公共卫生研究摘要 (2026-02-03)
共收录 57 篇研究文章
1. Acquired motility of Babesia microti-infected red blood cells.
期刊: Proceedings of the National Academy of Sciences of the United States of America 发表日期: 2026-Feb-17 链接: PubMed
摘要
Babesia microti is an intraerythrocytic protozoan parasite and the main causative agent of human babesiosis in the United States. While extensive research has focused on the prevalence of this vector-borne pathogen in natural populations, increases of human cases and clinical manifestation, and pathogen structure, little is known about the movements of B. microti within vertebrate red blood cells (RBCs). RBCs are nonmotile due to their lack of cellular structures for active movement. Here, we report a phenomenon in which B. microti-infected RBCs exhibit an acquired motility compared to uninfected RBCs. Using live-cell tracking, we observed a subset (around 1% in whole blood and 10% in 1:100 diluted blood) of infected RBCs displayed active movement. This acquired motility suggests that B. microti may induce host cell modifications that facilitate its survival, dissemination, or immune evasion potential, allowing it to successfully move through the blood and infect new RBCs. Our findings highlight unconventional RBC dynamics and a potential broad aspect of B. microti pathogenesis. Further investigation into the molecular mechanisms underlying this phenomenon could provide insights into parasite-host interactions and reveal targets for therapeutic intervention in treatment and/or prevention of babesiosis.
2. For reducing premature adult mortality in India, education matters more than income.
期刊: Proceedings of the National Academy of Sciences of the United States of America 发表日期: 2026-Feb-10 链接: PubMed
摘要
Preventing premature death is a global policy objective reflected in the SDGs. While numerous studies have found socioeconomic factors to be significantly associated with premature death everywhere in the world, the debate on the relative effect of such factors on mid-age (15 to 59 ages) has not received enough attention, particularly in low-income countries, where this question is pertinent due to scant resources in the healthcare sector. Using nationally representative, longitudinal data from the India Human Development Survey, we assess the relative importance of individual- and community-level education vs. income and wealth in India, where approximately 3 million premature deaths occur annually in mid-ages. We find a clear downward gradient in mid-age mortality with increasing education within each wealth category, whereas no consistent mortality advantage with increasing wealth status is visible within education subgroups. Multilevel logistic regression models show that the decline in the risk of death across the education spectrum by far exceeds (14% for male and 13% for female) the decline moving along the wealth distribution, even after controlling for other relevant demographic, socioeconomic, regional variables. Along with the direct effect of individual-level educational attainment, we also find a protective effect of education at the community level, particularly for women. Based on these findings, we infer that educational attainment is essential for reducing mid-age mortality in India. Population and health policies in developing countries, therefore, should focus on education to prevent adult mortality.
3. Health-focused frames mobilize Americans to action to address LGBTQ inequality.
期刊: Proceedings of the National Academy of Sciences of the United States of America 发表日期: 2026-Feb-10 链接: PubMed
摘要
“More than 1 in 8 LGBTQ people live in states where doctors can refuse to treat them.” This headline describes a flurry of laws passed in 2025 allowing doctors to refuse treatment of LGBTQ patients based on personal beliefs. This and other laws like it limit healthcare access and exacerbate health inequality for LGBTQ individuals. But health is not the only domain in which LGBTQ individuals face disparities. Long-standing inequalities also exist in other domains of life, for example, gay men earn up to 32% less wages than their heterosexual peers. In the current research, we ask if exposure to LGBTQ inequality in one domain (e.g., health) motivates more support for action than exposure to inequality in other domains (e.g., economics). In six experiments (five preregistered), we test our hypothesis that emphasizing health-based LGBTQ inequality (vs. economics and belonging) spurs engagement with and support for mitigating action (S1-2). We also investigate why people support action (S1a-1b) and what boosts support (S3a-3c). As predicted and preregistered, we find greater support for action to mitigate health-based LGBTQ inequality, compared to economics and belonging. This occurs, in part, because people blame LGBTQ individuals less for health (vs. economic) disparities and perceive health inequalities to violate morally sacred values, which is associated with greater perceived injustice. Finally, we find that connecting economic inequality to health inequality in individuals’ minds can increase support for mitigating economic inequality.
4. Neuron-specific modulation of SLC30A10 identifies dopaminergic and glutamatergic neurons as targets of manganese-induced motor disease.
期刊: Proceedings of the National Academy of Sciences of the United States of America 发表日期: 2026-Feb-10 链接: PubMed
摘要
Essential metals accumulate in the basal ganglia at elevated levels and induce incurable motor disease. But, unlike other motor diseases, the neuronal targets of essential metals are unknown, and this fundamental knowledge gap has limited therapeutic progress. Because metal efflux transporters have high specificity, we hypothesized that neuron-specific knockout or knockin (i.e., overexpression) of efflux transporters may alter metal levels in targeted neurons and define the neuronal targets of metal-induced disease. To test this, we focused on manganese (Mn)-induced motor disease, which is a public health problem. We generated six neuron-specific Slc30a10 mouse strains with knockout or knockin of the Mn efflux transporter Slc30a10 in dopaminergic, GABAergic, or glutamatergic neurons. In the knockout strains, SLC30A10 was depleted and Mn levels were elevated in targeted brain regions. However, only dopaminergic- or glutamatergic-, but not GABAergic-, specific knockouts developed motor deficits without Mn exposure. Conversely, in the knockins, SLC30A10 was elevated and the increase in Mn levels after Mn exposure was attenuated in targeted regions. However, only dopaminergic- or glutamatergic-, but not GABAergic-, specific knockins were protected against Mn-induced motor deficits. Dopaminergic-specific Slc30a10 knockouts also exhibited deficits in dopaminergic neurotransmission that were consistent with their motor phenotype. Overall, 1) elevated Mn targets dopaminergic and glutamatergic neurons to induce motor disease, and 2) neuron-specific knockout/knockin of efflux transporters is an effective strategy to isolate the neuronal targets and underlying mechanisms of metal-induced neurological disease.
5. Optimizing Cervical Cancer Screening by Age at Vaccination for Human Papillomavirus: Health and Resource Implications.
期刊: Annals of internal medicine 发表日期: 2026-Feb-03 链接: PubMed
摘要
Widespread vaccination for human papillomavirus (HPV) alters the landscape of cervical cancer (CC) risk, requiring adaptations to the CC screening program. To assess the cost-effectiveness and harm-benefit tradeoffs of adapting CC screening strategies on the basis of age at HPV vaccination. Individual-based mathematical modeling study. Published data. Hypothetical cohorts of women vaccinated in 7 different age groups (12, 13 to 15, 16 to 18, 19 to 21, 22 to 24, 25 to 27, and 28 to 30 years) with either bivalent or nonavalent vaccines in Norway. Lifetime. Extended health care sector (that is, including patient time and travel costs). HPV-based screening strategies that varied screening start age, interval, and number of lifetime screening tests. Incremental cost-effectiveness ratios, defined as the additional cost per quality-adjusted life-year (QALY) gained. “Preferred” (that is, cost-effective) screening for each age group was identified using a cost-effectiveness threshold of $55 000 per QALY. Harm-benefit tradeoffs were quantified as the ratio of colposcopy referrals to CC cases averted. For all vaccination age groups and both vaccines, less frequent screening with longer intervals between screening than the 5-year interval currently recommended was consistently preferred at the threshold of $55 000 per QALY, but the preferred strategy varied by age at vaccination. For women vaccinated between ages 12 and 24 years, preferred strategies involved screening every 15 to 25 years, resulting in screening 2 to 3 times per lifetime. Less frequent screening remained a preferred strategy under imperfect screening adherence and in scenarios that excluded bivalent vaccine cross-protection. The analysis did not address screening for unvaccinated women, who may benefit from herd immunity. A high-value screening program likely involves less frequent screening for women who were vaccinated against HPV by age 30 years. Strategies could be tailored on the basis of age at vaccination and type of HPV vaccine. Norwegian Cancer Society and National Cancer Institute.
6. Adapting Cervical Cancer Screening in Vaccinated Populations: Individualized Versus Population-Based Approaches.
期刊: Annals of internal medicine 发表日期: 2026-Feb-03 链接: PubMed
摘要
7. Context Matters: Comparing the United States and Denmark in Vaccine-Preventable Disease Risk.
期刊: Annals of internal medicine 发表日期: 2026-Feb-03 链接: PubMed
摘要
8. Blockchain-Based Mobile App for Digital Identification of Older Adults in Rural Peru: Design and Usability Evaluation Study.
期刊: JMIR rehabilitation and assistive technologies 发表日期: 2026-Feb-02 链接: PubMed
摘要
Older adults in rural areas of Peru encounter many challenges in accessing critical public services, such as health care, education, and social assistance, due to low levels of digital literacy, limited access to technology, and the lack of formalized, secure ID. This inhibits entry into digital health, education, and social assistance systems and increases their risk of vulnerability and social exclusion. This study aimed to design a blockchain technology-based mobile app architecture that helps facilitate secure and inclusive digital ID for older adults in rural areas of Peru, enabling access to vital services through a decentralized, privacy-preserving solution. This study followed the design thinking process, which consists of five phases: empathize, define, ideate, prototype, and evaluate. A total of 16 adults (aged 61-85 years) were interviewed to determine the usability barriers and security and privacy concerns with mobile technology, which was used to define functional and nonfunctional requirements. These requirements were developed based on the interviews. The primary features the target population valued included blockchain authentication, assisted registration, multilingual functionality, and a user-friendly interface. The features were prioritized and prototyped using the Figma web-based app. The architecture of the app was developed using the C4 model and accounted for sequential development while ensuring scalability, modularity, and decentralization. Usability was assessed quantitatively by administering the System Usability Scale to the same 16 participants after they had interacted with the prototype. The mean System Usability Scale score was 60.78 (SD 13.68), indicating acceptable usability. The main issues identified were a lack of skills to navigate digital interfaces, concerns regarding data security, and accessibility challenges for people with disabilities. Participants provided high ratings for the assisted registration system and notifications. The modular, blockchain-based system architecture showed substantial potential for scalability and broader inclusion. The prioritization matrix identified that, for adoption, features must incorporate good design, be multilingual, and require secure authentication. The proposed blockchain-based mobile app offers a viable technical and socially inclusive model for secure digital ID of older adults in underserved contexts. Usability testing suggested that the solution was perceived as secure, usable, and appropriate for the target population. Although not fully deployed, our prototypes and system architecture provide a good starting point for future implementation. The findings in this study can contribute to efforts to facilitate digital inclusion, access to services, and respect for people’s autonomy in identity management systems for vulnerable people.
9. "Everything We Do in Life Is a Teaching Tool": The Role of Indigenous Cultural Generativity in Promoting "Aging in a Good Way" and Cultural Endurance.
期刊: Issues in mental health nursing 发表日期: 2026-Feb-02 链接: PubMed
摘要
While older adults often experience improved health and well-being from intergenerational sharing, also known as generativity, little research exists on the benefits of sharing across generations and few studies explore generativity as a component of successful aging. Given that Indigenous societies use storytelling and role modeling to pass down cultural values, beliefs, and ways of knowing, there is an urgent need to document traditional knowledge and better understand the benefits of generative practices. This study explores how Alaska Native Elders enact Indigenous cultural generativity as a tenant of successful aging and documents benefits as described by Alaska Native Elders. Data were collected over 18 years through qualitative interviews with 162 Elders from four of the five regions in Alaska. Elders engaged in generative practices such as storytelling, demonstrating skills, and modeling ways of living well. Generative practices helped Elders feel happy, gave them a sense of purpose, and supported their well-being. Overall, Indigenous cultural generativity is not solely a component of Alaska Native successful aging, but the primary pathway to achieving successful aging. Future research is needed to better understand how different forms of generativity benefit Elders and how to promote and support Indigenous cultural generativity in Alaska Native communities.
10. Gamified Physical Education and Cognitive Performance Among Chinese Secondary School Students: Cross-Sectional Moderation Mediation Study.
期刊: JMIR serious games 发表日期: 2026-Feb-02 链接: PubMed
摘要
Educators are exploring new methods to educate beyond the classroom as global concerns about students’ cognitive, emotional, and social well-being grow. Physical education (PE) has been demonstrated to boost cognitive and psychological outcomes in several studies. Most research has neglected the benefits of gamification and artificial intelligence (AI)-based feedback in PE, focusing instead on conventional PE formats. The impacts of technologically enhanced PE settings on students’ cognitive performance through feedback and reward mechanisms remain understudied. This study aimed to investigate how intrinsic motivation and AI-based feedback moderated the effects of gamified PE on students’ cognitive performance. The study used a cross-sectional design. In Beijing, Shanghai, Chengdu, and Guangzhou, a total of 1029 public high school students completed a standardized questionnaire. Students in secondary school (male: n=490, 47.6% and female: n=539, 52.4%) aged 10-18 years, were recruited from urban, suburban, and rural locales. Participants were sourced from public, private, and semigovernment schools, reflecting a range of academic achievement levels and access to technology. Students participating in standard PE sessions were included, whereas those with medical conditions that restricted physical exercise were excluded. Data were gathered via standardized questionnaires during designated PE sessions. Gamified PE, cognitive performance, intrinsic motivation, teacher support, collaboration, and AI feedback were examined using standardized instruments. Trained facilitators helped younger participants understand and follow ethical norms. The study used maximum likelihood estimation for structural equation modeling. Bootstrapping was used to analyze mediation and moderation effects at a 5% significance level (α=.05). According to structural equation modeling, gamified PE highly predicts cognitive performance (β=.34; P<.001). Other significant factors were teacher support (β=.31; P<.001), physical exercise enjoyment (β=.28; P<.001), and teamwork (β=.26; P<.001). AI-based feedback strengthened the link between gamified PE and cognitive performance under moderation analysis (β=.18; P<.001). Mediation analysis indicated that intrinsic motivation partially mediated the relationship, resulting in a significant indirect effect (β=.21, 95% CI 0.12-0.31; SE=0.05). This research integrates gamified PE with AI-based feedback mechanisms to evaluate students’ cognitive outcomes, a domain that has been rarely investigated experimentally. This study highlights the combined effect of intrinsic motivation and AI-generated feedback in a technology-enhanced PE context, in contrast to previous research that primarily focuses on traditional PE methods or isolated gamification elements. The findings enhance the field by demonstrating that student-centered, feedback-rich PE environments may improve cognitive abilities through social interaction, enjoyment, and instructor support. AI-assisted, gamified PE programs may enhance learning outcomes and academic performance among secondary school students.
11. Projected Poststroke Aphasia Prevalence by 2050: Demographic Trends, Contributing Factors, and Implications for Clinical Practice and Research.
期刊: Journal of speech, language, and hearing research : JSLHR 发表日期: 2026-Feb-02 链接: PubMed
摘要
Stroke is the leading cause of aphasia, disproportionately impacting racially and ethnically diverse populations. With the aging and diversification of the U.S. population, stroke-related aphasia prevalence is expected to rise significantly. This article estimates projected prevalence trends of poststroke aphasia through 2050, focusing explicitly on racial/ethnic differences and contributing social determinants of health (SDOH). This article synthesizes national epidemiological data on stroke prevalence, integrating population projections from the U.S. Census Bureau and public health sources to assess the expected rise in aphasia across racial and ethnic groups. A brief review of literature on SDOH, including socioeconomic status, health care access, and neighborhood factors, is included to contextualize disparities observed in projected aphasia prevalence. The findings demonstrate significant disparities in stroke and aphasia prevalence across different racial and ethnic groups. Specifically, by 2050, poststroke aphasia cases are projected to nearly double, with the Black population expected to have the highest prevalence rate among all racial and ethnic groups. These trends are driven by demographic shifts, including the aging population and racial/ethnic diversification. The findings highlight the need for targeted health care interventions that address disparities rooted in SDOH affecting stroke and aphasia care. Key priorities include expanding culturally responsive speech-language services, improving access to preventive care and poststroke rehabilitation, and supporting high-risk regions like the Stroke Belt. Integrating demographic and SDOH factors into public health planning and workforce development is essential to reduce the growing burden of stroke-related aphasia and prevent deepening health disparities. https://doi.org/10.23641/asha.31141657.
12. Changing Habits With the Happy Hands App: Qualitative Focus Group Study of a Hand Osteoarthritis Self-Management Intervention.
期刊: Journal of medical Internet research 发表日期: 2026-Feb-02 链接: PubMed
摘要
People with hand osteoarthritis represent a large patient group with limited access to recommended treatment. In recent years, there has been a notable shift in health care delivery, with increased use of digital technologies. The Happy Hands app (The University Information Technology Center [USIT]) is a digital self-management intervention developed to provide evidence-based treatment for people with hand osteoarthritis, with the goal of empowering them to self-manage their disease. Participants’ experiences and perceptions of using this digital intervention are crucial for the adoption and continued use of the Happy Hands app. The objective of this qualitative study was to explore participants’ experience with using the Happy Hands app, focusing on whether and how it empowered them to self-manage their hand osteoarthritis. The study is embedded within a randomized controlled trial (RCT). The participants were recruited from the intervention group in the RCT, who got access to the Happy Hands app. The 12-week self-management intervention included a hand exercise program and informational videos about hand osteoarthritis. Focus groups were conducted in various geographical areas in Norway. The focus groups were transcribed verbatim, coded, and analyzed inductively using reflexive thematic analysis. Seven focus groups, with a total of 26 participants, were recruited from both specialist and primary health care. The mean age was 67 years. Three themes were developed from the analysis. The first theme, “Being acknowledged,” highlights the essential role of recognition for people with hand osteoarthritis. It suggests that the Happy Hands app provided participants with a sense of validation and support. The second theme, “Changed perception of hand osteoarthritis,” indicates that participants gained insights and knowledge about their condition. This new understanding empowered them to make more informed decisions about their care, fostering a sense of hope and motivation by demonstrating that effective measures are available to manage the disease. The third theme, “Changing habits with the Happy Hands app,” describes how participants developed new habits after using the self-management intervention delivered through the app. The exercise program was experienced as motivating, flexible, well-structured, and committing. Some challenges were reported, including experiencing pain during or after exercising. The new habits included performing hand exercises and implementing ergonomic working methods, which were tailored to meet the individual needs and integrated into the participants’ daily lives and routines. The findings suggest that the Happy Hands app is a valuable tool for supporting people with hand osteoarthritis in managing their disease by helping them integrate hand osteoarthritis management into their daily lives. ClinicalTrials.gov NCT05568875; https://clinicaltrials.gov/study/NCT05568875.
13. Traditional Rehabilitation Experiences, Unmet Needs, and Perspectives on Virtual Reality-Based Rehabilitation Among Patients With Stroke in China: Qualitative Thematic Analysis and Semistructured Interview Study.
期刊: Journal of medical Internet research 发表日期: 2026-Feb-02 链接: PubMed
摘要
Traditional stroke rehabilitation is facing challenges, and virtual reality (VR)-based rehabilitation is a promising solution. However, results from studies focusing on VR-based stroke rehabilitation remain inconsistent, largely due to the use of noncustomized interventions in previous trials. To enhance rehabilitation services and inform the development of patient-centered VR rehabilitation systems, this study aimed to (1) explore the experiences and unmet needs of survivors of stroke during current hospital rehabilitation, and (2) examine their perspectives on the use of VR technology in poststroke rehabilitation. We conducted a qualitative thematic analysis based on descriptive phenomenology between January and July 2025 at the China Rehabilitation Research Center. Adult patients with a clinical diagnosis of stroke within the past 18 months were eligible. A total of 21 survivors of stroke (mean age, 52.7, SD 17.3 y; men, n=17) were included. Data were collected through face-to-face semistructured interviews, complemented by a short questionnaire on sociodemographic, clinical, and technology-use characteristics. All interviews were audio-recorded, transcribed verbatim, and analyzed using a thematic approach, with thematic saturation used to determine the sample size. After a stroke, patients experience significant physical and psychological changes. On the one hand, the sudden loss of abilities alters their perceived roles within the family and society; on the other hand, the sharp contrast between their desire for recovery and their current recovery limitations creates substantial psychological pressure. Accepting their condition and rebuilding confidence is a long-term process. Traditional rehabilitation is commonly described as burdensome, monotonous, and lacking continuity after discharge. Although patients desire a better rehabilitation approach and improved outcomes, attitudes toward VR-based rehabilitation vary. Some view VR as a convenient tool, while others express no interest or perceived need for technology-based rehabilitation. Patients indicated that serious games should be diversified to meet different individual and training needs, and should incorporate clearer feedback mechanisms, appropriate scoring systems, adjustable difficulty levels, and progressive game chapters. Functional expectations for VR systems included family involvement, access to personal rehabilitation data, telerehabilitation support, safety monitoring, and technical support. Stroke rehabilitation services in China require improvement in the appeal of rehabilitation content, patient self-management, and continuity of care. Although patients desire better rehabilitation approaches and outcomes, the effective integration of VR technology must account for factors, such as personal characteristics and preferences, as well as socioeconomic status. Unlike previous studies that primarily examined user experiences with digital technologies or compared rehabilitation outcomes, our research contributes to the literature by linking the challenges and patient needs in conventional rehabilitation with concrete directions for the future design of VR rehabilitation. These insights deepen current understanding of how VR technologies can be meaningfully integrated into stroke care and provide a roadmap for developing patient-centered and culturally responsive VR solutions.
14. Development of Therapeutic Competencies in Health Care Students: Qualitative Focus Group Study Using 360-Degree Video and Virtual Reality Technology.
期刊: JMIR medical education 发表日期: 2026-Feb-02 链接: PubMed
摘要
Therapeutic competence is a critical skill for health care professionals, encompassing communication, interaction, and guidance in vulnerable situations. Virtual reality (VR) and 360-degree video technologies have emerged as innovative tools in health care education, offering immersive and interactive learning experiences. However, there is limited research on their effectiveness in developing therapeutic competencies among health care students. This pilot study aimed to explore the feasibility, usability, and perceived educational value of a virtual learning resource using VR and 360-degree video to enhance therapeutic competence in health care students. A virtual learning resource was developed, consisting of three modules: (1) a virtual home visit, (2) observation of therapeutic conversations using a 360-degree video, and (3) practice of therapeutic conversations in a simulated environment using VR. The resource was tested with students (n=12) from occupational therapy, psychology, and dentistry programs. Data were collected through focus group interviews after the students completed the modules. Thematic analysis was conducted to identify key themes related to the educational value and learning outcomes of the resource. The analysis revealed four key themes: (1) active exploration, where students engaged deeply with the material and contextualized theoretical knowledge; (2) observation, which provided practical insights into therapeutic conversations; (3) practice and reflection, which allowed students to refine their skills and build confidence; and (4) translation of theoretical knowledge into practical skills. Students reported that the resource was engaging, immersive, and effective in promoting learning compared to traditional teaching methods. Some students found the VR experience intense but valuable for skill development. This pilot study demonstrates the feasibility and potential educational value of integrating VR and 360-degree video into health care education. The findings provide preliminary insights into the resource’s ability to enhance therapeutic competence and student engagement. Future research should focus on larger, multi-institutional studies to validate these findings and assess the resource’s impact on measurable learning outcomes.
15. The Relationship of Radiation Therapy Parameters and Perioperative Morbidity and Toxicities on Breast Reconstruction Outcomes.
期刊: Annals of plastic surgery 发表日期: 2026-Feb-02 链接: PubMed
摘要
Postmastectomy radiation therapy (PMRT) is a key component of breast cancer care, reducing locoregional recurrence in appropriately selected patients. Concurrently, use of mastectomy with implant-based breast reconstruction has expanded, heightening attention to how patient, surgical, and radiation factors interact. There is a knowledge gap in how reconstructive strategies and PMRT parameters jointly influence complications, toxicities, and treatment timing across the expander-implant continuum. The aim of this study was to determine how reconstructive and radiation therapy (RT) parameters relate to surgical-site complications, delays in PMRT initiation, acute radiation toxicities, delays in expander-to-implant exchange, and capsular contracture. This study examined a single-center retrospective cohort of women undergoing mastectomy with immediate tissue expander or direct-to-implant reconstruction and PMRT (2017-2022). Complications classified as postmastectomy pre-RT, intra-RT, and post-RT. Associations between clinical and radiation factors and complications, toxicities, and delays were estimated using generalized estimating equation logistic models. One hundred forty-six patients underwent 260 mastectomies, and 152 reconstructions received PMRT. The majority underwent dual-stage reconstruction (87.5%). Adverse surgical site outcomes occurred in approximately one-quarter of breasts before PMRT and in a similar proportion after PMRT. Neither pre-RT surgical site outcomes delayed PMRT (P = 0.61) nor did severe dermatitis delay expander-to-implant exchange (P = 0.63). Severe dermatitis was less frequent with intensity-modulated RT (P < 0.01) and proton therapy (P < 0.02) than with three-dimensional conformal RT, whereas bolus use increased the risk of dermatitis (P < 0.01). Severe capsular contracture occurred less frequently after prepectoral versus submuscular reconstruction, but the difference did not reach statistical significance (P = 0.30). In an integrated care setting where PMRT and reconstruction are performed in the same institution, pre-RT complications do not correlate with delaying PMRT, nor do post-RT complications or acute toxicities alter the implant exchange course. Complications were substantial during the pre-RT period, suggesting further opportunities for improvement. These findings emphasize the importance of multidisciplinary planning/communication to optimize patient treatment and outcomes.
16. Diminishing Returns Among Black Patients With Cancer: The Intersection of Race and Neighborhood Socioeconomic Status.
期刊: Journal of clinical oncology : official journal of the American Society of Clinical Oncology 发表日期: 2026-Feb-02 链接: PubMed
摘要
Despite narrowing racial gaps, disparities persist across cancer types and socioeconomic levels. The diminishing returns hypothesis suggests that economic advantage yields fewer health benefits for Black individuals but is largely unexplored in the context of cancer. We examined the diminishing returns among Black and White individuals across cancer types using a nationally representative study population. The study analyzed cancer-specific survival among 5.3 million non-Hispanic Black and White adults diagnosed with primary cancer (2006-2020) using SEER-22. We assessed how race and neighborhood socioeconomic status (SES) jointly affects survival across 21 cancer types. A 10-level race-SES variable was created, using White individuals in the highest-SES group as the reference. The main outcome was cancer-specific death. Diminishing returns were defined quantitively and qualitatively as worse survival for Black individuals even at higher SES. Cox models adjusted for demographics and clinical factors, with multiple imputation for missing data. Social gradients were also evaluated. Black women showed strong evidence of diminishing returns overall and for seven cancers, especially uterine and breast cancers. A social gradient was also evident in cancers with diminishing returns, except uterine cancer. For Black men, diminishing returns were not observed across all cancers combined but was present in eight cancers-including prostate and colorectal cancers. Most cancers among men exhibited a strong social gradient. Findings were consistent by time period and upon restricting to localized and regional disease in sensitivity analyses. Higher SES improves cancer survival for White patients but not Black patients, worsening racial disparities for certain cancers.
17. Addressing Gaps in the Hypertension and Diabetes Care Continuum in Rural Bangladesh Through Digital Technology Supported Decentralized Primary Care: Study Protocol and Baseline Results for a Hybrid Effectiveness-Implementation Trial.
期刊: JMIR research protocols 发表日期: 2026-Feb-02 链接: PubMed
摘要
Hypertension and diabetes are very common, interrelated chronic conditions. Awareness, diagnosis, treatment, and control rates of these conditions remain low, and access to quality care-particularly in rural areas-is a persistent challenge in many low- and middle-income countries. Strengthening primary health care, including the use of digital tools, is important to improve management of these chronic conditions. This study aims to assess the implementation and effectiveness of a multicomponent, decentralized primary care model in comparison with a digital health-only intervention and usual care in rural Bangladesh. The study applies a type 2 hybrid effectiveness-implementation design, using a 3-arm quasi-experimental approach, comprising 2 intervention arms and 1 usual care comparison arm. The study is being conducted across 3 subdistricts in the Dinajpur district, Rangpur division, northern Bangladesh. Primary outcomes include blood pressure and blood glucose control rates, assessed by population-based repeated cross-sectional surveys with independent samples, supplemented by facility-based prospective cohort data. Additionally, a mixed methods process evaluation is being conducted to capture the quantity, fidelity, adaptations, reach, and context of the interventions. The baseline community survey was conducted between January and March 2024, enrolling 6849 participants distributed across 3 arms: 2262 in usual care, 2287 in the digital-only arm, and 2300 in the multicomponent intervention arm. Participants had a mean age of 55.9 (SD 10.6) years with equal sex distribution (female: 3432/6849, 50.1%). Educational attainment was low, with 39.5% (2704/6849) of participants having no formal schooling and only 12.1% (917/6849) attaining secondary or higher education. The majority (6316/6849, 92.2%) reported being either self-employed or homemakers. The age-standardized baseline blood pressure control rate among all participants with hypertension was 10.2% overall, while the glycemic control rate among those with diabetes was 14.9%. Awareness and treatment rates for hypertension were 35.3% and 23.0%, respectively, compared to 60.7% and 34.5% for diabetes. The study findings will provide critical evidence on scalable models for decentralized noncommunicable disease care and will have important implications for improving the management of hypertension and diabetes in Bangladesh and similar low-resource settings globally.
18. Modeling Zero-Dose Children in Ethiopia: A Machine Learning Perspective on Model Performance and Predictor Variables.
期刊: JMIR pediatrics and parenting 发表日期: 2026-Feb-02 链接: PubMed
摘要
Despite progress in childhood vaccination, many children in low- and middle-income countries, including Ethiopia, remain unvaccinated, presenting a significant public health challenge. The Immunization Agenda 2030 (IA2030) seeks to halve the number of unvaccinated children by identifying at-risk populations, but effective strategies are limited. This study leverages machine learning (ML) to identify Ethiopian children aged 12-35 months who are at higher risk of being zero dose (ZD). By analyzing demographic, socioeconomic, and health care access data, the study developed predictive models using different algorithms. The findings aim to inform targeted interventions, ultimately improving vaccination coverage and health outcomes. This study aimed to develop an ML model to predict ZD children and to identify the most influential predictors of ZD in Ethiopia. We examined how well the predictive algorithms can characterize a child at risk of being ZD based on predictor variables sourced from the recent National Immunization Evaluation Survey data. We applied supervised ML algorithms with the survey datasets, which included 13,666 children aged 12-35 months. Model performance was assessed using accuracy, area under the curve, precision, recall, and F1-score. We applied Shapley Additive analysis to identify the most important predictors. The Light Gradient Boosting Machine (LGBM), Random Forest, Extreme Gradient Boosting (XGBoost), and AdaBoost classifiers effectively identified most ZD children as being at high risk. Among these, LGBM demonstrated the best performance, achieving an accuracy of 93%, an area under the curve of 97%, a precision of 94%, and a recall of 91%. The most significant features impacting the model included poor perception of vaccination benefits, lack of antenatal care utilization, distance from immunization services, and absence of maternal tetanus toxoid vaccinations. The developed ML models effectively predict children at risk of being ZD, with the LGBM model showing the best performance. This model can guide targeted interventions to reduce ZD prevalence and address vaccination inequities. Key predictors include access to immunization sites, maternal health service utilization, and perceptions of immunization benefits. By focusing on these vulnerable groups, public health efforts can tackle disparities in vaccination coverage. Enhancing maternal care, raising caregiver awareness, and improving immunization access through outreach can significantly reduce the number of ZD children.
19. Development and Validation of the Kazakhstan Version of the Questionnaire Based on the Telehealth Usability Questionnaire and Model for Assessment of Telemedicine Models for Evaluating the Usability and Effectiveness of Telemedicine Services Among Physicians: Multiphase Cross-Sectional Study.
期刊: JMIR formative research 发表日期: 2026-Feb-02 链接: PubMed
摘要
Kazakhstan has lacked validated tools to comprehensively assess physicians’ perceptions, usability, and perceived effectiveness of telemedicine services. International frameworks such as the Telehealth Usability Questionnaire (TUQ) and the Model for Assessment of Telemedicine (MAST) have not previously been adapted to the national clinical and organizational context. This study aims to develop and validate TUQ-MAST-KZ, a Kazakhstan-adapted questionnaire integrating components of the TUQ and MAST models to assess physicians’ perceptions, usability, and effectiveness of telemedicine services. A multiphase study was conducted, including literature review, questionnaire development, linguistic and cultural adaptation, expert content validity assessment, and pilot testing. An online survey (Google Forms) was administered to 156 physicians representing different regions and levels of health care delivery in Kazakhstan. Internal consistency (Cronbach α) and content validity indices were calculated. Additional evaluations covered clarity, structure, and practical applicability. The final TUQ-MAST-KZ instrument contains 27 items capturing technological, clinical, organizational, and behavioral dimensions of telemedicine use. The scale demonstrated high content validity (scale-level content validity index=0.94). Internal consistency was excellent, with an overall Cronbach α of 0.924. Respondents reported that the questionnaire was clearly structured, easy to complete, and relevant to clinical practice. Organizational items identified key barriers to telemedicine adoption, including limited infrastructure, insufficient managerial support, and the need for additional training. TUQ-MAST-KZ is a valid, reliable, and practice-oriented instrument for assessing physicians’ perceptions of telemedicine services in Kazakhstan. It can support digital health monitoring, implementation analysis, educational planning, and policy development. Future studies should evaluate its applicability across broader samples and diverse clinical specialties.
20. Age, period and cohort effects on heavy episodic drinking among adolescents in Ontario, Canada: 1999-2023.
期刊: The American journal of drug and alcohol abuse 发表日期: 2026-Feb-02 链接: PubMed
摘要
Background: Heavy episodic drinking (HED) poses significant risks during adolescence. Despite declining prevalence over years, it remains unclear whether these trends are influenced by historical changes or are independent of age and birth cohort effects.Objectives: To investigate the age-period-cohort (APC) effects on HED among adolescents in Ontario, Canada.Methods: Data drawn from the Ontario Student Drug Use and Health Survey (OSDUHS) from 1999 to 2023. OSDUHS is a repeated cross-sectional survey of students in grades 7 through 12 attending publicly funded schools in Ontario, Canada. The survey used a stratified two-stage cluster sampling method, including 103,977 adolescents (50.9% females) aged 12-18 years.Results: The observed prevalence of HED in the past 30 days declined from 27% in 1999 to 9.6% in 2023. In the pooled sample, HED increased from 2.2% at age 12-41.6% at age 18, with a notable divergence in HED rates between males and females at ages 17 and 18. APC analysis revealed that adolescents born in the early 1990s (cohort effect) were nearly twice as likely to engage in HED as those born in 2000 (RR = 1.78, 95%CI: 1.63-1.95). The strongest period effect was evident in 2000, with odds of HED higher than 2015 (RR = 1.55, 95%CI: 1.39-1.72), followed by a peak in 2018 and a decline in recent periods.Conclusions: Teen binge drinking has declined over time, with newer generations drinking less. These shifts may reflect changing social norms and lifestyle preferences. Identifying the most affected age and cohort groups can guide targeted prevention.
21. The Relational Playbook Nurse Leadership Development Program Using the Whistle Systems Employee Recognition Platform: Feasibility Mixed Methods Study.
期刊: JMIR nursing 发表日期: 2026-Feb-02 链接: PubMed
摘要
Leadership development programs in health care often fail due to their lack of adaptability to the schedules of busy clinicians. This study addressed the need for scalable, flexible programs tailored to nurse leaders. This study evaluated the acceptability, appropriateness, and feasibility of the Relational Playbook, an evidence-based leadership development program developed in the Veterans Health Administration delivered through the Whistle Systems employee recognition web application and mobile app. A 1-year, single-team pilot was deployed using descriptive survey data and qualitative interview analysis. The Relational Playbook’s educational content and interventions were hosted on the Whistle platform, which integrates behavioral science and gamification strategies. Content was delivered weekly via app-based nudge notifications and email. Engagement metrics included activity completion rates. User experience data were collected through weekly reflection surveys (with Likert-scale responses and open-text options); monthly check-ins; and a postimplementation acceptability, appropriateness, and feasibility survey and interview. Descriptive statistics summarized engagement levels and trends, and qualitative data were analyzed using content analysis to identify recurring concepts. Quantitative and qualitative data were analyzed sequentially for comprehensive insights. The section chief and 4 practicing cardiology nurse practitioners from a large academic medical center participated. The nurse practitioner section chief deemed the Whistle platform an acceptable, appropriate, and feasible technology for delivering the Relational Playbook content. They valued the weekly nudges, microlearning content, and flexibility of the web application and mobile app. The Relational Playbook content supported their personal growth and fostered positive shifts in attitudes toward work. Delivering leadership development content through the Whistle platform is an acceptable approach to support the growth and well-being of busy nurse leaders. The small sample and absence of a comparison group limit generalizability.
22. Cost of illness of scrub typhus in South India - a population-based, mixed-methods study.
期刊: PLoS neglected tropical diseases 发表日期: 2026-Feb-02 链接: PubMed
摘要
Scrub typhus is a potentially life-threatening acute febrile illness found in many parts of Asia. This study aimed to estimate the cost of illness among scrub typhus cases in Tamil Nadu, South India and explore treatment-seeking behaviour. Cases were enrolled from a population-based cohort study on scrub typhus in 32,279 individuals living in rural villages. Data on direct and indirect costs were collected using structured questionnaires from 311 scrub typhus cases of which 26 were severe. Thirteen cases with severe infections (or their relatives) underwent in-depth interviews to understand treatment-seeking pathways. The mean age of cases was 41.1 years, and 64% were female. The average monthly household income was USD 236 (Standard deviation, SD 155). The average number of workdays missed in severe infection was 18 days per episode (SD 22.2) compared to 4 days (SD 11.6) in non-severe illness. The mean overall cost of illness was USD 189 (SD 495), disaggregating to USD 1,321 (SD 1045) for severe cases and USD 86 (SD 209) for non-severe. In both severe and non-severe cases, hospital admission was common (69/311) and was associated with a cost increase of over USD 400. Costs were almost twice as high in males compared to females. Catastrophic health expenditure exceeding 25% of annual income occurred in 10% of cases. Treatment by traditional healers, untrained practitioners, pharmacies and local clinics was sought even for mild fever of short duration. In-depth interviews revealed that patients preferred to have a one-off treatment enabling them to return to daily routines with little demand for fever diagnostics. There was demand for higher level of care and diagnostic procedures only when symptoms became severe or the case was a child or a pregnant woman. Hospitalisation, common in both severe and non-severe patients, was the driving factor for high costs. Early case recognition may reduce hospitalisations and health expenditure in highly endemic settings.
23. Development and Feasibility Assessment of an Intrinsic Capacity Program in Primary Care: Protocol for an Implementation Science Approach.
期刊: JMIR research protocols 发表日期: 2026-Feb-02 链接: PubMed
摘要
The World Health Organization (WHO) public health framework for healthy aging advocates for action on the trajectories of intrinsic capacity (IC) across a person’s life course to optimize functional ability. While the WHO integrated care for older people (ICOPE) framework provides guidance on a systematic care pathway on IC screening, clinical assessment to clarify IC deficits and person-centered management, its real-world implementation and evaluation remain nascent. The Intrinsic Capacity Promotion in Primary Care for the Frail (IMPACTFrail) program for mildly frail older adults in Singapore’s primary care seeks to operationalize WHO ICOPE and national strategies. The objectives of this study are (1) the co-development of IMPACTFrail’s core functions and its delivery, as well as selecting, specifying and operationalizing implementation strategies to address anticipated barriers and leverage anticipated facilitators and (2) to conduct a feasibility assessment on the readiness to scale to a main study. For the first objective, the co-development process is guided by the United Kingdom Medical Research Council’s (MRC’s) framework for developing and evaluating complex interventions and the Framework of Actions for Intervention Development (FAID). The identification of contextual barriers and facilitators will draw on the updated Consolidated Framework for Implementation Research (CFIR) and its Outcomes Addendum. To identify individual-level behavior change barriers, we will extend this framework using the Theoretical Domains Framework (TDF). The Expert Recommendations for Implementing Change (ERIC) taxonomy guided our selection and development of implementation strategies. The collaboration involves implementation researchers, clinic leadership, frontline health care providers, and older adults. A 12-month, single-arm feasibility study will recruit 180 older adults aged 60 years and older with mild frailty (Clinical Frailty Scale score 4-5) across 5 public primary care clinics. Feasibility criteria include implementation, acceptability, practicality, and adaptability. We will narratively triangulate findings across study components to enhance the validity and credibility of the feasibility study, including (1) process evaluation using quantitative process indicators, (2) qualitative study to elicit barriers and facilitators to feasibility, sustainability and scalability, and to assess the attribution of the selected implementation strategies to implementation outcomes, (3) cost analysis, and (4) program description. The study was funded in September 2024. Data collection for the feasibility assessment commenced in April 2025 and will conclude by March 2026. As of manuscript submission, 98 participants have been recruited across 5 sites. Recruitment, data collection, and analysis are ongoing. Publication of results is expected in early 2027. This protocol contributes to the literature by providing a detailed protocol on the co-development and feasibility testing of a complex intervention to enhance transparency, fidelity, and replicability. It disseminates knowledge on the integration of frameworks and methodologies to accelerate the translation of evidence to sustainable and scalable programs in practice. ClinicalTrials.gov NCT06753643; https://clinicaltrials.gov/study/NCT06753643. DERR1-10.2196/84257.
24. Effects of an 8-Week App-Based Mindfulness Intervention on Mental Health in Working Women: Randomized Controlled Trial.
期刊: Journal of medical Internet research 发表日期: 2026-Feb-02 链接: PubMed
摘要
Although working women experience increased work-related stress, preventive interventions to reduce its negative effects on their mental health are insufficient. This study evaluated the effectiveness of an 8-week mindfulness-based self-help intervention via a smartphone app across 4 domains (general psychological, work-related, family-related, and work-to-conflict) among working women. This study recruited women workers via various media sources, such as crowdsourcing sites and social networking services. Participants were randomly assigned to the intervention (n=106) or waitlist control groups (n=107). Participants in the intervention group practiced guided mindfulness meditation every day at their convenience via an app on their cell phones for 8 weeks. The app provides an 8-week program with 4 meditation contents per 2 weeks. Participants in the waitlist control group lived as usual for 8 weeks. We conducted web-based questionnaires to assess participants’ general psychological (life satisfaction, perceived stress, depressive and anxiety symptoms, trait anger, and mindfulness), work-related (work performance, job satisfaction, quantitative job overload, and job control), family-related (family satisfaction and partner satisfaction), and work-to-family conflict indicators. An analysis of covariance, controlled for preintervention scores, revealed that the intervention significantly increased life satisfaction (b=1.47, β=0.11; P=.005) and decreased perceived stress (b=-2.00, β=-0.17; P=.01), depressive and anxiety symptoms (b=-1.24, β=-0.15; P=.02), and trait anger (reaction; b=-0.59, β=-0.11; P=.04). The intervention group demonstrated significantly increased life satisfaction (t93=-3.36; P=.001) and decreased depressive and anxiety symptoms (t93=2.35; P=.02). The app was effective in reducing perceived stress, depressive and anxiety symptoms, and trait anger (reaction), and in improving life satisfaction among working women. However, to improve work- and family-related indicators, higher-intensity interventions may be required, such as modifying the intervention content or extending its duration. University Hospital Medical Information Network Clinical Trials Registry (UMIN-CTR) UMIN000051796; https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000059110.
25. Extraintestinal Invasive Escherichia coli Infections in the US.
期刊: JAMA network open 发表日期: 2026-Feb-02 链接: PubMed
摘要
Extraintestinal invasive Escherichia coli infections are a leading cause of sepsis and hospitalization, further complicated by increasing rates of antimicrobial resistance. To describe the US epidemiology of invasive E coli infections and their clinical and molecular features. This cohort study used active laboratory- and population-based surveillance data from 9 US sites with a total population of more than 7.2 million people for invasive E coli in normally sterile body sites, collected from June to August 2023 from medical records and isolate characterization. Data were analyzed from November 2023 to February 2024. Laboratory-confirmed identification of any E coli organism isolated from a normally sterile body site obtained from a resident of the surveillance area. Outcomes of interest were population-based and site-specific incidence rate estimates of E coli infections, demographic and clinical characteristics, antimicrobial susceptibility profiles, and predicted O serotypes by in silico serotyping. Among 1345 cases of E coli infection in 1334 unique case-patients, the median (IQR) age was 68 (55-79) years, and 762 case-patients (57.1%) were female; 1223 infections (90.9%) were from blood and 122 infections (9.1%) were from other sterile sites. The overall estimated annual incidence rate was 74.7 per 100 000 population (surveillance site range, 51.4-96.0 per 100 000 population). Estimated incidence rates were higher among cases in patients aged 60 years or older compared with younger patients (225.0 vs 30.6 per 100 000 population), although rates were similar for females and males aged 60 years or older (224.5 vs 224.0 per 100 000 population). The most common underlying medical condition reported was diabetes (457 patients [34.0%]). Pyelonephritis (267 infections [19.9%]) and lower urinary tract infections (495 infections [36.8%]) were the most frequently associated infection types. In total, 1279 cases (95.1%) were hospitalized for less than 30 days after isolate collection; 106 case-patients (7.9%) died. Overall, 185 infections (13.8%) were due to extended-spectrum β-lactamase-producing E coli; 275 of 1061 isolates (25.9%) were resistant to ciprofloxacin and 370 of 1286 (28.8%) were resistant to trimethoprim-sulfamethoxazole. Of 846 sequenced isolates, the most prevalent O serotypes were O25B (137 isolates [16.2%]), O2 (93 isolates [11.0%]), and O6 (84 isolates [9.9%]). This cohort study using population-based public health surveillance data identified a substantial burden of invasive E coli disease, especially in older people, with high rates of antimicrobial resistance. These results can help inform national public health prevention efforts.
26. Concurrent therapeutic and behavioral interventions are associated with a reduced number of emerging Dracunculus medinensis worms in dogs in Chad.
期刊: PLoS neglected tropical diseases 发表日期: 2026-Feb-02 链接: PubMed
摘要
Dracunculus medinensis (Guinea worm; GW) is a parasitic nematode that causes dracunculiasis (Guinea worm disease; GWD). The annual incidence of GWD in humans has been reduced by over 99.9% globally since the 1980s thanks to the implementation of complementary interventions. Dogs are now the primary hosts of GW and impede eradication efforts. The antihelmenthic drug, flubendazole (FLBZ), was suggested as a possible therapeutic intervention after it was found to be partially effective at reducing fertility of D. medinensis in experimentally infected ferrets. A 2019 clinical trial of FLBZ in Chad found no statistically significant difference in GW infections between treated and control dogs, but longer term effects may be observed if FLBZ reduced fertility of D. medinensis. This study leveraged surveillance data from the National Guinea Worm Eradication Program of the monthly count of D. medinensis worms in dogs between January 1, 2019, and September 30, 2021, for 56 villages to examine whether FLBZ would have an observable effect over 33 months and in the presence of another intervention, proactive tethering. We fit hypothesis-informed models of the combined interventions using negative binomial generalized linear mixed models. We averaged the top models together and predicted the number of D. medinensis infections per month for an average village. Based on the model predictions, we observed a clear delineation of effects between March and August 2021, approximately one year after most villages initiated proactive tethering and approximately two years after a few villages initiated FLBZ treatment. During this period, the predicted number of dog infections were reduced by 83% (95% CI, 76% to 88%) when using FLBZ and proactive tethering concurrently, by 63% when using FLBZ alone (95% CI: 44% to 75%), and by 55% when using proactive tethering alone (95% CI: 52% to 58%) compared to baseline control methods. When used together, proactive tethering and FLBZ may be important tools in reducing the village-level D. medinensis burden in dogs.
27. Preclinical Evaluation of Synthetic Biology-Driven Engineered Escherichia coli Nissle 1917 as a Living Therapeutic for Sustained L-DOPA Delivery.
期刊: ACS synthetic biology 发表日期: 2026-Feb-02 链接: PubMed
摘要
Dopamine deficiency resulting from nigrostriatal dopaminergic neuronal damage manifests as extrapyramidal motor symptoms of Parkinson’s disease (PD). Oral tablet dosing of levodopa, administered 3-4 times a day, remains the standard of care due to its tolerability and effectiveness; however, it is prone to deleterious side effects, including off-periods and levodopa-induced dyskinesia after long-term use. Herein, using synthetic biology approaches, we developed and systematically evaluated the feasibility of a probiotic-based live-biotherapeutic system to continuously deliver L-DOPA stably, thereby relieving motor symptoms. Our data demonstrate that our engineered plasmid-based L-DOPA-expressing Escherichia coli Nissle 1917 probiotic strain (EcN2LDOPA-P3) efficiently produced up to 12,000 ng/mL L-DOPA in vitro. In mouse model systems, EcN2LDOPA-P3 readily colonized for up to 48 h, achieved steady-state plasma L-DOPA concentrations, and increased brain L-DOPA and dopamine levels by 1- to 2-fold. Lastly, EcN2LDOPA-P3 significantly diminished motor and nonmotor behavioral deficits in a mouse model of PD compared to traditional chemical L-DOPA therapy. These findings support the therapeutic feasibility of a noninvasive, orally administered bioengineered bacterial therapy for the chronic delivery of L-DOPA, which may address limitations associated with current treatment alternatives.
28. Early vascular toxicity induced by Bothrops atrox venom in the chorioallantoic membrane assay: Kinetic profile and translational insights.
期刊: PLoS neglected tropical diseases 发表日期: 2026-Feb-02 链接: PubMed
摘要
Snakebite envenoming is a neglected tropical disease with significant morbidity and mortality, particularly in areas with limited resources. Bothrops atrox is the most important snake involved in human envenomings in the Amazon. Its venom induces complex vascular damage that contributes to hemorrhage and systemic complications. This study employs the chicken chorioallantoic membrane (CAM) model to illustrate and quantify the acute vascular toxicity of B. atrox venom. Fertilized chicken eggs at embryonic day 9 were exposed to escalating doses of B. atrox venom (1, 50, and 100 µg/egg) for up to 300 seconds. Vascular alterations were assessed using macroscopic imaging, quantitative analysis with ImageJ and AngioTool, and histological examination. Venom exposure resulted in dose- and time-dependent vascular disruption, mainly vascular rupture and hemorrhage. At low doses, we observed minimal hemorrhage without any significant changes in vascular network architecture. At high doses, histopathology revealed endothelial disorganization, vessel dilation, leukocyte infiltration, and microthrombi formation, consistent with direct cytotoxic and inflammatory effects. B. atrox venom rapidly compromises vascular integrity and triggers an inflammatory response in the CAM model, reflecting key pathophysiological features of envenomation. The severity of these effects was proportional to the duration of exposure and the venom dose used. These findings support the use of CAM assay as a translational tool for screening venom-induced vascular toxicity and underscore the imperative of early antivenom administration.
29. Functional Diversity of Probiotic Effector Molecules: Insights into Their Role in Improving Gut Health.
期刊: Annual review of food science and technology 发表日期: 2026-Feb-02 链接: PubMed
摘要
Probiotics exert many effects through probiotic effector molecules (PEMs), which are secreted or surface-associated bioactive compounds. Key classes of PEMs include bacterial glycan polymers (e.g., exopolysaccharides), surface proteins and pili, secreted peptides and enzymes, extracellular vesicles, and small-molecule metabolites. These bioactive compounds mediate host-microbe crosstalk, reinforcing epithelial barrier integrity, shaping gut microbial communities, and modulating immune responses. Their production is strain-specific and influenced by environmental conditions, whereas their activities depend on receptor interactions such as with Toll-like receptors, G protein-coupled receptors, and aryl hydrocarbon receptors. Major challenges include high-throughput identification of novel PEMs, in situ verification of their gut production, and determination of effective doses. Emerging approaches, including comparative genomics, synthetic biology, and next-generation probiotics, promise to unlock PEMs’ therapeutic potential. A mechanistic understanding of PEM diversity and function will facilitate the design of targeted probiotic therapies and innovative functional foods.
30. Comparing occupational well-being between cochlear implant users and individuals with hearing loss or typical hearing.
期刊: International journal of audiology 发表日期: 2026-Feb-02 链接: PubMed
摘要
With this cross-sectional study, we aimed to assess whether cochlear implant (CI) users have different occupational well-being than individuals with hearing loss (HL) without CI (HL group) and those with typical hearing (TH). We used validated questionnaires to assess all outcomes. We included 98 CI users (mean age 51 y), 52 HL group participants (mean age 49 y) and 54 TH group participants (mean age 46 y). Capabilities, physical and psychosocial working conditions were similar overall across the three groups. However, compared to the HL group, the CI group had significantly better outcomes on a range of variables, reporting fewer psychosomatic symptoms, better health, higher acceptance of their HL, better verbal coping strategies, fewer interruptions during work, and lower perceived noise level. There were no variables indicating that CI users performed worse than their peers from the HL group. Overall, CI users show occupational well-being and capabilities comparable to those of other groups. However, CI users appear to be more advanced in their progress towards acceptance of their HL, use of verbal coping strategies, are better adjusted at work, and report better health than individuals with HL without a CI.
31. Body composition and physical activity as predictors of immune-related adverse events in patients undergoing cancer immunotherapy: a systematic review.
期刊: Expert review of anticancer therapy 发表日期: 2026-Feb-02 链接: PubMed
摘要
- Host factors may affect immune-related adverse events (irAE) during immune checkpoint inhibitor (ICI) therapy. We systematically reviewed studies on body composition (BMI, CT/DXA-defined sarcopenia, sarcopenic obesity) and physical activity (PA) in relation to irAE incidence and severity in ICI-treated adults.
- PubMed, Embase, Scopus, and Web of Science were searched from inception to 15 December 2024. Eligible studies assessed baseline body composition and/or PA in relation to irAE. Risk of bias was evaluated using the NIH tool and QUIPS. Findings were synthesized using structured narrative methods.
- Seven studies (2,590 patients) were included. Two large cohorts found overweight/obese patients had higher odds of any-grade irAE (OR = 1.4-1.5); one disease-specific cohort found no association. One CT-based study showed higher irAE risk with sarcopenia (OR = 2.64) and more with sarcopenic obesity (OR = 5.50). Two studies on PA were conflicting: one found higher PA reduced severe irAE risk (OR = 0.19), another found no association.
- Body composition and PA may help predict irAE in ICI-treated patients. Evidence is low to very low certainty: overweight/obesity may increase toxicity risk, higher PA may lower risk, and evidence for sarcopenia is limited. Standardized prospective studies are needed to confirm these associations.
- https://www.crd.york.ac.uk/PROSPERO identifier is CRD420251084119.
32. Quantifying and improving performance of a low-cost PM sensor used for occupational hygiene applications.
期刊: Annals of work exposures and health 发表日期: 2026-Feb-02 链接: PubMed
摘要
Low-cost particulate matter (PM) sensors are useful for measuring exposure to hazardous particles in the workplace but show different levels of structural under- or overestimation (ie bias) and random variation (ie error) for different types of particles. Traditional calibration methods that are based on comparing with reference measurements can improve sensor performance but require substantial quantities of reference measurements, which may be infeasible to collect when sensors are used in many different situations. This study aimed to quantify sensor performance in different occupational situations and compare methods for improving performance without requiring reference measurements. Sensor measurements with paired reference measurements for particle number (n = 253) and mass (n = 33) concentrations were collected for 6 situations, where particles were assumed to consist of primarily cinnamon, flour, quartz, spruce wood, varnish, or welding fumes. Absolute and relative bias and error were calculated for sensor-reported measurements and 4 methods to calculate mass concentrations from particle number counts. Methods included a literature-derived calibration model and 3 physics-based algorithms that included combinations of particle size, density, and shape. For particle number concentrations, the highest relative bias was observed for the smallest size bin (0.3 to 0.5 µm). PM2.5 mass concentrations were underestimated by 72% compared to reference respirable dust measurements. This underestimation was reduced to 4.5% by recalculating mass from particle number concentrations, assuming uniform particle density and shape and attributing size fractions according to the respirable dust convention. Including particle-specific density and shape showed minor additional changes in overall bias (4.4% overestimation) but halved relative bias for 4 situations. Error was comparable for sensor-reported and recalculated mass concentrations (SD ranging from 93% to 106%) but differed between situations. This study addresses challenges in sensor performance in occupational settings. It shows that recalculating mass from particle counts can reduce bias without extensive reference measurements. This practical approach enhances sensor accuracy, aiding in better monitoring and managing hazardous particle exposure, ultimately improving occupational health.
33. Estimating the causal effect of cardiometabolic conditions on socioeconomic and healthcare outcomes: a scoping review of Mendelian randomization studies.
期刊: Health economics review 发表日期: 2026-Feb-02 链接: PubMed
摘要
Cardiometabolic risk factors and conditions are the leading contributors to morbidity and mortality, yet quantifying their causal effects on socioeconomic outcomes using observational data is challenging due to endogeneity. Using genetic variants as instrumental variables, Mendelian randomization (MR) offers a unique approach to strengthen causal inference in this context and has also gained popularity in health economic literature. This study aimed to: i) map the current landscape of MR studies evaluating the impact of cardiometabolic exposures on healthcare and socioeconomic outcomes; ii) describe how core MR assumptions were tested and reported; iii) summarize how additional assumptions underlying causal interpretation were discussed. We searched MEDLINE and EMBASE for studies applying MR to examine the impact of cardiometabolic risk factors or conditions (e.g., obesity, blood pressure, cholesterol, coronary artery disease, type 2 diabetes) on socioeconomic and healthcare outcomes (e.g., education, income, occupational status, social deprivation, healthcare use and costs, health-related quality of life). Study characteristics, MR design choices, and reporting of assumption testing and causal interpretation were extracted and narratively summarized. Sixteen studies were included, covering 79 exposure-outcome pairs. Most studies examined the effects of body mass index on employment or healthcare costs. Only one study assessed home ownership, social income transfers, resource utilization, and quality-adjusted life years as outcomes, respectively. Effects of childhood cardiometabolic exposures were rarely examined beyond educational outcomes. UK Biobank was the predominant data source. None of the core MR assumptions were mentioned across all studies. While weak instrument bias was frequently tested, less than 40% of studies assessed associations between instruments and observable confounders as falsification tests. Only few studies discussed monotonicity or homogeneity assumptions. Although MR is a promising identification strategy for assessing causal effects of cardiometabolic risk on healthcare and socioeconomic outcomes, reporting practices for assumption testing and causal interpretation vary widely. This review highlights opportunities to strengthen transparency and coherence in future MR applications. With increasing data availability and clearer methodological guidance, MR could complement conventional observational approaches in supporting policy decisions.
34. Consultant Occupational Health Physicians' Consensus on fatigue risk management.
期刊: Occupational medicine (Oxford, England) 发表日期: 2026-Feb-02 链接: PubMed
摘要
35. Evaluation of a markerless motion capture to measure 3D joint kinematics during occupational lifting tasks using mobile devices.
期刊: Applied ergonomics 发表日期: 2026-Feb-01 链接: PubMed
摘要
Recent advances in human pose estimation (HPE) have enabled markerless motion capture (MoCap) techniques as a promising alternative to traditional marker-based MoCap systems. However, most HPE algorithms only provide sparse video keypoints, which are insufficient to estimate joint angles in all anatomical planes according to biomechanical guidelines. OpenCap, an open-source smartphone-based markerless MoCap platform, addresses this limitation using a deep learning model (named the marker augmenter) that predicts dense anatomical markers from sparse video keypoints. However, it has shown lower performance for activities not included in its training dataset, such as occupational lifting tasks. In this study, we adapted the original marker augmentation model of OpenCap and proposed a task-specific model for occupational lifting, trained on a large and diverse dataset of manual lifting tasks. The proposed model reduced both kinematic errors (mean RMSE = 9.45° vs. 15.04°) and error variability (SD = 7.26° vs. 16.13°) compared to the original model. These findings suggest that OpenCap can be adapted for occupational lifting tasks, offering a low-cost, easy-to-use, and field-viable solution to collect 3D lifting kinematics for ergonomics applications.
36. Multi-season analysis reveals hundreds of drought-responsive genes in sorghum.
期刊: The Plant journal : for cell and molecular biology 发表日期: 2026-Feb 链接: PubMed
摘要
Persistent drought affects global crop production and is becoming more severe in many parts of the world in recent decades. Deciphering how plants respond to drought will facilitate the development of flexible mitigation strategies. Sorghum bicolor L. Moench (sorghum), a major cereal crop and an emerging bioenergy crop, exhibits remarkable resilience to drought. To better understand the molecular traits that underlie sorghum’s remarkable drought tolerance, we undertook a large-scale sorghum gene expression profiling effort, totaling nearly 1500 transcriptome profiles, across a 3-year field study with replicated plots in California’s Central Valley. This study included time-resolved gene expression data from roots and leaves of two sorghum genotypes, BTx642 and RTx430, with different pre-flowering and post-flowering drought-tolerance adaptations under control and drought conditions. Quantification of genotype-specific drought tolerance effects was enabled by de novo sequencing, assembly, and annotation of both BTx642 and RTx430 genomes. These reference-quality genomes were used to construct a pangene set for characterizing conserved and genotype-specific expression. By integrating time-resolved transcriptomic responses to drought in the field across three consecutive years, we identified a set of 726 drought-responsive genes that responded similarly in all 3 years of our field study. Functional enrichment analysis identified abiotic stress, secondary cell wall-related processes and metabolism as particularly affected under both types of drought stress. We also found that some glyoxylate cycle pathway genes, including malate synthase and isocitrate lyase, are differentially regulated particularly during post-flowering drought stress, implicating this pathway as potentially important for drought responsiveness. This expansive dataset represents a unique resource for sorghum and drought research communities and provides a methodological framework for the integration of multi-faceted time-resolved transcriptomic datasets.
37. Staffing Conditions In US Nursing Homes Before, During, And After The COVID-19 Pandemic.
期刊: Health affairs (Project Hope) 发表日期: 2026-Feb 链接: PubMed
摘要
The COVID-19 pandemic exacerbated long-standing challenges in US nursing homes around staffing conditions, with nearly one in five nursing homes reporting severe staffing shortages during the early months of the pandemic in 2020. However, less is known about how nursing home staffing has evolved since the early part of the pandemic. This study used Payroll-Based Journal daily staffing data from the second quarter of 2018 through the fourth quarter of 2024 and other administrative data to examine trends in nursing home staffing levels and turnover before, during, and after the COVID-19 pandemic. Since the start of the pandemic, staffing hours per resident day decreased for all nurse types, especially in nursing homes associated with private equity funds or real estate investment trusts, during the late pandemic and postpandemic periods. Staff turnover decreased slightly during the pandemic and postpandemic periods for all nurse types. Policy makers should consider additional measures to ensure appropriate nursing home staffing levels going forward.
38. Changes In Medical Debt And Bankruptcy After Acute Traumatic Injuries, 2019-21.
期刊: Health affairs (Project Hope) 发表日期: 2026-Feb 链接: PubMed
摘要
Despite expanded insurance coverage after the Affordable Care Act, medical debt remains a significant burden for millions of Americans, particularly after acute medical events such as traumatic injuries. We evaluated the financial impact of hospitalization for acute traumatic injury, using data from a statewide trauma registry linked to consumer credit reports from the period 2019-21. Using a stacked difference-in-differences event study design, we compared financial outcomes for 12,823 injured patients versus 25,195 not-yet-injured matched controls. At eighteen months post-injury, the proportion of patients with medical debt in collections increased by 5.2 percentage points (a 24 percent relative increase compared with the pre-injury baseline), and the mean medical debt in collections (including patients with no debt) rose by $290 (a 76 percent relative increase). Post-injury changes in bankruptcy filings peaked at 3.2 per 1,000 patients (a 6 percent relative increase) at fifteen months post-injury. Financial hardship disproportionately affected uninsured, younger, lower-income, and privately insured patients, whereas those with Medicare and Medicaid experienced minimal change. These findings highlight persistent financial vulnerabilities, even among privately insured patients, and they underscore the need for policy enhancements that strengthen protections against the financial consequences of unanticipated acute medical events.
39. 'Ghost' Physicians: More Than One-Quarter Of Physicians Enrolled In Medicaid Delivered No Care To Beneficiaries In 2021.
期刊: Health affairs (Project Hope) 发表日期: 2026-Feb 链接: PubMed
摘要
Concerns about low physician participation in Medicaid have long motivated policy reforms, but the extent to which enrolled physicians actually care for Medicaid patients remains unclear. To assess patterns of Medicaid participation among physicians, we linked physician enrollment files to Medicaid administrative claims from the period 2019-21, focusing on five physician specialties: cardiology, dermatology, ophthalmology, primary care, and psychiatry. We examined the proportion of Medicaid-enrolled physicians with any claims activity and the volume of unique Medicaid patients and encounters per physician. We found that although 68-89 percent of physicians were enrolled in Medicaid, nearly 28 percent delivered no care to Medicaid beneficiaries in 2021. Participation in Medicaid varied widely by specialty: More than 40 percent of psychiatrists were “ghost” physicians who saw no Medicaid enrollees in a given year, whereas primary care physicians were most likely to be high-volume “core” participants. Although most physicians maintained stable participation over time, approximately one-fifth of ghost providers and one-third of “peripheral” providers (those seeing 1-10 Medicaid enrollees per year) transitioned to a higher-engagement group between 2020 and 2021. Taken together, our findings demonstrate that given relatively limited and variable Medicaid participation, targeted policy efforts-particularly in specialties such as psychiatry-may help strengthen physician engagement and reduce access gaps.
40. Fluctuating State Medicaid Dental Coverage: Asymmetric Impact Of Benefit Cuts And Expansions, 2010-21.
期刊: Health affairs (Project Hope) 发表日期: 2026-Feb 链接: PubMed
摘要
Medicaid adult dental coverage is an optional benefit that states often add or remove in response to budgetary pressures. The effect of these fluctuations on access to dental services is unclear. Using 2010-21 Health and Retirement Study data and a dynamic difference-in-differences event study, we examined the effects of removing versus adding Medicaid adult dental benefits among adults ages 50-64 with income up to 100 percent of the federal poverty level. Eliminating benefits was associated with increased dental uninsurance (60.1 percentage points) and any out-of-pocket spending in the past two years (20.2 percentage points), as well as decreased dental visits in the past two years (-37.4 percentage points) and edentulism (complete loss of all natural teeth; -13.4 percentage points). Expanding benefits was associated with decreased dental uninsurance (-40.7 percentage points) and any out-of-pocket spending (-36.5 percentage points), as well as increased dental visits (22.1 percentage points) and edentulism (16.9 percentage points). Both changes were associated with increased unawareness of dental coverage (11.7 and 33.0 percentage points, respectively). Several effects persisted up to eight years, indicating that Medicaid dental policy shifts have lasting implications. These findings underscore the importance of stable Medicaid dental coverage, particularly as Congress and states weigh large-scale Medicaid cuts.
41. SARS-CoV-2T-cell vaccine VB10.2210 induces broad T-cell responses in a phase 1/2 open-label clinical trial.
期刊: Vaccine 发表日期: 2026-Feb-01 链接: PubMed
摘要
The repeated emergence of highly transmissive SARS-CoV-2 variants requires a broadly protective vaccine. We developed a T-cell vaccine VB10.2210 that targets SARS-CoV-2 viral antigens to antigen presenting cells comprising 96 validated immunogenic T-cell epitopes covering a global HLA diversity. We report results from a first in human open-label dose-escalation phase 1/2 clinical trial evaluating safety, reactogenicity and immunogenicity of VB10.2210. The study investigated three dose levels (0.3, 1.0 and 3.0 mg), delivered intramuscularly as DNA plasmid by jet injection (NCT05069623), in 34 healthy adults previously vaccinated with mRNA SARS-CoV-2 vaccines. The safety profile was favorable with no observed dose-limiting toxicity. The 3 mg dose elicited the most potent immune response with enhanced breadth and a CD8+ dominated T cell response. T cell responses towards spike protein and de novo responses to non-spike antigens were confirmed by ELISpot. Expansion of VB10.2210 specific T-cell clones was confirmed by TCR sequencing. Further studies are needed to evaluate the clinical benefit of DNA vaccines inducing broad virus specific T-cell immunity in preventing severe COVID-19 or as treatment of patients with persistent infection.
42. Direct comparison of three herpes simplex virus-2 vaccine candidates using peripheral or mucosal routes of vaccination.
期刊: Vaccine 发表日期: 2026-Feb-01 链接: PubMed
摘要
Despite decades of research, no vaccine has been approved for herpes simplex virus-2 (HSV-2). While HSV-2 subunit vaccines have been more extensively studied, various HSV-2 mutants have also been tested. We compared three types of HSV-2 mutant viruses (replication-defective, single-cycle replication, and replication-competent) using five routes of vaccination (intramuscular, subcutaneous at two different sites, intrarectal, or intravaginal) for their ability to protect mice from intravaginal challenge with HSV-2. The replication-competent virus vaccine gave the best protection compared to the other vaccines after intravaginal vaccination of mice resulting in complete prevention of disease, and 90 % of the animals had no detectable shedding after challenge despite very low serum neutralizing titers. The replication-competent virus vaccine was also superior to the other vaccines when given intrarectally, although less effective than when given intravaginally. In contrast, when given subcutaneously in the scruff of the neck, the replication-defective vaccine was more effective than the replication-competent vaccine and the replication-defective vaccine tended to be more effective than the live vaccine when given intramuscularly. The highest levels of serum neutralizing antibody were observed with the replication-defective and single-cycle replication vaccines given intramuscularly. Thus, excellent protection from genital herpes was obtained after intravaginal vaccination with the replication-competent vaccine providing evidence that a replication-competent vaccine given by the natural route of HSV-2 infection is superior to replication-defective or single-cycle replication vaccines to reduce virus infection and spread in the genital mucosa.
43. Comparison of central FLAIR hypointensity and central vein sign on FLAIR* in a diagnostic cohort.
期刊: European journal of radiology 发表日期: 2026-Jan-29 链接: PubMed
摘要
The central vein sign (CVS) is a neuroimaging biomarker in multiple sclerosis (MS) with high diagnostic specificity. CVS is best detected with high-quality susceptibility-sensitive MRI sequences. For concurrent detection of lesions and veins, FLAIR* was developed as a post-processing method to provide contrast for T2 hyperintense lesions (FLAIR) and paramagnetic hypointense veins (T2-weighted). Occasionally, CVS-like features have been noted on FLAIR, but the reliability of this finding is unknown. To compare the central FLAIR hypointensity to FLAIR CVS. Scans from the CentrAl Vein Sign in MS (CAVS-MS) pilot study were included for the analysis. A blinded rater assessed all lesions for CVS on 3-tesla post-contrast FLAIR. A second blinded rater assessed the same lesions for central hypointensity on FLAIR images alone. Counts were compared between methods. The same approach was applied for a subset with available non-contrast FLAIR lesion ratings. With post-contrast FLAIR* CVS as the standard (n= 92; 1737 lesions), central FLAIR hypointensity demonstrated concordance of 64%, with sensitivity of 34% (95% CI, 30-37%) and specificity of 83% (95% CI, 81-85%). With non-contrast FLAIR* CVS as the standard (n= 38; 768 lesions), FLAIR demonstrated sensitivity of 40% (95% CI, 33-47%) and specificity of 85% (95% CI, 82-88%). Select 6 (≥6 central hypointense lesions) FLAIR was 59% accurate for a diagnosis of MS, with a lower specificity (63% vs. 90%, p= 0.008) in comparison to post-contrast FLAIR*. Assessment of CVS on FLAIR alone is unreliable and requires susceptibility-sensitive sequences to be clinically useful.
44. "On-off-on" fluorescent probe based on g-C3N4 quantum dots for sequential detection of Ag+ and glutathione.
期刊: Spectrochimica acta. Part A, Molecular and biomolecular spectroscopy 发表日期: 2026-Jan-26 链接: PubMed
摘要
This study reports the successful synthesis of graphitic carbon nitride quantum dots (g-C3N4 QDs) that demonstrate remarkable fluorescence properties and excellent dispersion through a hydrothermal method. Leveraging the specific fluorescence quenching effect of Ag+ on g-C3N4 QDs together with the strong chelating affinity of glutathione (GSH) for Ag+, a novel “on-off-on” fluorescence sensing platform was developed to enable sequential and highly sensitive detection of both Ag+ and GSH. This probe exhibited outstanding sensitivity, anti-interference ability, and selectivity with detection limits of 0.0114 μM for Ag+ and 0.3916 μM for GSH. Mechanistic studies revealed that the fluorescence “off” state was mainly governed by a photoinduced electron-transfer (PET) effect, with additional contributions from the internal filtering effect (IFE). Conversely, the fluorescence “on” state was restored when GSH coordinated with Ag+, thereby blocking the PET pathway and recovering the intrinsic fluorescence of g-C₃N₄ QDs. Furthermore, spiked-recovery experiments in real water and serum samples yielded satisfactory results, demonstrating the sensor’s strong practical applicability and providing a reliable analytical approach for environmental monitoring and biomedical analysis.
45. SIRT1 Facilitates Beclin-1 Nuclear Translocation to Mitigate Nociceptive Hypersensitivity in Rats with Bone Cancer Pain by Restoring Autophagic Flux.
期刊: Pain physician 发表日期: 2026-Jan 链接: PubMed
摘要
The etiology of bone cancer pain (BCP) is multifaceted, and effective therapeutic strategies for treating the condition remain elusive. Prior research has implicated sirtuin 1 (SIRT1) in the pathogenesis of BCP, suggesting the protein’s potential to modulate autophagy and mitigate nociceptive sensitization; however, the underlying mechanisms of BCP are not fully understood. This study aimed to elucidate the role of SIRT1 in activating autophagy and its impact on the development of nociceptive hypersensitivity in a rat model of BCP. Controlled animal study. Female Sprague Dawley® rats weighing 180-220 g were used. The BCP model was established by a single injection of Walker 256 breast cancer cells (10 µL, 107cells/mL) into the tibia. Mechanical pain sensitivity was assessed behaviorally using an Electronic von Frey Anesthesiometer. Western blot (WB) analysis revealed reduced SIRT1 levels and elevated beclin-1 expression, an increased LC3II/LC3I ratio, and enhanced P62 expression in the dorsal horns of spinal cord tissues from rats with BCP. Immunofluorescence assays demonstrated co-localization of SIRT1 with neuronal cells and beclin-1. Subsequent experiments indicated that intrathecal administration of a SIRT1 agonist in rats with BCP postponed the downregulation of SIRT1, decreased the acetylation of beclin-1, and facilitated beclin-1 nuclear translocation. This treatment also led to a reduction in the LC3II/LC3I ratio and P62 expression levels. Collectively, these findings suggest that SIRT1 may ameliorate nociceptive hypersensitivity in rats with BCP through the promotion of beclin-1 nuclear translocation, thereby restoring autophagic flux. This study focused on peripheral/spinal mechanisms but not supraspinal/cortical contributions. Pharmacological tests were limited to a single time point, potentially missing dynamic pain changes during tumor progression. Nevertheless, the findings of this study offer valuable preliminary insights. This research uncovers a novel mechanism of SIRT1 in the genesis of nociceptive hypersensitivity in BCP and offers potential avenues for therapeutic intervention.
46. Applying human-centered design to adapt a multifaceted implementation strategy for integrating HIV and NCD services in Lusaka, Zambia: Healthcare worker perspectives.
期刊: PLOS global public health 发表日期: 2026 链接: PubMed
摘要
There has been limited research reporting approaches used in the adaptation of implementation strategies for integrating HIV and NCD services that involve healthcare providers in low- and middle-income country (LMIC) settings. This paper describes how human-centered design (HCD) was used to 1) adapt a multifaceted implementation strategy for integrating HIV and NCD services through end-user engagement and 2) share insights from the specific suggestions made through the HCD process with healthcare providers. As part of the TASKPEN an implementation science-driven intervention aimed at task shifting and integrating the evidence-based WHO Package of Essential NCDs Interventions (WHO-PEN) approach into routine healthcare settings for PLHIV, we co-designed implementation strategy components (i.e., “sub-components”) to strengthen HIV/NCD integration in four HIV clinics in Lusaka, Zambia. The HCD process involved qualitative approaches with healthcare providers, namely lay and non-physician healthcare workers (NPHWs) such as nurses and community healthcare workers (CHWs). A four-phased approach of exploration through formative qualitative work, ideation with intervention deliverers, analysis, and refinement was used to develop strategy sub-components. Rapid thematic data analysis was used to synthesise the data. Applying HCD to a locally-informed intervention for screening and managing cardio-metabolic co-morbidities for Zambian PLHIV informed the addition of sub-components to the multi-faceted implementation strategy to improve adoption, appropriateness, and feasibility. Through co-design workshops, healthcare providers suggested specific sub-components be added to enhance the intervention. Specifically, four sub-component strategy ideas were produced: introducing NCD/HIV champions, circulating a weekly facility NCD medication bulletin, dashboard reporting of HIV/NCD cases, and community sensitization. The use of HCD in implementation science is a promising approach to refining implementation strategies that are likely to result in the success of HIV/NCD integration in Zambia and similar LMIC settings.
47. Community voices: Exploring beliefs, attitudes, practices and recommendations for improving stroke prevention and stroke care in rural and urban communities in Nigeria.
期刊: PloS one 发表日期: 2026 链接: PubMed
摘要
Globally, stroke is a leading cause of mortality with higher incidence in low- and middle-income countries. However, stroke beliefs and knowledge among community partners are essential considerations for tailoring of interventions in West Africa. To describe differences in beliefs, attitudes, and practices related to stroke risks, prevention, and care delivery from alternative/complementary providers/healers, orthodox/modern medicine/health care providers, community members and leaders in Nigeria. Six focus groups with community members and leaders (n = 57) and key informant interviews with health providers (n = 24) from alternative/complementary and orthodox/modern medicine providers were conducted to qualitatively explore beliefs, attitudes, practices, and recommendations related to stroke in urban (Ibadan) and rural (Ibarapa) communities in Nigeria. The Socio-Ecological Model guided selection of participants, and the Health Belief Model guided the development of questions for participants. Participants perceived stroke as disabling, though manageable, and having higher odds of repeat stroke for survivors. High blood pressure, stress, sleep issues, heredity, and lifestyle factors were some stroke risk factors perceived by participants from both sites although God, witchcraft/evil people were reported by rural participants. Hospital visits and consumption of herbal concoction, self-medication and visit to church for prayers were some actions taken to manage stroke by both urban and rural participants. Low literacy levels, limited funds, fear of and distance to hospitals, and absence of insurance were some barriers to uptake of recommendations from orthodox medicine practitioners which are drivers to unorthodox practitioners. To improve stroke care and prevention across communities, free risk factor screening, indigenous stroke awareness programs via print, audio-visual and electronic media were suggested by all participants. Diverse beliefs and practices are related to stroke risk factors, prevention and care and barriers with obtaining care. There is need to work across systems to improve stroke prevention and care in communities.
48. Psychosocial and occupational predictors of health among Spanish University Employees: The role of job type, contract status, and seniority.
期刊: PloS one 发表日期: 2026 链接: PubMed
摘要
The digital transformation of work environments, particularly in academia, has introduced new psychosocial risks, including technostress. This cross-sectional study analyses the relationship between technostress and general health among university employees at the University of Zaragoza, examining the moderating effects of job type, contract status, and seniority. A total of 458 staff members, including academic and research staff and administrative and service staff, completed an online survey assessing general health, technostress, perceived stress, burnout, job satisfaction, resilience, social support, and other occupational variables. The results revealed that perceived stress was the most consistent predictor of emotional symptomatology across all subgroups. Technostress also emerged as a significant predictor, especially among permanent employees and those with longer tenure. Conversely, resilience and job satisfaction functioned as protective factors. Differences in health outcomes were observed depending on employment conditions, highlighting the importance of organizational context. These findings underscore the need for tailored interventions to mitigate psychosocial risks associated with information and communication technologies use and to enhance well-being in academic institutions. This study contributes to the growing evidence base on the health implications of digital work environments in the higher education sector.
49. Differences and commonalities in barriers and facilitators experienced by participants enrolled in an online behavioral weight management program: A qualitative comparison.
期刊: PloS one 发表日期: 2026 链接: PubMed
摘要
Online behavioral weight management programs offer a scalable solution to address overweight and obesity but often face high dropout rates and variable success. Understanding the barriers and facilitators experienced by participants who achieve weight loss targets versus those who do not is critical for optimizing programs. This study compared the barriers and facilitators reported by participants achieving ≥5% weight loss with those achieving <5%, using a social-ecological framework to capture influences across individual, interpersonal, and environmental levels. The framework was chosen to reflect the complex, interacting factors beyond the individual that shape behavior. Forty-eight participants completed semi-structured telephone interviews exploring factors affecting their weight loss journey. Interviews were analyzed using a thematic framework approach. Across both groups, key facilitators included willpower, knowledge, social support, and perceived safety in the local environment, with their absence acting as barriers. Food availability at home and in the workplace was also reported as a barrier due to temptation. Social roles could challenge behavior change, though perceiving themselves as role models provided motivation. Program-specific factors, such as group dynamics and difficulty using the platform, were barriers for both groups. Notable differences emerged between groups in responding to challenges. The ≥ 5% weight loss group proactively addressed stressors and sought solutions, while the < 5% weight loss group reported greater difficulty overcoming barriers, more interpersonal stressors, and dissatisfaction with their weight targets. This is the first study to compare qualitative experiences across social-ecological domains between participants achieving ≥5% and <5% weight loss during program participation. Findings highlight the need to address environmental infrastructure, interpersonal skills, and communication of weight targets to improve program effectiveness. Future research should examine how these factors can identify individuals at risk of not achieving 5% weight loss and inform tailored interventions.
50. Systematic analysis of proton pump inhibitors-related adverse reactions using the FDA adverse event reporting system database.
期刊: PloS one 发表日期: 2026 链接: PubMed
摘要
Proton pump inhibitors (PPIs), known for their potent acid-suppressing effects, are widely used in various clinical settings, including treatment and prevention. Understanding their adverse effects is crucial. This study, utilizing the FDA Adverse Event Reporting System (FAERS) database, comprehensively analyzes PPI-related adverse events to guide clinical medication practices. This study analyzed suspected adverse drug reactions (ADRs) related to specific PPI drugs using data from the FAERS database, covering Q1 2004 to Q4 2024. Multiple statistical methods, including ROR, PRR, IC025, and EBGM, were employed for evaluation, with ADRs defined according to System Organ Class (SOC) and Preferred Term (PT). A comparative analysis was conducted to assess potential differences in ADR profiles among different PPI drugs. This study analyzed 176,680 cases of PPI-related adverse events, with a total of 632,468 adverse reaction reports recorded when PPIs were designated as the primary suspected drug (PS). PPIs showed significantly elevated risks in the renal/urinary and gastrointestinal systems, with other common adverse reactions including hypomagnesemia, hypocalcemia, and renal anemia. Most adverse reactions occurred either within the first 0-30 days of use or after prolonged exposure (>6 months), and elderly patients (≥65 years) were disproportionately affected. For high-risk populations using PPIs long-term (such as elderly patients or those with pre-existing renal impairment), continuous monitoring is essential to mitigate potential complications. Unnecessary use should be strictly avoided, and long-term medication should be minimized to ensure safety and appropriateness.
51. Modeling HBV transmission dynamics in Indonesia (2024-2030) using a SIVRM model: Evaluating optimal control strategies for elimination by 2030.
期刊: PloS one 发表日期: 2026 链接: PubMed
摘要
Hepatitis B remains a global health concern. Achieving the World Health Organization’s (WHO) goal of eliminating the disease by 2030 requires a comprehensive understanding of its transmission dynamics. This study aimed to develop and apply an extended SIVRM (Susceptible-Infected-Vaccinated-Recovered-Mortality) model to simulate hepatitis B transmission in Indonesia and to evaluate optimal vaccination strategies. The model comprises 14 compartments that distinguish between vertical and horizontal transmission, account for vaccination and loss of immunity, and incorporate hepatitis B virus (HBV) reactivation among recovered individuals, a novel feature of this model. Parameters were estimated using data from the Social Security Administrator for Health (BPJS Kesehatan) from 2019 to 2023 through a least-squares fitting approach. The basic reproduction number ([Formula: see text]) and disease-free equilibrium (DFE) were analytically derived. Simulations were conducted using MATLAB 2018 to project hepatitis B trends from 2024 to 2030 and to evaluate scenarios of adult and newborn vaccination coverage. A key finding from the parameter estimation was an HBV reactivation rate of 0.30, indicating that 30% of recovered individuals remain at risk. The model estimated a baseline [Formula: see text] of 4.39, indicating that current control strategies in Indonesia are insufficient to achieve the WHO elimination goal. However, scenario-based analysis revealed that increasing adult vaccination coverage to at least 59%, while maintaining newborn vaccination at 70%, could reduce [Formula: see text] to 0.90 and substantially lower the disease burden. These findings underscore the urgent need to expand adult vaccination programs and strengthen post-recovery monitoring to advance hepatitis B elimination in Indonesia.
52. Viral zoonoses assessment in invasive rodent species from São Tomé and Príncipe.
期刊: PloS one 发表日期: 2026 链接: PubMed
摘要
Zoonoses are diseases transmitted from animals to humans, highlighting the inseparable link between animal and human health. They are responsible for approximately 2.4 billion cases of illness and 2.2 million deaths annually, posing a significant challenge to public health and food security. Transmission of infectious agents from animals to humans occurs through direct contact, ingestion, inhalation, or inoculation of the infectious agent. Finding practical ways to monitor the presence and/or abundance of zoonotic pathogens is important to estimate the risk of spillover to humans. Since rodents are present almost everywhere, live in proximity with humans and host several zoonotic viruses, we conducted a screening in different tissue samples of black rats (Rattus rattus) and brown rats (Rattus norvegicus) collected in São Tomé and Príncipe in 2021 and 2022 for the presence of five zoonotic families of viruses, including Arenaviridae, Coronaviridae, Flaviviridae, Hantaviridae, and Poxviridae. Although we found no evidence of the presence of these viral taxa among the rodent samples tested, our study does not exclude their presence in São Tomé and Príncipe. Continued monitoring of these and other zoonotic viruses is advisable to prevent or mitigate the emergence of viral diseases that are often fatal to humans.
53. In-silico identification of anti-cholera phytochemicals from Indian medicinal plants.
期刊: PloS one 发表日期: 2026 链接: PubMed
摘要
Cholera is a severe diarrheal disease caused by ingestion of food or water contaminated with pathogenic Vibrio cholerae. Treatment for cholera includes rehydration therapy and antibiotics to avert death and reduce bacterial burden to prevent rapid transmission of the disease. In addition, in Indian subcontinent, there is historical evidence of using plants for treating cholera. This study was designed to investigate the cholera toxin-inhibitory properties of phytochemicals sourced from Indian medicinal plants. For this, three reported genotypes of cholera toxin subunit B (ctxB) associated with 7PET V. cholerae O1 El Tor strains were used as targets in molecular docking. Analysis results showed strong binding affinities (≤-7.5 kcal/mol) for 298 out of 7,607 phytochemicals, with minor variations for the ctxB genotype-specific targets. Multiple phytochemicals from the same plants were identified with high binding affinities, e.g., 101 from Morus alba, 24 from Citrus aurantium, 17 from Emblica officinalis, and 16 from Capsicum annuum. However, further analyses, including drug-likeness, pharmacokinetics, and toxicity, identified five promising phytochemical candidates, namely, Abyssinone V (Azadirachta indica), Diosgenin (Achyranthes bidentata), Yamogenin (Borassus flabellifer), and two other unnamed phytochemicals (one from Azadirachta indica and one from Morus alba) for cholera toxin inhibition. Molecular dynamics simulation using YASARA and GROMACS showed structural stability of the ctxB-phytochemical complexes, while exhibiting adaptive rearrangements of ligand within the active binding sites of the proteins. In the simulations, MM-PBSA binding free energies showed a favorable total binding energy for the complexes. Per-residue energy decomposition analysis identified different highly contributing sets of amino acids to the binding energy with variation for both ctxB genotypes and phytochemicals, suggesting bacterial evolutionary changes may affect binding patterns of the drug candidates. This study suggests five inhibitors of cholera toxin with varying genotypes, which may have potential as an alternative medication for cholera.
54. Geochemical signatures in plastic debris from the Curonian Lagoon, Lithuania.
期刊: PloS one 发表日期: 2026 链接: PubMed
摘要
This study examined elemental accumulation on weathered plastic waste as a contributor to environmental pollution. Twenty-five plastic samples collected near the Curonian Lagoon in Lithuania were analyzed for 32 elements using inductively coupled plasma-mass spectrometer (ICP-MS). Five common polymers (polyethylene, polypropylene, Polyethersulfone, polyester, and polyethylene terephthalate) were identified, with polyethylene exhibiting the highest elemental uptake, followed by polypropylene and polystyrene. Correlation analysis suggested relationships between elemental uptake and geochemical behavior, with alkali and alkaline earth elements (REEs) potentially enhancing the uptake of intermediate ions. However, elements such as sulfur, lead, cadmium, and antimony showed limited correlation with other elements. Despite their low mobility, REEs were used to infer sources of pollution, and the aluminum to lanthanum ratio was proposed as a potential indicator of possible anthropogenic pollution from industrial, petroleum, and vehicle emissions.
55. Insecticidal potential of Areca catechu nut extract against multiple life stages of Aedes aegypti and Aedes albopictus.
期刊: PloS one 发表日期: 2026 链接: PubMed
摘要
This study investigates the insecticidal efficacy of Areca catechu nut extract against Aedes aegypti and Aedes albopictus, in response to increasing insecticide resistance, declining effectiveness of conventional agents, and environmental safety concerns. The primary objectives were to evaluate the adulticidal, ovicidal, and oviposition deterrent activities of methanolic A. catechu nut extract across a concentration range of 300-2000 ppm, and to identify its major bioactive constituents. Laboratory bioassays were conducted following World Health Organization protocols. The extract induced dose-dependent adult mortality, with LC50 values of 767.501 ppm for Ae. aegypti and 758.278 ppm for Ae. albopictus. Ovicidal assays showed progressive increases in egg mortality, reaching 100% at 1600 ppm for Ae. aegypti and 1400 ppm for Ae. albopictus. In oviposition deterrent tests, complete inhibition of egg-laying occurred at concentrations of 900 ppm and above under both dual-choice and non-choice conditions. Observational data confirmed strong repellence, as gravid females avoided treated substrates even in the absence of alternatives. Liquid chromatography-mass spectrometry analysis identified arecoline, arecaidine, and N-lauryldiethanolamine as key constituents with known inhibitory effects on neural and detoxification enzymes in insects. This research provides a comprehensive assessment of A. catechu nut extract across multiple mosquito life stages and behavioural endpoints, demonstrating its broad-spectrum efficacy. The results support its potential as a sustainable, plant-derived bioinsecticide for integrated vector control programs targeting Aedes mosquitoes and associated disease transmission.
56. Making community-based health planning and services work: Staffing, accountability and digital integration for quality primary health care in Northern Ghana.
期刊: PloS one 发表日期: 2026 链接: PubMed
摘要
Strengthening primary health care through Ghana’s Community-based Health Planning and Services (CHPS) strategy depends on functional community structures, responsiveness, and integration into health information systems. However, the extent to which CHPS zones use the Ghana Community Scorecard (CSC) to promote accountability, equity, and service improvement remains unclear. We assessed CHPS staff categories and functionality in Northern region of Ghana and their ability to support Community Health Management Committees (CHMCs) in health facility assessments, Community Health Action Plans, and updating of results into existing digital platforms. A cross-sectional design combined quantitative surveys and qualitative interviews across 86 CHPS zones in six districts between March 13-20, 2024. Analysis focused on staff categories, functionality, CSC trainings, facility assessment, utilization of results, feedback mechanisms, and service improvements. Qualitative data explored barriers and enablers shaping CHPS performance. The 86 CHPS zones employed 549 health workers, predominantly female (51%). Categories included Community Health Officers (5%), midwives (17%), registered nurses (14%), enrolled nurses (33%), community health nurses (27%) and others (5%). Overall, 96% of CHPS zones were functional based on staff, CHMCs, volunteers, equipment, and service provision. About 88% had basic equipment. Services include outreach, home visits, minor illness treatment, antenatal care, and referrals. CSC training reached 41% of Community Health Officers and other health workers. Only 36% of the CHPS zones uploaded facility assessment results to existing digital platforms, and 46.5% implemented improvements from CSC recommendations. High-performing districts benefitted from adequate staffing, training, Non-Governmental Organization support, and community mobilization. Barriers included limited training coverage, exclusion of midwives and nurses from training, and persistent Gender, Equity and Social Inclusion (GESI) gaps. CHPS zones show functionality but face challenges in staff capacity, training, and digital integration. Gaps in inclusivity and equipment provision limit effectiveness. Scaling-up training, strengthening human resources, improving basic equipment provision, and embedding GESI are essential to ensure CHPS zones deliver equitable, accountable, and quality services.
57. Bridging Evidence and Practice: The Role of Daily Cetylpyridinium Chloride Mouthrinses in Disease Prevention.
期刊: Compendium of continuing education in dentistry (Jamesburg, N.J. : 1995) 发表日期: 2025-Sep 链接: PubMed
摘要
Oral diseases affect nearly 3.7 billion people worldwide,1 with conditions such as untreated dental caries and periodontal diseases impacting more than 2 billion and 1 billion individuals, respectively, thus imposing significant functional, social, and economic burdens. Despite the dental profession’s progress in understanding the etiopathogenesis of dental caries and periodontal diseases, the global burden of these disorders remains high, with case numbers increasing due to population growth and aging. Unfortunately, this trend is expected to continue. Projections for the United Kingdom, for example, suggest that by 2050, over 60% of the adult population aged 60 or older will have untreated dental caries, and more than half will be affected by periodontal diseases. The expected increase in these conditions poses a threat to dentists’ ability to provide curative care to all affected patients, highlighting the need to focus on actions toward health promotion and disease prevention.