公共卫生研究摘要 (2026-01-30)
共收录 59 篇研究文章
1. The parent attitudes about childhood vaccines survey at 15: A summary of its use, reach, and scope.
期刊: Human vaccines & immunotherapeutics 发表日期: 2026-Dec 链接: PubMed
摘要
The Parent Attitudes about Childhood Vaccines (PACV) survey is a 15-item parent-report measure of vaccine hesitancy. The initial description of the PACV’s development was published in the pages of this journal 15 y ago in 2011 as the first survey of its kind. Subsequent evaluations in 2011 and 2013 of the PACV’s psychometric performance in a United States population established its construct validity, predictive validity, test-retest reliability, and its internal consistency reliability. Overall, the PACV has now been featured in 141 studies published in one of three bibliographic databases (PubMed, Embase, and/or Web of Science), with 16-20 publications each year for the last 5 y. The PACV has been translated into 20 languages and has been used in 59 countries across 6 continents in studies involving over 100,000 participants. It has been most frequently used as descriptive tool, but it also has been the subject of psychometric evaluations and critical reviews as well as used as an outcomes measure, surveillance tool, screening tool, and as an intervention itself. The PACV has become a widely used valid and reliable method for measuring vaccine hesitancy.
2. Cognitive Impairments and Health System Outcomes in Inpatient Rehabilitation: A Comparison of Patients With Stroke and Those With Type II Diabetes Mellitus.
期刊: The American journal of occupational therapy : official publication of the American Occupational Therapy Association 发表日期: 2026-Mar-01 链接: PubMed
摘要
Cognitive impairment is associated with poor outcomes in inpatient rehabilitation (IPR) but may be underrecognized among patients without neurologic diagnoses. To compare cognitive impairment prevalence between IPR patients with ischemic stroke and patients with Type II diabetes mellitus (T2DM) without a cerebrovascular diagnosis and to examine associations with functional outcomes and readmissions. This observational, cross-sectional study used retrospective electronic medical record data collected from 2019 to 2022. Single inpatient rehabilitation facility in an academic health system. The sample consisted of 360 patients admitted to IPR, including 147 patients with ischemic stroke without T2DM and 213 patients with T2DM without a neurologic diagnosis. Cognitive status was assessed at admission using the Montreal Cognitive Assessment (MoCA). Outcomes included discharge self-care and mobility (Section GG), within-stay readmission, and 30-day postdischarge readmission. Mild cognitive impairment was more prevalent among patients with T2DM than among patients with stroke at admission. Patients with stroke had lower mean MoCA scores at admission and discharge. Diagnosis was not associated with discharge self-care, discharge mobility, or readmission outcomes. Higher admission functional status and lower disease burden were associated with better functional outcomes, and higher admission mobility was associated with lower odds of within-stay readmission. Routine, diagnosis-agnostic cognitive screening identified high rates of cognitive impairment across diagnostic groups in IPR. Occupational therapy practitioners should incorporate systematic cognitive screening and follow-up functional cognition assessment to guide intervention planning and discharge preparation. Plain-Language Summary: Many people receiving inpatient rehabilitation experience problems with thinking and memory that can affect daily activities and recovery. These problems are often expected after stroke but may be overlooked in people with other health conditions, such as diabetes. This study compared cognitive impairment and rehabilitation outcomes in people with stroke and people with Type II diabetes who did not have a stroke. The study found that mild cognitive impairment was common in both groups, including many people with diabetes. Whether a person had a stroke or diabetes did not explain differences in functional outcomes or hospital readmissions. Instead, a person’s functional ability at admission and overall health burden were more strongly related to outcomes. These findings suggest that occupational therapy practitioners should routinely screen cognition for all patients in inpatient rehabilitation, not only those with neurologic diagnoses. Early identification of cognitive challenges can support therapy planning, daily functioning, and safe discharge.
3. Accessible Home Modification and Impacts: A Qualitative Study.
期刊: The American journal of occupational therapy : official publication of the American Occupational Therapy Association 发表日期: 2026-Mar-01 链接: PubMed
摘要
Accessible home modifications (HMs) can positively influence the lives of people with disabilities (PwDs). Occupational therapists may recommend HMs, but implementation often falls to clients. Research on the experiences of PwD related to implementing accessible HMs in a North American context is lacking. To describe the process and impacts of implementing accessible HMs from PwDs’ perspective. Qualitative descriptive design with semistructured interviews with codebook thematic analysis to identify themes. Community-dwelling adults with musculoskeletal and sensory disabilities (n = 31) and 2 cohabiting caregivers from Ontario, Canada, who had either made HMs or required accessible housing. Fourteen of these participants also had professional expertise related to accessible housing. The primary outcome was participant perspectives and experiences related to HMs. No standardized measures or hypotheses were used, consistent with the exploratory qualitative design. Four themes emerged that depict the process and impacts of implementing HMs: (1) impacts of an unmet need for HMs, (2) barriers to and (3) facilitators of effective HMs, and (4) outcomes and benefits of having HMs. Issues related to independence, safety, and dignity, as well as how structural, financial, and attitudinal barriers intersect in decision-making. Participants also described a lack of guidance on how to approach the HM process. Findings highlight the importance of HMs to achieve person-environment fit. Given the complexities of the HM process, occupational therapists are well positioned to support individuals in navigating this process and to contribute to broader advocacy efforts. Plain-Language Summary: This study looked at how people with disabilities make their homes more accessible or how they assist others with this process and the challenges they run into. People who took part said they had to find information on their own and speak up for themselves. They described their independence, individual needs, and finances as being important. The results highlight the importance of helping people make their homes more accessible and ways that occupational therapists can help.
4. Digital Skills Assessments in Occupational Therapy: A Scoping Review.
期刊: The American journal of occupational therapy : official publication of the American Occupational Therapy Association 发表日期: 2026-Mar-01 链接: PubMed
摘要
Digital skills are increasingly essential in performing daily activities. Occupational therapy practitioners require valid and accessible assessments to evaluate and address these competencies. However, the availability and quality of these assessments have not been established. To identify and map existing, accessible, low-cost measures to assess digital skills in adult populations, supporting occupational therapy practitioners. Literature searches were conducted using the CINAHL, PsycINFO, and PubMed/MEDLINE databases and the American Journal of Occupational Therapy archives, supplemented with Google Scholar and online resources covering 2000 to May 2024. This review followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist. It included tools for adults ages 18 yr and older that were published in English, available online or through author contact, and free or low cost. Tools requiring substantial training or high cost were excluded. Two reviewers independently screened records for inclusion; a third reviewer verified final selections against the criteria. Twenty-seven assessments were included, covering the Computer Skills, Mobile and Tablet Skills, Technology and Internet Skills, Technology Proficiency for Students, and IADLs domains. Most demonstrated high reliability (Cronbach’s α > .80) and validity; however, normative data and test-retest reliability were limited. Notably missing were assessments of touchscreen skills, online safety, and artificial intelligence competency. This review identified multiple validated and accessible assessments for clinical practice; however, significant gaps remain. Future studies should address these gaps to enable comprehensive evaluation of and intervention for emerging digital competencies in occupational therapy. Plain-Language Summary: This review examined assessments that can be used by occupational therapy practitioners to measure the digital skills adults need for various daily tasks. Twenty-seven practical tools were identified, with most being reliable and easy to use. However, there is a lack of tools addressing touchscreen skills, internet safety, and artificial intelligence use. Filling these gaps will help occupational therapy practitioners better support clients in their daily digital activities.
5. Practical and Ethical Considerations Related to Supporting Students and Practitioners With Disabilities.
期刊: The American journal of occupational therapy : official publication of the American Occupational Therapy Association 发表日期: 2026-Mar-01 链接: PubMed
摘要
People with disabilities comprise roughly 13% of the U.S. population, but fewer than 5% of occupational therapy practitioners identify as disabled. As we work toward the goals outlined in the American Occupational Therapy Association’s Vision 2030, this gap represents more than a disparity-it is an opportunity. Occupational therapy is uniquely positioned to lead the broader health care field in advancing disability inclusion across education, practice, and leadership. Qualified practitioners with disabilities bring lived experience that deepens empathy, strengthens clinical reasoning, and challenges outdated assumptions. Research supports what many of us have witnessed firsthand: Diverse teams that include qualified disabled professionals are more creative, compassionate, and effective in meeting complex needs. In this column, we offer practical strategies to help educators, employers, and professional leaders build a more inclusive and resilient profession. When we actively support qualified students and practitioners with disabilities-whether those disabilities are long-standing or newly acquired-we do not just remove barriers; we build a more resilient, responsive workforce that is capable and ready to meet the evolving needs of our world.
6. Postmortem Associations Between Alzheimer Disease Pathology and Plasma pTau217, GFAP, and NfL in AD and AD-Related Dementias.
期刊: Neurology 发表日期: 2026-Feb-24 链接: PubMed
摘要
Alzheimer disease (AD) and its related disorders (ADRDs) are characterized by a high frequency of copathologies. We aimed to determine the specificity of plasma pTau217, glial fibrillary acidic protein (GFAP), and neurofilament light chain (NfL) for AD neuropathological change (ADNC) in the presence of common ADRD copathologies. pTau217, GFAP, and NfL were measured using S-PLEX immunoassays from Meso Scale Discovery in banked plasma samples from 2 groups of participants in the Massachusetts Alzheimer’s Disease Research Center (MADRC) Longitudinal Cohort study: (1) participants spanning the cognitive spectrum, who underwent brain autopsy, and blood collection within 6 years before death, and (2) participants with normal cognition and no neurologic diagnosis during 5 years of follow-up, but no autopsy data (normal controls [NCs]). Cross-sectional associations between biomarker levels and ADNC, primary neuropathologic diagnosis (NPDx1), and presence of non-AD copathologies were evaluated using linear regression models controlling for age, sex, and time to death. One hundred eighty-seven participants with brain autopsy (NPDx1: AD n = 85; other n = 102; mean age: 74.3 years, 38.5% female; interval blood collection-death [mean ± SD]: 2.8 ± 1.6 years) and 67 NC without brain autopsy (mean age: 66.5 years, 71.6% female) were included. pTau217, but not GFAP, levels increased stepwise with increasing Thal phases (β = 0.61; 95% CI [0.24-0.97] to β = 0.91 [0.55-1.27]) and Braak stages (β = 0.59; [0.16-1.01] to β = 0.74 [0.33-1.15]). Although 23% of individuals with a non-AD NPDx1 had increased pTau217 levels using a cutoff defined by the contrast between ADNC and NC, the majority (62%) had intermediate/high ADNC copathology and the remaining pTau217+ individuals had borderline increased levels. By contrast, 48% of individuals without ADNC had increased GFAP levels. pTau217 and GFAP were not different in the presence or absence of cerebral amyloid angiopathy, α-synuclein or TDP-43 proteinopathies, or primary tauopathies. NfL was not specifically associated with ADNC. Plasma pTau217, but not GFAP or NfL, levels accurately reflect the presence of ADNC in the brain even in individuals with an NPDx1 of a non-AD dementia. Thus, a positive plasma pTau217 test in an individual with a suspected non-AD dementia should not necessarily be considered a misdiagnosis of the presumed non-AD dementia or as a false positive, but rather as evidence of ADNC copathology.
7. Ab Interno Minimally Invasive Glaucoma Surgery Effectiveness in Black Patients: An IRIS Registry Study.
期刊: Journal of glaucoma 发表日期: 2026-Feb-01 链接: PubMed
摘要
MIGS in combination with cataract surgery resulted in clinically significant reductions in IOP and IOP-lowering medications up to 24 months in Black patients. Describe outcomes following ab interno Minimally Invasive Glaucoma Surgery (MIGS) procedures US FDA cleared or approved for intraocular pressure (IOP) reduction in primary open angle glaucoma combined with cataract surgery and cataract surgery alone in Black patients. An observational, retrospective study of glaucoma in Black patients treated with MIGS (Hydrus®, iStent Inject®, OMNI® Surgical System) with cataract surgery or cataract surgery alone, in the American Academy of Ophthalmology IRIS® Registry (Intelligent Research in Sight). Deidentified data included glaucoma diagnosis, procedure data, IOP, and medication use from preoperatively through 24 months. The study period was 07/01/2016 and 12/31/2023. Eligible patients identified via Current Procedural Terminology codes coupled with electronic health records. Outcomes were changes in IOP, and medication class usage (months 6, 12, 18, and 24) stratified by baseline IOP (≤18; >18 mm Hg). In 12,828 eyes of 12,828 patients, including 189 Hydrus, 491 iStent, 91 OMNI, and 12,057 cataract surgeries, mean IOP and medication use decreased significantly in each cohort. Mean IOP reductions were in the range of 1.2-2.7 mm Hg, and medication reductions were 0.4-1.0 medications across all cohorts and time points. In MIGS cohorts, IOP reductions were greater with higher baseline IOP, and medication reductions were greater with lower baseline IOP. Each MIGS procedure produced clinically and statistically significant reductions in both IOP and IOP-lowering medications up to 2 years postoperatively in Black patients. Surgeons could consider offering MIGS at the time of cataract surgery to this population.
8. Childhood blindness prevention in Aotearoa New Zealand.
期刊: The New Zealand medical journal 发表日期: 2026-Jan-30 链接: PubMed
摘要
While less common than adult blindness, childhood blindness has a significant burden in terms of the total number of “blind years”. We aim to determine if there is scope for improved strategies in the prevention of childhood blindness in Aotearoa New Zealand. We conducted a review of New Zealand childhood blindness data. In New Zealand, there is a paucity of data on childhood blindness. However, significant scope remains for prevention through optimising maternal health, neonatal care, increasing uptake of immunisations and attendance at vision screening programmes, as well as the earliest possible detection of myopia and keratoconus. Ophthalmologists and the Royal Australian and New Zealand College of Ophthalmologists must continue to actively collaborate with obstetricians, paediatricians, general practitioners, optometrists, national screening units, vaccination programmes, epidemiologists and Health New Zealand - Te Whatu Ora to promote primary prevention strategies and improve visual outcomes for our tamariki.
9. Putting communities at the centre for a more effective and equitable health system in Aotearoa New Zealand.
期刊: The New Zealand medical journal 发表日期: 2026-Jan-30 链接: PubMed
摘要
Community-led action is essential for building a more effective and equitable health system. Yet Aotearoa New Zealand’s history of top-down structural reforms has undermined progress toward “healthy futures for all”. We draw on complexity science and system-change principles to explain why genuine devolution and community engagement are not just ideological preferences but practical necessities in a complex health system. Community agency and locally tailored innovation can drive emergent, system-wide improvements, but only if central structures enable and sustain these relationships. A key step is reframing our mental model of the health system from a linear machine to a complex adaptive system. We discuss how the turbulence of current policy changes fits into long-running patterns and why a clearer conceptualisation of complexity can guide policymakers toward tangible actions that reorient the system towards patients and communities. Finally, we outline some essential ingredients for how New Zealand can transition from rhetoric and good intentions to the effective implementation of an equitable, community-centred health system.
10. Glucose Metabolic Enzyme PFKFB3 in Cardiopulmonary Vascular Health and Disease.
期刊: Circulation research 发表日期: 2026-Jan-30 链接: PubMed
摘要
Cardiopulmonary vascular diseases are the leading cause of death worldwide. Metabolic reprogramming and inflammation are 2 commonly shared hallmarks of such diseases. The bifunctional enzymes PFKFB (6-phosphofructo-2-kinase/fructose-2,6-bisphosphatases) 1 to 4 are well-known for their critical functions in glucose metabolism. Emerging evidence has indicated that PFKFB enzymes, particularly PFKFB3, are essential immunometabolic regulators and implicated in cardiopulmonary vascular and other pathologies. We here first summarize the structural basis for the catalytic function of PFKFB family enzymes, introduce the recent advances on the regulation of PFKFB3 expression and activity as well as its nonmetabolic functions, then elaborate on how dysregulation of PFKFBs influences physiological and pathological states of the cardiovascular and pulmonary systems, and finally touch on the current development of pharmacological inhibitors of PFKFB3 as potential therapeutics.
11. Detection of Antithrombotic-Related Bleeding in Older Inpatients: Multicenter Retrospective Study Using Structured and Unstructured Electronic Health Record Data.
期刊: Journal of medical Internet research 发表日期: 2026-Jan-29 链接: PubMed
摘要
Bleeding complications are a major contributor to adverse drug events among older inpatients, particularly in those treated with antithrombotic agents. Timely and accurate detection of bleeding events is essential for improving drug safety surveillance and clinical risk management. The study aimed to develop and validate automated algorithms for detecting major bleeding (MB) and clinically relevant nonmajor bleeding (CRNMB) events from electronic medical records (EMRs) by combining structured data-based rule models and a natural language processing (NLP) approach, and to evaluate their performance and generalizability against a manually reviewed gold standard and an external dataset. We conducted a multicenter retrospective study using routinely collected EMR data from 3 Swiss university hospitals. Patients 65 years or older who received at least one antithrombotic agent and were hospitalized between January 2015 and December 2016 were included. To detect MB and CRNMB events, rule-based algorithms were developed using structured data (International Statistical Classification of Diseases, 10th Revision, German Modification [ICD-10-GM] codes, laboratory values, transfusion records, and antihemorrhagic prescriptions), with variables and cutoff values defined according to adapted International Society on Thrombosis and Haemostasis definitions and expert consensus. In parallel, a supervised NLP model was applied to discharge summaries from one hospital. A manual review of 754 EMRs served as the reference standard for internal validation, and the algorithm performance of the structured data algorithms (SDA), NLP, and their combination (SDA+NLP) was evaluated against this manually reviewed gold standard using standard performance metrics. External validation was performed on an independent dataset from the Lausanne University Hospital to assess model robustness and generalizability. Among 36,039 inpatient stays, SDA identified 8.26% (n=2979) as MB and 15.04% (n=5419) as CRNMB cases. ICD-10-GM codes alone detected 28.5% (n=849) of MB and 31.48% (n=1706) of CRNMB cases, while laboratory data contributed most to event detection (n=1994, 66.94% for MB and n=3663, 67.60% for CRNMB). Integrating SDA with NLP improved detection, identifying 12.2% (920/7513) of MB and 27.4% (2062/7513) of CRNMB cases at 1 hospital. The combined model achieved the best performance (sensitivity 0.84, positive predictive value 0.51, F1-score 0.64). External validation on Lausanne University Hospital 2021-2022 data (n=24,054 stays) confirmed the algorithms’ reproducibility; the prevalence of MB decreased while CRNMB increased, reflecting evolving clinical practices and antithrombotic use patterns. Our integrated approach, combining SDA with NLP, enhances the detection of hemorrhagic events in older hospitalized patients treated with antithrombotic agents, suggesting its potential usefulness for drug safety monitoring and clinical risk management.
12. Exploring Medical Information Needs and Accessibility in Swedish Dental Care by Analysis of Documentation Workflows and Electronic Dental Records in Dalarna: Sociotechnical Qualitative Study.
期刊: JMIR human factors 发表日期: 2026-Jan-29 链接: PubMed
摘要
Despite growing evidence demonstrating the connection between oral and systemic health, medical and dental care remain institutionally divided. A significant consequence of this division is the lack of information sharing, which is particularly problematic in dental care, where knowing patients’ medical information is crucial for providing safe and effective treatments. This separation poses additional challenges in Swedish regions with limited resources, such as Dalarna, where dental care practices would benefit from improved access to relevant medical information in their electronic dental record (EDR) systems. This study aimed to explore how current documentation workflows and EDR systems support the medical information needs within dental care practices in Dalarna and consider what influence direct access to medical information could have. The study adopted an exploratory-descriptive qualitative approach. Semi-structured interviews were conducted with dental practitioners working in general dental practices. Data collection followed a sociotechnical framework, and thematic analysis was performed to identify key medical information needs, as well as current workflow and system limitations. Conceptual models were developed to reflect these findings. Eighteen dental practitioners were interviewed. The identified medical information needs included specific types of medical conditions, pharmacological information, treatment history, and laboratory values. Furthermore, dental practitioners highlighted substantial challenges in existing documentation workflows and the EDR system. Proposed conceptual models demonstrated how integrating EDR systems with the Swedish National Patient Overview (“Nationell Patientöversikt”) via National Service Platform (“Nationell Tjänsteplattform”) could streamline workflows and enhance information accessibility. The findings show a clear need to improve medical information accessibility in dental care. A solution is to facilitate interoperability and align digital infrastructure with the identified needs. The proposed recommendations offer a feasible starting point for improving medical information access in Swedish dental care, particularly in resource-constrained regions like Dalarna.
13. Integrated Biomonitoring of Organophosphate Mixtures Reveals Food-Driven Exposure and Hormetic Oxidative Responses in Urban Adults.
期刊: Environmental science & technology 发表日期: 2026-Jan-29 链接: PubMed
摘要
Dietary exposure to organophosphate (OP) pesticides remains a growing concern in urban environments. In this study, six urinary OP metabolites and four oxidative stress biomarkers (OSBs) were quantified in a cohort of urban Chinese adults. Dimethylthiophosphate (DMTP), diethyl phosphate (DEP), and dimethyl phosphate were detected in nearly all individuals, with DMTP exhibiting the highest mean concentration (6.18 ng/mL). Multivariate analysis identified pork and poultry as primary dietary contributors, collectively explaining over 36% of variability in urinary OP metabolites, while processed food intake was positively associated with dimethyldithiophosphate (DMDTP) and diethyldithiophosphate, consistent with OP residues, preformed dialkyl phosphates (DAPs), and organophosphate esters in packaged products. Reverse dosimetry of urinary DAPs indicated that phorate and dimethoate were major contributors to estimated daily intake, with hazard quotients exceeding 1 in certain individuals. Multiple mixture models revealed significant inverse and nonlinear associations between OP mixtures and OSBs, particularly 8-hydroxy-2’-deoxyguanosine and o,o’-dityrosine, suggesting a potential low-dose hormetic response and adaptive oxidative stress mechanisms. DMDTP and DEP emerged as key drivers across the models. Collectively, these findings provide integrative evidence linking specific dietary OP sources to systemic oxidative stress in nonoccupational populations, highlighting complex exposure-response dynamics and the need for targeted dietary risk management and biomonitoring.
14. A Home-Based Intervention to Improve Adherence to the 24-Hour Movement Guidelines in Young Children: Protocol for a Mobile App-Based Randomized Control Trial.
期刊: JMIR research protocols 发表日期: 2026-Jan-29 链接: PubMed
摘要
One in 10 preschoolers (aged 3-4 y) meet the three 24-hour Movement Guidelines, that is, (1) physical activity, (2) sedentary screen time, and (3) sleep. The overarching aim of this study is to evaluate the effectiveness and feasibility of a 12-week mobile health home-based intervention on 24-hour movement behaviors in preschoolers who meet few guidelines (zero or 1 guideline). We will conduct a 12-week randomized controlled trial with a wait-list control in 80 families (40 per arm). Preliminary studies in this population informed intervention app content, features, and app development. Behavior change theories, including transfer theory and the multi-process action control framework, helped inform content presentation and topics. Primary outcomes include device-based and parent-report measures of 24-hour movement behaviors, and the secondary outcome is the feasibility and acceptability of the app. Exploratory outcomes include preschoolers’ cognitive and motor skills, changes within the home environment, and behavioral control processes. This 2-phase study (K99/R00) received initial funding in March 2022, and preliminary studies were concluded in December 2023. The main grant received institutional review board approval in April 2024, and the grant funding began in May 2024. The study was registered in Clinical Trials in October 2024 and enrolled its first participant in January 2025. As of October 2025, the study has enrolled 39 families. We anticipate the trial will be completed in late 2026. This research is designed to test a novel approach to improve all three 24-hour movement behaviors in preschoolers in home settings by using a mobile app. Results from this study will have implications for future 24-hour movement interventions, our understanding of improving all 3 behaviors, and ultimately, improvements in preschoolers’ health. Clinicaltrials.gov NCT06667661; https://clinicaltrials.gov/study/NCT06667661. DERR1-10.2196/75621.
15. Efficacy of a Virtual Reality Game on Children's Fear and Anxiety During Dental Procedures (VR-TOOTH): Protocol for a Randomized Controlled Trial.
期刊: JMIR research protocols 发表日期: 2026-Jan-29 链接: PubMed
摘要
Dental fear and anxiety (DFA) affects approximately a quarter of children and adolescents. It significantly contributes to pediatric patients avoiding dental care later in adulthood. Lack of cooperation due to DFA can create a stressful environment, often forcing dentists to end appointments prematurely and consider alternative pharmacological treatments. The use of virtual reality (VR) during dental procedures, offering an immersive sensory experience, may serve as an additional nonpharmacologic tool to better manage DFA in children with special health care needs (SHCN) undergoing dental treatment. This study aims to assess the effectiveness of VR immersion in reducing anxiety and pain among pediatric patients with SHCN undergoing dental procedures. The study also seeks to understand the satisfaction of parents and health care providers with the use of VR during dental appointments. This randomized controlled trial follows a parallel design with two groups: a control group receiving standard care and an experimental group using VR. A sample size of 400 participants was calculated. Participants will be randomly assigned equally to each group. Recruitment will take place at the dental clinic of the Centre Hospitalier Universitaire Sainte-Justine, a tertiary- and quaternary-care center that primarily serves pediatric patients with SHCN. The two primary outcomes will include both observed and objective biomarker-based measures of anxiety. DFA will be evaluated using the Venham Anxiety Rating Scale as well as changes in mean levels of salivary alpha-amylase. Sociodemographic characteristics, parents’ and health care professionals’ satisfaction levels, participants’ pain intensity and behavior during the procedure, changes in heart rate, occurrence of side effects, procedure duration, and any deviations from normal procedural length will also be collected. Descriptive and comparative statistics will be conducted for demographic and clinical comparisons and will be used to present sociodemographic and clinical data, parents’ and health care professionals’ satisfaction levels, child satisfaction with the game, and procedural time. This study will be conducted from November 2023 to December 2025. As of November 2025, 300 participants have been recruited. Results are expected to be available in June 2026. We believe that the results of this study will confirm the efficacy of VR in reducing DFA in children with SHCN, providing an additional nonpharmacological alternative for better managing this condition in pediatric hospital settings.
16. Characterization of Models for Identifying Physical and Cognitive Frailty in Older Adults With Diabetes: Systematic Review and Meta-Analysis.
期刊: Journal of medical Internet research 发表日期: 2026-Jan-29 链接: PubMed
摘要
Physical frailty and cognitive frailty are increasingly recognized as critical geriatric syndromes among older adults with diabetes, contributing to adverse outcomes such as disability, hospitalization, and mortality. Early identification of individuals at high risk is therefore essential for timely prevention and intervention. Although a growing number of prediction models have been developed for this population, evidence regarding their methodological rigor, predictive performance, and generalizability remains fragmented. This study aims to evaluate and characterize existing models for detecting or predicting physical frailty and cognitive frailty in older adults with diabetes. PubMed, Embase, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang, and VIP databases were searched from their inception to December 2025. Retrospective, cross-sectional, and prospective studies that developed or validated models predicting frailty or cognitive frailty in older adults with diabetes were included. The Prediction Model Study Risk Of Bias Assessment Tool (PROBAST) was used to assess risk of bias and applicability. Random effects meta-analyses using the Hartung-Knapp-Sidik-Jonkman method were conducted to synthesize model performance, including the pooled area under the receiver operating characteristic curve (AUC). Heterogeneity was explored through subgroup and sensitivity analyses. Small study effects were evaluated using funnel plots, the Egger test, and the Deeks funnel plot asymmetry test. A total of 24 studies comprising 32 diagnostic models were included. The overall pooled analysis demonstrated an AUC of 0.851 (95% CI 0.820-0.882) with a 95% prediction interval of 0.710-0.992, sensitivity of 0.810 (95% CI 0.740-0.850), and specificity of 0.850 (95% CI 0.810-0.890). Statistical comparisons in the modeling approach revealed that logistic regression models achieved a significantly higher pooled AUC (0.850) compared with machine learning models (0.785; P=.003). Similarly, retrospective studies demonstrated superior performance, with an AUC of 0.900 compared with 0.843 for cross-sectional studies (P=.03). Conversely, no significant differences were observed across subgroups stratified by data source (P=.42), patient characteristics (P=.77), validation methods (P=.16), or specific outcomes (P=.94). The most common predictors identified were depression, age, and regular exercise; however, all included studies were assessed as having a high risk of bias. To our knowledge, this review provides the first comprehensive synthesis of models for risk stratification of physical frailty and cognitive frailty in older adults with diabetes. The findings indicate that existing models demonstrate satisfactory discrimination; specifically, CIs confirmed a robust average effect, while prediction intervals suggested that performance in future settings, though variable, is likely to remain acceptable. However, clinical utility is currently constrained by high risk of bias and limited external validation. Future research must prioritize rigorous, prospective, multicenter studies adhering to standard reporting guidelines (eg, TRIPOD [Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis or Diagnosis]) to establish valid, generalizable, and clinically actionable prognostic instruments.
17. Demystifying Quality Metrics and Unveiling the True Measure of Quality of Care in Nursing Homes: Mixed Effects Analysis.
期刊: JMIR human factors 发表日期: 2026-Jan-29 链接: PubMed
摘要
The 5-Star Quality Rating System for nursing homes plays a central role in evaluating quality of care, although it has both strengths and limitations. This system relies heavily on the Minimum Data Set and derives several quality measures (QMs) from it. In this study, we validated the effectiveness of the 5-Star Quality Rating System for nursing homes and its underlying QMs in estimating quality of care. We constructed a panel dataset of US nursing homes (n=15,416) active from May 2020 to June 2023, retrieving data from three major sources: (1) COVID-19 nursing home data, (2) Payroll-Based Journal data, and (3) nursing home QM snapshots. The outcome variables included (1) resident infection, (2) staff infection, or (3) resident and staff deaths. The predictor variables were the 5-Star Quality Rating System for nursing homes and its underlying QMs classified as structure, process, or outcome (SPO) QMs. This study aims to evaluate the effectiveness of nursing home QMs by regressing nursing home COVID-19 outcomes on nursing home QMs, classified using the Donabedian SPO framework. We hypothesized that nursing homes with better structural quality (eg, greater staff availability, better skill mix, and so on), better process quality (eg, lower restraint use and higher vaccination rates), and better outcome quality (eg, lower number of residents with pressure ulcers and a lower number of resident falls) experienced better COVID-19 performance in terms of resident and staff infections and deaths. To examine the association between the COVID-19 outcomes and SPO QMs, we imputed missing values in the dataset using random forest. Subsequently, we modeled the imputed dataset using hurdled zero-inflated negative binomial mixed effects models. The zero inflation model included factors influencing initial susceptibility to COVID-19 or factors influencing the possibility of death after COVID-19 had been contracted. The model estimates were conditioned on zero inflation and random effects. Staffing measures (P<.001 for all variables in all models), health deficiency scores (P<.001 for all variables in at least 1 model), COVID-19 hospitalization rates (P<.001 for all variables in at least 2 models), and vaccinations (P<.001 for all variables in at least 2 models) exhibited meaningful relationships with the COVID-19 outcomes, while the 5-star components, Medicaid dependency, and ownership showed no clear relationships. Although widely used, the 5-Star Quality Rating System for nursing homes is an unreliable performance measure. Concerted efforts from lawmakers, policy makers, and lobbyists are needed to refine and enhance the measure, thereby ensuring its reliability and effectiveness.
18. Common variation at 1q23.3, 2p23.3, 2q33.3, and 2p21 influences risk of acute myeloid leukemia.
期刊: Blood 发表日期: 2026-Jan-29 链接: PubMed
摘要
Acute myeloid leukemia (AML) is a complex hematological malignancy with multiple disease sub-groups defined by somatic mutations and heterogeneous outcomes. Although genome-wide association studies (GWAS) have identified a small number of common genetic variants influencing AML risk, the heritable component of this disease outside of familial susceptibility remains largely undefined. Here we perform a meta-analysis of four published GWAS plus two new GWAS, totalling 4710 AML cases and 12938 controls. We identify a new genome-wide significant risk locus for pan-AML at 2p23.3 (rs4665765; P=1.35x10-8; EFR3B, POMC, DNMT3A, DNAJC27) which also significantly associates with patient survival (P=6.09x10-3). Our analysis also identifies three new genome-wide significant risk loci for disease sub-groups, including AML with deletions of chromosome 5 and/or 7 at 1q23.3 (rs12078864; P=7.0x10-10; DUSP23) and cytogenetically complex AML at 2q33.3 (rs12988876; P=3.28x10-8; PARD3B) and 2p21 (rs79918355; P=1.60x10-9; EPCAM). We also investigated loci previously associated with risk of clonal hematopoiesis (CH) or clonal hematopoiesis of indeterminate potential (CHIP) and identified several variants associated with risk of AML. Our results further inform on AML etiology and demonstrate the existence of disease sub-group specific risk loci.
19. Airborne dust exposure during the application of talc-based pressed powder makeups.
期刊: Journal of occupational and environmental hygiene 发表日期: 2026-Jan-29 链接: PubMed
摘要
Pressed powder makeup, such as foundation powder, blush, and eyeshadow, is frequently used by consumers worldwide. Due to the binding agents utilized in these products, authoritative bodies do not expect any potential significant inhalation exposures during the use of these products. However, due to the relatively short duration of the application process, detection of airborne particulates by traditional analytical methods is limited. To date, no study has investigated the non-asbestos particulate inhalation potential of pressed powders in real-world use conditions involving direct application by human users. This study utilized a light scattering photometer to quantify airborne particulate during the application of pressed powder makeup by regular cosmetic users in a controlled environment. The study found an average total dust level of 0.028 mg/m3 and an average respirable dust level of 0.002 mg/m3 during the combined application of foundation powder, blush, and eyeshadow. The average duration of application was 6.35 min, and the amount of product used, by mass, was consistent with that reported by authoritative bodies. Microscopic analysis of the bulk product found that the diameter of these products was consistent with the specifications for these products and what was observed through airborne measurements. Using a multidisciplinary approach across the fields of industrial hygiene, toxicology, microscopy, and epidemiology, and considering the magnitude and duration of exposures measured in this study, significant inhalation hazards would not be expected under normal use conditions.
20. Regional Audit and Feedback Intervention to Improve Quality of Care in Ovarian Cancer Treatment: The Easy-Net Experience.
期刊: JCO oncology practice 发表日期: 2026-Jan-29 链接: PubMed
摘要
In 2009, a regional audit on ovarian cancer in the Regional Cancer Care Network (RCCN) of Piemonte (Italy) documented that patients were widely distributed across different treatment centers, with evidence of suboptimal care. We present the re-audit and feedback (A&F) intervention performed in 2016-2020 and the variation on quality of care and outcomes. An A&F intervention was implemented across gynecologic units treating ovarian cancer in Piemonte. Key recommendations and indicators were identified from international guidelines. Global adherence to guideline recommendations was measured as the mean percentage of adherence across all the indicators. Data were collected retrospectively (May-December 2016, baseline period) and prospectively (May 2017-September 2020). Change in adherence to recommendations over time was monitored and feedback provided during quarterly meetings. Overall survival was identified as clinical outcome. Among 1,030 women (77% advanced stage), the global adherence to guidelines increased by 2.1% (95% CI, 1.6 to 2.6) every 6 months, from 51.3% to 70.4%. The likelihood of treatment in high-volume surgical centers and multidisciplinary team discussions before treatment increased over time (odds ratio [OR], 1.15 [95% CI, 1.08 to 1.21] and OR, 1.21 [95% CI, 1.15 to 1.28]). Five-year survival was 47% overall (87% among early and 35% among advanced stages). Although no consistent trend in survival was observed during the A&F period, a 10% increase in global adherence was associated with improved 5-year survival (hazard ratio, 0.91 [95% CI, 0.87 to 0.95]). The implementation of this A&F initiative was associated with improvements in quality-of-care indicators for ovarian cancer, highlighting the potential value of A&F methodologies to support quality improvement activities.
21. The FOXC2-LAMA4 Axis Orchestrates Vasculogenic Mimicry and Immunosuppressive Niche Formation to Drive Metastatic Cascade in Renal Cell Carcinoma.
期刊: Advanced science (Weinheim, Baden-Wurttemberg, Germany) 发表日期: 2026-Jan-29 链接: PubMed
摘要
The aggressive metastatic propensity of advanced clear cell renal cell carcinoma (ccRCC) originates from intratumoral heterogeneity. Through integrated single-cell and spatial multi-omics profiling, we identified a FOXC2+ tumor subpopulation endowed with vasculogenic mimicry capability as pivotal effector cells driving metastasis. Mechanistically, the transcription factor FOXC2 binds the promoter region of LAMA4 to activate its expression, initiating metastatic cascades via vasculogenic mimicry remodeling. In orthotopic lung metastasis models, FOXC2+ tumor cells leveraged LAMA4 to reshape the pulmonary metastatic niche, thereby reinforcing distant metastatic dissemination. Tumor-secreted LAMA4 engaged macrophage surface receptor ITGA6 to trigger GATA3 activation and reprogram macrophages toward a pro-metastatic and immunosuppressive phenotype. Disruption of LAMA4-ITGA6 binding substantially attenuated FOXC2-LAMA4-mediated metastatic burden. These results reveal a novel mechanism by which FOXC2+ tumor cells promote metastasis in advanced ccRCC and further establish the therapeutic potential of targeting FOXC2-LAMA4 in blocking the metastatic cascade of ccRCC.
22. Operationalizing Equity: A Methodologic Framework for Revising Pediatric Clinical Guidance.
期刊: Pediatrics 发表日期: 2026-Jan-29 链接: PubMed
摘要
Healthcare inequities and resultant disparities in health outcomes can be influenced by clinical guidelines and organization policies. This guidance may be implicitly or explicitly embedded with bias, discrimination, and racist ideologies which have the potential to cause harm, not only for historically marginalized and minoritized communities, but also at a broader population health-level. The American Academy of Pediatrics (AAP) is a professional society responsible for the creation and dissemination of many clinical practice guidelines (CPGs) and clinical reports (CRs) to promote child health. Recognizing the importance of ensuring that these CPGs and CRs promote health equity, the AAP convened a group of health services researchers to develop and pilot an evidence-informed instrument to assess for the inappropriate use of race and/or ethnicity. This article describes the methodological approach to developing and applying the evidence-informed instrument to the compendium of active AAP CPGs and CRs. We also present an approach for prioritizing CPGs and CRs most urgently in need of revision and describe a process to achieve buy-in within AAP leadership, and among the authoring groups and other partners. The process described here may be utilized by other professional societies and healthcare organizations to assess their own clinical guidelines.
23. Opportunities for Nursing Leadership in Family Caregiver Policy: A Policy Analysis of the RAISE Family Caregivers Act Using the Health Policy Triangle and Multiple Streams Framework.
期刊: Policy, politics & nursing practice 发表日期: 2026-Jan-29 链接: PubMed
摘要
Family caregivers provide essential unpaid care to millions of older adults and individuals with chronic illness or disability in the United States, yet federal support policies have historically been fragmented and underdeveloped. The Recognize, Assist, Include, Support, and Engage (RAISE) Family Caregivers Act of 2018 (Pub. L. 115-119) established the first national framework to coordinate federal actions, disseminate evidence-based practices, and institutionalize caregiver recognition. This study analyzed the RAISE Act using Walt and Gilson’s Health Policy Triangle and Kingdon’s Multiple Streams Framework to understand how its structure, political origins, and implementation mechanisms institutionalize caregiving support and create opportunities for nursing leadership. Primary data included legislative text, congressional records, and federal implementation documents; secondary data comprised policy briefs, nursing literature, and grey reports from 2016-2024. Analysis revealed that the Act reframes family caregiving as a coordinated national responsibility through recurring strategy updates, multi-sector collaboration, and public transparency, ensuring sustainability without new appropriations. The convergence of social need, feasible policy alternatives, and bipartisan support created a durable policy window (an opportune moment when conditions align for policy enactment). Nursing has substantial opportunities to shape implementation through care coordination, caregiver education, evaluation, and advocacy. The RAISE Act demonstrates how modest, consensus-based policy can generate structural impact, creating expanded opportunities for nursing to lead caregiver integration, strengthen care transitions, and advance equitable aging policy.
24. The effect of combining HIV latency reversal with inhibition of phosphoinositide-3 kinases or B-cell lymphoma-2 on the HIV reservoir.
期刊: PLoS pathogens 发表日期: 2026-Jan-29 链接: PubMed
摘要
The persistence of latently infected CD4 + T-cells in people with HIV (PWH) on suppressive antiretroviral therapy (ART) is the major barrier to an HIV cure. We investigated the impact of two classes of pro-apoptotic drugs, phosphoinositide-3 kinases (PI3K) inhibitors or the B cell lymphoma 2 (Bcl-2) inhibitor venetoclax on depletion of latently infected CD4 + T-cells when administered ex vivo either alone or in combination with a latency reversing agents (LRA) to induce expression of pro-apoptotic viral proteins. We quantified cell death in three latently infected cell lines (J-Lat clones) and the parental cell line (Jurkat) using a live dead stain and flow cytometry. Using CD4 + T-cells isolated from blood from PWH on ART, we quantified intracellular HIV RNA, integrated HIV DNA and intact proviral DNA using quantitative PCR. In the Jat10.6 latently infected cell line, the combination of an LRA with either a PI3K inhibitor or venetoclax, compared to an LRA alone resulted in higher levels of cell death. Using CD4 + T-cells from PWH on ART, there was a significant decrease in HIV DNA following administration of wortmannin (a pan-PI3K inhibitor), venetoclax (a Bcl2 inhibitor) and JQ1 (an LRA) when administered alone. There was minimal additional effect on reservoir reduction following the addition of an LRA with a pro-apoptotic drug, compared to either an LRA or pro-apoptotic drug alone. However, when CD4 + T-cells from PWH on ART were treated with LRAs combined with a PI3K inhibitor, the fold increase in cell associated unspliced HIV RNA correlated with the decline in HIV DNA. Overall, reduction in the HIV reservoir by LRAs could be further enhanced in the presence of pro-apoptotic drugs, but the magnitude of the effect was modest, was dependent on the in vitro model used and for PI3K inhibitors, depended on the potency of latency reversal. These results are consistent with minimal additional efficacy in reservoir reduction when combining currently available LRAs and either PI3K inhibitors or venetoclax.
25. Parental investment across neighborhood contexts: Evidence from a randomized controlled trial of poverty reduction.
期刊: Child development 发表日期: 2026-Jan-29 链接: PubMed
摘要
This study investigated how low-income parents with infants and toddlers make differing caregiving investments depending on neighborhood conditions. It leverages a randomized controlled trial in which 1,000 low-income mothers and newborns (Mage = 27; 42% Black; 41% Hispanic; 10% White; 2018-2022) received unconditional cash transfers of $333 or $20 per month. Mothers’ addresses were linked with census tract-based measures of “opportunity” for economic mobility. Parents in -lower-opportunity neighborhoods who received larger cash transfers engaged their child in more enriching activities and purchased more child-focused goods than parents who received the cash transfers in higher-opportunity neighborhoods (effect sizes of .12 and .09 more as opportunity decreased by 1 SD). These results suggest that parents compensate for challenging neighborhood conditions with increased caregiving investments. This study examined how low-income parents with infants and toddlers adjust their caregiving based on the neighborhoods they live in. As part of a large experiment, 1,000 low-income mothers in the U.S. were randomly assigned to receive either $333 or $20 in monthly cash gifts for several years after their babies were born. We linked families’ home addresses to data showing rates of upward mobility for each neighborhood. We found that low-income parents increased enriching activities and purchased stimulating materials more in neighborhoods where intergenerational poverty was entrenched than in places that offered opportunities for mobility. These results suggest that parents may compensate for structural disadvantages with greater investments in their children, highlighting families’ strength amid adversity.
26. Awareness and care journey of Glaucoma patients attending three referral hospitals in South-East Nigeria: Implications for public health intervention.
期刊: International ophthalmology 发表日期: 2026-Jan-29 链接: PubMed
摘要
Glaucoma, the primary cause of permanent blindness, occurs frequently, progresses aggressively, and more challenging to treat among Blacks. In South-East Nigeria, Igbos who have ancestral ties to blacks in the Barbados eye study are more likely to have primary open-angle glaucoma and are at risk of blindness. This study aims to evaluate glaucoma patients’ awareness, care-seeking pathway and identify policy areas for planning and advocacy. This cross-sectional survey was performed at three referral ophthalmology facilities. 303 eligible and consented participants were enrolled. Data collected with semi-structured researcher-administered questionnaire were imported into Stata v15.0. Charts and maps were used for descriptive percentages and proportions. At p-value < 0.05, statistically significant risks were determined using multiple logistic regression models. Over half of the participants (56.6%; 87/151) who had heard of glaucoma before diagnosis were early presenters. Social interactions between friends and family (57%), mass media-radio, television and print (31%) and internet (4%) were the three most common ways that participants learned about glaucoma. Fifty-one percent who presented late had been previously screened for glaucoma; a greater percentage of them spent more time visiting a spiritual home, optical store, or traditional healer compared to those who presented earlier. Basic literacy (0.18: CI 0.07-0.47) and the ability to pay rent (0.52: CI 0.31 - 0.91) were socio-economic factors independently associated with lower odds of presenting late to the glaucoma referral facility. Glaucoma awareness was linked to early presentation, although delays persist due to reliance on non-medical providers. Predictors of timely presentation suggest that socioeconomic empowerment may be a crucial lever for improving glaucoma health-seeking behaviour.
27. Behavioral Determinants and Effectiveness of Digital Behavior Change Interventions for the Prevention of Sexually Transmitted Infections and HIV: Overview of Systematic Reviews.
期刊: Journal of medical Internet research 发表日期: 2026-Jan-29 链接: PubMed
摘要
Unsafe sexual practices remain a major contributor to global morbidity, premature mortality, and health care burden. More than 1 million people acquire a sexually transmitted infection (STI) daily, including HIV. Although biomedical innovations such as pre-exposure prophylaxis have expanded prevention options, consistent condom use and regular HIV and STI testing remain essential behavioral strategies. Adherence to these behaviors remains uneven, underscoring the need for complementary digital and behavioral approaches. Digital behavior change interventions (DBCIs), technology-based programs designed to support health-related behavior change, offer scalable and personalized tools for safer-sex promotion. However, evidence regarding their behavioral components and effectiveness remains fragmented across systematic reviews (SRs). This study aims to synthesize and critically appraise evidence on the effectiveness of DBCIs for preventing STIs and HIV, and to identify which behavior change techniques (BCTs) and theoretical domains framework (TDF) have been used to improve safe-sex behaviors. A search was conducted in MEDLINE, Cochrane Database of SRs, Epistemonikos, and PsycINFO for all publications up to November 12, 2025, without language or date restrictions. Eligible SRs examined DBCIs targeting STI and HIV prevention or reduction of risky sexual behaviors. Two reviewers (GDA and DLA) independently screened, extracted data, and appraised methodological quality using the AMSTAR-2 tool. The reporting followed the PRIOR (Preferred Reporting Items for Overviews of Reviews) and PRISMA-S (Preferred Reporting Items for SRs and Meta-Analyses Literature Search Extension) recommendations. Overall, 23 SRs, comprising 514 primary studies and 129,481 participants, met the inclusion criteria. Most interventions were SMS-based, mobile app-based, or web-delivered. Digital interventions consistently improved STI and HIV testing uptake and engagement with sexual health services. Evidence for condom use and biological outcomes was mixed. Improvements in cognitive determinants, such as HIV-related knowledge, motivation, and self-efficacy, were frequently reported. Only 4 reviews explicitly applied BCT or TDF taxonomies, identifying goal setting, feedback on behavior, and prompts and cues as commonly used techniques. Research predominantly originated from high-income settings, with limited evidence from low- and middle-income countries and minimal reporting of sex- or gender-disaggregated outcomes. DBCIs show promise for strengthening STI/HIV prevention, particularly by increasing testing behaviors and supporting cognitive determinants of risk reduction. However, sustained condom use and biological outcomes remain inconsistent, and reporting of behavioral mechanisms is limited. This overview is the first to integrate effectiveness evidence with a systematic, mechanism-focused mapping of BCTs and TDF constructs, providing an innovation not present in earlier reviews. Clarifying which active components of digital interventions are most consistently linked to beneficial outcomes offers concrete guidance for designing culturally tailored, theory-driven, and equity-focused digital strategies. These insights have direct implications for researchers, clinicians, and policymakers seeking to develop digital prevention programs that more effectively address behavioral determinants of STI and HIV risk. PROSPERO CRD42023485887; https://www.crd.york.ac.uk/PROSPERO/view/CRD42023485887. RR2-10.5867/medwave.2025.02.3020.
28. A study of the association between static behavior and mental health among Chinese adolescents.
期刊: Psychology, health & medicine 发表日期: 2026-Jan-29 链接: PubMed
摘要
The purpose of this study is to investigate the relationship between adolescent static behavior and mental health, and to provide a scientific basis for improving adolescent mental health. A total of 5713 adolescents aged 13-18years were sampled from September to December 2023 in Shanghai, Suzhou, Taiyuan, Wuyuan, Xingyi, and Urumqi using stratified whole cluster random sampling method. Physical Activity Level Questionnaire for Children and Adolescents Aged 7 to 18Years and Brief Questionnaire for the Assessment of Adolescent Mental Health were used to investigate static behavior and mental health, respectively. Spearman’s correlation and linear regression were used to analyze the associations between static behavior and mental health dimensions. The sedentary time in the good mental health group was significantly lower than that in the poor mental health group (z = -4.23, p < 0.01). Significant differences existed in the distribution of adolescents’ mental health across different levels of meeting screen time recommendations (x2=12.27, p < 0.01). Sedentary time was significantly negatively correlated with emotional problems, conduct problems, and social adjustment difficulties (r-values of -0.08, -0.05, and -0.06, respectively, with p-values < 0.01); and screen time was significantly negatively correlated with emotional problems, conduct problems, and social adjustment difficulties (r-values of -0.11, -0.14, and -0.11, respectively, with p-values < 0.01). Linear regression showed that sedentary time and screen time were significantly negatively associated with emotional problems, behavioral problems, and social adjustment difficulties, respectively (p-value < 0.01). There is a significant negative correlation between adolescents’ static behavioral time and mental health scores, and reducing sedentary time and screen time may help improve their emotional problems, conduct problems, and social adjustment difficulties, and provide a reference basis for developing mental health interventions for adolescents.
29. Advancing Healthcare Provision to Autistic Clients: A Systematic Review of Autism Focused Digitally Delivered Professional Education Programs (DDPE) for the Health Workforce.
期刊: Journal of autism and developmental disorders 发表日期: 2026-Jan-29 链接: PubMed
摘要
30. Intraperitoneal Paclitaxel-Induced Eosinophil Recruitment as a Potential Mediator of Tumor Response in Peritoneal Metastases from Gastric Cancer.
期刊: Annals of surgical oncology 发表日期: 2026-Jan-29 链接: PubMed
摘要
The peritoneal cavity constitutes a unique immune microenvironment that critically influences the pathobiology of peritoneal metastasis (PM). This study aimed to clarify the mechanisms by which local immune alterations affect the efficacy of intraperitoneal (IP) chemotherapy for PM from gastric cancer (GC). Peritoneal lavage or ascitic fluid was obtained from 42 patients with GC and PM treated with IP paclitaxel (PTX) in combination with systemic oxaliplatin and oral S-1. Serial samples from 31 patients were analyzed after 1-3 cycles of chemotherapy. Immune cell subsets were evaluated using multicolor flow cytometry with monoclonal antibodies, and the functional properties of peritoneal eosinophils were assessed using gene expression profiling and cytotoxicity assays. IP chemotherapy was associated with decreased CD4(+) T cells and increased CD11b(+) myeloid cells. Notably, many patients, particularly those with negative cytology (CY0), exhibited striking recruitment of CD66b(+) CD16(-) CD193(+) Siglec-F(+) eosinophils into the peritoneal cavity. Eosinophil expansion was correlated with improved clinical outcomes. Post-treatment eosinophils displayed an activated, partially degranulated phenotype with elevated CD11b and CD63 expression and distinct messenger RNA signatures compared with circulating eosinophils. Peritoneal eosinophils demonstrated the ability to induce apoptosis in GC cells. IP PTX promotes the recruitment and activation of eosinophils with potent antitumor activity in the peritoneal cavity. Early post-treatment abdominal eosinophilia is a robust prognostic biomarker and may represent a promising therapeutic target to enhance the efficacy of IP chemotherapy in patients with PM from GC.
31. A Clinically Oriented Framework for Real-Time Heart Rate Variability Analysis: A Novel Approach To Personalized and Robust Monitoring.
期刊: Journal of medical systems 发表日期: 2026-Jan-29 链接: PubMed
摘要
Heart rate variability (HRV) is a well-established, noninvasive measure of autonomic nervous system activity and is associated with clinical outcomes. Although real-time monitoring of HRV is valuable in clinical practice, its effectiveness is often compromised by major challenges: high inter-individual variability and frequent data contamination from procedural artifacts. To address these challenges, we developed and validated a computational framework for robust and personalized real-time HRV analysis oriented toward clinical application. The framework performs simultaneous analysis and visualization of both time- and frequency-domain HRV indices and incorporates an adaptive alert algorithm that personalizes alert thresholds using the interquartile range of each patient’s own data. A workflow-integrated mechanism for manually annotating and excluding artifact-prone periods prevents procedural artifacts from skewing the statistical baselines, and a multi-scale visualization module provides a unified view of short-term fluctuations and long-term trends. While existing HRV tools are powerful for research or offline analysis, they often lack the integration of personalized alerting and workflow-oriented artifact management needed for bedside care. The proposed system uniquely combines personalized alerting, care-linked artifact exclusion, and multi-scale bedside visualization within a single real-time software package. The framework was validated using open-access electrocardiogram (ECG) databases and synthetic noise-contaminated signals, confirming robust R-wave detection across pediatric and adult recordings and under low signal-to-noise conditions. In addition, the framework was operationally validated at the bedside using ECG data from 24 newborn patients. By systematically addressing the core challenges of personalization and artifact management in a clinically integrated manner, this work represents a significant step toward translating real-time HRV analysis into routine vital sign management and, ultimately, improved patient outcomes.
32. Lifetime Earnings in Pediatric Cardiology: A Net Present Value Analysis of Academic and Private Practice Pathways.
期刊: Pediatric cardiology 发表日期: 2026-Jan-29 链接: PubMed
摘要
Pediatric cardiology requires extensive training, yet the long-term financial implications across academic subspecialties and private practice remain poorly characterized. A clearer understanding of these differences is essential for informed career decision-making and institutional workforce planning. We used a net present value (NPV) framework to model lifetime earnings for pediatric cardiologists across three academic subspecialties (diagnostic, cardiac intensive care, and interventional) under five promotion trajectories and compared them with private practice. Compensation data were sourced from the Association of Academic Administrators in Pediatrics, the Association of American Medical Colleges, and the Medical Group Management Association. Monte Carlo simulations (10,000 iterations) and sensitivity analyses accounted for variation in salary percentile, discount rate, and career length. Lifetime earnings were substantial across all pediatric cardiology career pathways, with NPVs exceeding $7 million in nearly all modeled scenarios. Interventional cardiology yielded the highest NPV at the 50th percentile under a typical academic promotion trajectory ($7.99 million), followed by cardiac intensive care ($7.76 million) and diagnostic cardiology ($7.00 million). Private practice produced an NPV of $7.08 million at the 50th percentile, with a ramp-up model increasing this to $7.30 million; still below interventional and CICU academic tracks. Academic earnings increased by up to $2.44 million through early promotion compared to no promotion, and by up to $1.5 million through leadership roles, depending on subspecialty. Salary percentile was the most influential driver of NPV; interventional cardiology at the 90th percentile exceeded $10.4 million, and private practice reached $10.76 million. Private practice exhibited the widest range of lifetime earnings. Pediatric cardiologists, particularly those in interventional subspecialties or academic leadership; achieve substantial lifetime earnings. At the 50th percentile, academic and private practice careers offer comparable financial outcomes, but private practice shows greater variability. Optimizing academic career pathways through early promotion, high-percentile salaries, or leadership roles can match or exceed private practice earnings. These findings provide financial context that may inform trainee deliberation and institutional discussions regarding recruitment, retention, and compensation equity in pediatric cardiology.
33. Retreatment of Direct Acting Agents (DAAs) After Initial DAA Failure in Hepatitis C Patients.
期刊: Hepatology research : the official journal of the Japan Society of Hepatology 发表日期: 2026-Jan-29 链接: PubMed
摘要
Glecaprevir/pibrentasvir (GLE/PIB) and sofosbuvir/ledipasvir (SOF/LDV) are widely used as first-line direct-acting antiviral (DAA) regimens for chronic hepatitis C, achieving high virus eradication rates. However, a small proportion of patients experience treatment failure, and the optimal retreatment strategies for such cases remain unclear. This nationwide, multicenter, prospective study aimed to evaluate the efficacy of retreatment regimens in patients who failed initial DAA therapy. A total of 330 patients were enrolled, including 117 with prior GLE/PIB failure and 213 with prior SOF/LDV failure. The primary outcome was sustained virologic response at 12 weeks after retreatment (SVR12). Retreatment regimens included 12 weeks of GLE/PIB, sofosbuvir/velpatasvir (SOF/VEL) plus ribavirin (RBV), or SOF/LDV. Among patients retreated after GLE/PIB failure, SVR12 rates were 99.0% (98/99) with SOF/VEL + RBV, 92.3% (12/13) with GLE/PIB 12 weeks, and 100% (5/5) with SOF/LDV, with no significant differences among regimens. Among patients retreated after SOF/LDV failure, SVR12 rates were 100% (12/12) with SOF/VEL + RBV, 99.5% (197/198) with GLE/PIB 12 weeks, and 66.7% (2/3) with SOF/LDV. Retreatment of SOF/VEL + RBV or GLE/PIB demonstrated high therapeutic efficacy in patients with prior SOF/LDV failure. One patient who relapsed after GLE/PIB 8-week therapy and harbored a P32del mutation achieved SVR12 with SOF/VEL + RBV retreatment. Retreatment with SOF/VEL + RBV, GLE/PIB for 12 weeks, or SOF/LDV achieved high SVR12 rates, indicating that effective viral eradication is feasible using currently available DAA regimens even after prior treatment failure.
34. Immune biomarkers of increased infection risk in multiple myeloma.
期刊: Blood 发表日期: 2026-Jan-29 链接: PubMed
摘要
Infection remains a leading cause of morbidity in multiple myeloma. Preventing infections is paramount and immune profiling could reflect the cumulative effect of host, tumor and treatment-related immunosuppression. However, current understanding of immune dysfunction and its association with infection is limited. To address this gap in knowledge and identify immune biomarkers of increased infection risk, we performed immune profiling using next-generation flow cytometry in bone marrow and peripheral blood samples from 1,786 patients at various disease stages and treatment scenarios. Patients developing infection had significantly lower percentages of CD27+ B cells and CD27- NK cells, as well as increased CD27-/CD27+ T-cell ratio in bone marrow. These immune risk factors were validated in three independent datasets. An immune score was developed to stratify patients with ≤1 vs ≥2 of the aforementioned risk factors, which was associated with higher infection incidence (35% vs 60%, P <.001). The immune score (odds ratio: 2.31, P <.001), disease stage and CD38, BCMA or GPRC5D targeted therapy were independently associated with infection incidence. All cell types detectable in bone marrow and peripheral blood were significantly correlated, suggesting that immune biomarkers of increased infection risk could be monitored using minimally-invasive methods that are available in routine laboratories.
35. Dual-antigen-targeting T-cell immunotherapies in MM: circumventing tumor heterogeneity and preventing antigen escape.
期刊: Blood 发表日期: 2026-Jan-29 链接: PubMed
摘要
BCMA- or GPRC5D-directed T-cell immunotherapies have substantially improved the survival of patients with relapsed/refractory multiple myeloma (MM). Despite these advances, a subset of patients does not respond, and most patients will eventually relapse. Tumor heterogeneity, resulting in rapid selection of both antigen-negative and antigen-low cells, is a critical issue affecting response to T-cell immunotherapies targeting single tumor-associated antigens. In addition, antigen escape (due to deletions, mutations, or epigenetic alterations) is frequently observed in patients who experience disease progression after CAR T-cell infusion or during BsAb treatment. Simultaneous targeting of two tumor-associated antigens may improve efficacy by addressing heterogeneous target expression and preventing antigen escape. Various dual-targeting strategies are currently evaluated in MM, including the combination of two single-antigen targeting BsAbs. Notably, the efficacy of the combination of teclistamab and talquetamab appears to have enhanced anti-MM activity, compared to the corresponding conventional BsAbs alone in similar patient populations. Furthermore, dual-antigen targeting with T-cell redirecting trispecific antibodies (e.g., ramantamig [BCMAxGPRC5D] and ISB2001 [BCMAxCD38]) has already demonstrated promising results in heavily pretreated MM with several studies ongoing in earlier stages of the disease. Studies with limited numbers of patients have demonstrated that CAR T-cell products with specificity for more than one antigen are also effective in advanced MM, but at this time none of the dual-targeting CAR T-cell products is clearly superior to targeting BCMA alone with ciltacabtagene autoleucel (cilta-cel). Dual-targeting should eventually be compared in large phase 3 trials with the classical approach of serial treatment with mono-targeting agents with target switch.
36. Use of Vending Machines to Deliver Oral Rapid HIV Self-Tests to Veterans: Protocol for a Pilot Study.
期刊: JMIR research protocols 发表日期: 2026-Jan-29 链接: PubMed
摘要
California has the largest number of people living with HIV in the United States, and in 2022, there were 4882 new diagnoses. Veterans with histories of substance use, viral hepatitis, sexually transmitted infections, and homelessness carry substantial HIV burden. Testing is essential, yet approximately 12% of Californians with HIV were undiagnosed in 2020, and 50% of veterans in care had never been tested as of 2023. HIV self-tests (HIVSTs) can mitigate stigma, confidentiality, and access barriers, and vending machines (VMs) offer private, convenient distribution. However, the use of VM-dispensed HIVST has not been evaluated for veterans or within Veterans Affairs (VA) settings. We describe a Reach, Evaluation, Adoption, Implementation, and Maintenance-guided pre-implementation protocol to evaluate VM-dispensed HIVSTs in Northern California VA clinics and supportive housing settings. Fifteen VMs will stock oral-fluid HIVSTs (n=900). Program data (de-identified dispense logs), veteran electronic surveys (n=90), and qualitative interviews (n=15) will quantify reach (uptake), early effectiveness proxies (use, results, and next steps), adoption (machine/site dispensing), implementation (stockouts, restocking interval, and costs), and maintenance (dispensing trends). Ethics approval activities (study material development and Institutional Review Board submission) began 2 months prior to the receipt of award funding (January to February 2025). Following funding, the project is planned for over a total of 18 months (12 months original project period + 6 months no-cost extension; March 2025 to August 2026). Ethics approval was obtained in August 2025. Veteran feedback was incorporated into study materials, and HIVSTs were purchased and packaged in September to November 2025. HIVSTs were added to VMs, and data collection is projected to occur from December 2025 through June 2026. Results are anticipated to be available in August 2026. This study will generate practice-ready evidence on the feasibility, acceptability, and early behavioral impacts of VM-dispensed HIVSTs for veterans. By pairing a stigma-responsive delivery channel with pragmatic measures, findings can inform equitable scale-up across VA and community settings, guide comparative evaluations of distribution channels (VMs, mail-to-home, or clinic pick-up), and support privacy-preserving linkage strategies to confirmatory testing, HIV pre-exposure prophylaxis, and treatment. Results will address a critical evidence gap for veteran-focused HIV prevention and provide parameters for multi-site evaluations.
37. DNA-protein cross-links promote cGAS-STING-driven premature aging and embryonic lethality.
期刊: Science (New York, N.Y.) 发表日期: 2026-Jan-29 链接: PubMed
摘要
DNA-protein cross-links (DPCs) are highly toxic DNA lesions that block replication and transcription, but their impact on organismal physiology is unclear. We identified a role for the metalloprotease SPRTN in preventing DPC-driven immunity and its pathological consequences. Loss of SPRTN activity during replication and mitosis lead to unresolved DNA damage, chromosome segregation errors, micronuclei formation, and cytosolic DNA release that activates the cyclic GMP-AMP synthase (cGAS)-stimulator of interferon genes (STING) pathway. In a Sprtn knock-in mouse model of Ruijs-Aalfs progeria syndrome, chronic cGas-Sting signaling caused embryonic lethality through inflammation and innate immune responses. Surviving mice displayed aging phenotypes beginning in embryogenesis, which persisted into adulthood. Genetic or pharmacological inhibition of cGas-Sting rescued embryonic lethality and alleviated progeroid phenotypes.
38. Digital Twins Framework for Clinical Decision-Centric Co-Management of Patient Monitoring and Environment Management.
期刊: IEEE journal of biomedical and health informatics 发表日期: 2026-Jan-29 链接: PubMed
摘要
The convergence of continuous physiological monitoring and intelligent building systems in smart clinics offers a transformative opportunity for patient-centered care, yet it introduces the challenge of harmonizing clinical fidelity, patient comfort, and operational sustainability. We present DT-ECO, a privacy-preserving digital twins framework that enables decision-centric co-management of multi-modal patient monitoring and clinical environmental systems. DT-ECO constructs a hybrid digital twin that integrates a physics-informed building model with graph-temporal physiological inference and battery electrochemistry, enabling real-time synchronization between patient state, IoT device operation, and environmental dynamics within a differentiable programming environment. On this foundation, a hierarchical control strategy is developed, in which a constrained deep reinforcement learning agent adaptively schedules wearable IoT sensor sampling to extend device lifetime, while a model predictive controller orchestrates HVAC operation and on-site energy resources to maintain a therapeutic environment. Extensive evaluations on DOE reference hospitals and public ECG datasets demonstrate that DT-ECO achieves a 31.8% reduction in annual energy consumption and extends median wearable battery life by 28%, while rigorously maintaining clinical standards-evidenced by less than 0.6% thermal comfort violation and no degradation in arrhythmia detection capability (F1-score 0.956). By bridging the gap between patient physiology and the clinical environment, DT-ECO establishes a pathway toward precision healthcare facilities that are simultaneously patient-centric, diagnostically robust, and operationally sustainable.
39. Conformation of CD40LG and ANXA5 as Key Events of 2,7-Dibromocarbazole-Induced Cardiotoxicity Using in Vivo and in Vitro Models.
期刊: Environmental science & technology 发表日期: 2026-Jan-29 链接: PubMed
摘要
Polyhalogenated carbazoles (PHCZs) are emerging dioxin-like compounds (DLCs) with uncertain toxicological effects. Cardiotoxicity caused by DLCs has been well-characterized within the framework of an adverse outcome pathway, demonstrating consistent aryl hydrocarbon receptor (AhR) activation as the molecular initiating event. However, the downstream key events (KEs) contributing to PHCZ-induced cardiotoxicity have been less characterized. Herein, PHCZ-induced cardiotoxicity was evaluated by in vivo (Sprague-Dawley rats) and in vitro (rat cardiomyocytes) models, and the underlying mechanisms were confirmed using rat cardiomyocytes (H9c2 cells). As a model PHCZ, 2,7-dibromocarbazole (2,7-DBCZ) induced significant rat cardiac tissue apoptosis following exposure to 100 μg/kg/d via intragastric infusion. In addition, 2,7-DBCZ also induced apoptosis and suppressed the mitochondrial membrane potential in H9c2 cells (at 10-5 M). CD40LG promotes apoptosis and inhibits cell growth through the phosphatidylinositol 3-kinase (PI3K)/protein kinase B (Akt) signaling pathway, and ANXA5 plays a vital role in apoptosis by possessing Ca2+ channel activity. Apoptosis-focused PCR array and Ingenuity Pathway Analysis further indicated CD40LG and ANXA5 as upstream regulators for 2,7-DBCZ-induced apoptosis. 2,7-DBCZ increased Akt phosphorylation and intercellular Ca2+ levels, which were reversed by pretreatment with an Akt agonist and a Ca2+ inhibitor. Silencing of Ppp2ca further confirmed Ca2+ as a key intercellular messenger in regulating induced apoptosis. Finally, rat cardiac tissue and H9c2 cell gene profiles and AhR antagonist cotreatment demonstrated that CD40LG and ANXA5 are potential downstream KEs in regulating 2,7-DBCZ-induced cardiotoxicity, as they exhibited the same transcription patterns with the AhR activation indicators CYP1A1 and CYP1B1. These findings offer crucial new insight into the mechanisms underlying PHCZ-induced cardiotoxicity, providing valuable mode of action data that can be used in the Weight of Evidence components of risk assessments and regulation decisions regarding these emerging contaminants.
40. A global imperative to remediate Ukraine's soils.
期刊: Science (New York, N.Y.) 发表日期: 2026-Jan-29 链接: PubMed
摘要
41. Strengthening of Agbani clay with granite and characterization of its properties and toxicity for applications in building services.
期刊: Environmental science and pollution research international 发表日期: 2026-Jan-29 链接: PubMed
摘要
Developing countries with a high growth of young population are often faced with the burden of a housing deficit. Manufacture and utilization of locally abundant natural materials in building services remain the most viable option in mitigating such challenges. However, environmental safety and public health concerns due to toxic pollutants in such construction materials should be given priority attention. The need to develop local sustainable construction materials that meet the United Nations’ 2030 target for Sustainable Development Goals (SDGs) necessitated this study. Agbani has large deposits of quality clay minerals that have been studied. The authors blended and reinforced Agbani clay with granite to produce composite clay materials that can be used in building services. The samples were heated to 900 °C, 1000 °C, 1100 °C, and maximum temperature of 1200 °C. XRF, XRD, physical properties, mechanical behaviour, and physicochemical properties of the samples were characterized using different combined experimental techniques. The result of the XRF analysis shows that SiO2, Al2O3, and Fe2O3 constitute the major oxides while the XRD analysis shows that quartz, orthoclase, kaolinite, and albite dominate the mineralogical composition of the clay. The results of the physical properties of the Agbani clay deposit suggest remarkable improvement in the physical properties such as apparent porosity, bulk density, and water absorption with the addition of granite and firing at 1200 °C. Mechanical property results show that impact strength, impact energy, modulus of rupture, and compressive strength all increased with the addition of granite and firing to elevated temperature. However, the plasticity limit was adversely affected as it reduced. For all the clay samples produced, blending them with granite and firing at 1200 °C led to a significant reduction in the toxic materials such as lead, mercury, arsenic, phosphorous, and chloride.
42. A review on integrated isotopic and receptor model approaches for urban REE source appointment.
期刊: Environmental geochemistry and health 发表日期: 2026-Jan-29 链接: PubMed
摘要
With rapid urbanization and industrialization, pollution of rare earth elements (REEs) in air, soil, and water is increasing in urban areas. These critical high-tech elements are becoming more abundant in urban dust and other environmental settings. It is difficult to differentiate and quantify the sources of REE pollution, as natural and anthropogenic sources overlap. This work couples isotopic tracing techniques (Pb, Sr, and Nd isotopes) with receptor models (positive matrix factorization (PMF) and absolute principal component scores/multiple linear regression (APCS/MLR)) to obtain robust source apportionment of REEs in urban environments. Isotopic fingerprints, including Gd anomalies, have been shown to serve as powerful tracers for distinguishing vehicular emissions, industrial discharges, and soil erosion. Non-exhaust vehicular emissions, especially those from brake and tire wear, have been identified as the main sources of REE release into the environment. The combination of isotopic methods and receptor models enhances the accuracy of source apportionment and contributions, facilitating better environmental management. The review highlights the need for standardized isotope libraries and sophisticated modelling tools to characterize sources, thereby improving source apportionment and informing sustainable control strategies for urban pollution. Focusing on controlling industrial and vehicle emissions can be an effective strategy to reduce REE contamination levels and human exposure.
43. Delays in tuberculosis care among the top-ten-tuberculosis-high burden countries in the world: a scoping review.
期刊: The Journal of the Egyptian Public Health Association 发表日期: 2026-Jan-29 链接: PubMed
摘要
Delayed diagnosis and treatment can be detrimental not only to patients but also to the community, as such delays can perpetuate TB transmission. This presents a significant challenge in the ongoing efforts to eliminate TB from the community. The primary objectives of this scoping review were to map out research surrounding delays in TB care across the ten countries with the highest TB burden globally and to identify research gaps in this area. The guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Reviews (PRISMA-ScR) were adhered to in reporting this scoping review. Three databases: PubMed, DOAJ, and Scopus, were searched to collect articles published between 2004 and 2024, all in the English language. A total of eighty-one articles were included in this review. Out of 831 articles, following the eligibility criteria, 81 full-text open-access articles were deemed suitable for review. The findings indicate that delays in TB care are influenced by several factors, including patient-related, household and social, health system, economic, and occupational factors, as well as health-seeking behaviour. Significant variations in delay duration were observed across the reviewed studies. Myanmar recorded the longest median total delay of 170.6 days, while India and China reported median total delays ranging from 8 to 111 days. Due to resource constraints, Mozambique experienced the highest median health system delay of 150 days. There were a very limited number of studies conducted in the Democratic Republic of Congo, the Philippines, and Zambia. This scoping review found that delays in TB care in high-burden countries are influenced by a combination of patient, social, economic, and health-system factors, with significant differences in delay durations between different countries. These findings underscore the need for stronger health systems, targeted community education to encourage timely care-seeking, and stigma-reduction efforts to minimise delays and support TB elimination goals.
44. [Assessment of noise damage-part 1 : Occupational fundamentals of causal attribution].
期刊: HNO 发表日期: 2026-Jan-29 链接: PubMed
摘要
Noise has the potential to exert a harmful effect on the auditory system. Whether damage actually results depends primarily on the individual susceptibility of the auditory system as well as on the intensity and duration of exposure. Occupational noise-induced hearing loss typically develops over years to decades of hazardous exposure, affects only a subset of those exposed, and is irreversible. To assess whether an insured activity constitutes a health-relevant noise exposure in terms of causal attribution (“Einwirkungskausalität”), a fundamental understanding of physical and technical parameters is required; a medical diagnosis alone is insufficient for establishing causality. In part 1 of this article, the fundamentals of exposure assessment and causal relationship (e.g., daily noise exposure level normalized to 8 h [LEX,8h], single event sound exposure level [LAE], effective noise dose [ELD]) are outlined, while part 2 addresses the medically professional requirements for recognizing occupational noise-induced hearing loss as an occupational disease under item 2301 of the Occupational Diseases Ordinance (BKVO). Lärm stellt zunächst eine potenziell schädigende Noxe für das Gehör dar. Ob daraus eine tatsächliche Schädigung resultiert, hängt wesentlich von der individuellen Empfindlichkeit des Gehörs sowie von Intensität und Dauer der Lärmeinwirkung ab. Eine beruflich verursachte Lärmschwerhörigkeit entwickelt sich i. d. R. über Jahre bis Jahrzehnte gehörgefährdender Tätigkeit, betrifft jedoch nur einen Teil der Exponierten – und ist irreversibel. Zur Beurteilung, ob eine versicherte Tätigkeit eine gesundheitlich relevante Lärmeinwirkung im Sinne der Einwirkungskausalität darstellt, sind physikalisch-technische Grundlagenkenntnisse erforderlich. Eine medizinische Diagnose allein ist für die Kausalitätsbeurteilung nicht ausreichend. Während Teil 1 die Grundlagen zur Expositionsbewertung und Einwirkungskausalität vermittelt (z. B. Tages-Lärmexpositionspegel, bezogen auf einen Arbeitstag von 8 h [LEX,8h], Einzelereignispegel [LAE], Effektive Lärmdosis [ELD]), befasst sich Teil 2 mit den medizinisch-fachlichen Voraussetzungen zur Anerkennung einer beruflich bedingten Lärmschwerhörigkeit nach Nr. 2301 der Berufskrankheiten-Verordnung (BKVO).
45. Long-term safety and efficacy of tocilizumab in adult-onset Still's disease: open-label, long-term extension of the phase III trial.
期刊: Rheumatology (Oxford, England) 发表日期: 2026-Jan-29 链接: PubMed
摘要
To investigate the long-term safety and efficacy of tocilizumab, an interleukin-6 receptor inhibitor, in patients with adult-onset Still’s disease. Patients who completed the precedent phase III trial of tocilizumab for adult-onset Still’s disease were enrolled in a long-term extension (LTE) study. Patients received intravenous tocilizumab (8 mg/kg every two weeks) until its approval in Japan. The primary end point was safety and tolerability, and secondary endpoints included the ACR coreset response, glucocorticoid doses, tocilizumab dosing interval, remission defined as achieving ACR50 without fever, and other laboratory parameters. Efficacy was assessed every 12 weeks. All 22 patients who had completed the precedent phase III trial participated in the LTE study. 16 (72.7%) completed the LTE study, with the mean observation period of 168.9 ± 10.8 weeks. Whereas three (13.6%) patients experienced serious adverse events, resulting in two patients withdrawn from the trial, no new safety signal was detected. Treatment efficacy was maintained through the LTE study, with the ACR70 response rate of 68.2% and 95.2% reduction in glucocorticoid doses from the start of the phase III trial and glucocorticoid-free remission of 40.9% at the last visit. Laboratory markers such as C-reactive protein and ferritin remained well controlled. The dosing interval was successfully extended in 63.6% of patients, with the overall mean tocilizumab interval at the final visit of 3.4 weeks. During the observation period, no new safety findings were observed with the long-term use of tocilizumab. Response to tocilizumab was sustained even with an extended dosing interval, with substantial glucocorticoid dose reduction or discontinuation. UMIN000018414.
46. The conversion rate to total hip arthroplasty after hip arthroscopy in patients with femoroacetabular impingement syndrome is 8% and is affected by older age, cam morphology and osteoarthritis.
期刊: Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA 发表日期: 2026-Jan-29 链接: PubMed
摘要
Patients with femoroacetabular impingement syndrome (FAIS) may experience persistent hip problems following arthroscopic surgery, with some patients requiring total hip arthroplasty (THA). Therefore, the purpose was (1) to investigate the proportion of THA conversion in a large national Danish cohort of patients with FAIS who had previously undergone hip arthroscopy. (2) To investigate factors that might affect time to conversion. (3) To describe patient-reported outcomes after THA. Patients aged 18 years or above registered with arthroscopic surgery for FAIS between January 2012 and November 2023 in the Danish Hip Arthroscopy Registry (DHAR). Eligible patients were invited to participate in an online survey. If they responded ‘yes’ to the entry question ‘Have you had total hip arthroplasty?’, they were asked to complete the Copenhagen Hip and Groin Outcome Score (HAGOS), the Hip Osteoarthritis Outcome Score (0-100 scores, 100 being no problems), the Hip Specific Sports Scale, and Patient Acceptable Symptom State. To perform survival analysis, a Kaplan-Meier method was used to estimate cumulative all-cause conversion to THA. A Cox regression model was fitted after examining proportional-hazards assumptions to examine predictor variables on conversion to THA. A total of 5109 patients were eligible and invited for the survey. Of which, 2383 (46.6%) responded; 406 patients had received THA at a median of 4.2 [2.1; 7.0] years after hip arthroscopy. Regarding HAGOS, patients (N = 199) treated with THA reported mild pain (75 [55; 93] points) and problems with daily activities (70 [40; 90] points) and moderate problems with sports activities (53 [28; 81] points) and hip-related quality of life (50 [30; 80] points), 56% participated in sports activities and 62% reported an acceptable symptom state. A low number of conversions to THA (8%) was observed. Older age decreased lateral joint space width, Tönnis grade > 0, higher alpha angle and femoral cartilage pathology were associated with conversion to THA. Level II, retrospective study.
47. Development and efficacy test of a live, attenuated Mycoplasma hyorhinis vaccine candidate strain.
期刊: Vaccine 发表日期: 2026-Jan-28 链接: PubMed
摘要
Mycoplasma (M.) hyorhinis causes substantial economic losses in swine. Currently, prevention and treatment rely on minimizing risk factors and administering antibiotics, as no vaccines are commercially available in Europe. However, antibiotics often cannot fully eliminate the bacteria. The development of an effective vaccine could lead to a potentially long-term control method. A temperature-sensitive M. hyorhinis strain was developed using 1-methyl-3-nitro-1-nitrosoguanidine (NTG) mutagenesis. The immunogenicity and efficacy of this vaccine candidate clone were evaluated in combination with an adjuvant. Three-week-old piglets were immunized with the candidate vaccine strain, and the vaccination site was monitored daily. At six weeks of age, the pigs were challenged intravenously on two subsequent days. Daily clinical examinations were conducted, with blood and nasal swabs collected weekly throughout the study for M. hyorhinis enzyme-linked immunosorbent assay (ELISA), real-time PCR analysis, and isolation. Three weeks post-challenge, the animals were euthanized for gross and histopathological examinations. Body temperature was recorded daily, and body weight was measured upon arrival, and then at six and nine weeks of age. Vaccination significantly reduced clinical signs (p = 0.03), as well as gross pathological (p = 0.01) and histopathological (p = 0.005) lesions compared with the positive control group. The vaccinated group exhibited an earlier and higher increase in M. hyorhinis-specific IgG antibody levels post-challenge than the positive control group. However, the vaccine candidate did not mitigate the impact of M. hyorhinis infection on the weight gain. After the challenge (days 21-42), both the vaccinated (p = 0.001) and the positive control (p = 0.003) groups exhibited reduced weight gain compared with the negative control group. Overall, the attenuated M. hyorhinis strain, combined with the adjuvant, provided protection against M. hyorhinis infection. These results form a basis for the development of a novel vaccine candidate that offers effective prevention.
48. Beyond the shot: A framework of individual and external influences on U.S. young adults' COVID-19 vaccination decisions derived from thematic analysis.
期刊: Vaccine 发表日期: 2026-Jan-28 链接: PubMed
摘要
Understanding vaccine decision-making among young adults is critical for shaping effective public health responses during and beyond the COVID-19 pandemic. This qualitative study investigates two key questions: (1) What are the reasons young adults choose to be vaccinated or remain unvaccinated against COVID-19? (2) What distinct attitudinal groups emerge based on these reasons? This cross-sectional online study assessed 1863 unique open-ended free-text responses provided by 1863 U.S. young adults between February 14 and June 15, 2022. The data originated from the COVID-19 Adult Resilience Experiences Study (CARES). Participants reported their vaccination status and then shared free-text explanations of their decision. Thematic analysis led to the development of the “COVID-19 Vaccination Attitudes Among Young Adults” model, illustrating how vaccination decisions were shaped by the dynamic interplay of individual and contextual factors. At the individual level, pro-vaccination, vaccine-hesitant, and anti-vaccination attitudes emerged. Pro-vaccination individuals emphasized motivations such as protecting health, trusting in science and institutions, and having a sense of collective responsibility. Vaccine-hesitant respondents were marked by uncertainty, including a fear of unknown risks and decision paralysis. Anti-vaccination individuals expressed distrust in governmental and scientific authorities, had a strong emphasis on personal autonomy, and expressed beliefs rooted in spiritual, naturalistic, or fatalistic frameworks. Beyond the individual level, three contextual influences shaped attitudes: government policies and mandates, social influence from other people around them, and vaccine accessibility. A key distinction across these groups was between collectivistic and individualistic motivations. Vaccine-hesitant individuals were characterized by ambivalence. COVID-19 vaccination attitudes among U.S. young adults reflect a complex intersection of personal beliefs and social context. Understanding these patterns can inform more nuanced public health strategies and communication efforts.
49. Caregiver-reported evaluation for and diagnosis of fetal alcohol spectrum disorders in the United States.
期刊: Drug and alcohol dependence 发表日期: 2026-Jan-21 链接: PubMed
摘要
In-person, active case ascertainment studies suggest the prevalence of children with fetal alcohol spectrum disorders (FASDs), lifelong disorders caused by prenatal alcohol exposure, in selected communities ranges from 11.3 to 71.4 per 1000 (including diagnosed and undiagnosed FASDs). National, population-based estimates of children with an FASD diagnosis and who are at different stages of a prototypical diagnostic process are limited. Data are from the 2022-2024 National Survey of Children’s Health (n = 160,640). We estimated the caregiver-reported prevalence of children who had ever been recommended for an FASD evaluation, received an FASD evaluation, and received an FASD diagnosis, overall and by demographic subgroups; Chi-square tests assessed differences by subgroup. Based on caregiver report, 2.4 per 1000 children were recommended for an FASD evaluation, 3.1 per 1000 received an evaluation, and 2.0 per 1000 received an FASD diagnosis. Prevalence varied by several characteristics; for example, the prevalence of children with an FASD diagnosis was higher among those cared for by grandparents or other relations (10.8 per 1000, 95 % confidence interval [CI]: 7.2-16.0) than those cared for by two parents (1.2 per 1000, 95 % CI: 0.9-1.6). Of the 4.6 per 1000 children either recommended for an FASD evaluation, received an evaluation, or diagnosed with an FASD, 20.0 % had all three experiences. These nationally representative, caregiver-reported estimates for children with an FASD diagnosis are lower than those from active case ascertainment studies, suggesting efforts are needed to improve the screening, evaluation, and diagnosis process for children suspected of an FASD.
50. The Public Health Consequences of the 2025 Public Charge Announcements-Uncertainty as Policy.
期刊: JAMA network open 发表日期: 2026-Jan-02 链接: PubMed
摘要
51. Age-Related Germline Landscape of Endometrial Cancer: Focus on Early-Onset Cases.
期刊: JCO precision oncology 发表日期: 2026-Jan 链接: PubMed
摘要
Early-onset endometrial cancer (eoEC) is increasing, and germline drivers may be enriched in younger patients. We sought to define germline pathogenic variants (gPVs) in those with EC by age. We identified patients with EC who underwent clinical tumor-normal sequencing from December 2014 to June 2021 and collected clinical variables. Logistic regression models evaluated associations between age at EC diagnosis and presence of gPV, biallelic inactivation, and Lynch Syndrome (LS). Age categories were defined as early-onset (eoEC, EC < 50 years) and late-onset (EC ≥ 70 years) and were compared with those diagnosed ages 50-69 years. Among 1,625 patients with EC, the median age at diagnosis was 63 (range, 24-96) years. We observed gPV in 28 (16%) of 170 patients with eoEC, 152 (14%) of 1,066 patients diagnosed age 50-69 years, and 36 (9%) of 389 patients with late-onset EC (P = .016). LS was enriched in eoEC, with 6.5% of patients diagnosed age <50 years having LS. In multivariable models compared with those with EC diagnosed age 50-69 years, eoEC was more likely to exhibit biallelic inactivation (odds ratio, 3.34 [95% CI, 1.44 to 7.35]) and be associated with LS (hazard ratio [HR], 3.49 [95% CI, 1.63 to 7.01]). Among early-onset EC, 14 (50%) of 28 gPV were high penetrance and 14 (50%) of 28 exhibited biallelic inactivation. However, heterogeneity was observed, and rates of gPV were 8.9% and 19%, biallelic inactivation was 0% and 11%, and LS was 2.2% and 8% in those diagnosed age <40 years and 40-49 years, respectively. Rates of gPV, biallelic inactivation, and LS differ across age groups for EC, with high-penetrant genes driving tumorigenesis enriched in younger patients. However, very-early-onset EC may have different drivers and necessitates more research.
52. Intervention research to protect human health in the era of climate extremes.
期刊: PLoS medicine 发表日期: 2026-Jan 链接: PubMed
摘要
Climate change is accelerating the frequency and severity of extreme weather events and increasingly threatening human health and life, particularly in low- and middle-income countries. Research on the effectiveness of climate adaptation interventions for human health, as well as their desirability, implementation, and financial viability, are urgently required.
53. Health information anxiety in social media users during public health emergencies: A qualitative comparative analysis using attribution theory.
期刊: PloS one 发表日期: 2026 链接: PubMed
摘要
This article investigates the mechanisms influencing health information anxiety among social media users during sudden public health emergencies, aiming to provide insights for managing social media users’ negative emotions in such contexts. By employing literature analysis and case studies and integrating Three-Dimensional Attribution Theory, the factors contributing to health information anxiety are classified into individual, informational, and situational dimensions. Questionnaire data were gathered via scenario simulation, and a Qualitative Comparative Analysis (QCA) method was used to validate causal configurations leading to health information anxiety among social media users. The findings indicate that, within the context of sudden public health emergencies, the emergence of health information anxiety is the result of the interplay among individual, situational, and informational dimensions. Specifically, six key factors, including event severity, involvement, textual sentiment, collective emotions, information overload, and information asymmetry, are identified as playing a critical role in the development of severe health information anxiety. Notably, the situational dimension is found to exert a crucial and decisive influence on the generation of health information anxiety among social media users.
54. The mediating role of self-efficacy in the relationship between self-management and health-promoting behaviors in post-PCI patients.
期刊: PloS one 发表日期: 2026 链接: PubMed
摘要
Coronary artery disease (CAD) has become one of the most prevalent diseases worldwide. Self-management and self-efficacy are critical for enhancing healthy lifestyles in patients with postoperative CAD and are strongly associated with health-promoting behaviors. However, the underlying mechanisms of this association remain unclear. To explore the mediating role of self-efficacy between self-management and health-promoting behaviors in patients following percutaneous coronary intervention (PCI). From November 2024 to March 2025, 400 post-PCI patients were selected by convenience sampling from a tertiary first-class hospital in Xinjiang. Surveys were administered using a general information questionnaire, a self-management scale, a self-efficacy scale, and a health-promoting lifestyle scale. Structural equation modelling was employed to investigate the pathways of action among the three variables. The scores for self-management behaviour, self-efficacy, and health-promoting lifestyle were (96.66 ± 10.11) scores, (44.49 ± 6.10) scores, and (162.91 ± 12.24) scores, respectively, with positive correlations between each pair of items. Self-efficacy partially mediated the relationship between self-management and health-promoting behaviors, with a standardized indirect effect of 0.317, accounting for 61.3% of the total effect. Self-efficacy plays a partial mediating role between self-management and health-promoting behaviors. Healthcare professionals should pay attention to the self-efficacy of patients post-PCI to enhance their awareness of personal health and strengthen self-management, thereby promoting proactive adoption of healthy lifestyles.
55. From awareness to action: Health Belief Model-based educational intervention to improve breast self-examination practice among college teachers in Pakistan (CRCT).
期刊: PloS one 发表日期: 2026 链接: PubMed
摘要
Breast cancer (BC) is the most common malignancy among women globally, with Pakistan showing similar trends. Teachers, especially female college teachers, are influential in health promotion. This study assessed the effectiveness of a Health Belief Model (HBM)-based educational intervention in improving breast self-examination (BSE) knowledge, beliefs, and practices. A parallel cluster-randomized controlled trial was conducted among 114 female teachers from four colleges in Hyderabad, Pakistan, with colleges as the unit of randomization. The intervention group received multimedia presentations, survivor testimonials, pamphlets, breast models, gamified quizzes, and reminders, while the control group was offered the session after study completion. Data was collected at baseline, 1-month, and 3-month follow-ups using validated Urdu questionnaires. Analyses included descriptive statistics, bivariate tests, and Generalized Estimating Equations (GEE), using the Statistical Package for the Social Sciences (SPSS) version 29. A p-value < 0.05 was considered statistically significant. Baseline characteristics were comparable across groups. Following the intervention, BSE practice improved significantly in the intervention group. At 1 month, participants were 5.7 times more likely to practice BSE (Adjusted Odds Ratio (AOR) = 5.724, p < 0.001), rising to 26.5 times at 3 months (AOR = 26.500, p < 0.001). Knowledge scores also increased significantly (p < 0.001). Significant between-group differences were observed in perceived susceptibility, severity, benefits, barriers, self-efficacy, and cues to action (all p ≤ 0.001). HBM-based intervention effectively enhanced BSE knowledge, beliefs, and practices while reducing barriers. Findings emphasize the value of structured educational interventions in promoting preventive health behaviors among female educators.
56. Venous Thromboembolism in Women with Breast and Gynaecological Cancers: What Do We Know and What Should We Do?
期刊: Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis 发表日期: 2026 链接: PubMed
摘要
Cancer-associated thrombosis (CAT) is a major cause of morbidity and mortality in oncology. Female-specific cancers-including breast, ovarian, endometrial, and cervical malignancies-demonstrate distinct thrombotic profiles influenced by hormonal mechanisms, anatomical features, and treatment strategies. This narrative review synthesizes epidemiological evidence, mechanistic pathways, and clinical trial data to characterize CAT risk across these cancer types. Key modulators of thrombosis include hormonal exposures, tumor histology, inflammatory signaling, tissue factor expression, and therapeutic interventions such as surgery, chemotherapy, endocrine therapy, targeted agents, and immunotherapy. Despite growing understanding, current CAT risk prediction models insufficiently reflect the heterogeneity of female cancers and fail to integrate bleeding risks specific to gynecologic disease and treatment. Optimizing CAT prevention and management will require improved risk stratification tools, individualized thromboprophylaxis strategies, and incorporation of survivorship considerations, including fertility and contraception counseling. A multidisciplinary approach involving oncology, gynecology, and thrombosis specialists is essential to reduce the burden of CAT and improve outcomes for women with cancer.
57. Intelligent technology-driven diabetes prevention and control: From informatization management to artificial intelligence.
期刊: Science progress 发表日期: 2026 链接: PubMed
摘要
The escalating prevalence of diabetes, along with its complications and mortality risks, imposes a substantial disease burden worldwide. The current suboptimal medical conditions and poor self-management among diabetic patients have exacerbated the deterioration of diabetes globally, particularly in economically underdeveloped countries. However, this situation may now be approaching a turning point. With the constantly advancement of intelligent technologies, the widespread adoption of information management systems and the rise of artificial intelligence have made it possible to enhance the efficiency of diabetes treatment and reduce management costs. Therefore, we have reviewed the relevant literature and conducted a narrative review following the guidance of the Scale for the Assessment of Narrative Review Articles (SANRA). The present paper provides a narrative review of research advances from information management to artificial intelligence in the field of diabetes treatment and management, while also discussing the opportunities and challenges in clinical translation and application. The present review offers a conceptual framework to inform future research and development in intelligent diabetes care.
58. Workplace stress, support and stress management strategies for healthier lifestyles among healthcare workers in Ethiopia.
期刊: PloS one 发表日期: 2026 链接: PubMed
摘要
Workplace stress is an ongoing global and local challenge in healthcare, driven by high demands, long hours, and emotional strain, requiring urgent attention to safeguard workers’ well-being and ensure quality care. This study assessed workplace stress, support systems, and coping strategies among healthcare professionals in Jimma Zone, Ethiopia. A facility based cross sectional study was conducted in Jimma Zone, Ethiopia, in August 2023. A total of 496 healthcare professionals from five different hospitals were randomly selected to participate in the study. Various validated scales, including the Workplace Stress Scale (WSS), Workplace Support for Health Scale (WSHS), and Oslo Social Support Scale (OSSS-3) were used to assess the participants’ stress levels, social support systems, and their utilization of coping strategies. The data analysis involved descriptive statistics and ordinal logistic regression techniques. Results showed that 53% of healthcare workers experienced stress, with 25% reporting low, 16% moderate, and 12% severe stress. Positive workplace support for a healthier life was reported by 54% of respondents. Stress levels were significantly linked to factors like qualifications, facility type, and salary level (p < 0.05). Female workers had slightly lower stress odds than males. Workers aged 30-39 and 50-59 had lower odds of stress compared to those under 30. Higher income and working in primary hospitals were associated with reduced stress odds compared to lower income and referral hospitals. This study found considerable workplace stress driven by individual, organizational, and external factors, calling for targeted interventions like stress management training and resilience building programs to enhance health workers’ coping skill and improve healthcare environments in Ethiopia.
59. The epidemiology of ceftriaxone and cotrimoxazole-resistant Escherichia coli from humans, poultry, and their environment in central Malawi: A cross-sectional study.
期刊: PLOS global public health 发表日期: 2026 链接: PubMed
摘要
The poultry industry represents an important reservoir for clinical antibiotic resistance, especially in low- and middle-income-countries where food security pressures drive intensified farming and antibiotic use. However, evidence linking poultry production to public health risks remains limited in settings such as Malawi. This study examined Escherichia coli resistance to ceftriaxone and cotrimoxazole, two antibiotics with distinct stewardship priorities. We conducted a cross-sectional study between July and September 2022 in Malawi’s Central region, targeting poultry farms. Our mixed-methods design combined microbiological sampling from farm workers, poultry, and effluent water with a structured questionnaire on antibiotic use. E. coli isolates underwent antimicrobial susceptibility testing by disk diffusion for ceftriaxone and cotrimoxazole. 376 poultry farms were enrolled and among these, 17.6% reported using Trimovet, a veterinary formulation containing the same active ingredients as cotrimoxazole. Antibiotic use was more common among farms using commercial feed (aOR = 6.97; 95% CI: 3.43-14.17), and among farm workers with prior antibiotic knowledge (aOR = 5.56; 95% CI: 3.01-10.25). From 1,432 E. coli isolates recovered across all sources, resistance to cotrimoxazole was high: 80% in humans, 75% in environmental specimens, and 64% in poultry. In contrast, ceftriaxone resistance remained comparatively low (7.9%, 12%, and 7.3%, respectively). Predictors of cotrimoxazole resistance included farms in Nkhotakota district (aOR = 3.26; 95% CI: 1.84-6.01), fully housed chickens (aOR = 2.60; 95% CI: 1.67-4.08), commercial feed use (aOR = 1.54; 95% CI: 1.09-2.18), and prior antibiotic use (aOR = 1.67; 95% CI: 1.19-2.35). These findings highlight the risk that commercial poultry farming systems pose to public health, particularly for cotrimoxazole, which remains a cornerstone of Human Immunodeficiency Virus (HIV) prophylaxis and community care in Malawi. Strengthening antimicrobial stewardship across both human and animal sectors is urgently needed to mitigate transmission at the human-animal-environment interface.