied and environmental microbiology 发表日期: 2026-Jan-14 链接: PubMed
摘要
Poultry house fine particulate matter (PM2.5) poses significant respiratory risks to poultry by penetrating deep into the lung and triggering inflammatory cascades. In this study, 21- to 28-day-old broilers were exposed to total suspended particulates enriched in PM2.5 (2 mg/m³, 2 h/day) to investigate pulmonary injury and gut-lung axis perturbations. PM2.5 exposure induced collapse of the hexagonal lobular architecture, elevated pulmonary expression of IL-1β, IL-2, IL-6, IL-8, and IL-10, and activated NF-κB signaling. Concurrently, cecal microbiota α-diversity increased while the community shifted toward pro-inflammatory taxa (Alistipes, Rikenellaceae) and away from SCFA-producing species (Bacteroides uniformis, Parabacteroides). Oral supplementation of B. uniformis restored its abundance, replenished acetate and propionate levels, and attenuated lung injury by reducing APC activation (CD40, CCL4) and Th1 polarization (T-bet, IFN-γ, IL-18), while promoting regulatory T cell markers (FoxP3). Dietary sodium propionate supplementation in feed (0.4%) similarly mitigated pulmonary inflammation and Th1 skewing, albeit without enhancing Treg responses. These findings demonstrate that PM2.5-induced lung damage is intricately linked to gut dysbiosis and SCFA depletion and that restoration of B. uniformis or its metabolite propionate can recalibrate the gut-lung axis to suppress innate and adaptive inflammatory pathways. This work highlights microbiota- and metabolite-based interventions as promising strategies to protect poultry respiratory health and performance under air-polluted conditions.IMPORTANCEThis study reveals that poultry house-derived PM2.5 not only causes direct lung inflammation but also perturbs the gut-lung axis by depleting beneficial SCFA-producing bacteria. The resulting gut dysbiosis amplifies respiratory immune injury, highlighting a previously underappreciated systemic effect of airborne pollutants in livestock environments. Our findings suggest that microbiota- and metabolite-targeted dietary strategies can mitigate air pollution-induced health risks in poultry. This work provides new insights into the broader ecological and agricultural consequences of PM2.5 exposure and supports sustainable, non-antibiotic interventions to enhance animal welfare and productivity under deteriorating air quality conditions.
34. Bariatric Surgery Outcomes in an Italian Single-Center Study: Does Chronotype Matter?
期刊: Obesity surgery 发表日期: 2026-Jan-14 链接: PubMed
摘要
Chronotype reflects an individual’s intrinsic circadian preference for the timing of daily behaviors, including sleep, eating, and physical activity. It influences not only biological rhythms but also lifestyle patterns that may impact metabolic health. In the context of bariatric surgery, numerous factors may affect postoperative outcomes such as weight loss and the risk of weight regain. Given the growing interest in chronobiology and its relevance to obesity management, this study aimed to explore whether chronotype is significantly associated with key weight loss outcomes following bariatric surgery at 6 and 12 months post-intervention. A total of 263 patients underwent bariatric surgery at a single center. Baseline assessments included anthropometric, biochemical, and behavioral evaluations, including chronotype categorization. Postoperative outcomes at 6 and 12 months included absolute weight, BMI, percentage of initial body weight loss (%IBWL), and percentage of excess body weight loss (%EBWL). There was no significant difference among the three different chronotypes (evening, intermediate, and morning chronotype) in terms of absolute weight, BMI, %EWL and %IBWL at 6 and 12 months after surgery. Our results suggest that chronotype does not seem to play a critical role in weight loss outcomes in bariatric surgery patients, characterized by severe obesity. Further studies are needed to more thoroughly assess the impact of chronotype on bariatric surgery outcomes and a more detailed characterization of chronotype itself in these patients could be decisive.
35. Pro-Environmental Volunteering in Chinese University Youth: Peer Selection, Influence, and the Roles of Social Media and Social Self-Efficacy.
期刊: Journal of youth and adolescence 发表日期: 2026-Jan-14 链接: PubMed
摘要
36. Non-occlusive mesenteric ischemia induced by methamphetamine: an autopsy case report.
期刊: Forensic science, medicine, and pathology 发表日期: 2026-Jan-14 链接: PubMed
摘要
Non-occlusive mesenteric ischemia (NOMI) is an acute form of intestinal ischemia that occurs in the absence of organic stenosis of the mesenteric arteries. Vasoconstrictive agents have been recognized as potential etiological factors. This report describes the first documented Japanese autopsy case of NOMI induced by methamphetamine (MA), a potent sympathomimetic agent. A forensic autopsy was performed on a man in his 60s who died suddenly. Gross and histopathological findings of the small intestine and mesenteric arteries were examined, and post-mortem toxicological analysis was performed to quantify the blood MA concentration. Autopsy revealed a dilated small intestine without mechanical obstruction, accompanied by non-contiguous ischemic necrosis and no signs of organic stenosis in the mesenteric arteries. Histopathological examination of the small intestine showed hemorrhage and necrosis, consistent with a diagnosis of NOMI. The blood concentration of MA was within the toxic range but below the fatal threshold, suggesting a causal relationship between MA use and the onset of NOMI. Given the fatal outcome despite an MA concentration below the reported fatal range, prolonged mucosal exposure from oral ingestion may have locally intensified vasoconstrictive effects, contributing to intestinal ischemia. This case highlights the importance of considering MA-induced NOMI in the differential diagnosis of sudden death among MA users and highlights the risk of fatal ischemic complications even at non-fatal MA concentrations.
37. Differential accumulation of enterococci and arsenic in pelagic Sargassum and seagrass wrack on South Florida beaches.
期刊: Environmental monitoring and assessment 发表日期: 2026-Jan-14 链接: PubMed
摘要
Wrack, composed of organic debris like seagrass and the brown macroalga, Sargassum, accumulates on beaches and when present in overwhelming quantities can impact ecosystem function and public health through microbial contamination, trace element accumulation, and toxic gas emissions. Although studies have started to evaluate the impacts to the microbial quality from different types of wrack, few evaluate the impacts of trace elements. This study assessed enterococci and arsenic levels in beach environments across five South Florida beaches with varying wrack types (Sargassum vs. seagrass) and management practices. Enterococci levels did not significantly differ between wrack types (p = 0.30), with a maximum of 9,600 CFU/g. However, Sargassum exhibited significantly higher arsenic concentrations (up to 64.3 mg/kg) compared to seagrass (2.18 mg/kg) (p < 0.001). In sand, arsenic levels were statistically higher (4.92 mg/kg) when Sargassum was managed through integration. These findings emphasize the need to consider wrack composition when assessing arsenic impacts and can inform beach management strategies to minimize environmental and public health risks associated with excessively large Sargassum strandings.
38. The impact of premature birth and low birth weight on motor, visual, and cognitive skills and mental health in adolescence: a systematic review and meta-analysis.
期刊: European child & adolescent psychiatry 发表日期: 2026-Jan-14 链接: PubMed
摘要
Mental disorders represent a significant challenge for individuals and society. Many of them have a detectable onset during adolescence. Being born preterm or with low birth weight (PTB) has been emerging as a potential risk factor for developing mental health disorders in adolescence. Since PTB infants are considered to be at an increased risk of cognitive and sensory difficulties and are at risk for visual impairments, this systematic review aims to explore (1) whether evidence for a possible interplay between PTB, cognitive, visual, and motor abilities exists in the literature, and (2) whether and how these factors may relate to mental health outcomes of PTB individuals in adolescence. We conducted a registered systematic review following the PRISMA guidelines (PROSPERO #42024513150). The search strategy focused on the databases PubMed, Scopus, PsycINFO and the Cochrane Library and included publications sampling participants born in 1980 or later. Upon screening 499 studies, we analysed 17 studies including a total of 10,842 adolescents aged 11-20 (PTB = 8,813, control = 4,029) published between 2005 and 2022. PTB adolescents exhibited deficits in cognitive and motor domains compared to their full-term peers (≥ 37 gestational weeks; FT), including lower intelligence quotient (IQ), attention and executive function, and motor control. These effects can persist into adolescence and even adulthood. Importantly, several studies demonstrated that PTB adolescents receive diagnoses of psychiatric disorders more often and get diagnosed with more complex psychiatric disorders. Contrarily, evidence for subtle visual alterations and direct links between PTB, the reviewed domains and mental health outcomes remains scarce. These findings highlight that PTB adolescents can face challenges across multiple separate domains, including an elevated prevalence of psychiatric diagnoses. Clarifying the nature of these observational relationships shall provide insights that could improve early detection approaches and targeted intervention in the future.
39. Becoming unemployed after a cancer diagnosis: associated characteristics and its impact on daily life.
期刊: Journal of cancer survivorship : research and practice 发表日期: 2026-Jan-14 链接: PubMed
摘要
This study compared characteristics of cancer survivors who became unemployed after diagnosis with those who remained employed and evaluated the association between employment status and the impact on daily life. A cross-sectional online survey was conducted among adult cancer survivors employed at diagnosis. Participants were categorized based on employment status post-diagnosis. Univariate and multivariate binomial generalized linear models and multinomial logistic regression analyses were applied. Among 2576 cancer survivors (mean age: 53.4 years, 77% female, 62% 0-5 years post-diagnosis), 1704 (66%) remained employed, while 872 (34%) became unemployed. Becoming unemployed was associated with older age [OR; 95% CI, 1.02; 1.01-1.03], low [OR; 95% CI, 2.43; 1.05-3.45] or intermediate education [OR; 95% CI, 1.60; 1.33-1.93], and indicating (probably) not getting better [OR; 95% CI, 3.94; 3.05-5.07] or having chronic cancer [OR; 95% CI, 1.68; 1.25-2.25]. Prostate cancer survivors and those diagnosed ≤5 years prior were less likely to become unemployed than those with other types of cancer or those diagnosed longer ago. Becoming unemployed was associated with a negative influence on psychological [OR; 95% CI, 2.22; 1.80-2.74] and physical well-being [OR; 95% CI, 1.96; 1.61-2.38]. Those who became unemployed were more likely than those who remained employed to perceive that financial consequences negatively influenced multiple aspects of daily life, including family and social relationships, participation in sports, hobbies, and leisure activities, for themselves as well as for their partners and children. Unemployment was disproportionately prevalent among older, less-educated individuals and individuals with advanced cancer and was associated with declines in personal and family well-being due to experienced financial consequences. Identifying cancer survivors vulnerable to unemployment can guide timely, targeted support to help them maintain employment if desired. The observed link between unemployment and daily life emphasizes the importance of addressing employment issues within survivorship care.
40. Development and Clinical Implementation of an Integrated Information System for Occupational Radiation Exposure.
期刊: Health physics 发表日期: 2026-Jan-14 链接: PubMed
摘要
Conventional occupational radiation exposure monitoring relies on cumulative dose data from personal dosimeters without providing information on when, where, or under what conditions exposure occurs. This lack of context limits analysis of causal factors, evaluation of protective behaviors, and the effectiveness of safety education. This study aimed to develop and clinically implement an integrated information system for occupational radiation exposure by combining dose data, spatiotemporal movement records, and angiography-related radiation information. We also assessed its utility and potential for improving radiation safety management. The system was implemented for 1 mo in a clinical angiography suite. It integrated (1) personal digital dosimeters recording dose and time, (2) Bluetooth Low Energy beacons tracking healthcare workers’ positions and movements, and (3) Radiation Dose Structured Reports providing exposure details. Data were synchronized to reconstruct when, where, and under what conditions exposure occurred. The system identified high-risk positions near x-ray tubes (Beacon IDs 1-3), where exposure was greatest. Avoidance behaviors were also detected, such as movement to low-risk areas (e.g., Beacon ID 8) before irradiation. We successfully developed, implemented, and evaluated the system, demonstrating its utility for improving radiation safety management. The insights gained support targeted interventions and the refinement of safety protocols, with potential for broader use in diverse radiation-controlled settings.
41. Tooth enamel EPR spectroscopy study of radiation doses for uranium miners in Northern Kazakhstan.
期刊: International journal of radiation biology 发表日期: 2026-Jan-14 链接: PubMed
摘要
In order to estimate the effect of radiation exposure on the workers of a uranium enterprise, teeth samples were collected for EPR dosimetry of tooth enamel from workers of uranium mines living in Shantobe settlement (Akmola region, Northern Kazakhstan) and from residents of this settlement who had never worked in the mine as a control. The accumulated radiation doses in enamel were estimated based on the magnitude of the radiation-induced EPR signal in the samples. Excess (additional) doses were obtained after subtracting the contribution of natural radiation at typical levels during enamel age, and they were interpreted as caused by radiation in the work environment and by radioactive contamination of the territory. For the personnel of the uranium mining enterprise (17 teeth samples), the average excess dose was 90 ± 20 mGy (standard uncertainty of the average is indicated here and below). For the rest of the population who did not work at the mine (10 teeth samples), the average excess dose is estimated at 20 ± 12 mGy. A higher mean dose and greater variation were observed for miners in comparison to non-mining people in the same settlement. These differences were likely due to the occupational exposure.
42. Correction to "Investigation of Occupational Health and Safety Levels in Genetic Disease Centers in Istanbul".
期刊: Journal of clinical laboratory analysis 发表日期: 2026-Jan-14 链接: PubMed
摘要
43. Association Between Antibiotic Use for Non-Gastrointestinal Infections and Inflammatory Bowel Diseases Flare-Ups: A Self-Controlled Case Series Study.
期刊: The American journal of gastroenterology 发表日期: 2026-Jan-13 链接: PubMed
摘要
Disruption of gut microbiota by antibiotic use has been linked to the development of inflammatory bowel disease (IBD). This study aimed to evaluate the association between antibiotic use for non-gastrointestinal (GI) infections and the risk of IBD flare-ups, and to examine whether route of administration, antimicrobial spectrum, and antibiotic class modulate this risk. We conducted a self-controlled case series (SCCS) study using territory-wide electronic medical records from Hong Kong. Adults with IBD who experienced at least one flare-up and received at least one course of antibiotics for infections outside the GI tract between 2000 and 2024 were included, to reduce indication bias related to gastrointestinal symptoms. Conditional Poisson regression models were used to estimate incidence rate ratios (IRRs) by comparing across predefined risk periods to the baseline period. Among 810 patients, IBD flare incidence was elevated during the month preceding antibiotics (IRR 2.85), increased further during treatment (IRR 3.44), and peaked within two weeks after treatment (IRR 4.79), and returned to baseline levels within six months, versus baseline. Increased incidences were observed for oral antibiotics during and two weeks after treatment (IRRs 3.91 and 3.70), but not for injectable antibiotics (interaction p-values <0.01). The IRRs for broad-spectrum antibiotics were higher than those for narrow-spectrum agents from one month before to six weeks after antibiotic use, versus baseline. Antibiotic use for non-GI infections was associated with a short-term increase in IBD flare risk. Injectable or narrow-spectrum antibiotics may have a relatively smaller impact on potential IBD flare-ups.
44. Advocacy Pillar Development in a Division of Pediatric Emergency Medicine Using a Strategic Planning Process.
期刊: Annals of emergency medicine 发表日期: 2026-Jan-13 链接: PubMed
摘要
Advocacy is a cornerstone of emergency medicine as emergency physicians care for all patients regardless of insurance status, socioeconomic demographics, or other social determinants of health. As they have experience providing care to diverse populations, emergency physicians are uniquely positioned to address systemic health inequities and public health crises, such as mental health access and the opioid epidemic. Within academic emergency medicine, establishing an academic pillar for advocacy legitimizes this work, fosters research and mentorship, and ensures its sustainability in the field. Despite being a critical aspect of emergency medicine, limited formalized pathways exist to pursue an advocacy-focused career, including within pediatric emergency medicine. Addressing systemic health care gaps through a team-based approach is essential to improving health outcomes for patients and communities. This conceptual article describes the strategic development and integration of an Advocacy Pillar within a Division of Emergency Medicine at a freestanding, urban, academic children’s hospital, designed to complement existing strategic pillars such as clinical operations, fast track/urgent care, education, safety/quality, scholarly activity/research, and workforce growth. With support from Division leadership, staff were invited to codify an Advocacy Pillar within the Division. A multidisciplinary team began by creating divisional advocacy mission, vision, objectives, and goals. Five objectives were created, and then an assessment of the strengths, weaknesses, opportunities, and threats (SWOT analysis) was conducted on each objective. Action items were subsequently generated to accomplish each objective. The team used a Delphi process to rank action items by importance and feasibility to help prioritize initiatives and strategic goals. The results of this Advocacy Pillar Strategic Planning Process were included in the Division’s 5-year Strategic Plan. Advocacy work within the Division is now better supported and integrated throughout the domains of scholarship, service, and education. The Division has implemented structural changes that enhance advocacy for its staff, including new roles for staff (a Director and Associate Director of Advocacy and Health Policy, named nursing advocacy lead, Advocacy Steering Committee, and administrative support), financial incentives for engaging in high impact advocacy work that aligns with academic promotion, an annual advocacy award, and an advocacy-focused faculty development series and fellowship curriculum. We hope that these efforts can act as a framework for other groups that wish to formalize and amplify advocacy in their own settings.
45. System Dynamics of Preadolescent Mental Wellbeing: A Causal Loop Diagram of the Scientific Evidence.
期刊: The Journal of adolescent health : official publication of the Society for Adolescent Medicine 发表日期: 2026-Jan-13 链接: PubMed
摘要
Preadolescent mental wellbeing is influenced by several interconnecting factors spanning individual, familial, and societal levels. Despite the potential of complex systems methods based in system dynamics to increase the understanding of these interdependencies, their application in youth mental wellbeing remains limited. This paper is the first to identify the underlying system dynamics that drive the mental wellbeing of preadolescents by integrating insights from a literature review and focus groups with scientific experts into a comprehensive causal loop diagram (CLD). The study followed three steps: a scoping umbrella literature review was performed to identify factors underlying preadolescents’ mental wellbeing; focus groups with scientific experts were held to identify system dynamics (e.g., feedback loops, underlying mechanisms); and finally, a CLD was built and validated. The resulting CLD comprised nine subsystems based on underlying mechanisms: increasing pressure, seeking for own identity, parenting challenges, neighborhood ties, safety and security, healthy habits, always online, mental health talk, and supportive bonds. Thirty-eight feedback loops underlie these mechanisms, most of them being reinforcing. The CLD and its identified system dynamics highlight the complexity of preadolescent mental wellbeing and underscore the necessity of developing actions that target multiple leverage points across different system levels to drive change. By viewing this complex health issue through a systems lens, practitioners and policymakers should be better equipped to look beyond individual determinants and consider the broader structures, goals, and beliefs - laying the groundwork for sustainable, systemic change to benefit preadolescents’ mental wellbeing.
46. Electronic Intervention for Patient-Managed Benzodiazepine Tapering: A Randomized Clinical Trial.
期刊: JAMA network open 发表日期: 2026-Jan-02 链接: PubMed
摘要
More than 30 million people in the US take prescribed benzodiazepines, which, when taken long-term, carry risks of falls, cognitive decline, and dependence. A previous trial showed that a patient-focused self-management intervention (Eliminating Medications Through Patient Ownership of End Results; EMPOWER) can reduce long-term benzodiazepine dependence use and the risks that accompany it. To replicate the finding of the EMPOWER trial after converting the intervention from printed materials to electronic format. This 2-arm, individually randomized clinical trial with a 6-month follow-up was conducted at US Veterans Health Administration primary care clinics in 2 Veterans Affairs health care systems. Participants included 161 primary care patients taking benzodiazepines for 3 or more months and having access to a smartphone, tablet, or desktop computer. Recruitment occurred from June 1, 2022, to January 31, 2024. Participants were randomized to either the electronically delivered EMPOWER (EMPOWER-ED) protocol or asked to continue to follow clinician recommendations regarding their benzodiazepine use (treatment as usual). Preregistered primary outcomes were complete benzodiazepine cessation and at least 25% dose reduction at 6-month follow-up, assessed using pharmacy data. Secondary outcomes were self-reported anxiety symptoms, sleep quality, and overall health and quality of life. Analysis was performed on an intent-to-treat basis. The 161 participants had a mean (SD) age of 61.9 (13.7) years and were mostly male (134 [83.2%]). Individuals assigned to the EMPOWER-ED group had a significantly greater likelihood of complete benzodiazepine cessation (odds ratio [OR], 5.31 [95% CI, 1.12-25.12]). There was no likelihood of at least a 25% dose reduction in the EMPOWER-ED group relative to the control group (OR, 2.51 [95% CI, 0.91-6.90]). No statistically significant difference was found between the 2 groups for the secondary outcomes. This randomized clinical trial found a large effect of a low-cost, self-administered electronic intervention for reducing benzodiazepine use among long-term users. Findings from this replicated clinical trial are encouraging given the prevalence of benzodiazepine dependence and the constraints on clinician time available to address it. Dissemination of this intervention-which is in the public domain-by health care and public health systems seems warranted. ClinicalTrials.gov Identifier: NCT04572750.
47. Lyme Disease and Health Care Costs.
期刊: JAMA network open 发表日期: 2026-Jan-02 链接: PubMed
摘要
Lyme disease (LD) is the most common vector-borne illness in the US. Given the increasing prevalence and expanding geographic bounds of LD, in-depth, up-to-date understanding of costs associated with an LD diagnosis, including patient out-of-pocket (OOP) costs, is needed. To assess health care costs in a broad US population diagnosed with LD, overall and stratified by localized disease vs disseminated disease. This retrospective cohort study identified patients from Optum’s deidentified Market Clarity Data (Optum Market Clarity) between December 2, 2014, and January 30, 2023 (study period), with an LD diagnosis between January 1, 2016, and December 31, 2022 (identification period), having at least 14 months of continuous health plan enrollment. Optum Market Clarity is an integrated, multisource medical claims, pharmacy claims, and electronic health records data set. Outpatients had a claim with an LD diagnosis plus relevant antibiotics within 30 days, and inpatients had a claim with LD as the primary diagnosis or as a secondary diagnosis with an LD-associated condition as the primary diagnosis. Data were analyzed from February 27, 2023, to October 20, 2025. The main exposure was LD diagnosis. Case patients were classified as having disseminated, localized, or indeterminate LD based on diagnosis codes for LD and LD-associated conditions, inpatient vs outpatient services, or antibiotic treatment type. Health care costs (reported in US dollars) for LD cases overall and stratified by localized disease vs disseminated disease were assessed 4 ways: (1) LD-specific costs per episode, (2) all-cause 6-month baseline vs follow-up costs for case patients with LD, (3) all-cause 6-month follow-up costs for case patients with LD compared with the control group, and (4) multivariable case-control analysis. Costs are reported as estimated direct (standardized) costs and patient OOP costs. Wald 95% CIs were used for means of cost measures. A total of 70 531 case patients with LD were included. Their mean (SD) age was 44.8 (21.3) years; 51.3% were female. Estimated direct costs of LD were substantial across assessment methods, including episode cost (mean, $2227 [95% CI, $2111-$2342]), case patients as self-controls analysis (difference, $3304 [95% CI, $3117-$3491] in mean 6-month costs between baseline and follow-up), case-control analysis (difference, $4098 [95% CI, $3888-$4307] in mean 6-month follow-up costs), and multivariable-adjusted analysis (case-control difference, $5571 in projected mean 6-month follow-up costs; cost ratio, 1.96 [95% CI, 1.90-2.02]). OOP costs were available for 10 962 patients (15.5%) with LD. Mean OOP costs attributed to LD ranged from $188 to $399. Extrapolating to the US population in high-incidence states, annual costs of LD could range between $591 million and $1.05 billion (2022 dollars), with $411 to $771 million attributable to disseminated disease. In this retrospective cohort study, LD presented a large financial burden to the health care system and patients, especially for those with disseminated disease. These findings highlight the need for effective preventive measures to reduce costs for patients and the health care system.
48. Quality of Life of Parents of Premature Infants: A Systematic Review and Meta-Analysis.
期刊: JAMA network open 发表日期: 2026-Jan-02 链接: PubMed
摘要
Quality of life (QOL) of parents following the birth of a premature infant is substantially affected, necessitating a comprehensive understanding of its determinants to guide effective interventions. To systematically assess QOL among parents of premature infants and to identify modifiable factors associated with their well-being. PubMed, CINAHL, and Embase were searched from inception to October 5, 2025. Cross-sectional studies, longitudinal cohort studies, and randomized clinical trials reporting quantitative QOL data using validated instruments were included. The review is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. Meta-analysis was performed using random-effects models. All studies underwent qualitative synthesis and quality appraisal. Data were extracted and quality was assessed by 2 independent reviewers. Meta-analysis was carried out on studies that used the World Health Organization QOL-Short Form (WHOQOL-BREF; range, 0-100, with higher scores indicating better QOL) and the 12-Item Short Form Health Survey (SF-12; mean score, 50, with higher scores indicating better QOL) to assess the QOL among parents of preterm children. Qualitative analysis was performed to compare QOL of parents following preterm and full-term births, fathers vs mothers, and by degree of prematurity. Modifiable factors associated with QOL were identified by synthesizing evidence from longitudinal cohort studies and randomized clinical trials. A total of 34 studies, with 6617 parents of preterm children and 8295 parents of full-term children, were included. Meta-analysis of WHOQOL-BREF data (10 studies, 1147 parents of preterm children) showed pooled mean domain scores ranged from 63.63 (95% CI, 54.00-73.35) in the environmental domain to 66.68 (95% CI, 59.77-73.60) in the psychological well-being domain. Systematic review found that lower parental QOL was evident during infant hospitalization with improvement over time. Meta-analysis of SF-12 data (5 studies, 3137 parents) revealed pooled mean physical and mental component summary scores of 47.22 (95% CI, 40.06-54.39) and 44.58 (95% CI, 39.01-50.16), respectively. High heterogeneity reflected variability of infant maturity, assessment timing, and sociodemographic factors. Parents of preterm infants reported lower QOL than parents of full-term children in the early postpartum period, but this gap narrowed over time. Mothers reported poorer QOL compared with fathers during the infant’s hospitalization, but the gap diminished by 4 to 6 months post partum. Key modifiable factors of QOL were parental psychological well-being, knowledge and empowerment, social and systemic support, and infant-related health burdens. In this systematic review and meta-analysis, parental QOL was lowest during the premature infant’s hospitalization. A family-centered approach, with timely and tailored support from the neonatal intensive care unit through the postdischarge period, is essential to protect and promote parental well-being.
49. Adverse Events After Metastases-Directed Stereotactic Radiotherapy and Biological Cancer Therapy.
期刊: JAMA network open 发表日期: 2026-Jan-02 链接: PubMed
摘要
Metastases-directed stereotactic radiotherapy (SRT) is increasingly performed in patients with metastatic or oligometastatic cancer treated with immune checkpoint inhibitors (ICIs), monoclonal antibodies (mAbs), and small-molecule drugs (SMs). However, little is known about potential interactions between SRT and biological cancer therapy (BCT). To prospectively investigate adverse events associated with SRT combined with concurrent BCT. This international, prospective, multicenter, noninterventional registry cohort study (Toxicity and Efficacy of Combined Stereotactic Radiotherapy and Systemic Targeted or Immune Therapy [TOaSTT]) was conducted between July 2017 and August 2019 with a 24-month follow-up. Patients from 27 centers whose cancer was treated with metastases-directed SRT concurrently with BCT were eligible. Analyses were performed in January 2025. Patients treated with SRT for intracranial or extracranial metastases and concurrent (within ≤30 days) BCT. Indication for treatment, decision on the radiotherapy dose and fractionation, as well as interruption of BCT, were left to the discretion of the treating clinician. The primary outcome was severe (at least grade 3) adverse events of combined modality treatment, as graded by the treating physician. Overall survival (OS) and progression-free survival (PFS) were secondary end points. In total, 514 SRTs (271 cranial and 243 extracranial) concurrent with BCT were performed in 433 patients (median [IQR] age, 62 [54-70 years; 275 male [63.5%]). In 315 SRTs (61.3%) patients received ICIs, whereas in 150 SRTs (29.2%), patients received SMs and in 49 SRTs (9.5%) patients received mAbs. In 430 SRTs (83.7%), BCT had been initiated in patients before SRT, while 71 of 392 patients (18.1%) paused BCT during SRT. Severe (≥grade 3) acute adverse events were observed in 27 of 506 treatments (5.3%; 3 patients with grade 5 events), and severe late adverse events were observed in 29 of 459 patients (6.3%; 2 patients with grade 5 events). SRT with uninterrupted BCT was not associated with increased severe acute or late adverse events (odds ratio, 2.32; 95% CI, 0.87-6.22). Interruption of BCT during SRT was not associated with worse PFS and OS after correction for performance status and histologic type (hazard ratio, 0.81; 95% CI, 0.61-1.09; P = .17). In this cohort study of 433 patients, severe adverse events after SRT and concurrent BCT were uncommon (<10%), continuing BCT during SRT was not associated with increased risk of severe adverse events, and interrupting BCT was not associated with worse OS when correcting for patients’ performance status. These findings suggest a favorable safety profile of metastases-directed SBRT in combined modality treatment settings.
50. Blastomycosis, Histoplasmosis, and Coccidioidomycosis in Outpatient Community-Acquired Pneumonia.
期刊: JAMA network open 发表日期: 2026-Jan-02 链接: PubMed
摘要
Laboratory testing is necessary to distinguish blastomycosis, coccidioidomycosis, or histoplasmosis from other causes of community-acquired pneumonia (CAP). Robust data about testing for and diagnosis of these fungal diseases among patients with CAP throughout the US are lacking. To examine proportions and characteristics of (1) adult outpatients with CAP who underwent diagnostic testing for blastomycosis, coccidioidomycosis, or histoplasmosis; and (2) tested patients who received diagnoses of these diseases. This retrospective cohort study used 2017 to 2023 commercial health insurance claims data from the Merative MarketScan Commercial/Medicare Database. Adult outpatients with diagnosis codes for unspecified CAP were included. The primary outcome was the proportion of patients who underwent fungal diagnostic testing. The secondary outcomes were the proportions of tested patients who received diagnoses of blastomycosis, coccidioidomycosis, or histoplasmosis. Multivariable logistic regression models were used to estimate adjusted odds ratios (aORs) for characteristics independently associated with receiving a diagnosis of coccidioidomycosis or histoplasmosis. Among 573 994 patients (318 152 female [55%]; median [IQR] age, 54 [41-63] years) with unspecified CAP, 25 822 (5%) underwent fungal diagnostic testing, which occurred a median (IQR) of 3 (1-6) health care visits after the initial CAP diagnosis. Among tested patients, 755 (3%) received a blastomycosis, coccidioidomycosis, or histoplasmosis diagnosis code. Rash (aOR, 3.24; 95% CI, 2.27-4.63), lymphadenopathy (aOR, 1.74; 95% CI, 1.15-2.63), myalgia (aOR, 1.66; 95% CI, 1.11-2.49), chest pain (aOR, 1.65; 95% CI, 1.35-2.02), and receipt of antibiotics from multiple classes (aOR, 1.40; 95% CI, 1.17-1.67) were independently associated with increased odds of receiving a coccidioidomycosis diagnosis. Autoimmune inflammatory disease (aOR, 3.00; 95% CI, 1.72-5.21), chest pain (aOR, 1.84; 95% CI, 1.20-2.82), and abnormal weight loss (aOR, 5.15; 95% CI, 2.71-9.79) were associated with increased odds of receiving a histoplasmosis diagnosis. In this cohort study of patients with unspecified CAP, testing rates for blastomycosis, coccidioidomycosis, and histoplasmosis were low in many locations. Increased awareness of these fungal infections may help increase timely testing for fungal diseases among patients with CAP, decrease health care utilization and inappropriate antibiotic use, and improve patient outcomes.
51. Work Hours, Stress, and Burnout Among Resident Physicians.
期刊: JAMA network open 发表日期: 2026-Jan-02 链接: PubMed
摘要
Burnout is highly prevalent among resident physicians, producing serious personal, professional, and system consequences. While work hour restrictions were implemented to improve patient safety and resident fatigue, the relationship between work hours with burnout and well-being remains unclear. To evaluate the association of work hours with burnout, stress, and self-perceived competency among residents in high-burnout specialties, and to explore potential demographic and well-being-related moderators. This cross-sectional study included responses from a remote survey conducted from February to June 2024 as part of a randomized clinical trial evaluating a well-being intervention among resident physicians. Eligible participants were residents enrolled in high-burnout specialty residency programs (surgery, obstetrics-gynecology, family, internal, and emergency medicine) in the US. Self-reported average weekly work hours and total hours worked in the past week. Burnout, stress, and self-assessed Accreditation Council for Graduate Medical Education (ACGME) competency milestones, adjusting for demographics. A total of 540 residents responded (356 cisgender women [66.8%]; 112 Asian [21.1%], 28 Black [5.3%], 355 White [67.0%]). The sample was predominantly in a medical specialty (56%). The mean (SD) number of average hours worked was 65.4 (11.3) and the mean (SD) number of hours worked in the last week was 60.1 (17.4). There was no significant association between burnout and average hours worked (β = 0.05 [95% CI, -0.05 to 0.15]; P = .34) or hours worked last week (β = 0.06 [95% CI, -0.03 to 0.15]; P = .21). However, stress was positively associated with average hours worked (β = 0.17 [95% CI, 0.07 to 0.26]; P = .001) and hours worked last week (β = 0.27 [95% CI, 0.18 to 0.36]; P < .001). Self-assessed ACGME competency milestones were also positively associated with average hours worked (β = 0.14 [95% CI, 0.07 to 0.21]; P < .001) and hours worked last week (β = 0.08 [95% CI, 0.01 to 0.15]; P = .02). Despite exploring a large set of candidate moderators, very few moderators were identified and none survived P value adjustment. In this cross-sectional nationwide study of resident physicians in high-burnout specialties, longer work hours were associated with higher stress and self-perceived competency, but not with burnout. This suggests that work hours alone may not explain high burnout levels in residency; a more comprehensive approach beyond work hour restrictions is needed to support resident well-being in training.
52. Nocturnal Stage 1 Hypertension Defined by 2025 Guidelines in Adults With Chronic Kidney Disease.
期刊: JAMA network open 发表日期: 2026-Jan-02 链接: PubMed
摘要
The 2025 American College of Cardiology/American Heart Association (ACC/AHA) blood pressure (BP) guideline introduced new hypertension criteria. However, the association between newly defined nocturnal stage 1 hypertension (nocturnal BP 110-120/65-70 mm Hg) and kidney function progression in the population not receiving dialysis with chronic kidney disease (CKD) in China remains unclear. To determine whether nocturnal stage 1 hypertension as defined by 2025 ACC/AHA guidelines in patients with CKD is associated with kidney function progression. A retrospective cohort study involving patients with CKD not receiving dialysis was conducted in China at the Third Affiliated Hospital of Sun Yat-sen University from August 2010 to December 2017 and at the Fifth Affiliated Hospital of Sun Yat-sen University from November 2017 to December 2024. Participants were categorized into 3 groups based on nocturnal BP measurements according to the 2025 ACC/AHA guidelines: nonhypertension (nocturnal BP <110/65 mm Hg), stage 1 hypertension (nocturnal BP 110-120/65-70 mm Hg), and stage 2 hypertension (nocturnal BP ≥120/70 mm Hg). The primary outcome was a composite of kidney failure requiring replacement therapy (KFRT) and worsening kidney function (WKF). Secondary outcomes included the individual components of the primary outcome. Cox regression models were employed to assess the association between nocturnal stage 1 hypertension and outcomes. Among 2418 participants with CKD stage 1 through 4 not receiving dialysis included in the study, 1412 (58.4%) were men, the mean (SD) age was 45.4 (14.4) years, 436 (18.0%) had nocturnal nonhypertension, 345 (14.3%) had nocturnal stage 1 hypertension, and 1637 (67.7%) had nocturnal stage 2 hypertension. Over a median (IQR) follow-up of 3.9 (1.5-4.7) years, 394 composite kidney outcomes, 203 cases of KFRT, and 235 instances of WKF were recorded. After adjusting for confounders, nocturnal stage 1 hypertension (compared with nocturnal nonhypertension) was independently associated with an increased risk of KFRT (hazard ratio [HR], 2.37; 95% CI, 1.17-4.82), WKF (HR, 3.79; 95% CI, 1.04-13.84), and the composite kidney outcome (HR, 2.49; 95% CI, 1.31-4.72). In the older population (aged ≥65 years), nocturnal BP less than 110/65 mm Hg was associated with a higher risk of WKF and the composite kidney outcome compared with nocturnal BP in the range of 110/65 to 120/70 mm Hg. In this cohort study of adults with CKD not receiving dialysis, nocturnal stage 1 hypertension as defined by the 2025 ACC/AHA guidelines was independently associated with an increased risk of CKD progression.
53. Facile Access to IDT-Based Acceptor via Direct C-H Arylation and Its Exploration in Binary and Ternary Organic Solar Cells.
期刊: Chemistry, an Asian journal 发表日期: 2026-Jan 链接: PubMed
摘要
The pursuit of efficient and environmentally benign synthetic routes for electron acceptors via is vital to advancing the commercialization of organic solar cells (OSCs). In this study, we leverage a direct C-H arylation strategy to synthesis a novel A-D-π-D-A-type acceptor (D1), which offers significant advantages in step and atom economy, along with a reduced environmental impact compared to conventional cross-coupling methods. When combined with the polymer donor PM6, the optimized PM6:D1 binary devices attained a power conversion efficiency (PCE) of 9.85%. Furthermore, capitalizing on the well-aligned energy levels and complementary absorption with the benchmark blend PM6:Y6, D1 was successfully incorporated as a third component to fabricate ternary OSCs. The resulting PM6:Y6:D1 devices exhibited more balanced charge transport, enhanced exciton dissociation, and improved photovoltaic parameters, yielding a champion PCE of 16.58%. This work highlights the considerable potential of C-H arylation as a green synthesis method for constructing high-performance acceptors and offers key insights for designing efficient multi-component organic photovoltaic systems.
54. The Development of the Pain Threshold During a Long-Distance Run.
期刊: European journal of pain (London, England) 发表日期: 2026-Jan 链接: PubMed
摘要
Aerobic exercise leads to transient hypoalgesia, but little is known about these effects over extended periods. This study aimed to investigate exercise-induced hypoalgesia (EIH) responses in healthy individuals during long-distance running on a treadmill. Thirty healthy participants (18-50 years) completed a 15 km treadmill run. Pain sensitivity was assessed using pain pressure threshold (PPT) before and during the run. Additionally, cuff-PPT (cPPT), cuff-pressure pain tolerance threshold (cPTT), temporal summation of pain (TSP) and conditioned pain modulation (CPM) were assessed with pressure cuff algometry before and during the run. Data were analysed using repeated measures ANOVA. Exploratory subgroups, based on changes in PPT, were identified using latent growth mixture models, and logistic regression was used to predict subgroup membership. No significant changes were observed over time for PPT, PTT, cPPT or CPM at the group level. TSP decreased significantly after 10 and 15 km (p ≤ 0.004) when compared to baseline. Exploratory analysis identified two distinct subgroups: ‘increasing PPT’ and ‘decreasing PPT’. Subgroup membership was predicted using baseline CPM and EIH (p < 0.045). This study found no significant changes in PPT, cPPT, or CPM following aerobic exercise. A significant change was observed in TSP. CPM and EIH predicted changes in PPT during the 15 km run (increasing vs. decreasing) in an explorative analysis. Further research should test if baseline tests can predict pro- or anti-nociceptive responses to long-distance running. These findings highlight the importance of individual variability in endogenous pain modulation during endurance exercise. The lack of group-level effects underscores the need to move beyond average responses and consider subgroups when studying exercise-induced hypoalgesia. Identifying distinct modulatory profiles may offer insight into personalized exercise interventions and reveal stable traits related to pain regulation. This has potential clinical implications for tailoring exercise as a pain management strategy and for identifying individuals at risk of negative or absent hypoalgesic responses.
55. Evaluation of Suspected Dementia.
期刊: American family physician 发表日期: 2025-Dec 链接: PubMed
摘要
Dementia is a major neurocognitive disorder involving deficits that interfere with daily function. Age is the greatest risk factor for developing the disease. Other risk factors include family history, cardiovascular disease, uncontrolled diabetes, and lower education levels. The initial evaluation for dementia involves recognizing subtle signs that are often missed or mistaken for normal aging. Screening tools include the Mini-Cog, Memory Impairment Screen (MIS), and questionnaires that are completed by caregivers or friends. If cognitive impairment is suspected, a more detailed evaluation should be performed using tools such as the Montreal Cognitive Assessment (MoCA), Saint Louis University Mental Status (SLUMS), or Rowland Universal Dementia Assessment Scale (RUDAS). A thorough history should be taken and a medication review and physical examination should be performed for the assessment of vision; hearing; cardiovascular, nutritional, and functional status; neurologic function; and psychiatric status. Laboratory testing, such as vitamin B12 and folate levels, thyroid function, complete blood cell count, and comprehensive metabolic panel, may be necessary to rule out underlying conditions. Brain imaging with noncontrast magnetic resonance imaging (or non-contrast computed tomography of the head if magnetic resonance imaging is unavailable or contraindicated) can rule out secondary causes. Differentiating dementia from potentially reversible conditions such as depression and delirium is essential. Referral to a neurologist is recommended for early-onset symptoms (before 60 years of age), for severe behavioral disturbances, or if the diagnosis is unclear.
56. Heel Pain: Diagnosis and Management.
期刊: American family physician 发表日期: 2025-Dec 链接: PubMed
摘要
Heel pain accounts for 2 million office visits annually and is associated with higher body mass index, manual jobs, and a sedentary lifestyle. Retrocalcaneal bursitis is more common in women 40 to 60 years of age with Haglund deformity and a thickened Achilles tendon. Calcaneal apophysitis (Sever disease) is the most common cause of heel pain in active children and adolescents; in the outpatient setting, it accounts for up to 16% of musculoskeletal conditions in children. In os trigonum syndrome, athletes such as soccer players, gymnasts, and dancers who are engaged in repetitive plantar flexion commonly present with worsening posterior ankle pain and an antalgic gait. Risk factors for peroneal tendon injuries include corticosteroid injections into the peroneal sheath, use of fluoroquinolones, rheumatoid arthritis, hyperparathyroidism, and diabetes. Magnetic resonance imaging is the most accurate test for the diagnosis of most causes of heel pain, but ultrasonography is being used more often as it becomes more readily available at the point of care. Most patients with heel pain improve with conservative treatment, and surgical management should be reserved for recalcitrant cases. Pain catastrophizing and kinesiophobia are associated with diminished foot function and poorer prognosis.
57. Cancer Screening in Older Adults.
期刊: American family physician 发表日期: 2025-Dec 链接: PubMed
摘要
Cancer screening guidelines for older adults are increasingly recommending individualized decision-making rather than relying on age cutoffs. This is in large part due to the individual complexity of aging, such as functional differences, risks of diagnostic procedures, remaining life expectancy, perceived quality of life, and goals of care. The US Preventive Services Task Force (USPSTF) recommends screening for breast cancer until 74 years of age, whereas the American Cancer Society suggests screening as long as the patient is in good health or has a life expectancy of at least 10 years. The USPSTF recommends that men 55 to 69 years of age discuss the potential benefits and harms of prostate-specific antigen screening with their doctor before making an individual decision; for men 70 years and older, the USPSTF and the American Urological Association do not recommend routine screening. Most guidelines recommend that cervical cancer screening should stop at 65 years of age in patients who have adequate prior screening results and do not have high risk. The USPSTF and the American Cancer Society recommend routine colorectal cancer screening until 75 years of age, after which individualized screening can occur based on shared decision-making until 85 years of age. Guidelines recommend lung cancer screening for patients who are 50 to 80 years of age, have at least a 20-pack-year smoking history, and are able and willing to have curative surgery.