公共卫生研究摘要 (2026-04-18)
共收录 55 篇研究文章
1. Not coping with stress and screen-time: mixed methods.
期刊: International journal of circumpolar health 发表日期: 2026-Dec-31 链接: PubMed
摘要
Mental health problems are increasing among adolescents, where stress, screen time, social media and sleep deprivation are contributing factors. The aim of this study was to explore adolescents’ understanding and self-reporting of health for further development of the screening tool HEILUNG. Mixed-method study design based on qualitative (focus groups) and quantitative data (cross-sectional study) was used. The participants in both studies were adolescents in upper secondary schools across Iceland. The framework method was used in the data analysis for the focus groups and descriptive statistics for the cross-sectional study (CSS). The focus groups included 31 participants, and the CSS 648. The focus groups showed that mental health was important and dependent on physical and social health. Almost 56%, 45% and 27% of the participants (CSS) were stressed, anxious and depressed often/daily, respectively. Mental well-being was affected by sleep deprivation and social media. More than half of the participants (CSS) did not get enough sleep, and approximately 38% had seven hours or more of screen time daily. Mental health was of great concern to adolescents in both studies affected by many influential factors. Making health decisions regularly was difficult for them. They needed opportunities to discuss health issues and health promotion, which could be provided by school nurses.
2. Differences in Survival Associated With the First Antiseizure Medication in People With Dementia and Epilepsy.
期刊: Neurology 发表日期: 2026-May-12 链接: PubMed
摘要
Epilepsy is an increasingly recognized comorbidity in neurocognitive disorders. Although experts recommend newer antiseizure medications (ASMs), whether there are real-world benefits of selecting particular ASMs for epilepsy in dementia remains unknown. Our objective was to examine whether different ASMs are associated with differences in survival in persons with epilepsy and dementia. A cohort study was conducted using Swedish national registers. We included individuals with dementia who received ASM treatment after a diagnosis of epilepsy after January 1, 2006. Data were analyzed until December 2023. Dispensed ASMs (Anatomical Therapeutic Code N03) were used to identify treatment; patients were categorized as starting one of the 4 most common ASMs (carbamazepine, levetiracetam, lamotrigine, valproate) or other ASMs. Recurrent prescriptions were used to determine treatment duration. Associations between all-cause death and ASMs were assessed by Cox proportional hazards regression. We also assessed causes of death and the risk of cardiovascular death. In Sweden, between 2006 and 2023, we included 5,764 individuals (2,811 men [48.8%] and 2,953 women [51.2%]) using their first ASM after a diagnosis of epilepsy and dementia. Carbamazepine (n = 1,578) was the most common ASM before 2015 and levetiracetam (n = 2098) most common thereafter. In Kaplan-Meier analyses and Cox regression models adjusting for age, sex, year of ASM start, and comorbidities, valproate (n = 746) was associated with increased adjusted hazard ratio (aHR) of death (1.34, 95% CI 1.20-1.48), in contrast to lamotrigine (n = 922, aHR: 0.84, 95% CI 0.75-0.93) and levetiracetam (n = 2098, aHR: 0.93, 95% CI 0.85-1.03). The risks were similar in analyses using restricted mean survival time, propensity score-matched sets of participants, balancing weights in regression models, and cases with epilepsy onset in existing dementia. Cardiovascular causes of death were more common among users of valproate or carbamazepine than among users of lamotrigine and levetiracetam. Compared with carbamazepine, valproate was associated with increased risk of cardiovascular death (aHR: 1.30; 95% CI 1.11-1.52) while lamotrigine (aHR 0.79; 95% CI 0.66-0.94) was associated with a reduced risk. In this population-wide cohort study, use of valproate was associated with the highest risk of death in persons with epilepsy and dementia. Lamotrigine and, in some models, levetiracetam were associated with better survival than both valproate and carbamazepine. This provides real-world support for existing expert guidelines.
3. Cost-Effectiveness of Thrombectomy With or Without Alteplase in Large Vessel Occlusion Stroke: A Meta-Analysis Considering Time-to-Treatment.
期刊: Neurology 发表日期: 2026-May-12 链接: PubMed
摘要
In stroke patients directly admitted to thrombectomy-capable centers, the value of intravenous thrombolysis (IVT) with alteplase before thrombectomy is time dependent. While early IVT may improve outcomes, delayed IVT administration lowers the likelihood of benefit. To date, no previous cost-effectiveness study has considered onset-to-treatment time. This study evaluated the cost-effectiveness of intravenous (IV) alteplase plus thrombectomy vs thrombectomy alone in patients admitted directly to thrombectomy-capable centers across 16 countries, stratified by onset-to-IVT time. A decision tree integrated with a Markov model estimated costs, quality-adjusted life years (QALYs), and incremental net monetary benefit (INMB) over 15 years. A willingness-to-pay threshold of one gross domestic product per capita was applied for each country. Effectiveness data were derived from individual patient data from 6 trials including patients with anterior circulation large-vessel occlusion eligible for both IVT and thrombectomy who presented directly to thrombectomy-capable centers. Costs were obtained from a literature review. Onset-to-IVT time was categorized as <140, 140-169, 170-199, and ≥200 minutes. One-way sensitivity and probabilistic sensitivity analyses were performed to check robustness of results. Ninety-day functional outcome distributions from 2,268 patients (median age 71 years; 44% female) were used to model cost-effectiveness in a hypothetical cohort of 10,000 patients. Without accounting for onset-to-IVT time, IV alteplase plus thrombectomy seemed cost-effective in 13 countries (INMB: $85-$3,618; 50-65% probability of cost-effectiveness) and not cost-effective in the United States, China, and Vietnam, with modest health gains (0.06-0.08 QALYs per patient). Time-stratified analyses revealed that IVT plus thrombectomy was cost-effective in 16 countries when onset-to-IVT time was <140 minutes (INMB: $615-$30,645; 82%-98% probability) and at 140-169 minutes (INMB: $86-$16,918; 51%-77% probability). However, IV alteplase plus thrombectomy was no longer cost-effective in 8 countries at 170-199 minutes. Universally, the INMB was negative for onset-to-IVT times exceeding 200 minutes. Cost-effectiveness of IV alteplase plus thrombectomy varies per country and onset-to-IVT time. IV alteplase plus thrombectomy is cost-effective when IVT can be administered within 170 minutes from symptom onset. Cost-effectiveness of IV alteplase plus thrombectomy diminishes progressively with longer onset-to-IVT times and becomes detrimental after 200 minutes.
4. Feasibility and Acceptability of Barbershop-Based HIV Prevention Among Heterosexual Men in Kalangala Islands, Uganda: Protocol for a Cluster Randomized Trial (HPTN 111).
期刊: JMIR research protocols 发表日期: 2026-Apr-17 链接: PubMed
摘要
Globally, successful strategies to engage high-risk heterosexual men in HIV prevention are scarce, resulting in limited access and uptake. Barbershops offer a potential venue for HIV prevention. The primary objective was to evaluate the feasibility and acceptability of a barbershop-based HIV prevention initiative. The secondary objectives were to compare completion of self-initiated HIV testing between intervention and control groups, evaluate the preliminary effectiveness of the intervention on change in behaviors associated with HIV acquisition, compare interest in or use of HIV prevention services between intervention and control groups, and assess interest in long-acting preexposure prophylaxis among all participants and by study arm. The exploratory objective was to evaluate the preliminary effectiveness of the intervention on incident sexually transmitted infections. HIV Prevention Trials Network 111 (HPTN 111; Testing a Barbershop-based HIV Prevention Initiative Among Men [TRIM]) is a cluster randomized trial conducted in Kalangala district, Uganda, among barbershop-going men. Approximately 250 men were assigned to either an intervention barbershop (n=12) or a control barbershop to receive the standard of care (n=6). Participants assigned to intervention barbershops received an intervention package that included HIV-status neutral education, distribution of HIV self-test kits, and barber-led peer group sessions. Feasibility and acceptability of the intervention were assessed from participants in the intervention group at week 26 and week 52. The study will also assess the effectiveness of the intervention on changes in HIV testing and use of prevention services. Self-reported sexual behaviors associated with HIV incidence and sexually transmitted infection incidence rates will also be compared to the standard of care. Data collection began in March 2024 and concluded in June 2025. Participants were followed for 12 months. Data analysis has been completed. The primary manuscript is expected to be submitted for publication by March 30, 2026. The results of this study will provide crucial information about the feasibility and acceptability of novel interventions, such as barbershops, to impact behavior change, as well as about the engagement of heterosexual men in high HIV transmission settings in HIV prevention and treatment trials in the future. ClinicalTrials.gov NCT06148584; https://clinicaltrials.gov/study/NCT06148584. RR1-10.2196/87612.
5. Prevalence of Early Rheumatic Heart Disease Among Asymptomatic Students in Underserved Communities in Ethiopia: Cross-Sectional Observational Study.
期刊: JMIR public health and surveillance 发表日期: 2026-Apr-17 链接: PubMed
摘要
Rheumatic heart disease (RHD) is a sequela of recurrent, untreated group A Streptococcus infections. RHD disproportionately affects children and young adults in the Global South. Intermittent mass screening of early RHD by using affordable tools in these disease-endemic regions is essential for effective prevention. This study examined multimodal physiological data for assessing the prevalence of early RHD in a cohort of asymptomatic, at-risk students in rural Ethiopia. A total of 584 asymptomatic children aged 10 to 20 years were randomly selected for screening and stratified into 2 groups (≤14 and >14 years). Electrocardiogram, phonocardiogram, and echocardiography screening were performed, with diagnoses based on the 2012 World Heart Federation criteria. After excluding 1.4% (8/584) of the children, who had nonrheumatic findings, 576 participants were analyzed, including 334 (58.0%) female and 242 (42.0%) male children. The mean age was 16.1 (SD 2.4) years (95% CI 15.9-16.3). Echocardiographic screening identified 19 cases of RHD (n=10, 52.6% borderline and n=9, 47.4% definite). Female children accounted for 68.4% (13/19) of cases, and the association between female sex and RHD was not statistically significant (odds ratio 1.59, 95% CI 0.60-4.25; P=.35). The estimated prevalence of RHD was 32.5 per 1000 population (95% CI 18.1-46.9; SE 7.4; 19/576, 3.3%), which was significantly higher than the most recent multicenter prevalence estimate of 19 per 1000 population (95% CI 13.9-23.4; odds ratio 2.12; P=.03). Mitral regurgitation was the predominant lesion (16/19, 84.2%), followed by mitral stenosis (2/19, 10.5%) and aortic regurgitation (1/19, 5.3%). Phonocardiogram analysis showed mitral regurgitation (10/19, 52.6%), mitral stenosis (2/19, 10.5%), and subclinical findings in the rest of patients with RHD. Prolonged PR intervals were observed in 10.5% (2/19) of the RHD-positive participants. This study confirms persistent high prevalence of asymptomatic RHD among students in rural regions of Ethiopia. Although there was a female predominance in RHD incidence, the difference between the sexes was not statistically significant.
6. Involving Health Care Professionals in the Human-Centered Design of a Digital Platform for Work-Focused Health Care: Lessons From a Mixed Methods Study.
期刊: JMIR formative research 发表日期: 2026-Apr-17 链接: PubMed
摘要
Effective collaboration throughout the full cycle of care is essential for value-based health care. In the Netherlands, occupational health care and curative health care traditionally operate as 2 separate sectors. As a consequence, effective communication and robust collaboration between professionals working in these sectors are lacking. Digital collaborative care platforms (ie, digital systems that facilitate communication and collaboration between health care professionals) are recognized as a promising solution to address the fragmentation of work-focused health care (health care that supports people on long-term sick leave in staying at or returning to work). A human-centered design (HCD) approach can help ensure that such platforms align with professionals’ needs by involving them throughout the design process. This study examines the experiences of (work-focused) health care professionals, including occupational physicians, insurance physicians, medical specialists, and general practitioners, during the design phase of a real-world HCD process for developing a digital platform to support collaborative care. The study specifically focused on understanding how these professionals perceive this collaborative approach. A mixed method study design was employed, combining observations of 17 design sessions with semistructured interviews with health care professionals as intended users of the platform. Observational data captured session dynamics, while interview data provided deeper insights into professionals’ experiences with the participatory HCD approach. Health care professionals were generally motivated to contribute, driven by professional interest, social encouragement, or a desire to improve practice. They valued the open and informal atmosphere of the design sessions and described their role as actively sharing practical experiences and identifying bottlenecks in current practice. Participants emphasized the importance of clear goals, good preparation, and iterative involvement for meaningful engagement. Barriers identified included limited session time, constraints of virtual interaction, and uncertainty about the commercial context of the platform. Some professionals felt unsure about the relevance of their input or experienced limited interaction, especially when the session’s purpose was unclear. Others noted that the use of a mock-up platform as a conversational foundation, familiarity with similar system interfaces, and well-guided, structured discussions facilitated their input. Positive experiences included a sense of impact through involvement in the design process, note-taking as part of active user engagement, and a safe environment for open and constructive feedback. Participants recommended a clearer explanation of the platform’s broader aims in advance, enhanced participant preparation, and opportunities for multidisciplinary co-creation in future sessions. Health care professionals valued being part of the collaborative design process, but their engagement and perceived contribution were highly dependent on how the design sessions were facilitated. Structuring design sessions with clear expectations, preparatory tools, and opportunities for follow-up can support more effective, foundational co-creation in digital platform development for collaboration among professionals providing work-focused health care.
7. Integrating Sperm Microscopy, Environmental Exposures, and Lifestyle Factors for Male Fertility Analysis: Protocol for the Nippon Semen and Environmental Exposure Database (N-SEED) Cross-Sectional Study.
期刊: JMIR research protocols 发表日期: 2026-Apr-17 链接: PubMed
摘要
Conventional semen analysis does not fully capture male reproductive potential. The sperm DNA fragmentation index (DFI) may detect latent infertility, although the sperm chromatin structure assay (SCSA) is costly and technically demanding. Image-based analysis of semen microscopy, including artificial intelligence (AI), may enable lower-cost noninvasive assessment. However, progress is limited by a lack of standardized multimodal datasets linking sperm images with the DFI and relevant covariates. This protocol describes the initial phase of the Nippon Semen and Environmental Exposure Database (N-SEED) initiative. The study aims to (1) establish standardized acquisition and quality control procedures for sperm microscopy/video and DFI measurement; (2) evaluate the feasibility and magnitude of associations between predefined image-/video-derived variables and the DFI; and (3) characterize clinical, environmental, physical, and lifestyle factors that may act as candidate correlates or confounders for subsequent image-based fertility research. This multi-institutional cross-sectional study centralized clinical assessment and specimen collection at a single site in Japan. The prespecified group-specific enrollment targets were 25 for group 1 (a relatively homogeneous low-risk cohort for DFI quality control) and 100 for group 2 (apparently healthy community-based adult volunteers for exploratory association analyses). Microscopic sperm videos, automated semen parameters, and sperm oxidative stress data were obtained at collection. SCSA-based DFI assays are currently being performed sequentially. Group 2 participants additionally provided fasting blood and early-morning urine samples for endocrine, metabolic, environmental chemical, and elemental assays. They also underwent physical measurements and completed structured questionnaires/interviews on lifestyle, nutrition, sleep, psychological status, sexual function, and collection conditions. The primary outcome measure is the continuous DFI assessed with SCSA. Group 1 data will be used to evaluate intraday, interday, and interfacility variability and to fix flow cytometry gating settings. In groups 1 and 2, predefined image-/video-derived summary variables after standardized preprocessing will be analyzed against the continuous DFI using correlation analyses and simple linear regression to assess whether sperm microscopy data contain information relevant to sperm DNA integrity. Exploratory categorical DFI analyses will use simple logistic regression. Secondary exploratory analyses will examine candidate covariates and data completeness, including sensitivity analyses. The study was registered in the University Hospital Medical Information Network Clinical Trials Registry on January 18, 2026. Between January 18 and February 21, 2026, 124 unique participants were recruited (group 1: n=25; group 2: n=103; both groups: n=4). Sample and data collection were completed on February 21, 2026. Biospecimen assays and primary association analyses are expected to be completed by March 2028. This initial N-SEED phase will deliver a standardized, quality-controlled multimodal resource linking sperm microscopy/video data with the DFI and broader physiological and environmental measures. Its immediate contribution is not to provide an immediately deployable clinical AI tool but rather to support feasibility assessment, confounder identification, and planning for subsequent database expansion and external validation of image-based male fertility assessment methods. UMIN Clinical Trials Registry UMIN000060395; https://tinyurl.com/mryfymw5. DERR1-10.2196/93803.
8. Digital and Paper-Based Hospital Workflows and 60-Day Mortality in Acute Leukemia: Retrospective Natural Experiment.
期刊: JMIR cancer 发表日期: 2026-Apr-17 链接: PubMed
摘要
Electronic medical record (EMR) systems have been associated with better clinical workflows and fewer documentation errors. However, evidence regarding their effect on time-sensitive leukemia care in public hospitals in Latin America remains limited. This study aimed to compare 60-day mortality and urgent supportive-care processes between 2 tertiary public hospitals in Mexico with different documentation models (integrated EMR vs traditional physical records [TPR]), under the hypothesis that digital workflows may facilitate more timely treatment. We conducted a retrospective natural experiment including 274 patients with newly diagnosed acute leukemia treated between February 2023 and April 2025. Clinical characteristics, treatment intensity, complications during induction, antibiotic administration times, and survival outcomes were abstracted from finalized institutional records that are routinely reviewed at discharge by the institutional medical record committee as part of standard quality-assurance procedures. The primary outcome was 60-day mortality. Secondary outcomes included time to first antibiotic dose after recognition of febrile neutropenia, treatment-related complications, and the number of operational steps required for urgent care processes. A subgroup analysis of 70 patients with complete timing documentation was performed for antibiotic administration. Comparisons between hospitals were performed using univariate tests, Kaplan-Meier 60-day survival curves, and multivariable logistic regression. Of the 274 included patients, 104 (38%) were treated at the hospital using an integrated EMR, and 170 (62%) at the hospital using TPR. Sixty-day mortality was lower in the EMR hospital (6/104, 5.8%) than in the TPR hospital (61/170, 35.9%; P<.001). In the subgroup with complete timing data, the mean time from febrile episode recognition to first antibiotic administration was shorter in the hospital using EMR than in the hospital using TPR (54, SD 18.4 minutes; P<.001). Although the EMR hospital used a higher proportion of high-intensity regimens, patients in that hospital had better 60-day outcomes. In multivariable analysis, hospital type remained independently associated with 60-day mortality (odds ratio 0.11, 95% CI 0.05-0.26; P<.001), whereas kidney injury and hepatotoxicity were associated with worse outcomes. In this natural experiment, the hospital using an integrated EMR had a lower 60-day mortality and shorter time to antibiotic administration than the hospital using TPR. These findings are hypothesis-generating and suggest that digital workflows may contribute to more timely urgent supportive care, but they should be interpreted with caution, given the retrospective 2-center design and the potential for residual confounding.
9. Health and Humanities and Social Sciences Professionals' Perceptions Regarding the Teaching of the Effects of Racism in Medicine: Semistructured Interview Study.
期刊: JMIR medical education 发表日期: 2026-Apr-17 链接: PubMed
摘要
In France, as in other countries, health disparities arise from multiple interacting factors, among which racism plays a significant role. Racism affects health through exposure to discrimination-related stress, environmental conditions, differential access to and quality of care, as well as representations and behaviors, some of which are rooted in the historical legacy of colonial medicine. This study aimed to explore the perspectives of health care professionals and researchers in the humanities and social sciences (HSS) on the core content areas to be defined and the corresponding learning objectives to be established for the development of a curriculum addressing racial discrimination in medicine for undergraduate medical education. Physicians, psychologists, and researchers in the HSS who had published on the medical care of people from racialized minorities and who had organized or participated in educational initiatives on this topic were recruited. Semistructured interviews were conducted and analyzed using reflexive thematic analysis. This study is the first French study to bring together the experiences of French-speaking experts in this field to inform the development of educational content integrating medicine, psychology, and the HSS. A total of 20 participants were interviewed. Three main themes emerged: (1) teaching how to identify and dismantle stereotypes in clinical practice; (2) teaching the psychological effects of racism and its overall impact on health; and (3) teaching the risks associated with racialized care and so-called colorblind approaches. Participants emphasized the importance of addressing racial stereotypes specific to the French context, such as the “Mediterranean syndrome,” situating them within their historical background, and understanding the effects of discrimination on both physical and mental health. A key pedagogical challenge identified was finding a balance between acknowledging geographical or sociological specificities and avoiding culturalist interpretations that overemphasize context. All participants highlighted the necessity of such comprehensive education to ensure patient safety for all. Teaching about the effects of racial discrimination and racism on health should be framed as a core public health issue. Although racial discrimination is influenced by economic, political, and sociological factors that extend beyond the medical sphere, its impact on health is neither inevitable nor immutable and therefore warrants explicit educational attention. From a future perspective, the ongoing French debate regarding the feasibility of conducting epidemiological studies on racial health disparities needs to be addressed to further inform education, research, and policy.
10. Mapping Digital Nudges and Recommender Systems for Obesity Prevention: Scoping Review.
期刊: Interactive journal of medical research 发表日期: 2026-Apr-17 链接: PubMed
摘要
Recommender systems are pivotal in organizing information to enhance noticeability, reduce overload, and streamline decision-making. They can be even more effective if combined with digital nudges. Digital nudging is a subtle approach that combines design, information, and interaction elements to create a choice architecture that can guide user behavior in digital environments. While promising in many fields, there is a notable gap in health promotion, particularly because digital nudges and recommender systems can encourage and support sustained healthier choices in nutrition, physical activity (PA), and sedentary behavior reduction to prevent overweight and obesity. This scoping review addresses these gaps by exploring how digital nudges and recommender systems are used in obesity prevention. We prospectively published the scoping review protocol and adhered to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. Eligibility was defined using the PCC (Population, Concept, Context) framework. We searched 7 bibliographic databases (MEDLINE and PsycINFO via Ovid, Web of Science, CINAHL via EBSCO, Scopus, ACM Digital Library, and IEEE Xplore) up to October 2023. Following a 2-stage screening by independent reviewers, we selected 68 articles that included 94 user evaluations. Most articles (36/68, 53%) report on recommender systems focused on nutrition, with fewer (16/68, 23%) aiming to promote PA. Most studies on digital nudges (11/68, 16%) targeted nutrition-related nudges for shopping and meal selection (8/68, 2%). Articles address PA and sedentary behavior less frequently (3/68, 4%). Three out of 68 (4%) articles report on recommender systems in combination with games, and 2 out of 68 (3%) articles report on recommender systems and digital nudges. Approaches to item retrieval vary widely, with 31 out of 68 (46%) articles failing to describe their methods. In the scoping review, we found a discrepancy between the target group for which the system was developed and the group with which the evaluation was conducted. Sixty-eight evaluations report positive results, while 26 studies report mixed, negative, or no-difference results. Integrating digital nudges and recommender systems might hold potential in overweight and obesity prevention by subtly encouraging healthier lifestyle choices. However, the heterogeneity in study designs, outcome measures, and reporting quality limits the comparability of findings and makes it difficult to draw robust conclusions about effectiveness. Future work should include detailed definitions, mechanism descriptions, broader geographic representation, and rigorous intervention testing and user evaluations to fully leverage these systems for improved health outcomes and to support sustainability and well-being objectives.
11. Double-CRISPR Knockout Simulation (DKOsim): A Monte-Carlo randomization system to model cell growth behavior and infer the optimal library design for growth-based double knockout screens.
期刊: PLoS computational biology 发表日期: 2026-Apr-17 链接: PubMed
摘要
Advances in functional genomic technology, notably CRISPR using Cas9 or Cas12, now allow for large-scale double perturbation screens in which pairs of genes are inactivated, allowing for the experimental detection of genetic interactions (GIs). However, as it is not possible to validate GIs in high-throughput, there is no gold standard dataset where true interactions are known. Hence, we constructed a Double-CRISPR Knockout Simulation (DKOsim), which allows users to reproducibly generate synthetic simulation data where the single gene fitness effect of each gene and the interaction of each gene pair can be specified by the investigator. We adapted Monte-Carlo randomization methods to extend single knockout simulation methods to double knockout designs, which simulate the gene-gene interactions between all possible combinations of the input genes. Using DKOsim, we generated simulated datasets that closely resemble real double knockout CRISPR datasets in terms of Log Fold Change (LFC), GI distribution, and replicate correlation. We further inferred optimal CRISPR library designs by systematically investigating critical experimental parameters including depth of coverage, guide efficiency, and the variance of initial guide distribution. This simulation scheme will help to identify optimal computational methods for GI detection and aid in the design of future dual knockout CRISPR screens.
12. Covid-19 testing, sick-pay and public health outbreak management of respiratory infections in care homes: three rapid reviews of the literature.
期刊: Journal of public health (Oxford, England) 发表日期: 2026-Apr-17 链接: PubMed
摘要
Credible and costed plans for managing future outbreaks of Covid-19 and other respiratory infections depend on the availability of good quality evidence. Methods: Three rapid reviews (RRs) examined evidence on: Bibliographic database searches for each RR and supplementary grey literature searches of Google for RR1 and RR3. RR1 included 1 study, RR2 none, and RR3, 1 report. RR1: a study of testing undertaken during an outbreak of Covid-19 in one care home. RR3: a report briefly described recommended inputs of one local authority’s public health service into managing outbreaks of respiratory infections in settings including care homes. The reviews found little-to-no recent evidence on care home providers’ policy and practice on asymptomatic Covid-19 testing, care home sick pay and/or shift backfill, and the incidence of Covid-19 and other respiratory infections, nor on costs of public health teams’ outbreak management.
13. Developing a community pharmacy-based cardiovascular disease risk screening service in Saudi Arabia: a multi-stakeholder nominal group technique consensus study.
期刊: The International journal of pharmacy practice 发表日期: 2026-Apr-17 链接: PubMed
摘要
to develop a community pharmacy-based cardiovascular disease (CVD) risk screening service in Saudi Arabia (SA) through stakeholder involvement. A modified nominal group technique (m-NGT) consensus method was employed, integrating a pre-meeting questionnaire for idea generation and an in-person NGT meeting (conducted on 7th February 2025) for discussion, ranking, and consensus formation. Purposive sampling was adopted to recruit stakeholders from SA, including experts in CVD, health and pharmaceutical policy, and service delivery. Ideas regarding service-targeted populations, screening processes, and post-screening interventions were collected from a literature review and pre-meeting questionnaire. Experts ranked these ideas, with higher scores indicating higher priority. A consensus level of 70% was considered acceptable. An inductive thematic analysis was performed for the discussion. Six experts participated in the NGT meeting. The prioritised age group was ≥40 years, with the top 5 priorities for those with or on treatment for comorbidities, with a family history, or any risk factors, on medications that cause CV harm, without pre-existing comorbidities and not on treatment. The top 5 screening processes included calculating CVD risk scores, collecting patient data, performing point-of-care and anthropometric measurements, and assessing medication adherence. The top 3 interventions included providing education, physician referrals, and medication therapy management with follow-ups. A 100% consensus was achieved. Two main themes were identified: (i) drivers of strategic decision-making and (ii) facilitators for sustainable implementation. This study outlines a potential service model; however, further research is needed to achieve national consensus on it and support its future implementation.
14. Effectiveness of mHealth Interventions for Improving eHealth Literacy Among Patients With Chronic Diseases: Meta-Analysis and Systematic Review.
期刊: Journal of medical Internet research 发表日期: 2026-Apr-17 链接: PubMed
摘要
With the widespread use of the internet and mobile devices, eHealth literacy promotion is critical for medical equity. Mobile health (mHealth) serves as a pivotal tool for enhancing eHealth literacy by providing accessible, interactive platforms for health information engagement. However, the evidence regarding the effectiveness of mHealth interventions on eHealth literacy among patients with chronic diseases remains inconclusive. This study aimed to evaluate the effectiveness of mHealth interventions on eHealth literacy among patients with chronic diseases based on randomized controlled trials (RCTs) and summarize supportive evidence from quasi-experimental and qualitative studies. A comprehensive search strategy was developed, and 8 electronic databases were systematically searched for studies published up to February 12, 2026. Patients with chronic diseases were included based on predefined inclusion criteria. The Cochrane risk of bias 2 tool for RCTs and the ROBINS-I tool for quasi-experimental studies were used to assess the risk of bias. Given the anticipated substantial heterogeneity among the studies included, we used a random-effects model based on the Hartung-Knapp-Sidik-Jonkman method to pool effect sizes. A narrative and quantitative synthesis of the findings was provided where appropriate. A total of 15 studies were included in this review, including 6 RCTs, 5 quasi-experimental studies, and 4 qualitative studies, involving a total of 2884 patients with chronic diseases. Meta-analyses of RCTs suggested that mHealth interventions could improve eHealth literacy, with a pooled mean effect size of standardized mean difference (SMD)=1. 19 (95% CI 0.14-2.23; P=.03; I²=97.75%; PI [prediction interval]=-2.68 to 5.05). Subgroup analyses by intervention targets showed that interventions on targets with specific disease produced larger mean effects (SMD=1.61; 95% CI 0.16-3.06; PI=-5.40 to 8.63), while interventions targeting the population with general chronic diseases produced smaller effects (SMD=0.36; 95% CI 0-0. 73; PI=-0. 21 to 0. 94). Analysis by intervention duration subgroup showed that the combined effect of studies with intervention duration <3 months was statistically significant (SMD=0.61; 95% CI 0.09-1.13; I²=88.04%; PI=-5.72 to 6.95); while the combined effect of studies with intervention duration ≥3 months was not statistically significant. Taking into account bias and the risk of GRADE (Grading of Recommendations, Assessment, Development, and Evaluation), the certainty of RCT evidence was moderate, and the certainty of quasi-experimental evidence was low. mHealth interventions could improve eHealth literacy among patients with chronic diseases on average. By using prediction intervals, this study reveals that the effectiveness of mHealth interventions is highly context-dependent and closely linked to implementation factors. Advancing beyond prior work, this study centers on eHealth literacy as a core outcome and integrates multiple types of evidence. Meanwhile, this finding emphasizes the need for evidence-based intervention programs and more rigorous implementation of intervention designs in future research.
15. Motivational Drivers for Teachers as Informal Health Educators to Initiate In-Class Discussions With Adolescents About Smoking: Moderated Mediation Study Using Attribution Theory.
期刊: JMIR pediatrics and parenting 发表日期: 2026-Apr-17 链接: PubMed
摘要
Teachers have the potential to be influential figures in school-based health promotion as informal caregivers; yet little is known about what motivates them to initiate preventive conversations with students. Attribution theory offers a useful framework to explore how perceptions of responsibility shape communicative behavior, but it has rarely been applied in the context of teacher-student interactions around health risks such as smoking. This study applies the attribution theory to explore the motivational drivers that lead teachers to initiate discussions with adolescents about smoking. Data were collected from 101 middle schools in the Canton of Ticino, Switzerland, as part of a larger longitudinal study. The analysis focuses on 67 teachers who participated in the first wave. Responsibility attribution, concern, and previous classroom sanctions were examined in association with teachers’ communication. Results from a moderated mediation model showed that teachers who attributed greater responsibility to the school (internal attribution) reported higher levels of concern (β=-0.41; P=.002) and engaged in more frequent in-class discussions on smoking (β=-0.26; P=.02). Although concern alone was not directly related to communication (β=-0.14; P=.22), its effect was significantly moderated by contextual sanctions (β=1.01; P<.001). These findings highlight the motivational and contextual factors that shape teachers’ communication with students on smoking behavior. By applying attribution theory in the novel context of health communication, this research contributes to understanding how perceived responsibility influences preventive communication in schools.
16. Economic evaluation of automated scalp cooling systems for breast cancer patients in Spain.
期刊: Health economics review 发表日期: 2026-Apr-17 链接: PubMed
摘要
17. Racial Disparities in Biopsychosocial Predictors of Short-Term Smoking Cessation Following Acute Coronary Syndrome Hospitalization.
期刊: Journal of racial and ethnic health disparities 发表日期: 2026-Apr-17 链接: PubMed
摘要
18. Renalase knockdown inhibits proliferation of mouse satellite cells.
期刊: Molecular biology reports 发表日期: 2026-Apr-17 链接: PubMed
摘要
19. Tearing down the wall: emu-miR-745-3p in Echinococcus multilocularis exosomes attenuates host liver fibrosis to permit invasive lesion development.
期刊: The Journal of infectious diseases 发表日期: 2026-Apr-17 链接: PubMed
摘要
Alveolar echinococcosis (AE), caused by Echinococcus multilocularis (E. multilocularis), exhibits tumor-like, invasive growth in the liver. Unlike cystic echinococcosis, AE lesions are often bordered by loose fibrosis rather than a dense fibrotic capsule. The mechanism by which the parasite attenuates this host fibrotic response remains unknown. We performed small RNA sequencing of parasite-derived exosomes (EmV-EXOs) and multi-step screening to identify functional miRNAs. The candidate was validated via bioinformatics, dual-luciferase assays, and in vitro studies in hepatic stellate cells (HSCs). An adeno-associated virus (AAV6)-delivered Tough Decoy (TuD) RNA was used for in vivo inhibition in a murine model. emu-miR-745-3p was identified as an exosomal miRNA enriched in EmV-EXOs. It is delivered to HSCs and directly targets the 3’ UTR of dipeptidyl peptidase-4 (DPP4), a pro-fibrotic regulator. Downregulation of DPP4 suppressed HSCs activation, reducing expression of α-SMA, COL1A1, and TIMP1. In vivo inhibition of emu-miR-745-3p enhanced perilesional fibrosis, promoted a thicker fibrous capsule, and significantly reduced parasitic lesion burden. E. multilocularis employs exosomal emu-miR-745-3p to attenuate host fibrotic encapsulation, facilitating invasive growth. The emu-miR-745-3p/DPP4 axis is a critical determinant of AE pathology and a potential target for novel anti-fibrotic therapeutics.
20. Cryo-EM structure of shutdown human nonmuscle myosin 2A.
期刊: Science advances 发表日期: 2026-Apr-17 链接: PubMed
摘要
Determining the high-resolution structure of the widely expressed nonmuscle myosin 2A (NM2A), in its dephosphorylated shutdown state, is important in understanding its regulation and disease roles. In shutdown molecules, the coiled-coil tail wraps around the myosin heads, preventing them from forming filaments and binding to actin. We have solved the shutdown structure of NM2A to a global resolution of 3.0 angstroms in the head region and 6.3 angstroms for the whole molecule. This reveals specific ionic interactions that explain why the path of the coiled coil and the shutdown mechanism for NM2A differ from those of β-cardiac myosin and provides key insight into how specific mutations likely destabilize the shutdown state, leading to disease.
21. Impact of Background Noise on Visual Accommodation and Reading Performance.
期刊: Current eye research 发表日期: 2026-Apr-17 链接: PubMed
摘要
Noise, considered the second leading cause of environmental pollution, negatively affects health and cognitive performance, while music may enhance concentration. This study evaluates how different auditory environments influence the dynamics of the accommodative response, reading performance and subjective perceptions during a sustained near-vision reading task. Twenty-five healthy young adults participated in three randomized experimental sessions under pleasant (water sounds and preferred music), unpleasant (traffic noise and disliked music), and control (silence and classical music) auditory conditions. During each session, participants performed a 5-minute reading task at 50 cm while accommodative responses were recorded using the Grand Seiko WAM-5500 autorefractor. Perceived visual fatigue and reading performance were also assessed. The lag of accommodation was sensitive to the auditory stimuli (p = 0.015), where a higher lag of accommodation was observed for the unpleasant auditory condition compared to the control (corrected p-value = 0.017). No statistically significant differences were found for the variability of accommodation (p > 0.05). Reading performance showed statistically significant differences for the auditory conditions (p = 0.042), with a higher number of words read in the control condition compared to the unpleasant condition (corrected p = 0.037). Symptoms showed a lower activation level, greater fatigue and less comfort in the unpleasant condition in comparison to the control condition (p = 0.037, p = 0.039, p < 0.001, respectively). These findings emphasize that for efficient reading and optimal visual performance, unpleasant sounds such as traffic noise should be avoided, and silence or classical music is preferable.
22. Tracking Seamless All-Hour PM2.5 in China Using a Gridded Surface Visibility-Based Transformer Model.
期刊: Environmental science & technology 发表日期: 2026-Apr-17 链接: PubMed
摘要
High-resolution spatiotemporal monitoring of PM2.5 (particulate matter less than 2.5 μm in diameter) is essential for accurately assessing its environmental and health impacts. However, passive satellite-based techniques for estimating PM2.5 concentrations are hindered by persistent cloud cover and the lack of nighttime aerosol optical depth (AOD) data, resulting in spatially and temporally fragmented retrievals that are restricted exclusively to daylight hours or daily averaged values. To address this, we introduce surface visibility (SV) as a robust alternative to AOD and develop a gridded SV-based transformer model (GSVTM). By integrating multisource meteorological and environmental data through multihead attention mechanisms and residual networks, the GSVTM effectively decouples the complex nonlinear relationship between SV and PM2.5, enabling seamless all-hour PM2.5 tracking at 6.25 km and hourly resolution across China. Extensive cross-validation demonstrates that at the hourly scale, GSVTM achieves an R2 of 0.80 and an RMSE of 15.14 μg m-3. At the daily scale, its accuracy (R2 = 0.89 and RMSE = 9.73 μg m-3) is comparable to that of existing satellite-based PM2.5 products. Applied to a large-scale trans-regional pollution event, GSVTM successfully captures the complete dynamics of PM2.5 transport and evolution. This study marks a critical advance toward seamless all-day PM2.5 monitoring, effectively addressing the critical nighttime data gap in satellite-based PM2.5 products and delivering reliable, real-time data essential for understanding diurnal patterns and multiscale impacts of PM2.5 at national and urban scales.
23. Association between diagnostic history and cancer incidence within 5 years: a real-world observational analysis.
期刊: Cancer research communications 发表日期: 2026-Apr-17 链接: PubMed
摘要
Cancer is associated with many pre-existing health conditions (PHCs), but accurately quantifying these links remains challenging. Although some studies have examined these associations, large-scale analyses using diverse electronic health record (EHR) data remain limited and lack the ability to evaluate cancer risk when patients are stratified by interpersonal differences. Using a real-world EHR dataset from a large Louisiana health system comprising 8,283,236 records from 1,460,738 patients (2013-2022), we evaluated associations between pre-existing health conditions (PHCs) and subsequent cancer diagnoses within a fixed five-year risk window. We applied epidemiological, statistical, and artificial intelligence methods to the full dataset and to subgroups stratified by gender, race, and area deprivation index (ADI) for overall cancer and 20 cancer types. We identified nine ICD-10 chapters, including Chapter 4 (metabolic) and Chapter 14 (genitourinary), with 221 PHCs linked to increased cancer risk (RR > 1, 95% CI excluding 1.0, BH-FDR-adjusted p < 0.05). Key PHCs include systemic sclerosis, blood type, benign mammary dysplasia, immune mechanism disorders, disturbances of smell, lipoprotein metabolism disorders, HIV, vitamin D deficiency and diabetes. Chapter 12 (skin diseases) and Chapter 9 (circulatory diseases) showed strong associations with 10 and 13 cancer types, respectively. Age-, gender-, race-, and ADI-specific high-risk PHCs were also identified. However, these findings should be interpreted carefully, as ADI may not fully capture individual-level socioeconomic or environmental exposures, and the lack of tobacco data may introduce residual confounding.
24. Body Size and Bladder Cancer Risk: A Pooled Analysis of Prospective Studies From the National Cancer Institute Cohort Consortium.
期刊: Journal of clinical oncology : official journal of the American Society of Clinical Oncology 发表日期: 2026-Apr-17 链接: PubMed
摘要
Body size is an established risk factor for several cancers, but associations with bladder cancer risk remain unclear. We pooled data from 2,533,008 participants in 30 international cohort studies to assess associations of BMI, waist circumference, and height with bladder cancer risk. Multivariable Cox regression models, including smoking status, duration, and other confounders, were run separately by cohort and sex, and results combined by random-effects meta-analysis. Incident first primary bladder cancer was diagnosed in 15,259 males and 5,188 females. For males, overweight (BMI, 25.0-29.9 kg/m2) and obesity (BMI, ≥30 kg/m2) were associated with increased risk of bladder cancer, with hazard ratios (HRs) of 1.08 (95% CI, 1.04 to 1.12) and 1.16 (95% CI, 1.10 to 1.22), respectively, when compared with normal weight (BMI, 18.5-24.9 kg/m2). The corresponding HR for females were 1.02 (95% CI, 0.95 to 1.09) and 1.04 (95% CI, 0.95 to 1.14), respectively. The HR per 5 kg/m2 increment was 1.07 (95% CI, 1.05 to 1.09) for males and 1.00 (95% CI, 0.97 to 1.04) for females. Higher waist circumference was also associated with increased risk of bladder cancer for males (HR per 10 cm increase 1.06 [95% CI, 1.03 to 1.08]) but not females (HR, 1.01 [95% CI, 0.97 to 1.04]). Results for height were largely consistent with those for BMI and waist circumference, with strong and consistent evidence for males, but not females. Larger body size is associated with increased risk of bladder cancer for males, but not females. Public health interventions to prevent overweight and obesity, along with smoking cessation and reduced occupational exposure to bladder carcinogens, are likely to reduce bladder cancer incidence worldwide.
25. A scoping review of the Australian spinal cord injury research landscape: Insights and implications for research impact.
期刊: The journal of spinal cord medicine 发表日期: 2026-Apr-17 链接: PubMed
摘要
A systematic approach to undertaking spinal cord injury (SCI) related research will maximize the use of limited research funds and ensure that all stakeholders collaborate to address barriers to producing relevant, impactful research. To examine the breadth and scope of Australian SCI research published between January 2018 and September 2025. A systematic search of five relevant databases for Australian spinal cord injury research published from January 2018 to September 2025 was completed. A total of 271 eligible studies were included. Most publications reported clinical research (n = 233; 86%), with rehabilitation being the largest clinical research category (n = 76; 32.5%). The majority (n = 163; 70%) reported either cross-sectional, qualitative or retrospective designs, and more than half of all clinical studies were conducted at a single site only (n = 136; 58.4%). Most preclinical publications (n = 38; 14%) focused on discovery science and secondary conditions, with research into neuroprotection and regeneration representing the next largest category. Sixteen publications, all clinical, engaged people with lived experience in the research process. This review identified several issues that impact the efficiency and impact of SCI research in Australia, many of which are relevant to other jurisdictions. Issues include limited multi-center collaborations in both clinical and preclinical research, low engagement of people with lived experience in the research process, and a dearth of research from primary care. To maximize the use of finite research funds, all stakeholders with an interest in SCI outcomes should work together to define research priorities and strategically address barriers to producing relevant, impactful research.
26. Changing Patterns of Insomnia Incidence Among U.S. Air Force Physicians, 2014 and 2024.
期刊: Military medicine 发表日期: 2026-Apr-17 链接: PubMed
摘要
Military physicians face risks to sleep health common to civilian physicians alongside additional military-specific stressors. Insomnia is prevalent among service members and associated with cognitive, health, and occupational impairment, yet its incidence among military physicians remains poorly characterized. This project examined the one-year incidence of insomnia among U.S. Air Force (USAF) physicians and assessed variation by demographic and occupational characteristics across two cohorts a decade apart. We constructed a retrospective cohort using de-identified electronic health record and personnel data. USAF physicians on orders in 2014 and 2024 were included. Incident insomnia was defined as a first-time diagnosis using ICD-9 and ICD-10 codes, excluding individuals with prior diagnoses since 2006. Multivariable logistic regression assessed associations with rank, sex, race/ethnicity, and service component. Separate models examined associations with physician specialty and aggregated specialty categories. Robust standard errors and Bonferroni-adjusted comparisons were used. Analyses assume near-complete capture of clinically documented diagnoses within the Military Health System. The analytic sample included 8,292 physicians. The one-year incidence proportion of documented insomnia declined from 3.6 percent in 2014 to 1.1 percent in 2024. In 2014, higher incidence was associated with senior officer rank and active-duty status and differed by aggregated specialty category, with elevated odds in preventive, diagnostic, and administrative specialties compared with general medical specialties. In 2024, higher incidence was associated with junior officer rank and male sex, and no statistically significant specialty differences were observed, although point estimates remained highest in emergency and critical care fields. There was a marked decrease in documented insomnia incidence over the decade, alongside shifts in demographic and occupational correlates, among USAF physicians. These findings likely reflect changes in documentation, workforce composition, and help-seeking rather than true reductions in sleep disturbance. Continued surveillance and targeted prevention efforts are warranted to support physician readiness and force health protection.
27. Sex-Specific Associations Between Cadmium Exposure and Mortality Risk in Cardiovascular Disease Patients: A Cohort Study Integrating Molecular Mechanisms of Myocardial Dysfunction.
期刊: Cardiovascular toxicology 发表日期: 2026-Apr-17 链接: PubMed
摘要
28. Perceived housing inadequacy and health: Cumulative and gendered effects beyond objective housing standards.
期刊: Health & place 发表日期: 2026-Apr-16 链接: PubMed
摘要
This study investigates whether cumulative exposure to perceived inadequate housing conditions is associated with multiple health outcomes, independent of objective housing standards. We further examine whether these associations differ by gender. Using data from the Korea Welfare Panel Study (KoWePS, 2006-2022; N = 22,975 individuals; 177,267 person-years), we constructed a cumulative measure of subjective housing inadequacy based on the number of consecutive waves in which respondents reported lacking adequate soundproofing, ventilation, natural lighting, or heating. We employed individual fixed effects regression models to estimate within-person changes in four health outcomes: depressive symptoms, self-rated health, chronic disease, and outpatient visits. Gender-stratified analyses showed that the associations between cumulative perceived housing inadequacy and depressive symptoms were more pronounced among women, whereas gender differences in physical health outcomes were comparatively modest. Overall, perceived housing inadequacy takes a cumulative toll on mental and physical health, independent of objective housing standards. The findings highlight the importance of integrating subjective perceptions into housing and public health policy and the need for gender-sensitive interventions in addressing housing-related health disparities.
29. Seasonal variation in childhood acute lymphoblastic leukemia, but not in acute myeloid leukemia, or brain tumors - A Swedish population-based study.
期刊: Cancer epidemiology 发表日期: 2026-Apr-16 链接: PubMed
摘要
Acute lymphoblastic leukemia (ALL), the most common malignancy in children and adolescents, arises from a heterogeneous and multifactorial etiology involving genetic and environmental factors. Studies of seasonal variation in ALL diagnosis have yielded inconsistent results, likely reflecting differences in study design and population characteristics. Here, we evaluated seasonal variation across ALL immunophenotypes, including two common genetic subtypes. We analyzed seasonal variation by ALL subtype in 1504 ALL patients diagnosed before the age of 18 between 1995 and 2017 using data from the National Cancer Register and the Swedish Childhood Cancer Registry. Subgroup analysis included 1305 B-cell precursor ALL (BCP-ALL) cases, including 422 high hyperdiploid (HeH) and 259 ETV6::RUNX1 fusion-positive cases, and 175 T-cell ALL (T-ALL) cases. For comparison, 214 acute myeloid leukemia (AML) cases and 1367 brain tumor cases, including 224 medulloblastomas, were analyzed. Cases were grouped into overlapping 3-month diagnostic periods and analyzed using a Bayesian GARIMAX model, an extension of the autoregressive integrated moving average (ARIMA) framework. A sensitivity analysis was performed restricted to children aged 1-17 years. Seasonal variation was observed in the overall ALL cohort, with peaks between June and October. BCP-ALL and T-ALL also showed informative seasonality, with August consistently included among the peak months. Similar results were obtained in the sensitivity analysis. No seasonal variation was observed in AML, medulloblastoma, or other brain tumors. Informative seasonal variation was not detected in the HeH or ETV6::RUNX1-positive subgroups, although HeH showed peak quarters consistent with the overall ALL pattern. These findings support a role for seasonal triggers in ALL and warrant further investigation in larger, genetically stratified cohorts.
30. Cancer trends among young adults in Russian Federation: An analysis of population-based cancer registry data.
期刊: Cancer epidemiology 发表日期: 2026-Apr-16 链接: PubMed
摘要
Globally, cancer incidence is increasing in young adults and can rise to 2.3 million by 2045 according to GLOBOCAN 2022. Here, we present the first nationwide, long-term analysis of cancer incidence and mortality trends among young adults in the Russian Federation from 2013 to 2023. We analyzed 140,500 and 328,370 cases in men and women aged 20-44 years, along with 60,067 and 71,431 deaths, respectively. Age-standardized and crude incidence rates were calculated for 2013-2023 using data from the Cancer Registry of the Russian Federation and Russian Federal State Statistics Service. Overall, since 2013, cancer incidence remained stable in males but declined in females, with mortality decreasing in both sexes. By anatomical site, men showed a significant increase in thyroid, colorectal, liver, kidney, gallbladder cancers, ands melanoma, while cases of nasopharynx, lung, stomach, larynx, and connective or soft tissues cancers declined. Women demonstrated a higher incidence of small intestine, oropharynx, thyroid, oral cavity, pancreas, colorectal, breast, melanoma, and other skin tumors, whereas lip, stomach, cervical, and connective or other soft tissue cancers decreased. Mortality rates declined for the majority of cancer sites in both men and women, but remained stable for most cancers of the head and neck and gastrointestinal tract, as well as prostate, breast, and non-melanoma skin cancers. Our findings demonstrate a cancer incidence increase among young adults in the Russian Federation and highlight new preventive, organizational, and clinical strategies to improve medical monitoring, promote early detection of cancer, and ensure timely treatment for individuals of working and reproductive age.
31. Cure rate estimation of skin cancer patients in São Paulo, Brazil, through a cure fraction model.
期刊: Cancer epidemiology 发表日期: 2026-Apr-16 链接: PubMed
摘要
In survival analysis, cure fraction models are used to estimate the proportion of patients who have not experienced the event of interest (e.g., recurrence or death). These models consider both cured and non-cured patients, allowing for a more comprehensive approach to understanding survival. Cure fraction models can be applied to analyze the survival of cancer patients. This investigation aims to estimate the cure fraction in skin cancer patients based on the variables Treatment Type, Disease Stage, Gender, and Health Plan. The adjustment is performed using a mixture model applied to the GAMLSS regression methodology, which allows incorporating the cure fraction as a parameter in the population probability density function of the time to the event of interest. The results allow for the examination of the behavior of the cure fraction across different categories of the analyzed variables. The study demonstrates the feasibility of using cure fraction models to estimate the proportion of cured patients in different clinical and sociodemographic contexts, providing valuable insights for understanding survival in skin cancer patients.
32. No Clinic, No Problem: Acceptability of STI Self Collection Kits in a National Sample of Adolescents and Young Adults.
期刊: Sexually transmitted diseases 发表日期: 2026-Apr-16 链接: PubMed
摘要
Sexually transmitted infections (STIs) disproportionately affect adolescents and young adults (AYAs), yet testing rates in this group remain low. STI self-collection kits may potentially increase testing uptake. We sought to characterize barriers to using self-collection kits among AYAs. This cross-sectional study examined preferences and barriers related to STI self-collection kits among 445 sexually active AYAs aged 15-24 years across high STI incidence counties in the United States (U.S.). Data was collected via social media recruitment and analyzed using descriptive and inferential statistics. The study revealed disparities in comfort levels regarding receiving STI self-collection kits at home and other household members seeing them. Most participants preferred their kit to be delivered to their home, though participants aged 15-19 years and AYAs with lower education preferred to pick it up from school. Discreet delivery was perceived as more feasible by participants aged 20-24 years, those who were employed, and those living in the southern U.S. Individuals with less than a high school education were less likely to feel comfortable self-collecting for STI testing. Participants favored written or video instructions for specimen collection and email or text message for results notification. Participants expressed a high likelihood of referring their sexual partners for testing and treatment. These findings underscore the importance of tailoring STI self-collection kit design and delivery to AYA subpopulations. Future research and programs should prioritize AYAs’ desires for discreet delivery, clear specimen self-collection instructions, and digital communication options to benefit and optimize STI testing for AYAs.
33. Community-led conservation, nature exposure, and nature-based mental health in rural Ghana.
期刊: Health & place 发表日期: 2026-Apr-16 链接: PubMed
摘要
Nature-Based Mental Health (NbMH) is conceptualized as the psychological benefits individuals derive from direct or indirect interactions with natural environments, including reduced stress, improved mood, emotional resilience, and overall well-being. Although increasingly recognized, NbMH remains underexplored in rural and climate-vulnerable settings. Grounded in the Social-Ecological Model (SEM), this study examines how environmental exposure, measured through residence in Community Resource Management Area (CREMA), frequency of nature contact, and proximity to natural environments, shapes subjective NbMH among farmers in northern Ghana. NbMH was assessed using a 15-item scale capturing stress, anxiety, sleep quality, coping capacity, and emotional resilience. Drawing on cross-sectional survey data from 1107 respondents across 16 CREMA and non-CREMA communities, we employed nested ordered logistic regression models to examine multilevel determinants of reporting “good” NbMH. Findings show that residence in CREMA communities was consistently associated with a higher likelihood of reporting “good” NbMH (OR: 1.75-2.20; p < 0.001). Similarly, an increase in frequency of weekly nature contact increased the likelihood of “good” NbMH (OR: 1.06-1.07; p = 0.011), while an increase in the distance from natural spaces decreased the likelihood of reporting “good” NbMH (OR: 0.84-0.85; p < 0.001). Additional significant predictors included age, livelihood diversification, financial stressors, enrollment in social protection programs, and distance to health and water facilities. Poorly perceived social support systems were also negatively associated with reporting “good” NbMH. It is recommended that nature-based strategies be integrated into rural mental health policies and that support be provided for community-led conservation initiatives to enhance well-being.
34. The impact of micro- and nanoplastics on human pulmonary health; an umbrella review.
期刊: Reviews on environmental health 发表日期: 2026-Apr-16 链接: PubMed
摘要
The pervasive environmental contamination of microplastics (MPs) and nanoplastics (NPs) has raised significant public health concerns, with the respiratory tract being a critical route of exposure. While a growing body of evidence suggests adverse pulmonary effects, a comprehensive synthesis of systematic reviews (SRs) is lacking. This umbrella review systematically consolidates evidence from published SRs to evaluate the impact of MP and NP exposure on human pulmonary health. Accordingly, a comprehensive literature search was conducted across multiple databases. Fifteen SRs meeting the inclusion criteria were critically appraised using the AMSTAR-2 tool and included for narrative synthesis. The evidence unequivocally links MP/NP exposure to a spectrum of respiratory pathologies. Key determinants of toxicity can include particle size, shape, and polymer chemistry. NPs penetrate deeply into alveoli, causing oxidative stress, inflammation, and translocation, while MPs act as persistent irritants in the airways. Exposure is associated with acute conditions (airway inflammation, alveolar damage) and chronic diseases, including chronic bronchitis, chronic obstructive pulmonary disease (COPD) exacerbation, and pulmonary fibrosis. These effects lead to functional impairments such as reduced gas exchange and a progressive decline in lung function. Urban residents, occupational workers, and children are identified as high-risk populations due to heightened exposure and susceptibility. This synthesis study establishes MPs and NPs as a significant and multifaceted hazard to respiratory health. Addressing the global plastic pollution crisis at its source is paramount for protecting respiratory health.
35. Mapping the multiscale neuroanatomy of GRN-related frontotemporal dementia using mode-based morphometry.
期刊: NeuroImage. Clinical 发表日期: 2026-Apr-15 链接: PubMed
摘要
Individuals carrying Progranulin (GRN) mutations show asymmetrical grey matter atrophy, which could be used for early detection in the long asymptomatic phase. To capture these alterations, we employed both conventional Surface-Based Morphometry (SBM) and Mode-Based Morphometry (MBM). While the former provides high-resolution, location-specific estimates of cortical thickness (CT) differences, the latter has recently been introduced as a novel framework that decomposes CT maps into geometric eigenmodes, allowing a multiscale characterization of brain structural variability. Using both approaches enables the detection of complementary aspects of GRN-related neurodegeneration across spatial scales. SBM and MBM were applied to CT maps to quantify structural alterations in individuals, 15 presymptomatic and 27 symptomatic, compared to 19 healthy controls (HC). SBM was used to assess vertex-wise CT differences, whereas MBM was used to decompose individual CT maps into geometric eigenmodes and quantify alterations across spatial scales. From both pipelines asymmetry indices (SBM-AI and MBM-AI) were computed. Associations between SBM/MBM-derived measures and domain-specific cognitive performance as well as global disease severity scores were then assessed. Compared with HC, symptomatic GRN showed significant alterations in seven eigenmodes in the left hemisphere, while only two modes contributed to CT differences in the right hemisphere. For MBM-AI and SBM-AI symptomatic GRN exhibited significantly different values compared to HC and presymptomatic GRN (p < 0.001). Although both asymmetry indices showed significant differences across disease stages (p = 1.3 × 10-5 SBM-AI; p = 3.5 × 10-5 MBM-AI), only the MBM-AI revealed a U-shaped trajectory across disease progression, characterized by an early increase in asymmetry followed by a partial re-symmetrisation in later stages. MBM revealed multiscale cortical alterations in symptomatic GRN mutation carriers, capturing both large-scale hemispheric differences and more localized regional variations in CT that are less apparent with conventional SBM. These findings indicate that GRN-related neurodegeneration involves complex spatial pattern across multiple anatomical scales. Brain asymmetry remains a core hallmark of GRN-related pathology, supporting the use of asymmetry indices (derived from both SBM and MBM) as potential markers of disease progression at the symptomatic stage.
36. Engineering fast-acting anti-itching multifunctional dressing with quercetin-CD-MOF for atopic dermatitis.
期刊: Biomaterials advances 发表日期: 2026-Apr-13 链接: PubMed
摘要
Atopic dermatitis (AD) is a chronic inflammatory skin disorder characterized by susceptibility to infection and recurrent pruritus. Clinical treatment often focuses solely on skin lesions while neglecting direct control of pruritus symptoms. Herein, this study reports a novel powdered dressing (Que@CD@PH) that integrates in situ gelation, wet adhesion, and burst release of drugs for the treatment of AD. This dressing is composed of ε-polylysine, NHS-esterified hyaluronic acid, and quercetin-loaded water-soluble cyclodextrin metal-organic frameworks (Que@CD). Upon application to moist skin, it rapidly forms an adhesive gel, providing physical protection. Under the action of water molecules, the metal-organic framework structure of Que@CD rapidly decomposes, releasing quercetin to exert antipruritic effects. Meanwhile, Que@CD exhibits excellent biocompatibility and can directly scavenge reactive oxygen species at the lesion site while inhibiting the proliferation of AD-susceptible pathogenic bacteria such as Staphylococcus aureus (with a clearance ratio exceeding 99%), thereby alleviating skin inflammation through two key pathological mechanisms-oxidative stress and bacterial infection-and laying the foundation for subsequent remodeling of the immune microenvironment. Further mechanistic studies revealed that the dressing promotes macrophage polarization from the M1 to the M2 phenotype through activation of the AMPK/NRF2/HO-1 pathway, thereby exerting immunomodulatory effects. In a DNCB-induced mouse model of AD, Que@CD@PH alleviated dermatitis symptoms, reduced scratching frequency by 71.4%, lowered IgE (Immunoglobulin E) levels by 45.6%, and suppressed Th2-type inflammatory cytokines. This work presents a translatable strategy for managing AD through a biocompatible dressing with synergistic antipruritic, antibacterial, and immunomodulatory functions.
37. Polygenic depression risk, childhood parental substance abuse, and G×E interaction in divergent depression trajectories from middle to late adulthood.
期刊: Journal of psychiatric research 发表日期: 2026-Apr-12 链接: PubMed
摘要
National life course studies examining the interplay between genetic risk, parental substance abuse, and lifelong depression are lacking, despite the need for individualized interventions. This study investigates how the interaction between polygenic risk for depression and childhood exposure to parental substance abuse is associated with depression trajectories from mid-to late adulthood. Data from 14 waves (1994-2020) of the Health and Retirement Study included 7512 participants of European ancestry aged 51-90 years. Primary predictors were childhood parental substance abuse, polygenic depression-risk scores, and their interaction. Growth-curve linear mixed models estimated depressive symptoms (Center for Epidemiologic Studies-Depression [CES-D] scale, standardized) trajectories, and logistic mixed-effects models applied to binary probable clinical depression. Higher polygenic risk scores were associated with elevated depressive symptoms (β = 0.074; 95% CI = 0.058-0.090) and greater odds of probable clinical depression (OR = 1.38; 95% CI = 1.28-1.49). Childhood parental substance abuse was also associated with higher depression risk (OR = 1.61; 95% CI = 1.32-1.96). A significant gene × environment interaction revealed that the adverse effect of parental substance abuse on depressive trajectories was amplified among individuals with high genetic risk (P < 0.05), particularly in the mid-fifties and mid-sixties. Findings underscore the importance of considering both genetic susceptibility and early-life adversity in understanding lifelong depression. Individualized prevention and intervention strategies may be critical for those with elevated genetic risk who experienced parental substance abuse, with potential to mitigate the progression of depression into later life. Since our analyses were restricted to participants of European genetic ancestry to minimize population stratification in polygenic score estimation, this may limit the generalizability of findings to other ancestral groups.
38. Dissecting the prognostic role of metabolic markers in lung neuroendocrine Tumors: The MONET study.
期刊: Lung cancer (Amsterdam, Netherlands) 发表日期: 2026-Apr-10 链接: PubMed
摘要
Lung neuroendocrine tumors (LNETs) span well-differentiated typical/atypical carcinoids (TC/AC) to poorly differentiated large-cell neuroendocrine carcinoma (LCNEC). Robust biomarkers for grading and prognostication are lacking. We hypothesized that differential metabolic pathways activation, reflected by protein expression, holds prognostic relevance. We conducted a monocentric translational study on resected LNETs to characterize biomarkers involved in glycolysis, fatty acid, and amino acid pathways across different grades of LNETs. Secondary endpoints included assessing clinical outcomes and correlating biomarker expression with patient prognosis. Digital FFPE sections underwent standardized immunohistochemistry (IHC) and quantitative image analysis. Biomarkers included glycolysis (MCT1, MCT4, CD147), amino-acid metabolism (SLC1A5, SLC7A5, GLS), and fatty-acid synthesis (FAS, ACC). Expression was summarized by H-score and dichotomized. Associations with clinicopathologic variables, recurrence-free survival (RFS), and overall survival (OS) were tested using median and maximally selected rank statistics. Overall, 49 LNETs were included: 11 TC, 19 AC; 19 LCNEC. LCNEC showed marked upregulation of glycolytic and amino-acid transport markers versus TC/AC. Fatty-acid markers were generally low across subtypes. High MCT1 and SLC7A5 predicted shorter OS; MCT1 and CD147 predicted shorter RFS. In multivariable analysis, MCT1 remained independently associated with RFS. Notably, a subset of ACs with elevated glycolysis/amino-acid markers showed LCNEC-like outcomes, independent of Ki-67. GLS peaked in AC, suggesting divergent glutamine utilization along the spectrum. Quantitative digital pathology reveals distinct metabolic signatures in LNETs. MCT1 and SLC7A5 emerge as prognostic biomarkers, with MCT1 independently predicting RFS. Integrating metabolic immunophenotyping with histopathology refines risk stratification-especially for AC-and highlights potentially actionable metabolic axes for future therapeutic interventions in LNETs.
39. Mental health, health-related quality of life, and material and social deprivation: A hierarchical analysis of their relationships and determinants in people attending a Greek public hospital.
期刊: Maturitas 发表日期: 2026-Apr-08 链接: PubMed
摘要
To assess material and social deprivation, mental health, and health-related quality of life (HRQoL) and their determinants among patients and accompanying persons attending a public hospital cardiology clinic in Athens, Greece. Cross-sectional study, conducted in 2024. Patients and accompanying persons aged over 30 years were included. Material and social deprivation were measured using the European Union Material and Social Deprivation Index. Participants self-reported sociodemographic and lifestyle characteristics, medical history, HRQoL, and mental health indicators. Analyses were guided by a hierarchical framework using univariate and multivariate logistic regression. Among 456 participants (59% female; 25% aged ≥65 years; 40% with ≤12 years of education), 46.3% experienced deprivation, including 28.5% with severe deprivation, almost double the national estimates for 2024. Lower educational attainment, older age, and unemployment were significant determinants of deprivation. Smoking, sleep duration, and presence of physical health conditions were independently associated with deprivation. Deprived individuals reported substantially worse HRQoL, higher depressive symptoms and clinically significant anxiety, and lower life satisfaction. Material and social deprivation was highly prevalent and closely linked to adverse sociodemographic and lifestyle characteristics, physical morbidity, and impaired mental health and HRQoL. Routine assessment of deprivation in clinical care and targeted support programs for vulnerable populations are warranted.
40. Development of donkey milk fermented with Lactococcus lactis subsp. lactis CECT 31096 and characterization of the antioxidant and antihypertensive activity.
期刊: International journal of food microbiology 发表日期: 2026-Apr-07 链接: PubMed
摘要
Donkey milk (DM) is a nutritionally rich source of bioactive compounds, essential vitamins and minerals. However, its potential for developing functional fermented products remains unexplored. To address this gap, we investigated microbial dynamics during spontaneous fermentation of raw Zamorano-Leonese DM to isolate lactic acid bacteria (LAB) suitable for dairy applications. Raw milk from Zamorano-Leonese breed donkeys, raised on an organic farm in Salamanca (Spain), was spontaneously fermented at 37 °C until reaching pH 4.6. Metataxonomic analysis revealed a clear shift from environmental bacteria dominating the raw milk to an increased prevalence of LAB at the end of the fermentation process. Through culturomics, 34 bacterial strains were isolated and identified by 16S rRNA gene sequencing, including ten potential LAB candidates. Among these, five Lactococcus lactis isolates were selected to ferment pasteurized DM, which showed promising technological features and were subsequently subjected to whole-genome sequencing. L. lactis subsp. lactis CECT 31096 was selected due to its broad enzymatic repertoire linked to fermentation and the absence of antibiotic resistance or virulence-related genes. When used to ferment pasteurized DM, this strain improved both the physicochemical and nutritional profile of the resulting product. Fermentation significantly enhanced the bioaccesibility of bioactive compounds, as demonstrated by a higher inhibition of angiotensin-converting enzyme (the fermented sample showed IC50 values of 3.17 g/L compared with IC50 7.23 g/L from pasteurized milk), doubling after digestion (IC50 1.25 g/L). Additionally, fermentation with L. lactis subsp. lactis CECT 31096 significantly increased soluble free phenols and peptides, boosting the reducing power and antioxidant capacity, and thereby enhancing the functionality of the final product.
41. Leveraging deep learning to infer continuous predictions from ordinal labels in medical imaging.
期刊: PLOS digital health 发表日期: 2026-Apr 链接: PubMed
摘要
In clinical medicine, variables like disease severity are often categorized into discrete ordinal labels such as normal/mild/moderate/severe. However, these labels, commonly used to train and evaluate disease severity prediction models, simplify an underlying continuous severity spectrum. Using continuous scores can aid in detecting small severity changes more sensitively over time. We introduce a deep learning based approach that predicts continuously valued variables from medical images using only discrete ordinal labels during model development. We evaluated this approach using three medical imaging datasets: disease severity prediction for retinopathy of prematurity and knee osteoarthritis, and breast density prediction from mammograms. Deep learning models were trained with discrete labels, and model outputs were transformed into continuous scores. These were then compared against detailed expert severity assessments, which exceeded the granularity of training labels. Our study explored conventional and Monte Carlo dropout multi-class classification, ordinal classification, regression, and twin models. We found that models incorporating the ordinal nature of training labels significantly outperformed conventional multi-class classification. Notably, continuous scores from ordinal classification and regression models demonstrated a higher correlation with expert severity rankings and lower mean squared errors than multi-class models. The application of Monte Carlo dropout further enhanced the prediction accuracy of continuously valued scores, aligning closely with the continuous target variable. Our findings confirm that accurate continuous scores can be learned from discrete ordinal labels using deep learning, offering a robust method that effectively bridges the gap between discrete and continuous data across various image analysis tasks.
42. Equity, accessibility, and public health implications of digital platforms delivering real-time air quality information: A technology review.
期刊: PLOS digital health 发表日期: 2026-Apr 链接: PubMed
摘要
According to the World Health Organization, air pollution is the largest environmental risk to global health, with 99% of the world’s population living in areas exceeding recommended guidelines. Providing real-time air quality information through mobile or web-based applications, alongside behavioural guidance, represents a key strategy for reducing individual exposure and improving population health. Such information is delivered at varying geographic and temporal scales and has become increasingly widespread and decentralised. However, there is limited understanding of the quality, characteristics, and potential health impacts of digitally available air quality information and messaging. This study addresses this gap through a systematic technology review of publicly available digital platforms (“channels”) that share real-time local air pollution data. Using the UK as a case study, computational methods were applied to examine how data underpinning existing channels (websites, mobile applications, sensors, etc.) are generated and by whom. Systematic searches of Google, the Google Play Store (Android), and Apple App Store (iOS) were conducted using SerpAPI and predefined search terms. In total, 146 channels met inclusion criteria and were analysed. Channel metadata were used to identify trends in channel types, evolution over time, and emerging patterns across the digital information landscape. The review also compares differences in available information across channels but is limited to those accessible in the UK and excludes real-time social media data due to cost and access constraints. Finally, the study considers demographic and social factors influencing access to air quality information and its exposure-reducing benefits. These findings contribute to understanding the production and use of digital air quality information with global public health relevance.
43. Sustainable Synthesis of ZnO Nanoparticles From Melon (Cucumis melo L.) By-Products: RSM Optimization, Structural Characterization, Antioxidant Activity, and Photocatalytic Performance.
期刊: Chemistry & biodiversity 发表日期: 2026-Apr 链接: PubMed
摘要
This study explores the eco-friendly synthesis of zinc oxide nanoparticles (ZnO-NPs) using polyphenol-rich extracts from melon (Cucumis melo L.) peel and seeds as natural reducing and stabilizing agents. Optimization via response surface methodology (RSM) determined the ideal synthesis conditions at a 0.078 mol/L metal concentration, 14.73 mL extract, and pH 10.77. Characterization through XRD confirmed a hexagonal wurtzite crystal structure with an average size of 21.7 nm, while SEM and TEM imaging revealed predominantly spherical morphologies. UV-visible DRS analysis showed a 368 nm absorption edge with a calculated band gap of 3.21 eV. DLS measurements indicated a hydrodynamic diameter of 135.6 nm with a PDI of 0.206 and a zeta potential of -20.5 mV, confirming good colloidal stability. The resulting NPs exhibited strong antioxidant activity (IC50 = 40.7 µg/mL) and acted as effective heterogeneous photocatalysts for the degradation of organic dyes. Specifically, ZnO-NPs enabled the photodegradation of methyl orange (MO) and methylene blue (MB), achieving 63.56% degradation for 5 mg L-1 MO. These findings demonstrate that melon-waste-derived ZnO-NPs are sustainable and promising candidates for wastewater treatment and environmental remediation.
44. Alternative Approaches and Plant-Based Remedies for Livestock Health Management Among the Batswana of Southern Africa: A Review.
期刊: Chemistry & biodiversity 发表日期: 2026-Apr 链接: PubMed
摘要
Due to limited access to, and the high cost of conventional veterinary services, Batswana communities often rely on ethnoveterinary practices for livestock health management. This review provides an in-depth analysis on the ethnoveterinary uses, biological properties and safety assessment of plants utilised in livestock husbandry. A systematic literature search was conducted using scientific databases, focusing on articles published from 1997 to 2024. After generating the inventory of plants with ethnoveterinary data, further search was conducted to assess the documented biological activities, safety, and phytochemicals for the recorded plants. A total of 116 plants were documented as remedies for managing nine livestock conditions. The most cited health conditions were retained placenta (81 citations), diarrhoea (65), and wounds (44). The most prominent plants were Senna italica (10 citations), Terminalia sericea (8 citations), and Ziziphus mucronata (8 citations). Approximately 52% of the 116 plants with ethnoveterinary records have empirical data on their biological effect, safety, and phytochemicals. Antimicrobial screening was the most common assay conducted (36%), which dominantly used microbial strains such as Staphylococcus spp., Pseudomonas aeruginosa, and Escherichia coli. We established the vital role of ethnoveterinary practices in Batswana livestock management and the potential of plants in sustainable veterinary care.
45. Co-Design of strategies to enhance access to Virtual Urgent Care models by equity-deserving populations.
期刊: PLOS digital health 发表日期: 2026-Apr 链接: PubMed
摘要
Virtual urgent care (VUC) was introduced in 2020 across the province of Ontario, Canada, during the COVID-19 pandemic to provide urgent care for lower-acuity health needs for patients who did not require in-person care. Persons from equity-deserving populations (EDPs) often face barriers in using virtual models of care. To raise awareness and improve uptake of VUC among EDPs, a World Café was organized that convened a diverse group of individuals from healthcare, community, research, and/or people with living/or lived experience of health conditions to co-design VUC outreach strategies. The panel consisted of 36 persons (22 invitees; 14 members of the study team) who participated in a one-day, in-person event to reflect on key considerations related to VUC delivery for EDPs through facilitated small and large group discussions. We recorded all discussions via note-takers and analyzed the notes using content analysis. From this analysis, we identified three categories: a) lack of awareness about VUC and accessibility barriers; b) addressing issues of digital literacy and ensuring the perceived credibility of VUC; and c) opportunities for advancing VUC. Given the potential of VUC to serve as a culturally safe modality for EDPs, the World Café event served as a meaningful opportunity to exchange knowledge on health equity and to co-design strategies for improved awareness and uptake of VUC by EDPs.
46. Hurricanes, Neighborhood Disadvantage, and Cardiopulmonary Health in US Veterans.
期刊: JAMA network open 发表日期: 2026-Apr-01 链接: PubMed
摘要
Global climate change is increasing the frequency and severity of hurricanes, which are associated with adverse health outcomes. Veterans may be more susceptible to the health impacts of hurricanes because of prior military exposures. To determine whether hurricane exposure is associated with cardiovascular and respiratory events among US veterans. This retrospective cohort study included US veterans enrolled in Veteran Health Administration (VHA) primary care who lived in areas affected by Hurricane Sandy (2011-2013) or Hurricane Harvey (2016-2018). Data were analyzed between June 2024 and February 2026. Study areas were defined by VHA Veterans Integrated Service Networks (VISNs): VISN 1, 2, 3, 4, and 6 for Hurricane Sandy, and VISNs 16 and 17 for Hurricane Harvey. Living in an area affected by Hurricane Sandy or Hurricane Harvey. Outcomes of interest were cardiovascular events (CVEs) and respiratory events (REs) that required urgent care and/or emergency department visits or in-patient admission. Associations between hurricane exposure and outcomes were estimated using Andersen-Gill Cox regression models. Among veterans enrolled in VHA primary care, 1 468 774 lived in the study area during the quarter that Hurricane Sandy occurred, and 1 009 352 lived in the study area during the quarter that Hurricane Harvey occurred. After excluding veterans who were deceased at time of the hurricane or had incomplete data, the analytic cohort included 960 178 veterans exposed to Hurricane Sandy (mean [SD] age, 63 [16] years; 895 646 male [93.30%]) and 654 178 veterans exposed to Hurricane Harvey (mean [SD] age, 60 [16] years; 589 003 male [90.04%]). The analyses included 95 795 CVEs and 120 197 REs for the Hurricane Sandy cohort, and 91 774 CVEs and 98 660 REs for the Hurricane Harvey cohort. Higher levels of neighborhood disadvantage (for healthier veterans with highest levels of disadvantage, hazard ratios [HRs] for CVE were 1.75 [95% CI, 1.63-1.88] for Hurricane Sandy and 1.63 [95% CI, 1.48-1.80] for Hurricane Harvey; HRs for RE were 1.50 [95% CI, 1.43-1.58] for Hurricane Sandy and 1.67 [95% CI, 1.55-1.79] for Hurricane Harvey), age (among healthier veterans aged 60-70 years, HRs for CVE were 2.23 [95% CI, 2.11-2.35] for Hurricane Sandy and 4.12 [95% CI, 3.87-4.39] for those aged ≥70 years for Hurricane Harvey; HRs for RE among sicker veterans were 1.12 [95% CI, 1.08-1.16] for Hurricane Sandy and 1.31 [95% CI, 1.24-1.39] for Hurricane Harvey), and sex (among healthier female veterans, HRs for CVE were 0.52 [95% CI, 0.46-0.59] for Hurricane Sandy and 0.49 [95% CI, 0.44-0.53] for Hurricane Harvey; HRs for RE were 1.38 [95% CI, 1.32-1.43] for hurricane Sandy and 1.36 [95% CI, 1.31-1.41] for Hurricane Harvey) were associated with CVEs and REs in both cohorts. There were no associations between hurricane exposure and CVEs and REs after accounting for baseline differences between exposure regions. This cohort study of 1 614 356 US veterans used an approach that addresses preexisting differences to isolate the association of hurricane exposure with CVEs and REs among veterans. Although changes in HRs specifically attributable to hurricane exposure were not significant, neighborhood disadvantage, advancing age, and sex remained independently associated with acute health events. These findings suggest that disaster preparedness policies should shift from a reactive model toward a longitudinal strategy that addresses baseline social determinants of health and regional environmental hazards.
47. Thermal comfort, health, and performance effects among outdoor workers in northern Sweden.
期刊: Annals of work exposures and health 发表日期: 2026-Mar-12 链接: PubMed
摘要
To investigate subjective differences in thermal comfort, health, and performance outcomes between different outdoor professions and the sexes. The current study also aimed to explore whether thermal comfort affected health and performance outcomes. A questionnaire was used to collect data from three different professions: preschool (n = 65), park and maintenance (n = 36), and power grid workers (n = 31). The questionnaire contained items related to background variables (sex, age, body mass index, tobacco use, pre-existing diseases, and clothes provided by the employer), thermal comfort, self-assessed health, and performance outcomes. The findings show that women, to a greater extent than men, experience cold-related discomfort while working in cold environments. Cold sensitivity was most common among park and maintenance workers (57%) and power grid workers (47%). Raynaud’s phenomenon and abnormal cold sensitivity were most common among park and maintenance workers, with a prevalence of 31% and 56%, respectively. Statistically significant differences were also found in all reported performance outcomes (concentration, endurance, mobility, strength, and speed) between the different professions. Associations between cold-related discomfort and an increased reporting of health symptoms and a decrease in performance outcomes were found. There were differences in perceived thermal comfort, health, and performance outcomes between different outdoor professions and sexes. The associations between cold-related discomfort, cold-related symptoms, and decreased performance indicate a need to implement cold risk management to ensure a safe work environment.
48. Occupational noise exposure and hearing assessment of hydraulic fracturing employees.
期刊: Annals of work exposures and health 发表日期: 2026-Mar-12 链接: PubMed
摘要
Oil and gas extraction companies are exempt from implementing hearing conservation programs for their employees according to the Occupational Safety and Health Administration’s (OSHA) noise standard. The occupational noise exposure and hearing status of these employees has not been published in scientific literature before the present study, presumably due to this exemption. In this study, area and personal noise exposures and employee hearing acuity were measured at both conventional and quiet hydraulic fracturing fleets, allowing a comparison between the fleets. Quiet fleets refer to the use of engineering controls to decrease noise levels of the pumps while conventional fleets do not employ these measures. In both fleets, the authors performed personal noise dosimetry, equipment noise measurements, and pure tone audiometry pre- and post-work shift to determine if there were temporary threshold shifts (TTS) in hearing. Based on the personal noise dosimetry results, 42/50 (84%) of the quiet fleet employees and 34/34 (100%) of the conventional fleet employees sampled were at or over 100% noise dose according to the American Conference of Governmental Industrial Hygienists’ (ACGIH) noise Threshold Limit Value (TLV®). Based on the OSHA permissible exposure limit (PEL) noise criteria, 9/50 (18%) of the quiet fleet employees and 15/34 (44.1%) of the conventional fleet employees were at or over 100% noise dose. Employees in both fleets experienced TTS, but no significant difference was observed between the types of fleets in relation to TTS. Most equipment of both fleets exceeded 85 decibels, but the pumps of the quiet fleet were approximately 14 dB lower than those of the conventional fleet. Although the quiet fleet noise controls reduced personal noise exposure, a portion of the quiet fleet employees sampled still experienced noise levels that could increase the risk of hearing loss. The researchers suggest the initiation of a hearing conservation program despite OSHA exemption to safeguard employee health and recommend employees involved in certain job tasks employ dual hearing protection based on the exposure monitoring results.
49. Gout prevalence and management strategies among patients with moderate to advanced chronic kidney disease.
期刊: Jornal brasileiro de nefrologia 发表日期: 2026 链接: PubMed
摘要
Gout commonly coexists with chronic kidney disease (CKD), with prevalence increasing as kidney function declines. Despite its burden, data on monitoring and treatment practices in CKD are limited. This study describes the prevalence, characteristics, and management of gout in non-dialysis CKD patients. Cross-sectional data were analyzed from 3,524 stages 3a-5 CKD patients in the Chronic Kidney Disease Outcomes and Practice Patterns Study (CKDopps) in Brazil (n = 942) and the United States (n = 2,582) at enrollment (2013-2022). History of gout was extracted from medical records. Gout prevalence was 18.7% overall-20.5% in the US and 13.9% in Brazil-higher in stages 4-5 vs. 3a-3b CKD. Allopurinol was most used (Brazil 75%; US 62%). Colchicine (13%) and febuxostat (8%) were reported in the US but rarely in Brazil. Uric acid was measured in 70% of Brazilian vs. 33% of US gout patients. Gout is common in CKD, with notable cross-country differences in monitoring and treatment.
50. Unguided web-based brief intervention with genetic risk education to reduce unhealthy alcohol consumption in Japan: Protocol for a randomized controlled trial.
期刊: PloS one 发表日期: 2026 链接: PubMed
摘要
Alcohol consumption is a major global contributor to morbidity and mortality and is a well-established risk factor for multiple cancers. Acetaldehyde, a toxic metabolite of ethanol, is a causal factor in alcohol-related esophageal cancer. A substantial proportion of the Japanese population carries the aldehyde dehydrogenase 22 (ALDH22) allele, which impairs ALDH2 enzymatic activity and increases acetaldehyde exposure, thereby elevating esophageal cancer risk. Among individuals with the ALDH22 allele, cancer risk demonstrates a clear dose-response relationship with alcohol consumption, with relative risks reported to be up to four times the relative risk, compared to non-carriers. This project aims to evaluate the efficacy of an unguided, web-based brief intervention (BI) incorporating genetic cancer-risk education to reduce alcohol consumption in a randomized controlled trial. Participants will be recruited online between March and July 2026 through a Japanese research panel company. Eligibility will include moderate alcohol use and probable ALDH22 allele status. Participants will be randomized to either an experimental condition or a sham educational control. The experimental group will receive an unguided, web-based, brief video intervention providing information on genetic cancer risks associated with alcohol consumption and the benefits of reducing drinking. The primary outcome will be mean past-4-week alcohol quantity at the 3-month endpoint. Secondary outcomes will include alcohol use in grams, alcohol-related severity, motivation to change, health-knowledge retention, participant satisfaction, and quality of life. Assessments will occur at baseline and at 1, 2, and 3 months post-randomization via a secure web portal. This intervention is expected to reduce unhealthy alcohol use at low implementation cost by leveraging personalized genetic risk information as a motivational mechanism in the general population. Additional between-group differences are anticipated across secondary alcohol-related outcomes. Trial Registration: This trial registered on 11/28/2025 in the University Hospital Medical Information Network Clinical Trials Registry (UMIN000058012).
51. Patients with chronic kidney disease stage 3b: do general practitioners and nephrologists follow KDIGO guidelines?
期刊: Jornal brasileiro de nefrologia 发表日期: 2026 链接: PubMed
摘要
Appropriate referral and management of patients with chronic kidney disease (CKD) from primary care to nephrologists are essential to prevent disease progression and complications. To describe the demographic and follow-up characteristics of patients with CKD stage 3b at the time of nephrology referral, the medical care offered by general practitioners, and the initial care provided by nephrologists in the Brazilian Unified Health System (SUS). This retrospective cohort study included all patients with CKD stage 3b on the waiting list for nephrology consultation between January 2018 and January 2020 in a large city in southern Brazil. Sociodemographic data, comorbidities, and adherence to follow-up recommendations based on the 2021 Kidney Disease: Improving Global Outcomes (KDIGO) guidelines were analyzed. Laboratory test requests and results were compared between the periods of general practitioner care and the period following nephrology consultation. A total of 211 patients (mean age 74 ± 12 years) were included; 76.0% were hypertensive and 46.9% had diabetes. Approximately half had an adequate number of primary care appointments. Laboratory monitoring was suboptimal in both primary and specialized care. Before nephrology consultation, hemoglobin and urinalysis were available for 32.2% and 19.4% of patients, respectively. After consultation, hemoglobin and potassium results were documented in 68.3% and 58.8% of patients, respectively. Although patients with CKD stage 3b were regularly followed, low adherence to KDIGO testing recommendations raises concerns about the adequacy of care. Strengthening communication and guideline implementation between primary care and nephrology services is crucial to improve CKD management within the SUS.
52. Diagnostic testing intensity for Legionnaires' disease: Spatio-temporal assessment and its effect on surveillance case reporting, Denmark, 2014-2022.
期刊: PloS one 发表日期: 2026 链接: PubMed
摘要
The global, national and subnational geographical and temporal distribution of reported Legionnaires’ disease is extremely heterogeneous, and it is unknown to what extent this accurately reflects the variation in true disease incidence. We studied how diagnostic testing intensity varied across Danish municipalities between 2014 and 2022, how it influenced epidemiological surveillance, and how testing-adjusted reporting can be used to improve the study of disease incidence and its determinants. We used data from the clinical Danish Microbiology Database and the Epidemiological Surveillance System and considered a tentative causal model of how Legionella infections give rise to the observed Legionnaires’ disease surveillance data. We fitted spatio-temporal models using an approximate Bayesian inference for latent Gaussian models (INLA), providing probabilistic estimates. These allowed us to identify areas of increased risk and spatio-temporal interaction. Our assessment of the Legionnaires’ disease testing intensity in Denmark showed considerable spatio-temporal variation across the country. The estimated municipal annual testing intensity ranged from 128 to 2,446 persons receiving at least one Legionella urinary antigen or PCR test per 100,000 inhabitants. The median increased between 2014 and 2022 steadily from 275 to 620 tested persons per 100,000 inhabitants, reflecting an upward trend. The proportion of tested persons with age over 70 increased from 44.8% to 56.4%. Increasing testing intensity leads to higher case reporting, until testing intensity reaches approximately 1000-1200 tested persons per 100 000 inhabitants. The estimated municipal annual testing-adjusted case reporting ranged from 1.4 to 12.0 per 100 000 inhabitants. The median fluctuated over the study period between 2.5 (range 1.4-6.2) in 2014 and 5.2 (range 1.5-11.7) in 2022 with a flat overall time effect. We obtained estimates of the spatio-temporal variation of Legionnaires’ disease among Danish municipalities. We quantified the positive effect of testing intensity on Legionnaires’ disease reporting and found a threshold of annually testing slightly over 1% of the population above which the yield of new cases does not further increase. Despite limitations and possible bias, our study of testing-adjusted case reporting suggests that no substantial increase in Legionnaires’ disease has occurred over the nine-year study period. Instead, case ascertainment by physicians has improved considerably through increased Legionella testing, particularly in elderly patients. Insight in the variation of testing intensity and its effect on Legionnaires’ disease reporting can be used to improve guidance for Legionnaires’ disease diagnosis, to better study determinants of Legionnaires’ disease, and ultimately to improve Legionnaires’ disease prevention and control.
53. Risk prediction for cardiovascular related diseases using PRS and EHR in the Framingham Heart Study.
期刊: PloS one 发表日期: 2026 链接: PubMed
摘要
Cardiovascular disease is a leading cause of mortality and rising healthcare costs worldwide. Fortunately, the disease is preventable, and addressing risk factors can significantly reduce its effects. Over the past decade, risk prediction models have advanced significantly, with polygenic risk scoring analysis, which is often used in combination with clinical health information for prediction. However, most previous cardiovascular disease prediction studies based on polygenic risk scores have focused on a single specific disease or event, such as cardiac events. Given the complex nature of the cardiovascular disease, which involves a combination of genetic and environmental factors, a comprehensive analysis of the disease prediction results is essential. In this study, we investigate the genetic and environmental factors contributing to cardiovascular disease by utilizing data from the Framingham Heart Study, a leading cardiovascular cohort. We compared the prediction performance of different methods across various scenarios and assessed performance using various evaluation metrics to identify the best-fitting model for six cardiovascular related diseases. We also analyzed the feature importance of genetic and clinical variables, noting that different variables had varying effects on each disease. Our findings demonstrated the performance of prediction algorithms in forecasting cardiovascular disease by utilizing genetic and clinical factors, as well as highlighting the importance of each feature in the disease prediction. While models relying solely on polygenic risk score showed relatively low prediction performance for some diseases, integrating genetic information with clinical data improved prediction performance in most cases. For certain diseases, particularly those known to be heritable, polygenic risk scores demonstrated predictive ability, suggesting that they may serve as standalone predictive tools. We believe our study reveals the value of combining polygenic risk scores with clinical variables and expect that our thorough analysis can inform study designs tailored to specific diseases and research objectives.
54. Implementation fidelity of a community-based Aedes aegypti breeding site elimination program for dengue control in southeastern Mexico.
期刊: PloS one 发表日期: 2026 链接: PubMed
摘要
Dengue is a globally significant arboviral disease in tropical regions such as southeastern Mexico. The “Healthy Environments and Communities” (E&CS) program, led by the Health Secretariat, promotes community practices to eliminate Aedes aegypti breeding sites. However, factors influencing its implementation and fidelity remain unclear. To determine the factors affecting fidelity in implementing the E&CS program targeting breeding site elimination in Río Florido, Tapachula. An observational mixed-methods study was conducted. The quantitative component evaluated fidelity among health personnel using a CFIF-based instrument, measuring Content Details, Frequency, Duration, and Coverage. Independent-samples t-tests compared mean fidelity scores between subgroups (DSVII and CSLL). The qualitative component included semi-structured interviews with health personnel and community members, coded using a priori CFIR categories and emergent themes to identify barriers and facilitators. Frequencies of barriers and facilitators among health personnel subgroups were compared using Fisher’s exact test, and chi-square tests assessed differences in distribution. Overall mean fidelity was 91.2% (95% CI: 88.5-93.4%). By construct, Content Details reached 92.4%, Frequency 89.8%, Duration 90.5%, and Coverage 91.3%. Among health personnel (n = 23; 142 responses), Fisher’s exact test showed no significant differences (p > 0.05). After combining responses, the distribution did not differ from chance (χ² = 9.73, df = 6, p = 0.136). In the Río Florido community, significant differences were observed (χ² = 83.16, df = 11, p < 0.001). Main barriers included “insufficient attention from the health center” and perceiving the Health Secretariat as responsible for dengue. Key facilitators were recognition of E&CS, respectful relationships with health personnel, and belief in program success. High fidelity of the E&CS program (>90%) in Río Florido was accompanied by a differentiated pattern of barriers and facilitators, balanced among health personnel but uneven in the community. Addressing these factors through an implementation research (IR) approach could strengthen the sustainability and effectiveness of dengue control strategies.
55. Impact of prophylactic oral azithromycin during labor on Azithromycin Resistance (AMR) in nasal Staphylococcus aureus and Streptococcus pneumoniae in women and infants in the multi-country Azithromycin Prevention in Labor Use Study (A-PLUS).
期刊: PloS one 发表日期: 2026 链接: PubMed
摘要
Prophylactic oral azithromycin vs. placebo reduced maternal, but not neonatal, mortality/sepsis in the A-PLUS Randomized Trial. While prophylactic intrapartum azithromycin reduces maternal mortality/sepsis, it may promote antimicrobial resistance (AMR) in commensal bacteria,. Randomly selected women and their infants participating in A-PLUS were enrolled in a longitudinal cross-sectional sub-study to assess the presence of azithromycin resistance in selected bacteria in nasal cultures. Staphylococcus aureus and Streptococcus pneumoniae were cultured on selective agar, then azithromycin-containing agar to select for azithromycin resistant bacteria, identified biochemically. Azithromycin susceptibility was assessed by E-test. Nasal cultures were collected from women and infants between August 11, 2021 and September 18, 2023 during labor/day 1, day 7, 6 weeks, and 3, 6 and 12 months after delivery. The study enrolled 911 women and 915 liveborn infants at 8 sites in 7 countries. Azithromycin resistance in S aureus was higher and azithromycin susceptibility was lower in women receiving azithromycin compared with those receiving placebo on day 7 (P < 0.001), 6 weeks (P < 0.001) and 3 months (P = 0.009) after delivery. Azithromycin resistance in S aureus was also higher and azithromycin susceptibility was lower 6 weeks after delivery (P < 0.001) in infants born to women receiving azithromycin, Azithromycin resistance in S. pneumoniae was too sparse to interpret. There was an increase in prevalence of azithromycin resistance (or reduction in azithromycin susceptibility) in commensal nasal S. aureus between day 7, 6 weeks and 3 months in women exposed to azithromycin vs. placebo and only at 6 weeks in infants exposed to azithromycin vs. placebo. These differences between the azithromycin and placebo groups were no longer detected at 6 and 12 months post-partum in the women and after 6 weeks through 12 months in the infants.