公共卫生研究摘要 (2026-01-22)
共收录 52 篇研究文章
1. Long-Term Recovery, Morbidity, and Mortality After Maternal Ischemic Stroke.
期刊: Neurology 发表日期: 2026-Feb-24 链接: PubMed
摘要
The long-term prognosis after maternal ischemic stroke (IS) remains understudied. The objectives were to examine if mortality and long-term morbidity are more frequent in women with prior maternal IS compared with women without a pregnancy-related stroke and to assess recovery in maternal IS patients based on functional outcomes and vocational status. In this retrospective nationwide cohort study, maternal IS patients in Finland during years 1987-2016 were identified from national healthcare registers and verified from patient records. Three pregnant controls without a pregnancy-related stroke were selected for each case and matched by delivery year, age, parity, and geographical area. Deaths were acquired from the Causes-Of-Death Register until 2022. Morbidities (cardiovascular diseases and depression) were collected from Hospital Discharge Register and vocational status from Statistics Finland until 2016 for those who survived ≥1 year after stroke. Functional outcomes by modified Rankin scale (mRS) were estimated from patient records. There were 97 women with maternal IS, of whom 92 survived ≥1 year after stroke, and 265 matched controls (median age 30.6 years at index delivery in both groups). The median follow-up time was 17.4 years for mortality and 11.6 years for morbidity and vocational status. The overall mortality was higher in maternal IS patients than controls (8.3% vs 1.8%, age-adjusted odds ratio [aOR] 4.96, 95% CI 1.58-15.60) but did not differ significantly after the first year. There were 5 (5.6%) recurrent strokes in maternal IS patients. Patients had more frequently major cardiovascular events (6.7% vs 0%, p < 0.001), cardiac diseases (aOR 8.57, 95% CI 2.22-33.08), and depression (aOR 3.92, 95% CI 1.86-8.24) than controls. Of the patients who survived until the end of follow-up, 92.1% had good functional outcomes (mRS 0-2). Still, employment was rarer (aOR 0.55, 95% CI 0.32-0.94) and retirement (aOR 4.55, 95% CI 2.03-10.17) more common in maternal IS patients than controls. Maternal IS patients had a significant cardiovascular burden and were retired more often than controls at the end of follow-up, although most patients had good functional outcomes. Optimizing long-term prognosis in these young patients necessitates comprehensive management of vascular risk factors and targeted rehabilitation strategies to address residual neurologic deficits.
2. Hepatitis B treatment response and factors associated with HBV treatment success: A population-based study in Rwanda.
期刊: Hepatology communications 发表日期: 2026-Feb-01 链接: PubMed
摘要
Timely treatment of chronic hepatitis B virus (HBV) infection reduces complications such as cirrhosis and hepatocellular carcinoma and improves overall survival. In Sub-Saharan Africa, data on HBV treatment success are limited, especially among people living with HBV mono-infection. We assessed the success of HBV treatment and associated factors among people diagnosed with HBV mono-infection and HIV co-infection. We used data from the District Health Information System 2 in Rwanda, covering 4.6 million screened individuals (January 2016-June 2023). Patients receiving HBV therapy for ≥12 months were included. Treatment success was defined as undetectable HBV DNA or normal ALT at 12 months. We used multilevel logistic regression to assess risk factors, accounting for clustering by hospital. Among 4733 treated individuals (median age: 39 y, 58.4% male), 4518 (95.5%) achieved treatment success, increasing over time (90.3% for <2 y vs. 95.8% for ≥2 y of follow-up). Treatment success was mostly assessed by ALT normalization (87.5%). HBV mono-infected and HBV/HIV co-infected individuals had similar overall treatment success rates [3730 (95.5%) vs. 788 (95.2%)]. However, among those treated for <2 years, success was lower in HBV/HIV individuals [7 (43.8%) vs. 283 (92.7%)]. In multivariable analysis, HCV co-infection (aOR: 0.33; 95% CI: 0.12, 0.85), follow-up at provincial/referral hospitals (aOR: 0.26; 95% CI: 0.08, 0.86), and cirrhosis (aOR: 0.36; 95% CI: 0.20, 0.63) were associated with a lower likelihood of HBV treatment success. HBV treatment success in Rwanda was high but lower in those with HBV/HCV co-infection or cirrhosis, underscoring the need for early detection and monitoring.
3. Clinical outcomes in MetALD compared with ALD in patients referred for liver transplant evaluation.
期刊: Hepatology communications 发表日期: 2026-Feb-01 链接: PubMed
摘要
In patients with steatotic liver disease, metabolic dysfunction and alcohol-associated liver disease (MetALD) is a recently defined entity combining metabolic syndrome and moderate-to-high alcohol consumption. Its prognosis and outcomes compared with alcohol-associated liver disease (ALD) remain underexplored. The aim of the study was to assess liver recompensation (LR) between the 2 groups in patients with decompensated liver disease referred for liver transplant (LT) evaluation. We conducted a retrospective cohort study of 194 patients with decompensated liver disease, diagnosed as MetALD or ALD, and referred for LT evaluation between October 2021 and August 2023 at a single U.S. transplant center, and compared the outcomes between the 2 groups. The diagnoses of MetALD and ALD were based on the Delphi consensus definitions. Of the 194 patients, 135 (70%) had ALD and 59 (30%) had MetALD. Baseline characteristics showed significantly higher BMI (31 vs. 28 kg/m2, p=0.001), chronic kidney disease (32% vs. 17%, p=0.025), and lower Karnofsky scores (51 vs. 62, p=0.014) in the MetALD group. While no statistical difference was found in listing and LT rates between groups, LR occurred significantly less in MetALD compared with ALD (3% vs. 18%, p=0.006). On multivariable analysis, MetALD independently predicted lower LR (HR 0.21, 95% CI: 0.05-0.91). Hypertension (HR 0.38, 95% CI: 0.16-0.89) and increasing BMI (HR 0.91, 95% CI: 0.84-0.99) were also significantly associated with lower LR. While overall mortality was higher in the MetALD group (42% vs. 26%, p=0.029), MetALD was not an independent mortality predictor after adjustment. Compared with ALD, MetALD is associated with significantly lower LR in patients with decompensated liver diseases referred for LT evaluation.
4. Postpartum as a Window of Opportunity to Improve Women's Cardiovascular Health.
期刊: Hypertension (Dallas, Tex. : 1979) 发表日期: 2026-Feb 链接: PubMed
摘要
5. BMP9 Modulates IL-33 Signaling to Mitigate EndMT in Pulmonary Arterial Hypertension.
期刊: Hypertension (Dallas, Tex. : 1979) 发表日期: 2026-Feb 链接: PubMed
摘要
Pulmonary arterial hypertension (PAH) is a progressive disorder involving disrupted BMP (bone morphogenetic protein) signaling, pulmonary inflammation, and endothelial-to-mesenchymal transition (EndMT). We hypothesized that IL (interleukin)-33 signaling contributes to PAH progression by inducing EndMT and interacting with BMP9, a key modulator of inflammation and vascular remodeling. IL-33 expression was assessed in lung tissues from Sugen/hypoxia and control mice, as well as in pulmonary arterial endothelial cells (PAECs) and lung tissues from patients with PAH and healthy donors. EndMT and signaling pathways were analyzed in PAECs and microvascular endothelial cells (MVECs) exposed to IL-33, BMP9, and sST2 (soluble supression of tumorigenicity 2) using quantitative polymerase chain reaction, Western blotting, ELISA, and immunostaining. Plasma BMP9 and sST2 levels were quantified in patients with PAH. Immunofluorescent analysis revealed elevated IL-33 expression in pulmonary endothelial cells of Sugen/hypoxia mice compared with controls, consistent with findings in PAECs from patients with PAH. BMP9 significantly upregulated sST2 expression in human PAEC and microvascular endothelial cells, inhibited IL-33 target gene expression, and effectively suppressed IL-33-induced EndMT. Notably, BMP9 demonstrated greater efficacy in preventing EndMT compared with rsST2 (recombinant soluble ST2) or ST2L-neutralizing antibodies. Circulating BMP9 and sST2 levels in the plasma of patients with PAH were positively correlated in specific patient groups stratified by sex, age, and New York Heart Association functional class, suggesting a protective role of BMP9 in modulating IL-33-induced EndMT. BMP9 plays a protective role against IL-33-induced EndMT in PAECs by upregulating sST2 expression and neutralizing IL-33, suggesting that targeting the IL-33 signaling pathway may represent a promising therapeutic strategy to mitigate EndMT in PAH.
6. Promoting Fairness in Screening Programs for Late-Career Practitioners.
期刊: The New England journal of medicine 发表日期: 2026-Jan-22 链接: PubMed
摘要
7. Sacituzumab Govitecan plus Pembrolizumab for Advanced Triple-Negative Breast Cancer.
期刊: The New England journal of medicine 发表日期: 2026-Jan-22 链接: PubMed
摘要
Triple-negative breast cancer is an aggressive breast cancer subtype, and there remains an unmet need to improve outcomes in patients with previously untreated, programmed death ligand 1 (PD-L1)-positive, locally advanced unresectable or metastatic triple-negative breast cancer. In this phase 3, open-label, international trial, we randomly assigned patients in a 1:1 ratio to receive sacituzumab govitecan plus pembrolizumab or chemotherapy plus pembrolizumab. The primary end point was progression-free survival as assessed by blinded independent central review. Secondary end points included overall survival, objective response (complete or partial response) and duration of response as assessed by blinded independent central review, and safety. A total of 443 patients were randomly assigned to receive sacituzumab govitecan plus pembrolizumab (221 patients) or chemotherapy plus pembrolizumab (222 patients). The median progression-free survival was 11.2 months (95% confidence interval [CI], 9.3 to 16.7) with sacituzumab govitecan plus pembrolizumab and 7.8 months (95% CI, 7.3 to 9.3) with chemotherapy plus pembrolizumab (hazard ratio for disease progression or death, 0.65; 95% CI, 0.51 to 0.84; two-sided P<0.001). Data for overall survival were immature. The percentage of patients with an objective response was 60% (95% CI, 53 to 66) with sacituzumab govitecan plus pembrolizumab and 53% (95% CI, 46 to 60) with chemotherapy plus pembrolizumab; among patients with a response, the median duration of response was 16.5 months (95% CI, 12.7 to 19.5) and 9.2 months (95% CI, 7.6 to 11.3), respectively. Adverse events of grade 3 or higher occurred in 71% of the patients receiving sacituzumab govitecan plus pembrolizumab and in 70% of those receiving chemotherapy plus pembrolizumab; the incidence of treatment discontinuation due to adverse events was 12% and 31%, respectively. Adverse events leading to death occurred in 3% of the patients in each group. Sacituzumab govitecan plus pembrolizumab led to significantly longer progression-free survival than chemotherapy plus pembrolizumab among patients with previously untreated, PD-L1-positive, advanced triple-negative breast cancer. (Funded by Gilead Sciences; ASCENT-04/KEYNOTE-D19 ClinicalTrials.gov number, NCT05382286.).
8. Activated carbon fiber (ACF) as a dual respirator media for particulate matter (PM) filtration and volatile organic compound (VOC) adsorption.
期刊: Journal of occupational and environmental hygiene 发表日期: 2026-Jan-21 链接: PubMed
摘要
Exposure to volatile organic compounds (VOCs) and particulate matter (PM) can cause adverse health effects such as pneumoconiosis-like symptoms, acute toxicity, and carcinogenesis. The present work aimed to test activated carbon fiber (ACF) as air-purifying media capable of dual-protection from both PM and VOC and evaluated the interaction between filtration efficiency (FE) and VOC retention by using breakthrough times. The first set of experiments exposed ACF 1200 (1,200 m2/g nominal surface area) to the VOC toluene at the permissible exposure limit (200 ppm) prior to introducing PM (NaCl, 200 mg/m3) into the airstream, and the second set of experiments introduced VOC into the airstream after PM exposure. Study findings suggest that ACF 1200 demonstrated a somewhat greater adsorption capacity (g/g) for toluene when PM was present, recording a value of 0.319 g/g, compared to 0.213 g/g in its absence. A slight decline in FE was observed in 1, and 4-layer combinations following initial exposure to VOCs. These findings suggest that the presence of PM may enhance ACFs’ adsorption of VOCs; however, the presence of toluene seemed to affect ACF filtration performance to a lesser degree. Understanding these interactions is necessary for the ongoing development of ACF as dual respirator media for both PM and VOCs.
9. Longitudinal Between- and Within-Person Associations Among Screen Time, Bedtime, and Daytime Sleepiness Among Adolescents: Three-Wave Prospective Panel Study.
期刊: Journal of medical Internet research 发表日期: 2026-Jan-21 链接: PubMed
摘要
Daytime sleepiness is prevalent among adolescents and linked to multiple health and functional impairments. Prior research has identified digital media use and insufficient sleep as key predictors, yet the reciprocal longitudinal associations among screen time, sleep, and daytime sleepiness remain understudied. This study examined the between- and within-person reciprocal longitudinal associations among adolescents’ screen time, bedtime, and daytime sleepiness. It also tested whether potential adverse effects of screen time were less pronounced over time among adolescents who limited their screen exposure before sleep at baseline. We conducted a prospective 3-wave panel study at 6-month intervals in a quota-based sample of 2500 Czech adolescents (mean age 13.43, SD 1.70 years; 1250/2500, 50% girls). Data were collected through an online survey. Screen time was assessed with 3 items covering total use of computers, smartphones, tablets, and television on a typical school day; bedtime with a single item on usual bedtime before school days; and daytime sleepiness with 4 items from the Pediatric Daytime Sleepiness Scale. Screen time restriction within 1 hour before sleep at baseline was examined as a moderator. Age and sex were included as covariates. Between- and within-person associations were estimated using random intercept cross-lagged panel models. Adolescents with higher screen time reported later bedtimes (r=0.23, 95% CI 0.15-0.31; P<.001) and greater daytime sleepiness (r=0.25, 95% CI 0.16-0.34; P<.001). No direct within-person effects emerged between screen time and daytime sleepiness (W1→W2: β=.02, 95% CI -0.11 to 0.16; P=.71; W2→W3: β=.02, 95% CI -0.10 to 0.14; P=.66). However, increases in screen time at Wave 1 predicted later bedtime at Wave 2 (β=.14, 95% CI 0.01-0.27; P<.05), which in turn predicted higher screen time at Wave 3 (β=.24, 95% CI 0.11-0.36; P<.001). Temporary within-person spikes in screen time coincided with delayed bedtimes (W1: r=0.16, 95% CI 0.04-0.27; P<.01; W2: r=0.23, 95% CI 0.09-0.36; P<.001; W3: r=0.09, 95% CI 0.00-0.20; P=.049). Baseline screen time restriction did not moderate within-person effects (Δχ26=5.3; P=.51). This study is the first to test reciprocal longitudinal associations among adolescents’ screen time, bedtime, and daytime sleepiness while separating between- and within-person associations, thereby addressing potential bias common in prior cross-lagged panel studies. The findings refine theoretical understanding by indicating a complex, bidirectional, and mutually reinforcing interplay between screen time and bedtime over time-even when individual differences are accounted for-whereas daytime sleepiness does not appear to be affected by this dynamic. Additionally, negatively correlated, within-person fluctuations in screen time and bedtime indicate that these behaviors are partly mutually exclusive and likely shaped by shared contextual influences. Screen time restriction before sleep did not mitigate within-person effects, indicating that interventions should prioritize consistent sleep schedules rather than focusing solely on reducing screen use.
10. Enhancing detection of asbestiform minerals in asbestos contaminated talc using FTIR and multivariate data analysis.
期刊: Journal of occupational and environmental hygiene 发表日期: 2026-Jan-21 链接: PubMed
摘要
Talc has been widely used for decades in cosmetic and personal care products because of its unique properties. However, certain talc deposits have historically been found to contain asbestiform minerals, making the detection of these contaminants critical for mitigating asbestos exposure risks in consumer products. To investigate this, laboratory generated mixtures of talc/anthophyllite asbestos and talc/tremolite asbestos were prepared at various concentrations. These mixtures underwent thorough processing with sodium polytungstate (SPT), a heavy liquid, followed by centrifugation, settling, and extraction of separated mineral components. Each extracted sample was analyzed using Fourier Transform Infrared (FTIR) spectroscopy and mineral type was predicted through multivariate data analysis (Partial Least Squares-Discriminant Analysis (PLS-DA)). The PLS-DA model, trained on specific wavenumber regions displaying distinct mineral features, successfully identified anthophyllite and tremolite asbestos in most separated samples. However, in cases where misclassification occurred-where asbestiform minerals were labeled as talc or unassigned-a secondary separation procedure was required. The integration of heavy liquid separation, FTIR spectroscopy, and PLS-DA offers a promising approach for enhancing the detection of asbestiform minerals in asbestos-contaminated talc.
11. Marking Techniques for Target Lymph Nodes in Node-Positive Breast Cancer Treated With Neoadjuvant Therapy in the AXSANA/EUBREAST-03/AGO-B-053 Study.
期刊: Journal of clinical oncology : official journal of the American Society of Clinical Oncology 发表日期: 2026-Jan-21 链接: PubMed
摘要
Surgical axillary staging in patients with node-positive breast cancer (BC) who converted to clinical node negativity through neoadjuvant chemotherapy (NACT) has changed significantly in recent years. Targeted axillary dissection (TAD) and target lymph node (TLN) biopsy (TLNB) became increasingly popular. However, data comparing marking techniques for the TLN are limited. Here, we evaluate marking techniques in the largest prospective cohort worldwide. Among patients from the ongoing prospective multicenter AXSANA (EUBREAST-03) study who received TLN marking and TAD/TLNB, we evaluated different marking methods with respect to detection and removal rates and clinical performance. Until January 6, 2025, 6,129 patients from 26 countries were enrolled. Of these patients, 2,596 had ≥1 TLN marked before NACT and completed surgery; 13.3% of the patients had ≥4 suspicious nodes at diagnosis. Pre-NACT TLN marking used a clip in 2,003 patients (77.2%), magnetic seed in 287 (11.1%), carbon ink in 192 (7.4%), radar marker in 119 (4.6%), radioactive seed in 18 (0.7%), radiofrequency identification device (RFID) in 12 (0.5%), or other methods in two (0.1%). One TLN was marked in 2,427 patients (93.5%), two TLNs in 138 (5.3%), and ≥3 in 27 patients (1%). Targeted removal of the TLN was planned in 2,100 patients (80.9%; TAD in 2,076 [80.0%] and TLNB in 24 [0.9%]). The TLN was detected and removed by TAD/TLNB in 1,915 patients (91.2%). TLN detection rate was the highest in patients whose TLNs were marked pre-NACT with markers suitable for probe-guided detection (96.6%; radioactive seed: 100%, magnetic seed: 96.9%, radar marker: 96.1%, RFID: 90%), followed by carbon ink (94.9%) and clip (89.6%; P < .001). This large prospective analysis of patients with initially clinically node-positive BC receiving NACT demonstrates that probe-guided detection markers used to mark metastatic nodes before NACT provide superior detection rates.
12. Spectral frequency and broadband noise analysis of the firefighter environment: Potential implications for cardiac health.
期刊: Journal of occupational and environmental hygiene 发表日期: 2026-Jan-21 链接: PubMed
摘要
Firefighters are well known to have elevated risk of adverse health outcomes across a wide range of diseases and injuries, including cancer, hearing loss, fatal cardiac events, post-traumatic stress disorder (PTSD), sleep disorders, and many other adverse outcomes. It has been speculated that the noise environment is a significant risk factor for several of these diseases. In particular, the impact of noise on cardiac outcomes has recently been identified. An environmental survey of noise that included spectral and broadband analysis was conducted across all 14 firehouses in a southeastern city in the United States as a first step to investigate firefighter health and noise. An octave band analyzer was utilized to take area measurements of noise, including background, alarms, sirens, tools, and other important miscellaneous noise sources throughout these 14 firehouses, including an assessment of noise impacts on sleeping quarters. Data showed that generally the noise surveyed was highly variable, and specific frequencies were associated with specific sources. Overall, many of the noise sources in the firehouse were above a broadband sound pressure level that has been associated with an elevated stress response that may be associated with adverse cardiac impacts. There were also a number of noise sources, such as cutting tools, that had very high noise levels that could increase the risk of hearing loss. The spectral analysis also showed there were a number of sources that emitted noise frequencies in a range associated with enhanced physiological sensitivity, especially with regard to stress responses.
13. Occupational hearing impairment in coal mining across Asia-Pacific: Patterns, risks, and implications.
期刊: Journal of occupational and environmental hygiene 发表日期: 2026-Jan-21 链接: PubMed
摘要
Coal miners are among the most vulnerable workers exposed to hazardous occupational noise, leading to a heightened risk of noise-induced hearing loss (NIHL). In the Asia-Pacific region, rapid industrial growth and variable enforcement of occupational health regulations pose additional challenges in preventing hearing impairment among miners. This study aimed to synthesize existing evidence on the patterns, risk factors, and contextual challenges associated with occupational hearing impairment among coal miners in the Asia-Pacific region, with the goal of informing policy and guiding future interventions. A systematic review was conducted across five major databases to identify peer-reviewed studies published between 2014 and 2025 that examined occupational hearing loss in coal mining populations in the Asia-Pacific region. The quality of included studies was appraised using the Critical Appraisal Skills Programme (CASP) checklist. Twelve studies from China, Australia, Turkey, and India met the inclusion criteria, covering over 130,000 miners. Findings consistently revealed a high prevalence of NIHL and high-frequency hearing loss (HFHL), with exposure duration, job category, and age identified as key contributing factors. Workplace conditions, outdated machinery, and inadequate use of personal protective equipment further exacerbated hearing risks. In addition, hearing loss often co-occurred with other occupational diseases such as pneumoconiosis and hypertension, suggesting a complex interplay of health risks in mining environments. Occupational hearing impairment remains a significant yet preventable health issue among coal miners in the Asia-Pacific. Strengthened hearing conservation programs, regulatory enforcement, and targeted research are urgently needed to reduce the burden of NIHL and promote long-term auditory health in this high-risk workforce.
14. First they Came for our AHRQ Articles, then they Came for AHRQ: Scientific Suppression and Struggle in the United States.
期刊: International journal of social determinants of health and health services 发表日期: 2026-Jan-21 链接: PubMed
摘要
The authors of this commentary published two peer-reviewed online articles in 2020 and 2022 on the U.S. Agency for Healthcare Research and Quality (AHRQ) PSNet that were removed by the Trump administration because they violated White House policy on websites that “inculcate or promote gender ideology.” Ours were among thousands of articles and websites that had been removed or censored during the first month of the Trump administration. We describe the details of this censorship of our two articles one on suicide prevention, the other on endometriosis diagnosis challenges, neither of which was directly related to LGBT issues but used what are now banned terms. We further discuss the historical and political context of this removal, and the subsequent merger of AHRQ into a new Trump administration “Office of Strategy” that purports to target “the effectiveness of federal health programs” for improvement. In light of these censorship actions, large scale staff layoffs, and this reorganization, the fate of AHRQ’s mission, current activities, and future project funding is currently uncertain. We offer strategic suggestions for resisting such attacks on academic freedom and restoring scientific integrity for patient safety, quality, and public health.
15. Machine Learning Prediction of Pharmacogenetic Testing Uptake Among Opioid-Prescribed Patients Using Electronic Health Records: Retrospective Cohort Study.
期刊: JMIR medical informatics 发表日期: 2026-Jan-21 链接: PubMed
摘要
Opioids are a widely prescribed class of medication for pain management. However, they have variable efficacy and adverse effects among patients, due to the complex interplay between biological and clinical factors. Pharmacogenetic testing can be used to match patients’ genetic profiles to individualize opioid therapy, improving pain relief and reducing the risk of adverse effects. Despite its potential, the pharmacogenetic testing uptake (use of pharmacogenetic testing) remains low due to a range of barriers at the patient, health care provider, infrastructure, and financial levels. Since testing typically involves a shared decision between the provider and patient, predicting the likelihood of a patient undergoing pharmacogenetic testing and understanding the factors influencing that decision can help optimize resource use and improve outcomes in pain management. This study aimed to develop machine learning (ML) models, identifying patients’ likelihood of pharmacogenetic uptake based on their demographics, clinical variables, medication use, and social determinants of health. We used electronic health record data from a single center health care system to identify patients prescribed opioids. We extracted patients’ demographics, clinical variables, medication use, and social determinants of health, and developed and validated ML models, including a neural network, logistic regression, random forest, extreme gradient boosting (XGB), naïve Bayes, and support vector machines for pharmacogenetic testing uptake prediction based on procedure codes. We performed 5-fold cross-validation and created an ensemble probability-based classifier using the best-performing ML models for pharmacogenetic testing uptake prediction. Various performance metrics, uptake stratification analysis, and feature importance analysis were used to evaluate the performance of the models. The ensemble model using XGB and support vector machine-radial basis function classifiers had the highest C-statistics at 79.61%, followed by XGB (78.94%), and neural network (78.05%). While XGB was the best-performing model, the ensemble model achieved a high accuracy (32,699/48,528, 67.38%), recall (537/702, 76.50%), specificity (32,162/47,826, 67.25%), and negative predictive value (32,162/32,327, 99.49%). The uptake stratification analysis using the ensemble model indicated that it can effectively distinguish across uptake probability deciles, where those in the higher strata are more likely to undergo pharmacogenetic testing in the real world (320/4853, 6.59% in the highest decile compared to 6/4853, 0.12% in the lowest). Furthermore, Shapley Additive Explanations value analysis using the XGB model indicated age, hypertension, and household income as the most influential factors for pharmacogenetic testing uptake prediction. The proposed ensemble model demonstrated a high performance in pharmacogenetic testing uptake prediction among patients using opioids for pain. This model can be used as a decision support tool, assisting clinicians in identifying patients’ likelihood of pharmacogenetic testing uptake and guiding appropriate decision-making.
16. International Case Studies to Identify Success Factors and Contextual Conditions in the Digital Transformation of Health Care Systems and Derive Lessons for Germany: Study Protocol for a Mixed Methods Study.
期刊: JMIR research protocols 发表日期: 2026-Jan-21 链接: PubMed
摘要
Germany’s health care system continues to face significant challenges in its digital transformation due to outdated structures, interoperability issues, strict data protection regulations, and low user acceptance, despite numerous legislative initiatives, such as the Digital Care Act in 2019, which was intended to promote practical use and innovation. In contrast, several international health care systems have successfully advanced their digital transformation, offering valuable insights and potential lessons for the German health care system. This study, as part of the research project “NADI: Benefits and Acceptance of Digital Health,” analyzes international health care systems to identify key success factors and develop pragmatic recommendations for German policymakers to enhance the country’s digital health implementation. This study uses a mixed methods triangulation approach, combining case study selection, qualitative expert interviews, and a quantitative online survey to develop actionable policy recommendations for the digital transformation of health care in Germany. The study applies the conceptual framework of tipping points and success factors to identify critical factors in the digital transformation of health care systems, where certain actions or conditions fundamentally influence adoption and success. A total of more than 100 interviews were conducted with experts representing 8 stakeholder groups from 9 different health care systems. The qualitative data are evaluated using qualitative content analysis according to Kuckartz and Rädiker. In an online survey, a minimum of 305 participants from the German health care system will be surveyed regarding the relevance and feasibility of the key success factors identified in the international case studies. The dataset will be analyzed statistically using SPSS, both descriptively and inferentially (eg, subgroup analyses). Between November 2024 and September 2025, interviews with international health care experts were conducted. As of October 2025, the qualitative content analysis is still ongoing. The recruitment phase for the online survey is planned from October 15 to December 15, 2025. Initial results are expected to be available in 2026. The study protocol was submitted during the qualitative data collection phase before the commencement of the quantitative survey. Analysis had not yet begun at the time of submission. The use of a case study methodology has been demonstrated to facilitate the acquisition of invaluable insights into international best practices, while concurrently offering the opportunity to identify specific success and failure factors. The integration of qualitative expert interviews serves to contextualize international findings on tipping points and success factors in the implementation and use of digital health tools. The transfer of the international results to the German context represents a central component of the research project, which aims to investigate practical implementation. The combination of these approaches forms a comprehensive basis for deriving specific recommendations for action for the German health care system.
17. Global perspectives on telemedicine-enabled medications for opioid use disorder: Practices, priorities, and barriers.
期刊: Journal of telemedicine and telecare 发表日期: 2026-Jan-21 链接: PubMed
摘要
IntroductionTelemedicine (TM) has potential to address the global opioid use disorder treatment gap, yet its uptake, priorities, and barriers have not been mapped internationally.MethodsWe conducted a cross-sectional, web-based survey (July to November 2024) of clinicians and clinical leaders via the International Society of Addiction Medicine, World Psychiatric Association, and allied contacts. The questionnaire captured telemedicine facilitated medication for opioid use disorder (TMOUD) practices, priorities, and barriers. Responses were summarised overall and stratified by World Bank country-income group and by current TMOUD availability.ResultsSixty-eight experts from 37 countries, 32% from low/middle-income countries (LMICs), participated. General TM use rose from 57% before COVID-19 to 94% in 2024. TMOUD was available in 26 jurisdictions (38%), more often in high-income than LMIC settings (58% vs 11%). Barriers to prescribing were identified, and few settings reimbursed video and telephone consultations equally. Improving treatment retention (69%), reducing missed appointments (62%), and expanding medications to underserved (60%) or remote (57%) populations as top priorities, yet fewer than 40% reported that TMOUD was currently used to meet those goals. Key barriers were inadequate policy support (60%), lack of professional guidance (63%), restrictive regulation (48%), poor digital infrastructure (broadband 29%; e-prescribing 56%), and limited clinician training (54%); almost every barrier was more common in LMICs.DiscussionTMOUD remains uneven and concentrated in high-income countries. Updated clinical guidance, digital connectivity investment and interoperable e-health systems, and targeted workforce development, particularly in LMICs, are needed to realise TM’s potential for equitable and effective treatment of opioid use disorder. This global survey fills a critical knowledge gap by documenting expert perspectives across income settings, offering cross-national evidence to inform equitable expansion of TMOUD worldwide.
18. Evaluating Dose Response of Cognitive Behavioural Therapy Using Outpatient Electronic Medical Record Data: An Observational Study: Évaluer la relation dose-réponse de la thérapie cognitivo-comportementale au moyen des données des DME des patients externes : Une étude d'observation.
期刊: Canadian journal of psychiatry. Revue canadienne de psychiatrie 发表日期: 2026-Jan-21 链接: PubMed
摘要
ObjectiveAccess to cognitive behavioural therapy (CBT) in Canada is limited by long wait times. Our objective was to determine the optimal dose of CBT sessions for patients to maximize recovery and minimize treatment time.MethodOutpatient data from electronic medical records at a specialized mental health centre between 1 January 2017 and 31 May 2024 was used. The primary outcome was having experienced a reliable and clinically significant improvement (RCSI) in symptoms since start of treatment. Kaplan-Meier estimators were used to determine the percentile who had achieved RCSI after a given number of CBT sessions. Adjusted Cox regression determined predictors of treatment response.ResultsAmong patients (n = 1,853) receiving treatment, 50% showed response in Patient Health Questionnaire-9 (PHQ-9) scores at 7 sessions of low-intensity CBT (LiCBT) and 95% showed response at 23 sessions. For high-intensity CBT (HiCBT), treatment response occurred between 14 and 36 sessions for 50-95% of patients. In Generalized Anxiety Disorder Assessment-7 (GAD-7) scores, treatment response occurred between 8 and 30 sessions in LiCBT and 15 and 37 sessions in HiCBT for 50-95% of patients. Cox regression results found that neighbourhood dependency [PHQ-9: hazard ratio (HR) (95% confidence interval (CI)) = 1.32 (1.08 to 1.63), GAD-7: HR (95% CI) = 1.36 (1.12 to 1.65)] and sex (male) [PHQ-9: HR (95% CI) = 0.83 (0.70 to 0.99), GAD-7: HR (95% CI) = 0.80 (0.66 to 0.96)] were significant predictors of non-response in HiCBT. Older age at admission was a significant predictor of non-response to LiCBT [PHQ-9: HR (95% CI = 0.99 (0.98 to 1.00), GAD-7: HR (95% CI) = 0.99 (0.98 to 1.00)].ConclusionsThere are differences in the dose and the predictors of patients’ responses to LiCBT and HiCBT. These results provide insight into potential check-in points for clinicians to assess CBT treatment plans. These results may inform treatment planning, reducing longer than necessary length of stays, allowing for more patients to access mental healthcare services. How many CBT sessions help most people feel better? A real-world study of anxiety and depression treatmentPlain Language SummaryWhy was the study done? Depression and anxiety are common mental health conditions. Cognitive behavioural therapy (CBT) is an effective treatment, but therapy access is often limited by long wait times. Understanding how many therapy sessions are typically needed for improvement can help with this problem.What did the researchers do? We looked at real-world therapy records from over 1,800 patients treated between 2017 and 2024 at an outpatient mental health clinic. We wanted to find out how many CBT sessions people needed before seeing meaningful improvements in their symptoms.What did the researchers find? In low-intensity CBT (shorter or less frequent sessions), half of the patients saw a clear improvement in depression after 7 sessions, and nearly all improved by 23 sessions. In high-intensity CBT (longer or more frequent sessions), improvements took longer, between 14 and 36 sessions for depression. Anxiety symptoms showed similar patterns, with 8-30 sessions for most in low-intensity and 15-37 in high-intensity. Certain groups took longer to improve. Men and people from more dependent neighbourhoods took longer to respond to high-intensity CBT, while older adults took longer in low-intensity CBT.What do the results mean? Different types of CBT require different numbers of sessions for most patients to benefit. By knowing when people are likely to improve, therapists can better plan treatment check-ins. This could reduce unnecessary sessions, shorten wait times, and allow more people to receive care.
19. Using Alcohol and Sleep Sensors to Understand Blackout Risk in Young Adults' Natural Settings (The Lights Out Study): Protocol for an Intensive Longitudinal Pilot Study.
期刊: JMIR research protocols 发表日期: 2026-Jan-21 链接: PubMed
摘要
Alcohol-induced blackouts (AIBs) are a serious consequence of alcohol use that are strongly associated with experiencing excess alcohol-related harms. AIBs are common and recurrent among young adults who drink. The risk factors for AIBs include dynamics of alcohol use (quantity, speed, duration), alcohol-related behaviors (eg, playing drinking games, not using protective behavioral strategies), and factors related to the subjective experience of alcohol intoxication (eg, expectancies, motivations). This study seeks to examine 2 modifiable behaviors that have been shown to impact both alcohol consumption and subjective experiences of intoxication and may therefore be associated with AIB risk: (1) other substance use and (2) sleep. Approximately 50 participants will be recruited to participate in this study. Interested individuals will complete an online screening assessment, and those who are eligible (young adults who report recent heavy episodic drinking and AIBs) will be invited to an in-person baseline visit. At the baseline visit, participants will complete a baseline assessment, be fitted with a wrist-worn alcohol sensor (BACtrack Skyn) and a sleep or activity ring sensor (Oura ring), and receive training on the study protocol. Participants will complete a 14-day intensive data collection period consisting of twice daily scheduled mobile surveys and participant-initiated drinking surveys with hourly follow-ups. Participants will also wear the alcohol and sleep or activity sensors continuously during this 14-day period. After the intensive data collection period ends, participants will complete an in-person return visit to return their sensors, complete a follow-up survey, and receive compensation. The data will be processed and cleaned, and analyses will include multi-level structural equation models. This study was funded in July 2025. Data collection is projected to span January 2026 through June 2026. This study seeks to understand 2 key modifiable behaviors that may be associated with increased AIB risk by leveraging multiple forms of innovative measurement. The integration of ecological momentary assessments with 2 sensors to capture alcohol use and sleep also supports potential applications in future digital interventions. This study will further enhance our preliminary data on the feasibility and acceptability of these methods, providing opportunities for conducting future research on a larger scale.
20. The impact of socioeconomic crisis on cancer patient outcomes in Lebanon, 2018-2020.
期刊: Journal of comparative effectiveness research 发表日期: 2026-Jan-21 链接: PubMed
摘要
Aim: The goal of this study was to assess the impact of economic and social crisis on access to cancer care in Lebanon. Materials & methods: A cancer Drug Access Program in Lebanon was launched, covering 80-90% of treatment costs. The program included three drugs for breast cancer, renal cancer, and lung cancer. A longitudinal follow-up of patients was conducted. The Multidimensional Poverty Measure (MPI) was used by year (2019 or 2021), i.e., before and after the onset of the economic crisis. Results: A total of 613 cancer patients were included in 50 hospitals. Mean patient age was 58.5 years (standard deviation = 12.3). The proportion of cancer types was 79.3% breast, 10.6% renal, and 7.3% lung cancer. Treatment with palbociclib (hazard ration [HR]: 1.64; 95% confidence interval [CI]: 1.53-1.76, p < 0.0004), enrollment prior to 1 January 2019 (HR: 1.24; 95% CI: 1.07-1.44, p = 0.004), treatment at a hospital with fewer than five physicians (HR: 1.11; 95% CI: 1.00-1.23, p = 0.04), and lower 2019 MPI (HR: 1.69; 95% CI: 1.30-2.20) were significant predictive factors associated with survival. Higher governorate-level MPI was associated with increased mortality (adjusted rate ratio per 0.1-unit, HR: 2.88; 95% CI: 0.95-8.77, p = 0.06). Conclusion: Economic crises have negative impacts on health outcomes, and we identified a change in survival pre/post crisis onset. This study argues strongly for coordinated efforts to mitigate the negative effects of poverty on health. What is this article about? Since 2019, several events (an ongoing economic crisis, war in a neighboring country, severe wildfires, a massive explosion at a large port, the COVID-19 pandemic and political unrest) have negatively impacted Lebanon’s economy and made it difficult for patients to receive care. This study identified factors that impacted survival for cancer patients who began treatment before the start of Lebanon’s economic crisis in 2019 and those who started treatment once the crisis had begun. What were the results? This study found that patients who began cancer treatment before the start of the 2019 crisis were more likely to survive than patients who started treatment in 2019 or 2020. Other factors associated with being more likely to survive were treatment with a specific drug for breast cancer, treatment at a hospital with fewer than five physicians, and lower levels of poverty in 2019. What do the results mean? The results mean that factors unrelated to a cancer patients’ disease – when they started treatment, staffing at the hospital where they were treated, and their poverty level – can impact how likely they are to survive. These findings add to other data that show how poverty can negatively impact health. They also suggest that reducing poverty is important for improving survival in patients with cancer.
21. Suckerin Colloids and Hydrogels With Low Immunogenicity as Resorbable and Hemostatic Tissue Adhesives for Wound Healing.
期刊: Small (Weinheim an der Bergstrasse, Germany) 发表日期: 2026-Jan-21 链接: PubMed
摘要
Squid sucker ring teeth proteins (suckerins) have recently been shown to exhibit higher molecular-level adhesion than mussel adhesive proteins-a well-known class of wet-resistant adhesive proteins-and can also assemble into nanoparticles in aqueous conditions. Herein, we present recombinant suckerin-12 colloids and hydrogels as bioadhesives with strong wet adhesion and excellent in vivo biocompatibility. These colloids and hydrogels displayed low cytotoxicity, minimal immunogenicity, and negligible hemolysis, while outperforming fibrin glue in hemostasis, skin cell proliferation and migration, wound closure, and healing. Suckerin hydrogels formulated via riboflavin-mediated di-tyrosine crosslinking preserved β-sheet content and elasticity at an optimal crosslinking density, resulting in enhanced adhesion, hemocompatibility, and in vivo wound closure. Transcriptomic analysis further revealed regulation of genes associated with hemostasis, angiogenesis, proliferation, and re-epithelialization, with minimal immune activation. Together, these findings establish suckerin-based adhesives as promising next-generation biomedical materials that combine scalability, stability under oxidative conditions, and superior performance for external wound repair.
22. A Markov model for fate and transport of Staphylococcus aureus at a swine barn and proposed interventions to reduce worker exposures.
期刊: Annals of work exposures and health 发表日期: 2026-Jan-21 链接: PubMed
摘要
Swine workers may be occupationally exposed to Staphylococcus aureus (S. aureus) during time spent inside swine barns. Exposure may occur by inhaling S. aureus-containing particles or by touching contaminated surfaces or infected animals. Despite strong evidence that swine production work is a risk factor for increased nasal carriage of S. aureus, pathways of worker exposure within the swine barn setting have not been well characterized. We developed a Markov chain model to address this research gap by first describing the fate and transport of S. aureus-containing particles within a swine finishing barn. We defined 7 possible physical locations in and around the barn in which S. aureus-containing particles may exist and used published data to determine the probability that a particle will transition from any of these locations to the other locations during a 1-s time interval. We then used our model to estimate worker exposure to S. aureus during a period of 1 s to 30 min spent inside the swine barn. Finally, we modified inputs to simulate interventions to protect workers, such as ventilation controls, respirator use, and handwashing. Increasing the ventilation rate (ie the rate at which outdoor air replaces indoor air in the barn) in our model from the recommended rate for cold weather to the rate for mild weather resulted in a 59% decrease in the number of S. aureus-containing particles in the worker’s respiratory system after 30 min. Increasing ventilation rates further to the recommended rate for hot weather resulted in an additional 58% decrease. Models simulating floor and surface cleaning prior to the worker’s entry into the barn had little impact on the air concentration of S. aureus (<1% change) but reduced worker exposure to facial membranes by up to 13%. Simulations of N-95 respirator wearing had the greatest impact on worker exposure. As modeled, a well-fitting N-95 respirator may reduce worker inhalation exposure from 1,772 to 72 S. aureus-containing particles after 30 min in the barn, a 96% reduction. In our model, a poorly fitting N-95 respirator reduced exposure by about 30%, indicating that the type and fit of respirator worn has an important impact on the level worker protection.
23. Low-cost sensors: Performance test and applications in occupational health studies related to exposure to respirable particles.
期刊: Journal of occupational and environmental hygiene 发表日期: 2026-Jan-21 链接: PubMed
摘要
Particulate matter (PM2.5), recently classified as a Group 1 carcinogen by the International Agency for Research on Cancer (IARC), represents a major concern for human health, particularly in occupational environments. In response to the need for accessible monitoring tools, this study aimed to: (1) develop a low-cost device for PM2.5 measurement, (2) evaluate its performance, (3) apply it in real-time workplace monitoring, and (4) Occupational health evaluation considering cancer risk associated with PM2.5 exposure. The sensing device integrates particulate matter, temperature, and humidity sensors. It is built around a Single Board Computer (SBC) and supports local data storage, GPS compatibility, and Wi-Fi communication. The entire system operates at a total cost of less than USD 500, providing a low-cost yet comprehensive solution for environmental monitoring. Performance testing of the constructed device demonstrated “good” precision (R2 = 0.66-0.68), a coefficient of variation between 4.5% and 21.3%, satisfactory accuracy, and a low detection limit. After validation, it was used to measure PM2.5 concentrations in occupational environments, revealing temporal patterns strongly linked to human activity. The highest average concentrations were recorded during the daytime hours of weekdays (working hours), ranging from 12.25 µg/m³ to 240.19 µg/m³, while nighttime levels were lower (11.22 µg/m³ to 152.08 µg/m³, respectively). The results indicate that local activities are the main contributors to PM2.5 emissions. On weekends, concentration decreased significantly in all periods, suggesting an overall reduction in line with the suspension of local activities. Occupational health assessed based on cancer risk associated with PM2.5, assuming 24-hr exposure to the pollutant, showed exposure levels exceeded the annual limits recommended by the WHO and ASHRAE/USEPA across all monitored sites.
24. From Digital Anxiety to Empowerment in Older Adults: Cross-Sectional Survey Study on Psychosocial Drivers of Digital Literacy.
期刊: JMIR aging 发表日期: 2026-Jan-21 链接: PubMed
摘要
Amid the convergence of global population aging and accelerating digital transformation, older adults’ digital adaptability has emerged as a critical indicator of their quality of life, autonomy, and capacity for successful aging. However, digital disparities, technology-related anxiety, and insufficient support systems continue to hinder older individuals from fully participating in digital society. Particularly in modern family structures-where children often live apart from aging parents-the diminishing role of family support further underscores the importance of broader social influences. This study aims to examine how environmental factors (family support and social influence) and psychological factors (digital anxiety and sense of achievement) are associated with older adults’ intention to use Assistive Digital Tools and Services (ADTS), and how these relationships contribute to the development of digital literacy. Drawing upon an integrative framework that combines constructs from the Technology Acceptance Model, the Unified Theory of Acceptance and Use of Technology, and social cognitive theory, the study also investigates the mediating and moderating mechanisms underlying these effects, offering strategic insights to support older adults in moving from social isolation to digital empowerment. A structured questionnaire survey was conducted using a convenience sampling method among adults aged 55 years and older in Shenyang, Liaoning Province, China, yielding 480 valid responses. Structural equation modeling, bootstrapping, and moderation analysis were used to test the proposed integrative framework. For both family support and social influence, their associations with digital literacy were fully mediated by ADTS. Higher family support was associated with lower digital anxiety, which in turn correlated with greater intention, while stronger social influence was directly associated with higher intention. Digital anxiety showed a strong negative association with intention; however, this relationship was significantly weaker among those reporting a higher sense of achievement. These findings highlight usage intention as a central pathway through which environmental and psychological conditions are related to digital competence. Digital literacy in later life is more than a technical skill set-it represents a vital form of psychological and social capital that empowers autonomy, well-being, and social integration. Strengthening older adults’ intention to engage with digital tools through emotional reinforcement, achievement-oriented experiences, and supportive social environments is key to narrowing the digital divide. Beyond its personal benefits, fostering digital competence contributes to successful aging, which in turn brings profound advantages for families, strengthens community cohesion, and supports national goals in public health, economic participation, and social sustainability. Intergenerational learning initiatives, community-based engagement programs, and leveraging social influence to offset weakened family support can create a more inclusive, resilient, and age-friendly digital ecosystem-one that benefits not only older individuals but society at large.
25. Health Risks of Pesticide Use and Agricultural Products Contamination in the Plateaux Region of Togo, West Africa.
期刊: Environmental toxicology and chemistry 发表日期: 2026-Jan-21 链接: PubMed
摘要
This study assesses pesticide in crops from Togo’s Plateaux region and evaluates health risks associated with farmers’ exposure during pesticide application. A survey was conducted involving 350 farmers and 48 pesticide sellers. Operator exposure was assessed using the British Predictive Operator Exposure Model (U.K.-POEM) and the European Food Safety Authority (EFSA) calculator. A multi-residue analysis of 51 pesticides was carried out after a QuECHERS extraction and purification, using a gas chromatography system on six types of agricultural products during both rainy and dry seasons. The survey established the profile of pesticides in use. The herbicide spectrum was dominated by glyphosate, 2,4-dichlorophenoxyacetic acid, nicosulfuron, paraquat, and propanil. For insect control, applications primarily relied on λ-cyhalothrin, cypermethrin, acetamiprid, imidacloprid, and chlorpyrifos. Notably, 83% of operators reported not using personal protection equipment during mixing, loading or spraying. Modelling indicated high-risk exposure levels (Risk Quotient >1) for all pesticides, highlighting inadequate phytosanitary practices Residue analysis detected 13 pesticides. The most frequently detected were chlorpyrifos, endosulfan sulfate, acetamiprid and lambda-cyhalothrin. In the most contaminated produce, lettuce and cabbage, total pesticides concentrations ranged from 69 to 219 and 192 to 330 ng/kg respectively with higher contamination levels observed in the dry season. This study reveals the likelihood of elevated pesticide exposure in Togo, taking into account agriculture products contamination and operator exposure, raising concerns about long-term health risks such as chronic cancer and autism. Further assessment of drinking water contamination by these organic pollutants is warranted.
26. Correction: Smartphone App-Based Eating Behavior Monitoring and Feedback Intervention for Glucocorticoid-Induced Appetite Increase in Patients With Systemic Lupus Erythematosus: Protocol for a Pilot Randomized Controlled Trial.
期刊: JMIR research protocols 发表日期: 2026-Jan-21 链接: PubMed
摘要
27. Strengthening clinical capacity in spinal muscular atrophy: Developing and implementing training on clinical outcome assessments.
期刊: Journal of neuromuscular diseases 发表日期: 2026-Jan-21 链接: PubMed
摘要
Clinical Outcome Assessments (COAs) are essential for monitoring progression and treatment response in neuromuscular diseases. However, substantial variability exists in training, confidence, and implementation of COAs among clinical evaluators working with individuals with Spinal Muscular Atrophy (SMA). This study aimed to identify and address these gaps within the Canadian clinical context through a phased educational initiative guided by the Rare Knowledge Mining Methodological Framework (RKMMF). A qualitative, phased design was used. A needs assessment with 71 physiotherapists and occupational therapists via focus groups identified inconsistent access to SMA-specific training and challenges in applying standardized assessments. Based on these findings, expert faculty co-developed and delivered bilingual workshops incorporating real-world evaluation videos, simulation-based learning, and multidisciplinary case discussions. Pre- and post-workshop surveys, based on an adapted Kirkpatrick Model, measured changes in familiarity, preparedness, and clinical confidence. Data were analyzed using thematic content analysis and descriptive statistics. Seventy-nine evaluators from Canada participated. Pre-workshop data revealed major gaps in familiarity with SMA-specific COAs. Post-workshop surveys indicated a 75% average increase in self-reported preparedness, with the greatest gains in the Adapted Test of Neuromuscular Disorders 3.0. Four key themes emerged: limited training and support networks; the critical role of multidisciplinary collaboration; constraints of current COAs due to ceiling and floor effects; and the value of integrating patient-reported outcomes in clinical practice. Peer-led, evidence-informed workshops significantly improved clinical preparedness in SMA assessment. These findings support the need for ongoing training strategies and demonstrate the RKMMF as a scalable approach for capacity-building in rare disease care.
28. Association of oil spill-related volatile organic compound exposure with CVD-related biomarkers in the Gulf Long-term Follow-up Study.
期刊: Annals of work exposures and health 发表日期: 2026-Jan-21 链接: PubMed
摘要
During the Deepwater Horizon disaster in 2010, oil spill response and cleanup (OSRC) workers were exposed to crude oil, including benzene, toluene, ethylbenzene, xylene, and n-hexane (BTEX-H). Growing evidence links these exposures to cardiovascular disease (CVD). Lipid and C-reactive protein levels are used to assess CVD risk and may serve as mediators of the observed associations with CVD. However, few studies have assessed associations of oil spill cleanup-related exposures with blood levels of lipids and C-reactive protein (CRP). This study examined associations of oil spill cleanup-related exposure to each individual BTEX-H chemical, total (aggregate sum) BTEX-H, and the BTEX-H mixture with blood lipids and CRP among OSRC workers in the Gulf Long-term Follow-up (GuLF) Study. Subjects comprised 2,544 OSRC workers who completed a home visit (May 2011 to May 2013) and had CVD biomarker measurements. Cumulative exposures to BTEX-H (ppb-days) were estimated using a job-exposure matrix that linked air measurements with self-reported Deepwater Horizon work histories. Study biomarkers were lipids, including low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), total cholesterol, and high-sensitivity CRP (hsCRP), which were measured in blood samples collected during the home visit. Multivariable linear regression was used to estimate mean differences and 95% confidence intervals (CI) for associations of quartiles of BTEX-H with lipid and hsCRP levels. We log-transformed hsCRP due to a non-normal distribution. We used quantile g-computation to assess the joint effect of the BTEX-H mixture. Each BTEX-H chemical was associated with elevations in total cholesterol up to 3 yr after exposure, with the strongest effect estimates in the top quartile, ranging from 2.3 to 5.1 mg/dL. A one quartile simultaneous increase in the BTEX-H mixture was associated with a 1.7 mg/dL increase in total cholesterol. While trends were less consistent for hsCRP, most estimates were above the null and a one quartile increase in exposure to the BTEX-H mixture was associated with a 3% increase in hsCRP. Our study suggests that oil spill cleanup-related BTEX-H exposures were associated with elevations in some CVD biomarkers.
29. Occupational exposure to tris (chloropropyl) phosphate in flexible polyurethane foam workers: exposure levels and risk assessment.
期刊: Annals of work exposures and health 发表日期: 2026-Jan-21 链接: PubMed
摘要
Tris (chloropropyl) phosphate (TCPP) is an organophosphate flame retardant (PFR) added to flexible polyurethane foam to adhere to national or sectorial flammability requirements. During the manufacturing of flexible polyurethane foam, workers can be potentially exposed to TCPP dermally or through inhalation. We aimed to determine the exposure to TCPP in European polyurethane foam workers and perform a risk assessment based on a newly determined derived no effect level (DNEL). In this study, 28 workers from 5 European flexible polyurethane foam production factories participated. Levels of the urinary metabolites of TCPP: bis(1-chloro-isopropyl) hydroxy-isopropyl phosphate (BCIPHIPP) and bis(1-chloro-isopropyl) phosphate (BCIPP) were measured using LC-MS/MS and risk assessment was performed by calculating estimated daily intakes (EDIs) of TCPP and comparing these with the DNEL. BCIPHIPP was detected in 100% of samples, with a median of 5.56 ng/mL (maximum 420 ng/mL). BCIPP had an overall detection frequency of 31%, but in workers from one individual factory it was detected in 93% (n = 13) of samples, with a median of 9.41 ng/mL (maximum 58.6 ng/mL). A DNEL of 3.0 mg/kg bw/day for TCPP was determined for an occupationally exposed population by evaluating a recently published chronic in vivo study on TCPP carcinogenicity. EDIs were all more than 2 orders of magnitude below the DNEL. Although BCIPHIPP levels detected in this study were higher than in the general population, the performed risk assessment indicated that the included workers are not expected to be at risk for carcinogenic effects following TCPP exposure at the measured levels and that the applied safety measures are sufficiently protecting the workers under these conditions.
30. Antipsychotic-disease duration interaction on glymphatic function in first-episode schizophrenia: Evidence from DTI-ALPS.
期刊: Schizophrenia research 发表日期: 2026-Jan-20 链接: PubMed
摘要
The glymphatic system’s role in early schizophrenia remains unclear. This study investigated glymphatic function using the DTI-ALPS index in first-episode schizophrenia (FES), exploring its relationships with clinical features, antipsychotic treatment, and cognitive function. The study included 37 first-episode drug-naïve (FESDN) patients, 22 first-episode treated (FEST) patients, and 42 demographically matched healthy controls (HCs). ALPS indices were calculated, and clinical assessments included cognitive function (RBANS), psychiatric symptoms (PANSS), and peripheral biomarkers. FES patients exhibited left-hemisphere predominant reductions in ALPS indices (p < 0.01). An interaction was observed between disease duration and treatment: the FEST group had lower DTI-ALPS than the FESDN group in patients with shorter illness durations, but this group difference diminished with longer disease duration (βinter = -0.8 × 10-2, p < 0.05). The ALPS-cognition association pattern differed between patients and HCs: left ALPS was positively correlated with RBANS in HCs (βHC > 0, p < 0.01) but negatively correlated in FES patients (βFESDN = -16.6, βFEST = -21.6, p < 0.1). Peripheral white blood cell count and total bilirubin were negatively associated with left ALPS in the FEST group (WBC: β = -0.63 × 10-2, p = 0.025; TBIL: β = -0.80 × 10-2, p = 0.039), with significant group interaction effects (p < 0.05). FES patients demonstrate left-lateralized glymphatic dysfunction, the severity of which is dynamically modulated by treatment and disease duration. The observed negative ALPS‑cognition correlation raises the possibility of a compensatory mechanism in early schizophrenia. Associations noted between peripheral inflammatory/metabolic markers and ALPS offer tentative support for an interactive “periphery-brain” clearance system. DTI-ALPS may serve as a dynamic biomarker reflecting neuropathological mechanisms in early schizophrenia.
31. Per- and polyfluoroalkyl substances (PFAS) in wastewater treatment plants: an overview of their occurrence, fate, effects, and ecological risks.
期刊: Journal of environmental management 发表日期: 2026-Jan-20 链接: PubMed
摘要
Wastewater treatment plants (WWTPs) are major reservoirs for per- and polyfluoroalkyl substances (PFAS). This review provides a systematic analysis and overview of the occurrence, transformation, and removal of PFAS in WWTPs. The behavior and impact of PFAS in WWTPs are significantly influenced by their chain length and functional groups. While long-chain PFAS accumulate in sludge and pose a secondary pollution risk upon land application, short-chain PFAS are primarily discharged with the effluent. It is particularly notable that PFAS promote the proliferation and horizontal transfer of antibiotic resistance genes (ARGs), which intensifies public health concerns. This review concludes that conventional biological processes (e.g., A2/O, SBR) are largely ineffective at removing PFAS, often exhibiting negligible or even negative removal efficiencies (-50 %-67.6 %), likely due to the biotransformation of precursors into more stable end products. In contrast, advanced treatment technologies, such as reverse osmosis and advanced oxidation processes, can achieve high removal efficiencies (> 90 %). However, their high operational costs and the challenges associated with managing concentrated waste streams restrict widespread implementation. The findings underscore the need for integrated treatment strategies, improved monitoring of precursors and transformation products, and stringent source control to mitigate the multifaceted ecological and public health risks posed by PFAS. Future research should prioritize cost-effective advanced treatment and risk assessments.
32. Comparative evaluation of limit-of-detection-based and K-nearest-neighbors-based classification approaches for detecting effluent contamination using fluorescence-derived water quality parameters.
期刊: Journal of environmental management 发表日期: 2026-Jan-20 链接: PubMed
摘要
Rapid and low-cost detection of wastewater treatment plant (WWTP) effluent contamination in aquatic systems protects public health and environmental quality. While optical whiteners and fluorescence-derived organic compounds in treated wastewater effluent serve as detection surrogates, few long-term studies have employed machine-learning methods to evaluate fluorescence excitation-emission matrices (EEMs) for predicting wastewater impacts. This study compares limit of detection (LOD)-based and k-nearest neighbors (KNN)-based classification methods using fluorescence-derived indicators and conventional physicochemical parameters for reliable wastewater effluent detection. For the first time in Korea, EEMs were obtained from water samples collected over 20 months from two uncontaminated upstream sites (Bukcheon and Byeongseongcheon Rivers), WWTP effluent, and an effluent-impacted downstream site in Nakdong River tributaries. The LOD-based classification achieved accuracies of 82-94 % under stable baseline conditions (Bukcheon River) but declined to 71-76 % under variable baseline conditions (Byeongseongcheon River). In contrast, the KNN approach demonstrated greater robustness, achieving optimal accuracies of 98 % and 91 % at the two sites, respectively, while maintaining stable performance across parameter combinations. Feature importance analysis identified tryptophan-like (Peak T) and microbial humic-like (Peak M), were the most important classification features, while conductivity was the most influential physicochemical parameter. Monte Carlo sensitivity analysis revealed minimum detectable effluent mixing ratios of 13-23 % required to achieve 90 % classification accuracy, with KNN demonstrating greater accuracy in challenging scenarios. These findings demonstrate the value of combining advanced fluorescence spectroscopy with machine learning for improved water quality monitoring and the detection of wastewater effluent contamination.
33. Targeting the 4-HNE-H₂S pathway as a therapeutic strategy for placental injury in pregnancy with MAFLD.
期刊: International immunopharmacology 发表日期: 2026-Jan-20 链接: PubMed
摘要
This study aims to investigate the molecular mechanisms by which 4-hydroxynonenal (4-HNE) regulates hydrogen sulfide (H₂S)-producing enzymes, mediating the pathogenesis of metabolic dysfunction-associated fatty liver disease (MAFLD) during pregnancy, thereby offering novel molecular targets for early diagnosis and intervention of related disorders. By establishing a MAFLD pregnant mouse model, we comprehensively examined the regulatory effects of 4-HNE on placental function and its interaction with the H₂S system. We found that MAFLD pregnant mice exhibited significant glucose metabolic disorders, hepatic steatosis, and placental damage. Mechanistically, 4-HNE disrupts H₂S biosynthesis, thereby impairing its inhibitory effect on the inflammasome pathway while simultaneously activating inflammatory cascades. This synergistic action exacerbates placental pathological damage, manifesting as abnormal vascular function and impaired materno-fetal exchange. Notably, exogenous H₂S intervention partially reversed 4-HNE-induced toxicity, suggesting the therapeutic potential of targeting this pathway. These findings demonstrate the pivotal role of the “4-HNE-H₂S-NLRP3” regulatory axis in MAFLD-associated placental injury, providing novel mechanistic insights and potential therapeutic targets for pregnancy complications.
34. Camelid-derived antibodies reduce myonecrosis and IL-1β release after treatment with Bothrops jararacussu venom in mice.
期刊: International immunopharmacology 发表日期: 2026-Jan-20 链接: PubMed
摘要
Snakebite envenoming in Latin America is both an occupational hazard and a neglected tropical disease. Globally, more than 420,000 envenomings occur annually, resulting in approximately 20,000 deaths. In Brazil, most cases are caused by snakes of the genus Bothrops, which comprises over 60 species distributed throughout the country. Although antivenom therapy efficiently neutralizes systemic effects, local manifestations such as myonecrosis, dermonecrosis, pain, and edema remain poorly controlled. These effects are largely mediated by snake venom phospholipases A₂ (svPLA₂s), which play a central role in cytotoxicity, myotoxicity, and local inflammation. Camelid hyperimmune serum contains heavy-chain antibodies (HcAbs; IgG2 and IgG3) that lack light chains and display reduced immunogenicity and enhanced tissue penetration, making them promising candidates as adjunct antivenom therapies. This study aimed to investigate the ability of Lama glama HcAbs (LHcAbs) to modulate local inflammatory responses and their association with NLRP3 inflammasome activation in experimental envenomation. LHcAbs were purified from hyperimmune serum obtained after immunization with whole venom and PLA₂ from Bothrops jararacussu venom (BjV) using Protein A and G Sepharose columns. Swiss mice received intramuscular injections of BjV into the gastrocnemius muscle, followed by LHcAbs treatment. Plasma analyses showed significant reductions in biomarkers of muscle damage (creatine kinase and lactate dehydrogenase) and cardiac injury (CK-MB) in treated animals. Aspartate aminotransferase levels were reduced, whereas alanine aminotransferase levels remained unchanged. Notably, LHcAbs treatment significantly decreased IL-1β levels in muscle tissue and attenuated NLRP3 inflammasome activation. These findings demonstrate that LHcAbs effectively reduce local tissue damage and inflammation, supporting their potential as complementary therapeutics to conventional antivenom therapy.
35. Contraceptive autonomy of adolescents and young adults in the U.S. South: The influence of healthcare providers, partners, and parents.
期刊: Social science & medicine (1982) 发表日期: 2026-Jan-17 链接: PubMed
摘要
A growing body of research describes coercive experiences in contraceptive care in the clinic setting, a phenomenon that disproportionately constrains the contraceptive autonomy of women who are young, low-income, Black, or Latinx. Less research has examined how other social influences may constrain contraceptive use and decision-making. We examine contraceptive autonomy across three domains of interpersonal influence (healthcare providers, sexual partners, and parents) and by race (Black vs. White). Between July-September 2023, we surveyed 1207 Black and White adolescents and young adults (AYAs) assigned female at birth living in five southern states. Over half of all respondents reported feeling social pressure related to their contraceptive use. More respondents spoke with a sexual partner or healthcare provider than with a parent about contraception, but those who did speak with a parent were most likely to report contraceptive pressure. Furthermore, respondents who reported social pressure were less likely to be using their preferred method of contraception. Black (vs. White) AYAs were less likely to have conversations with healthcare providers and sexual partners about contraception; more likely to report social pressure across all interpersonal domains; and less likely to be using their preferred method. By examining social pressures beyond the clinic setting, findings reveal the multifaceted and socially patterned ways that bodily autonomy is constrained for AYAs assigned female at birth and how this is magnified for Black AYAs.
36. Anthropometric Determinants of Rowing Performance in a Multinational Youth Cohort.
期刊: Journal of functional morphology and kinesiology 发表日期: 2026-Jan-17 链接: PubMed
摘要
Background: Rowing performance in youth athletes is strongly influenced by anthropometric characteristics, body composition, and limb proportions; however, the combined contribution of these factors across developmental stages remains insufficiently understood. This study investigated the relationships between key anthropometric variables and ergometer performance in a multinational cohort of young rowers. Methods: A total of 194 athletes (48 females, 146 males) from ten countries participated. Based on age and sex, participants were categorized into junior female (JF), junior male (JM), adult female (AF), and adult male (AM) groups. Body height, body mass, body fat (F%), relative muscle mass (M%), limb lengths, and body surface area (BSA) were measured. Rowing performance was assessed via maximal 2000 m ergometer trials. Results: Males outperformed females across all age groups (p < 0.001). Performance showed strong positive correlations with body height (r = 0.673, p = 0.003), body mass (r = 0.724, p = 0.005), arm span (r = 0.681, p = 0.002), lower-limb length (r = 0.394, p = 0.004), relative muscle mass (39.9 ± 5.2%; r = 0.531, p < 0.001), and especially BSA (1.94 ± 0.19 m2; r = 0.739, p < 0.001). Relative body fat was negatively associated with performance (17.6 ± 6.9%; r = -0.465, p < 0.001). Conclusions: Findings indicate that rowing performance in youth athletes reflects multidimensional anthropometric configurations rather than isolated traits, characterized primarily by the combined contribution of body surface area, relative muscle mass, and segmental body dimensions. From a practical perspective, higher-performing athletes typically exhibited body surface area values approaching or exceeding ~1.90 m2 and relative muscle mass above ~40%, suggesting these ranges as indicative reference benchmarks rather than fixed selection thresholds. Integrating anthropometric profiling with physiological assessment may enhance early talent identification and support individualized training strategies in competitive youth rowing.
37. The impact of media coverage of a celebrity suicide on suicide and attempted suicide rates in Taiwan.
期刊: Social science & medicine (1982) 发表日期: 2026-Jan-16 链接: PubMed
摘要
Media coverage of celebrity suicides can shape population-level suicidal behavior, yet most existing evidence focuses on mortality rather than non-fatal attempts. This study investigates the impact of media coverage following the suicide of Chiung Yao, an 86-year-old best-selling novelist and cultural figure in Chinese-speaking societies, on suicide mortality and suicide attempts in Taiwan. We drew on suicide attempt data from Taiwan’s National Suicide Surveillance System and mortality data from the Taiwan Death Registry. Using an interrupted time-series design with quasi-Poisson regression, we analyzed seven-day rolling counts of suicide attempts and deaths during the four weeks before and after her death (December 4th, 2024), stratified by sex, age group, and suicide method. No significant overall changes in suicide attempts or mortality were observed. However, suicide attempts increased by 12.3 % among women aged 45-64 (IRR = 1.123; 95 % CI: 1.030-1.225), with a slight increase of the post-death trend among women aged 25-44. Suicide deaths by charcoal burning, the method used by the celebrity, increased by 47.0 % (IRR = 1.470; 95 % CI: 1.195-1.807), and mortality among men aged 25-44 and ≥65 rose by 35.5 % (IRR = 1.355; 95 % CI: 1.095-1.679) and 20.7 % (IRR = 1.207; 95 % CI: 0.992-1.468), respectively. Media coverage of the suicide of an older celebrity was not associated with population-level increases in suicide, but associated with method- and subgroup-specific changes in suicide attempts and mortality. These findings highlight the importance of monitoring media practices with attention to differential vulnerability following highly publicized suicides.
38. Association of lifestyle and non-lifestyle variables with fertility problems in a population-based cohort of women in Australia.
期刊: Maturitas 发表日期: 2026-Jan-16 链接: PubMed
摘要
To assess the relative importance of a range of lifestyle and non-lifestyle variables in relation to the risk of fertility problems over time. A prospective cohort study using data from the 1973-1978 birth cohort of women participating in the Australian Longitudinal Study of Women’s Health. Women who completed at least one survey between 2006 (used as baseline) and 2018 and who reported a known fertility status were included (n = 8475). Participants were aged 28-33 years in 2006. Exposure variables included age, body mass index (BMI), polycystic ovary syndrome (PCOS), physical activity, fruit and vegetable intake, smoking and alcohol, and level of anxiety. Women were asked to report their fertility status, categorised as “fertility problems” (with or without treatment) and “no fertility problems”. A generalised estimating equation with log-binomial family was fitted, and the estimated probabilities along with 95% confidence intervals were obtained. The relative contribution of each variable to infertility was estimated by multimodel inference. The mean (SD) age and BMI of the 8475 women included was 33.2 (3.5) years and 25.9 (6.0) kg/m2; of the sample, 24% had problems with fertility. Age, PCOS, anxiety, BMI, and the interaction of age x PCOS had the same relative contribution, of 8.5%, to the risk of fertility problems at any given point across the 12 years. When the contributions of age with any of the exposures (except PCOS) were explored together, the relative contribution was less than that of the respective individual exposures, indicating that their interaction weakly contributes to fertility problems. BMI and anxiety contributed independently of age to infertility problems whereas the effect of PCOS was exacerbated with younger age. These findings highlight the importance of early pregnancy planning, particularly for women with PCOS, and support the need for preconception strategies targeting BMI and anxiety. However, temporal misalignment between current exposures and lifetime infertility reporting may limit causal interpretation.
39. Engaging patients in blood systems: A qualitative study on immune globulin recipient perspectives.
期刊: Social science & medicine (1982) 发表日期: 2026-Jan-16 链接: PubMed
摘要
Plasma-derived medical products (PDMPs) can represent life-saving treatments for immunodeficiencies, autoimmune diseases, and other health conditions. Immunogloublin (Ig) is a PDMP used to treat a large number of inherited or acquired diseases. As the beneficiaries of a highly complex supply chain, recipients of Ig can illuminate the practical implications of supply challenges and policy initiatives on their health and well-being. This study explores the perspectives of Ig recipients. This paper stems from a study based on Narrative Inquiry, which delved into the experiences and perspectives of Ig recipients. A two-interview format was employed to capture 1, the recipient’s diagnostic journey and challenges, reported elsewhere; and 2, their knowledge, awareness, and engagement in Ig production and distribution. The second interviews were analyzed with reflexive thematic analysis and are reported in this manuscript. Participants in this study described access to Ig as variable and uncertain. The uncertainty was shaped by the relationships that they negotiated with the other social actors in the blood system. They described feeling bound to their physician as the gatekeeper to a diagnosis, and therefore treatment, and to navigate a complex health system on their behalf. They were deeply grateful for the plasma donor, but when access felt precarious, the reliance on the donor was unsettling due to uncertainty around product availability. Finally, participants felt removed from the process in which decisions were made about treatment. Our study engaged Ig recipients as important social actors in the systems responsible for collecting and distributing Ig. Participants offered specific and thorough recommendations for meaningful change. Such guidance holds the potential to foster a more integrated environment in which all interest-holders collaborate to meet patient needs more equitably and sustainably.
40. Using herd frailty estimates from survival models in a mortality-based syndromic surveillance system.
期刊: Preventive veterinary medicine 发表日期: 2026-Jan-15 链接: PubMed
摘要
Syndromic surveillance, which monitors clinical or production data as potential indicators of disease, can complement existing diagnostic testing strategies for a more comprehensive surveillance system. Consistently recorded mortality data with established identification and traceability routes across cattle sectors could be useful indicators to monitor in a syndromic surveillance system. Ireland is progressing toward the eradication of bovine viral diarrhoea (BVD) virus following a programme initiated in 2013 to identify and remove calves that test positive for BVD. As the country prepares for BVD-free status under the EU Animal Health Law, stakeholders must consider strategies to detect possible re-emergence. Historical data from the eradication programme provides a unique opportunity to evaluate mortality-based syndromic surveillance for this purpose. This study aimed to develop a syndromic surveillance model based on calf mortality data and evaluate its use for early detection of BVD re-emergence in Ireland. For years 2014 through 2023, mixed-effects Cox proportional hazards models were built using calf mortality up to 100 days of age. Herd-level frailty estimates were extracted from these models for each year, which were then clustered to identify subgroups of herds with distinct temporal patterns in herd-level mortality hazard. Four separate thresholds were used to flag herds with increased calf mortality hazard. Overall, these flags demonstrated high specificity (86-92 %) but low sensitivity (11-22 %) for herd-level BVD status, suggesting that this approach alone would not reliably detect BVD re-emergence. Nonetheless, this method could support Ireland’s ability to achieve and sustain BVD-free status while providing valuable insights for similar surveillance efforts more broadly. This methodology is adaptable to other species, diseases, and syndromes, making it a versatile tool for animal health surveillance.
41. How employment-based clinical experience during undergraduate education influences transition to practice: A qualitative systematic review.
期刊: Nurse education today 发表日期: 2026-Jan-13 链接: PubMed
摘要
To synthesize qualitative evidence on the experiences of undergraduate nursing students and new graduate nurses engaged in formal paid employment models or health-related work during their undergraduate studies, to examine how these employment-based clinical experiences influence their transition to nursing practice, and to identify elements that facilitate or hinder this transition. Qualitative systematic review. Searches were conducted in MEDLINE, Embase, Emcare (Ovid), CINAHL Complete (EBSCOhost), ERIC (ProQuest), and gray literature sources, including ProQuest Dissertations and Theses and Google Scholar. No date or country limits were applied, although only English-language studies were included. The review followed JBI methodology for qualitative evidence synthesis and adhered to PRISMA reporting guidelines. Two reviewers independently appraised methodological quality using the JBI Critical Appraisal Checklist, with disagreements resolved through discussion with a third reviewer. Findings were aggregated through meta-aggregation. Twelve studies met the inclusion criteria, contributing 92 findings categorized into 13 categories and three synthesized findings: 1) Developing professional identities while navigating role-related challenges; 2) Developing clinical competence and confidence; and 3) Gaining environmental familiarity and workplace socialisation while managing high expectations. Formal paid employment and health-related work provided students and new graduates with opportunities to enhance confidence, competence, and workplace readiness. However, they also encountered challenges related to role boundaries, supervision variability, and dual expectations, illustrating the complex influence of employment-based experiences on transition to practice. Additional clinical experience acquired through formal paid employment and health-related work contributes meaningfully to the transition to nursing practice by strengthening professional identity, clinical proficiency, and workplace socialization. Persistent challenges highlight the need for structured support, clear supervision, and defined scopes of practice within employment-based roles.
42. Is Obesity a Modifiable Risk Factor in Multiple Sclerosis? Mechanistic Insights into Neuroinflammation and Oxidative Damage.
期刊: Pathophysiology : the official journal of the International Society for Pathophysiology 发表日期: 2026-Jan-13 链接: PubMed
摘要
Introduction: Multiple sclerosis (MS) is a chronic autoimmune inflammatory disorder of the central nervous system (CNS) that leads to demyelination of CNS neurons and is influenced by genetic, environmental, and lifestyle factors, including diet and obesity. Methods: This review aims to analyze at the molecular level the relationship between obesity, as a chronic inflammatory condition, and the pathophysiology of MS, as a chronic autoimmune inflammatory disease, in order to understand the complex links between obesity and MS through a search of the PubMed and Google Scholar databases. Discussion: Chronic inflammation and OS are interconnected processes, causing a toxic state, which contributes to the development of CNS neuroinflammation and neuronal damage, resulting in neuronal demyelination and the onset of MS. Adipose tissue is a complex endocrine organ; in addition to being a lipid storage organ, it secretes cytokines and adipokines, which are involved in the regulation of hormones, metabolism, inflammation, and whole-body homeostasis. Obesity triggers chronic low-grade inflammation, disruption of the blood-brain barrier (BBB) and brain metabolism, infiltration of the CNS by immune cells, production of ROS, and generation of oxidative stress (OS). Anti-inflammatory and pro-inflammatory adipokines are also implicated in MS and obesity. Conclusions: Obesity affects MS through common underlying mechanisms and seems to be a modifiable risk factor. Antioxidant and anti-inflammatory compounds with multi-functional characteristics could be additional tools to slow the progression of MS and its promotion through obesity while also offering potential treatment options for both conditions via their multi-targeting characteristics.
43. Multiuser Exercise-Based Telerehabilitation Intervention for Older Adults with Frailty: A Pilot Study.
期刊: NeuroSci 发表日期: 2026-Jan-13 链接: PubMed
摘要
This pilot study examined telerehabilitation, which has emerged as a crucial modality in light of recent global challenges such as the COVID-19 pandemic. We examined the effectiveness of a mobile health telerehabilitation intervention developed for older adults with frailty. Six participants received a telerehabilitation intervention (Rehab Studio) that included exercise training videos. The participants were aged ≥65 years, had no history of dementia or psychiatric disorders, and had mild-to-moderate care needs. For 1 month, the participants received 1 h live online rehabilitation sessions with real-time communication with rehabilitation specialists (physical therapists and occupational therapists: PTs/OTs). The quality of life (QoL) (EuroQol 5 dimensions 5-level [EQ-5D-5L] questionnaire) and self-rated health scores were recorded before and after the intervention, and the data were analyzed using paired t-tests to determine whether the service was effective. Significant differences were found in the total EQ-5D-5L and self-rated health scores (p < 0.05). The mean EQ-5D-5L score increased from 0.63 ± 0.13 before the intervention to 0.77 ± 0.14 after the intervention (p = 0.010), while the mean self-rated health score increased from 66.0 ± 18.0 to 83.3 ± 10.3, respectively (p = 0.019). This study revealed that the mobile health telerehabilitation intervention is safe and can improve QoL for older adults with frailty. However, the effectiveness of the intervention needs to be further investigated in patients with poor performance in daily living activities. Telerehabilitation could help to reduce the burden of nursing care in aging societies with declining birthrates. However, given the extremely small sample size (N = 6), these p-values should be interpreted with considerable caution. Statistical significance in such a small sample does not provide strong evidence for population-level effects, and our findings should be regarded as hypothesis-generating rather than confirmatory.
44. Relevance and Feasibility of a "Geriatric Delirium Pass" for Older Patients with Elective Surgeries: Findings from a Multi-Methods Study.
期刊: Geriatrics (Basel, Switzerland) 发表日期: 2026-Jan-13 链接: PubMed
摘要
Background/Objectives: Postoperative Delirium (POD) is a frequent complication in older patients undergoing elective surgery. Although multicomponent interventions are effective, deficits in interdisciplinary communication and intersectoral collaboration persist. This study developed and evaluated the “Geriatric Delirium Pass (GeDePa)”, a paper-based tool to systematically document risk factors for POD across care settings. Methods: A multi-method design was applied, comprising (i) a structured literature review, (ii) semi-structured expert interviews, and (iii) a standardized online survey utilizing the RAND/UCLA Appropriateness Method (RAM). A total of 21 healthcare professionals (general practitioners, geriatricians, anaesthetists, surgeons, and nurses) were recruited from Salzburg, Austria, and South Tyrol, Italy (2023-2024). Results: Healthcare professionals confirmed the GeDePa’s practical applicability for early POD risk detection across care settings. The expert rating using the RAM Disagreement Index (DI) method deemed all 45 risk factors as sufficiently relevant and, with the exemption of two risk factors (alcohol use, intraoperative complications), feasible. A detailed analysis provided a more differentiated picture, with full consensus reached for only 18 items. Several factors with uncertain consensus (e.g., cognitive impairment and polypharmacy) were retained based on strong evidence in the literature. Others were excluded despite high ratings if they were considered redundant or impractical (e.g., detailed intraoperative complications). In total, 38 of the 45 risk factors were retained. Conclusions: The GeDePa is a feasible and relevant tool for structured delirium risk assessment and enhancing interdisciplinary communication between primary and hospital care. The finalized German and Italian versions are now available and will undergo further testing and implementation in clinical practice.
45. Sociodemographic, behavioral, and geospatial factors associated with syringe services program use in San Francisco, California.
期刊: Drug and alcohol dependence 发表日期: 2026-Jan-13 链接: PubMed
摘要
Syringe services programs (SSPs) are a cornerstone of preventing infectious disease and overdose for people who use drugs. Given efforts to achieve universal access, we examined factors associated with SSP use, including proximity. We used cross-sectional data from 713 people who use drugs across San Francisco, California (September 2023-September 2024). We assessed proximity to an SSP by calculating the walking time between where participants slept the night before and nearest SSP location. We conducted multivariable negative binomial models to explore factors associated with SSP use and assess whether the association between proximity and SSP use was modified by race-ethnicity. Almost 80 % of participants used an SSP at least once in the past 3 months. Age, race-ethnicity, mode of use, and proximity to SSP were negatively associated with SSP use. Participants who only smoked used SSPs less often than those who used in other ways (adjusted rate ratio [aRR]=0.77, 95 % CI: 0.61-0.97), as well as those more than a 20-minute walk to an SSP (aRR=0.54, 95 % CI: 0.36-0.83). The effect size between walking time to SSP and SSP use was substantially larger for Black participants than non-Black (Black: aRR=0.38, 95 % CI: 0.15-0.60 vs. non-Black: aRR=0.72, 95 % CI: 0.40-1.31). Geographic distance was a barrier to SSP use, especially for Black participants. SSPs may not reach people who only smoke drugs. SSPs should be added to areas with limited geographic access and include safer smoking supply distribution.
46. A microfluidic microspheres accumulation platform for direct visualization of urine albumin-to-creatinine ratio in patients with chronic kidney disease.
期刊: Biosensors & bioelectronics 发表日期: 2026-Jan-13 链接: PubMed
摘要
The urine albumin-to-creatinine ratio (uACR) level is an essential biomarker for the early screening and monitoring of chronic kidney disease (CKD), particularly among patients with diabetic and hypertension. However, uACR requires quantitative assay, where the use of designated analyzers makes the assays difficult for large-scale screening. In this study, we developed a decentralized, instrument-free microfluidic microspheres accumulation platform (MMAP) that visualizes the uACR in patients with diabetic nephropathy. Albumin inhibits the binding between magnetic microspheres (MMSs) and polymer microspheres (PMSs) due to competitive immunoassay interactions, while creatinine is recognized by the anti-creatinine aptamer, which releases a DNA blocker strand to facilitate connections between MMSs and PMSs through DNA hybridization. The binding of MMSs and PMSs prevents PMSs from escaping magnetic attraction in the inlet, thereby reducing the free PMS accumulation length in the measurement zone of the microfluidic chip. The PMS accumulation length allows for the visual quantification of uACR with excellent selectivity, tolerance to varying pH levels, and high accuracy comparable to that of standard tests in the hospital. As a convenient, low-cost assessment tool that correctly classified all clinical samples in this pilot cohort to evaluate CKD stages from normal to end-stage, this device offers significant benefits for disease self-monitoring and community health services.
47. Qualitative non-targeted screening by high resolution mass spectrometry of chemicals transference from plastic food contact materials after cooking.
期刊: Food chemistry 发表日期: 2026-Jan-09 链接: PubMed
摘要
The aim of this study is to investigate human exposure to chemicals transference through ingestion of foods that are cooked in their plastic packaging. For this purpose, six different food types were analyzed before and after cooking in microwave and conventional oven, as well as their plastic containers. This approach allowed to tentatively identifying 35 intentionally added substances and 3 non-intentionally added substances. Several compounds already transferred upon contact and increased their transference after cooking. Conversely, decapropylene glycol, diisodecyl phthalate, undecaethylene glycol, 2-(14,15-epoxieicosatrienoyl)glycerol, 1-linoleoyl-glycerol and octyl 3,3,3-trifluoropropanoate only transferred during cooking. Low density polyethylene packaging exhibited a greater number of transferred plasticizers. In contrast, linear hydrocarbons that could transfer were prominent in high density polyethylene trays. Finally, obtained results will contribute to human exposure assessment of these chemicals. It has been tentatively identified 15 compounds to be considered of greatest safety concern, above all, benzylbutyl phthalate and butyl hydroxy toluene.
48. Cisplatin as a Xenobiotic Agent: Molecular Mechanisms of Actions and Clinical Applications in Oncology.
期刊: Journal of xenobiotics 发表日期: 2026-Jan-08 链接: PubMed
摘要
Cisplatin, a platinum-based compound, is a cornerstone of modern chemotherapy and remains widely used against a variety of solid tumors, including testicular, ovarian, lung, bladder, and head and neck cancers. Its anticancer activity is primarily attributed to the formation of DNA crosslinks, which obstruct replication and repair, ultimately leading to apoptosis. However, the clinical value of cisplatin is constrained by two major challenges: its toxic profile and the development of resistance. Cisplatin toxicity arises from its interaction not only with tumor DNA but also with proteins and nucleic acids in healthy tissues, resulting in a range of adverse effects, including, but not limited to, nephrotoxicity, ototoxicity, neurotoxicity, and gastrointestinal injury. In pediatric patients, permanent hearing loss represents a particularly debilitating complication. On the other hand, tumor cells can evade cisplatin cytotoxicity through diverse mechanisms, including reduced intracellular drug accumulation, enhanced DNA repair, detoxification by thiol-containing molecules, and alterations in apoptotic signaling. These resistance pathways severely compromise treatment outcomes and often necessitate alternative or combination strategies. This review examines the chemical structure of cisplatin, the molecular mechanisms of cisplatin cytotoxicity and cisplatin-induced resistance, as well as the main applications in cancer management and the complications associated with its clinical use.
49. Prevalence and Clinical Characteristics of Germline Epidermal Growth Factor Receptor Mutations in the Southeastern Unites States.
期刊: JCO precision oncology 发表日期: 2026-Jan 链接: PubMed
摘要
Up to 1% of patients with non-small cell lung cancer harbor germline epidermal growth factor receptor (EGFR) mutations, although they remain poorly described in unselected, noncancer populations. We sought to characterize the prevalence of germline EGFR mutations in Southeastern United States. We assessed the prevalence of EGFR mutations in unselected cohorts of individuals enrolled in the Duke CATHeterization GENetics, gnomAD, UK Biobank, and All of Us studies. We additionally performed comprehensive chart review for patients evaluated at the Duke Cancer Institute with germline EGFR mutations. We found the prevalence of germline EGFR T790M to be >1 in 3,000 individuals in the Duke catchment area. This prevalence was 7.5 times greater than the national All of Us cohort, 3.7 times greater than the international gnomAD cohort, and 55.8 times greater than the UK Biobank cohort. The Southeastern region also contained the highest proportion of T790M carriers in the All of Us cohort. Twenty-eight individuals with suspected germline EGFR mutations were identified in our institutional cohort. The majority of these patients did not have a history of smoking, had multiple lung nodules at the time of diagnosis, and had a family history of cancer. Forty-five percent of patients had a diagnosis of a second primary malignancy. Our analysis represents the largest study to date assessing the prevalence of germline EGFR mutations from both patients with lung cancer and unselected cohorts of individuals and presents evidence for increased prevalence of EGFR T790M mutations within the Southeastern United States. Given the high prevalence and documented hereditary risk of germline EGFR mutations, future studies investigating the role of familial testing and screening in these individuals is warranted.
50. Impact of Real-World Response to First-Line Immunotherapy and Chemotherapy on Subsequent Treatment Outcomes in Patients With Advanced or Metastatic Non-Small Cell Lung Cancer.
期刊: JCO clinical cancer informatics 发表日期: 2026-Jan 链接: PubMed
摘要
This study examined real-world overall survival (rwOS) in patients with advanced or metastatic non-small cell lung cancer (a/mNSCLC) treated with combination immunotherapy (IO) and platinum chemotherapy in first line (1L), followed by second-line or beyond (2L+) non-IO, nonplatinum chemotherapy and explored the association between real-world duration of response (rwDOR) to 1L treatment and rwOS on the 2L+ treatment. This study used two US-based data sets: ConcertAI Patient360 NSCLC data set (ConcertAI) and the Flatiron Health Research Database (FHRD), and included adults with a/mNSCLC diagnosed from January 1, 2018, to March 31, 2023 (data cutoff: March 31, 2024). Kaplan-Meier and multivariate Cox regression analyses estimated rwOS for the index regimen by rwDOR to 1L. Patients with rwDOR ≤6 (≈60%) v >6 months (≈40%) in 1L were similar across the 596 ConcertAI patients and 1,094 FHRD patients. Across the ConcertAI data set/FHRD, 52.6%/55.7% of patients achieved complete/partial response as real-world best overall response to 1L combination IO and platinum chemotherapy and 17.8%/19.1% had stable disease. The median rwOS on 2L+ treatment was 8.3 v 5.2 months (P = .001; ConcertAI) and 8.3 v 5.1 months (P < .001; FHRD) for patients with 1L rwDOR >6 v ≤6 months. The adjusted hazard ratio for patients with 1L rwDOR >6 v ≤6 months was 0.74 (95% CI, 0.61 to 0.90; P = .002) and 0.76 (95% CI, 0.67 to 0.88; P < .001) in the ConcertAI data set and FHRD, respectively. Our findings demonstrate that patients with rwDOR ≥6 months on 1L combination IO and platinum chemotherapy exhibit longer rwOS on subsequent treatments. This emphasizes the need for 1L treatments that extend DOR and delay the onset of acquired resistance, which remains an unmet need for approximately 60% of patients who do not achieve a sustained response in clinical practice.
51. Impact of sensory processing difficulties on academic performance and occupational balance in university students (PREstEO): Protocol for a cross-sectional and longitudinal study.
期刊: PloS one 发表日期: 2026 链接: PubMed
摘要
Sensory processing difficulties (SPD) could significantly impact the daily functioning of university students, potentially affecting their academic performance and occupational balance (OB). However, this critical issue remains underexplored in the literature. The PREstEO study aims to investigate the association between SPD, OB, and academic performance among first-year university students and throughout their undergraduate studies. Additionally, the study will assess the prevalence of SPD and its associated factors in this population. PREstEO is a longitudinal observational cohort study conducted at the Miguel Hernández University, Spain. The study aims to recruit first-year students (from September-October 2025) and follow them over four years (2025-2029). SPD will be assessed using the Adolescent/Adult Sensory Profile (AASP), while OB and academic performance will be measured using the Occupational Balance Questionnaire (OBQ-E) and students’ grade point average (GPA), respectively. Secondary measures include psychological distress, impulsivity, sleep quality, and problematic use of videogames, the internet, and psychoactive substances. Recruitment will involve in-person invitations and institutional media campaigns. Follow-ups will be conducted annually. Statistical analyses will include robust multiple linear regressions and generalized linear mixed models, adjusting for relevant sociodemographic and behavioral factors. By adopting a longitudinal approach, PREstEO will provide novel insights into how sensory processing patterns interact with students’ daily lives over time. The findings will help to build strategies to enhance university students’ well-being and academic success.
52. Bovine lactoferrin maintains antibacterial effect against neonatal Escherichia coli septicaemia isolates despite the presence of iron acquisition genes.
期刊: Journal of medical microbiology 发表日期: 2026-Jan 链接: PubMed
摘要
Introduction. Escherichia coli is a dominant cause of neonatal sepsis for which no prevention measures currently exist. Lactoferrin (LF) is an iron-sequestering antibacterial protein that has been noticed to decrease neonatal late-onset sepsis.Hypothesis/Gap Statement. LF’s effect on in vitro growth of neonatal E. coli clinical isolates causing septicaemia is unknown. The prevalence of iron acquisition virulence genes which contribute to pathogenicity outcomes in these strains has also not been described in detail.Aim. To evaluate bovine lactoferrin’s (bLF) effects on the in vitro growth of neonatal septicaemia E. coli isolates, and to determine the presence of iron acquisition virulence genes in these isolates.Methodology. E. coli clinical strains isolated from blood of septic neonates, including the archetypal RS218 strain, all representing prevalent phylogroups and multi-locus sequence types among neonatal invasive strains were studied. Strains were grown in batch growth with 0, 0.1, 1.0 and 10 mg ml-1 bLF. OD measurements over time were used to generate growth curves, and the area under these curves was statistically compared using ANOVA or Kruskal-Wallis tests. Whole-genome sequencing (WGS) data were used to identify iron acquisition genes.Results. For all strains, growth decrease with 10 mg ml-1 bLF compared to zero was highly significant (P<0.001), and with 1 mg ml-1 for some strains (P≤0.02). WGS showed that all neonatal strains carried several iron acquisition virulence genes, including chuA, fyuA, irp2 and sitA. Additional siderophore genes were found in some strains.Conclusion. bLF is effective in impairing growth of neonatal sepsis-causing E. coli regardless of the presence of multiple iron acquisition virulence genes.