公共卫生研究摘要 (2026-04-19)
共收录 49 篇研究文章
1. The hidden hazards of clay: a qualitative exploration of silica exposure and well-being in ceramic art studios.
期刊: International journal of qualitative studies on health and well-being 发表日期: 2026-Dec-31 链接: PubMed
摘要
This study examines how Ghanaian ceramic artists and students perceive and respond to crystalline silica exposure in studio environments, situated within Ghana’s ceramic traditions where safety infrastructure and occupational health regulation remain uneven, and how these experiences influence health awareness and artistic identity in creative practice. A qualitative interpretive phenomenological design was employed, using in-depth interviews with fifty Ghanaian ceramic artists and students with at least one year of active studio practice and exposure to clay-processing. Participants were selected regardless of respiratory symptoms to capture lived experiences. Participant observation was conducted in selected studios, and thematic analysis was applied to narratives to explore meaning-making and changing perceptions of silica-related health risks. Findings identified a process through which artists integrate health awareness into their artistic identity, moving from initial disbelief about clay-related danger to increased bodily awareness, fear, and negotiating of normalized studio risk. Participants reported persistent chronic cough, chest tightness, and breathing difficulties associated with prolonged dust exposure, generatinganxiety and behavioral adaptations. Silica exposure is a cultural, educational, and institutional issue, requiring integrated health education, improved studio design, strengthened safety communication, and embedded occupational health practices to sustain long-term creative practice.
2. Evaluating the Environmental Impact of Clinical Research: A Full Life Cycle Analysis of a French Academic Randomised Clinical Trial.
期刊: Fundamental & clinical pharmacology 发表日期: 2026-May 链接: PubMed
摘要
Climate change poses the greatest threat to human health in the 21st century. The healthcare sector contributes approximately 5% of global greenhouse gas emissions and has a significant environmental impact. Although clinical trials are crucial for identifying effective and safe treatments and preventing disease, their environmental impact is poorly documented. Our study aimed to assess the environmental impact of a publicly funded, academic clinical trial by adapting life cycle assessment (LCA) methodology to clinical research. We performed a retrospective, simplified, full LCA using the EF 3.0 methodology on a prospective, double-blind, randomised controlled neurosurgery trial. The trial included 202 patients at 18 university hospitals throughout France. To identify hotspots of interest, 16 impact indicators and their combination into a single score were evaluated. The results showed that climate change (or greenhouse gas emissions) was the most important indicator, accounting for almost 30% of the single score. Greenhouse gas emissions were estimated at 31.6 t of carbon dioxide equivalent. The next most important were resource use of fossils (24%), resource use of minerals and metals (12%), and particulate matter emissions (8%). The main hotspots identified were patient transport and travel by clinical research assistants for source data verification. In conclusion, by using a full LCA approach, our study confirms that conducting a clinical trial has a substantial environmental impact, particularly with regard to greenhouse gas emissions. The main hotspots identified were related to patient transport and clinical research assistants’ travel. Trial Registration: The SUCRE study (Treatment of Chronic Subdural Hematoma by Corticosteroids: A Prospective Randomised Study)-clinicaltrials.gov identifier: NCT02650609.
3. Global Vaccine Confidence at a Crossroads: Immunisation Coverage Declines, Misinformation, and the Future of Vaccine Policy.
期刊: Reviews in medical virology 发表日期: 2026-May 链接: PubMed
摘要
Vaccination remains one of the most effective public health interventions; however, recent global trends indicate a reversal in routine immunisation coverage alongside resurgent outbreaks of vaccine-preventable diseases. This review synthesises current evidence on declining immunisation coverage, the re-emergence of diseases such as measles and poliomyelitis, and the growing influence of vaccine hesitancy and misinformation on vaccine uptake. A systematic search of PubMed, Scopus, and WHO/UNICEF databases was conducted using terms including ‘vaccine hesitancy’, ‘immunisation coverage’, ‘vaccine-preventable diseases’, ‘misinformation’, and ‘vaccine policy’, covering literature published between 2000 and 2024. We examine how pandemic-related disruptions, structural inequities, and evolving information ecosystems have collectively weakened immunisation system resilience across diverse settings. Beyond epidemiological consequences, declining coverage reflects broader challenges related to trust, governance, and equity in vaccine delivery. The review highlights the limitations of reactive, outbreak-driven approaches and emphasises the central role of strong routine immunisation systems embedded within primary healthcare. We discuss policy implications for integrating behavioural and social science insights, strengthening risk communication, and advancing equity-oriented immunisation governance. We conclude that sustaining and extending global immunisation gains will depend on aligning scientific innovation with public trust and system resilience. Addressing vaccine confidence as a core component of immunisation performance is essential to safeguarding global health security in the coming decade.
4. The Effect of Empagliflozin on Renal Outcomes in Patients With Established Cardiovascular Disease: Systematic Review and Meta-Analysis of Randomised Placebo-Controlled Trials.
期刊: Endocrinology, diabetes & metabolism 发表日期: 2026-May 链接: PubMed
摘要
Empagliflozin, a sodium-glucose cotransporter-2 inhibitor (SGLT2i), may be associated with improved renal outcomes. However, the magnitude and potential heterogeneity of effect among patients with cardiovascular disease (CVD) remain unclear. This systematic review aimed to evaluate the efficacy and safety of empagliflozin on renal outcomes in patients with established CVD. Based on the PRISMA guideline, we searched PubMed, Embase, Scopus Google Scholar, Cochrane Library and Web of Science databases, as well as study references, to find randomised controlled clinical trials (RCTs) that evaluated the effect of empagliflozin (regardless of dose) compared with placebo on renal outcomes in patients with CVD, with no time limit, up to 20 August 2025. Outcomes included kidney disease progression, composite renal outcome, nephropathy, doubling of serum creatinine and safety. Thirteen RCTs involving 36,169 patients were included. A pooled analysis of 12 studies showed that empagliflozin was significantly associated with a reduced risk of progression of kidney disease (HR: 0.66, 95% CI: 0.58, 0.74, I2: 11.1%). Empagliflozin was also associated with a reduced risk of the composite renal outcome (HR: 0.7% 95% CI: 0.55, 0.86, I2: 0%), diabetic nephropathy (HR: 0.59% 95% CI: 0.42, 0.75, I2:0%) and doubling of serum creatinine in CVD patients (HR: 0.60% 95% CI: 0.41, 0.78, I2:0%). Empagliflozin may significantly reduce the risk of CKD outcomes in patients with CVD compared with placebo. Empagliflozin also had a favourable safety profile. Empagliflozin can be prescribed as an effective and safe antidiabetic drug in patients with CVD to improve renal outcomes and prevent CKD progression.
5. From Cure to Complexity: Post-SVR Liver and Metabolic Trajectories in Diabetic Patients.
期刊: Liver international : official journal of the International Association for the Study of the Liver 发表日期: 2026-May 链接: PubMed
摘要
The long-term impact of HCV cure on hepatic and metabolic outcomes in patients with type 2 diabetes (T2D) remains insufficiently defined. This study evaluated T2D-related vascular complications, liver disease progression and overall survival over 9 years of follow-up, also exploring genetic variability contribution. Consecutive T2D patients with HCV-related chronic liver disease or cirrhosis treated with direct-acting antivirals (DAAs) between 2015 and 2018 at the University Hospital of Messina were prospectively followed until September 2024. Demographic, biochemical, and clinical data were collected at baseline and throughout follow-up. Regression models were applied to identify predictors of metabolic and hepatic outcomes. Genetic variants-PNPLA3 rs738409, TM6SF2 rs58542926 and rs641738 at the MBOAT7/TMC4 locus-were also assessed. A total of 183 patients (52% males, median age 67 years; 56% cirrhotic) were followed for a median of 48 months (range 24-84). Despite significant improvements in HbA1c (p = 0.006), liver-stiffness (p < 0.001), gamma-globulins (p < 0.001), and aminotransferases (p < 0.001), only 27.3% maintained clinical stability. Liver disease progression occurred in 20.8% of patients and was related to cirrhosis (p = 0.021), prior decompensation (p = 0.07), and the MBOAT7 variant (p = 0.025). Macrovascular and microvascular complications developed in 50.8% and 33.9% of patients, respectively, mostly within 2 years after SVR. In multivariate models, higher TyG index (p = 0.038) predicted the composite progression endpoint, while elevated LDL cholesterol (p = 0.048), mortality. Although DAAs lead to metabolic and hepatic improvements, long-term prognosis in T2D patients remains largely determined by baseline liver disease severity, insulin resistance, and genetic background. These findings emphasize the importance of early antiviral treatment and optimized metabolic management in this high-risk population.
6. Community-Based Co-Design of Public Health Messaging for Harm Reduction and Overdose Response Technology.
期刊: Health promotion practice 发表日期: 2026-Apr-18 链接: PubMed
摘要
The overdose crisis remains a major public health emergency across North America, exacerbated by the presence of highly potent synthetic opioids and disproportionate access to harm reduction resources. To improve engagement with overdose response technology, this study employs a community co-design approach to develop and evaluate naloxone kit-based messaging, aiming to enhance awareness and uptake among people who use substances. An online workshop was conducted with eight participants to generate insights for improving public health messaging and engagement with overdose response technology. Using co-design-based methods and thematic analysis to interpret the results, the study identified several key messaging strategies and refined naloxone kit-based messaging through an iterative design process. Participants highlighted a significant gap in public awareness of overdose response technology, particularly outside of harm reduction circles, and emphasized the need for messaging that conveys safety, support, and empathy. Preferred dissemination strategies included social media campaigns, naloxone kit inserts, and partnerships with community organizations, while participants also called for increased public awareness of harm reduction resources. This study highlights critical gaps in public awareness of overdose response technology and emphasizes the need for strategic messaging to enhance accessibility. Participants stressed the importance of expanding outreach beyond harm reduction communities, using non-judgmental, supportive language, and leveraging digital and community-based dissemination methods to reach high-risk populations effectively.
7. Factors Associated With Examinations for Diabetic Complications During the COVID-19 Epidemic.
期刊: Asia-Pacific journal of public health 发表日期: 2026-Apr-18 链接: PubMed
摘要
This study investigated examinations for diabetes complications and associated factors during the COVID-19 epidemic in Korea. We used data from the 2021 Korea Community Health Survey (n = 28 477). Overall, 42.7% underwent fundus examination, and 51.7% underwent microalbuminuria examination. Factors associated with increased rates of fundus examination were increased physical activity due to COVID-19 (odds ratio [OR] = 1.16, 95% CI [1.02, 1.32]), decreased consumption of instant food (OR = 1.20, 95% CI [1.03, 1.41]), decreased alcohol drinking frequency (OR = 1.24, 95% CI [1.01, 1.53]), concern about COVID-19 infection (OR = 1.11, 95% CI [1.02, 1.20]), and COVID-19 vaccination experience (OR = 1.20, 95% CI [1.07, 1.34]). Factors associated with increased rates of microalbuminuria examination were decreased consumption of instant food decreased due to COVID-19 (OR = 1.16, 95% CI [1.00, 1.36]) and concern about criticism due to infection with COVID-19 (OR = 1.10, 95% CI [1.00, 1.20]). These results may be useful in planning for the management of chronic diseases during future periods of increased hospital workload.
8. High prevalence of a host-associated Anaplasma lineage in wild coatis (Nasua nasua) from the Brazilian Atlantic Forest.
期刊: Medical and veterinary entomology 发表日期: 2026-Apr-18 链接: PubMed
摘要
This study aimed to detect the DNA of Anaplasma spp., Ehrlichia spp., Borrelia spp. and protozoa of the order Piroplasmida in blood samples from 73 coatis captured at three sites in the Iguaçu National Park. PCR assays revealed a high prevalence of Anaplasma spp., with 47.9% (35/73) of animals testing positive for the 16S rRNA and 23S rRNA genes. None of the samples tested positive for Borrelia spp., Ehrlichia spp. or protozoa of the order Piroplasmida. Sequencing analyses indicated that all positive samples were genetically identical and closely related to Anaplasma platys and lineages previously described in cattle and ticks. Phylogenetic analyses based on multiple loci revealed distinct clades, supporting the circulation of a unique Anaplasma variant in coatis. Comparisons with tick-derived sequences showed genetic divergence, suggesting distinct strains infecting hosts and vectors. These findings provide novel insights into the epidemiology of haemoparasites in wildlife and highlight the role of coatis as potential reservoirs of diverse Anaplasma lineages in the Atlantic Forest.
9. From barriers to benefits: A personalized sleep intervention enhances sleep duration and emotional health in chronic short sleepers.
期刊: British journal of psychology (London, England : 1953) 发表日期: 2026-Apr-18 链接: PubMed
摘要
This pilot study evaluated a personalized sleep intervention incorporating motivational interviewing techniques to address sleep barriers, along with tailored sleep hygiene and extension for chronic short sleepers. Eleven university students completed a 14-day sequential intervention (baseline, sleep hygiene and a combined phase adding 90-min extension), assessed via actigraphy, daily diaries, ecological momentary assessments and qualitative interviews. The intervention was highly feasible. Total sleep time increased from 5.01 h (baseline) to 5.62 h (sleep hygiene) and 6.67 h (combined phase), alongside reduced bedtime procrastination and improved sleep hygiene practices. Multilevel modelling suggested that sleep hygiene increased time in bed (+0.72 h) and morning vitality, while sleep extension further extended time in bed (+1.49 h) and total sleep time (+0.55 h). Emotional benefits were linked to within-person increases in sleep duration. Qualitative findings highlighted heterogeneous barriers and the importance of context-based personalization. These preliminary results support the potential of personalized sleep interventions to improve sleep and emotional health in chronic short sleepers, warranting further controlled trials.
10. Causal inference in real-world dementia research: a systematic review protocol.
期刊: Systematic reviews 发表日期: 2026-Apr-18 链接: PubMed
摘要
Dementia presents complex challenges for causal inference due to its multifactorial aetiology and slow, heterogeneous progression. Randomized controlled trials are often limited in their potential to fully address these challenges because of ethical and practical constraints. As the field evolves, observational studies incorporating advanced causal inference methods are increasingly used to estimate real-world effects in dementia research. However, the implementation of these methods varies widely and has not been systematically evaluated, with an emerging trend towards integration with techniques such as machine learning. This systematic review will critically examine how causal inference techniques are applied in dementia research, assess their methodological rigor, and identify trends, assumptions, and gaps that may inform future applications and methodological innovation in the field. Following PRISMA guidelines, searches will be conducted in MEDLINE, EMBASE, Web of Science, PsycINFO, Scopus, and the Cochrane Library for studies published between 1960 and 2024. Eligible studies will include observational designs that use causal inference methods to investigate outcomes such as cognitive decline, disease progression, and quality of life. Data extraction will capture study characteristics, methodological details, and key findings, with risk of bias assessed using ROBINS-I. A narrative synthesis will summarize qualitative results, and meta-analyses will be performed when methodological homogeneity permits. This review will address a critical gap in the evaluation of the application of causal inference methods in real-world dementia research. By identifying methodological challenges, underlying assumptions, and emerging analytical techniques, it aims to strengthen research rigor and reproducibility and inform future methodological development, with potential implications for policy and practice in dementia care. PROSPERO (CRD42024619228).
11. Molecular cancer prevention: Intercepting disease.
期刊: Molecular oncology 发表日期: 2026-Apr-18 链接: PubMed
摘要
Over several decades, therapeutic advances have transformed oncology, yet for many tumour types, survival improvements have been incremental, with substantial treatment-related morbidity. A decisive pivot in oncology, from treating established malignancy to intercepting and preventing carcinogenesis, could deliver far greater population impact. Delivering this shift requires further mechanistic understanding of tumour initiation, validated biomarkers of premalignant progression and redesigned prevention trials in at-risk populations. Regulatory and commercial frameworks must evolve to enable scalable molecular prevention. Such trials must deliver tolerable side effect profiles and rely on biologically validated surrogate endpoints rather than traditional survival outcomes. Cancer interception should be established as a core pillar of oncological management, alongside early detection and the therapeutic management of established disease, together creating an opportunity to reduce global disease burden at a scale that decades of therapeutic progress in advanced cancer have yet to achieve.
12. Attitudes, knowledge, practices, and perceived barriers on sustainability actions among Italian anesthesiologists-intensivists: a nationwide survey.
期刊: Journal of anesthesia, analgesia and critical care 发表日期: 2026-Apr-18 链接: PubMed
摘要
Healthcare systems contribute approximately 4.6% of global carbon emissions, with anesthesia and intensive care representing major sources of environmental impact. Although awareness of sustainable practices is increasing, real-world implementation in these fields remains limited. This study aimed to describe knowledge, attitudes, practices, and perceived barriers toward sustainability among Italian anesthesiologists-intensivists. A cross-sectional, web-based survey was conducted among members of the Italian Society of Anesthesia, Analgesia, Resuscitation, and Intensive Care (SIAARTI) between June and July 2025. The questionnaire assessed demographics, clinical practices, environmental behaviors, and perceived barriers to sustainability. Descriptive statistics and an unsupervised clustering approach (Factor Analysis of Mixed Data followed by hierarchical clustering) were applied to identify distinct respondent profiles. A total of 459 responses were analyzed. Overall, 83.4% rated environmental sustainability as “very important,” and 95.6% supported the adoption of renewable energy in hospitals. Despite this, 93.1% reported routine use of single-use devices, and only 7.4% worked in departments with a designated sustainability officer. Cluster analysis identified two main groups: the Experienced Generation (older, senior specialists) and the Green Generation (younger, early-career clinicians). While both valued sustainability, the Green Generation more frequently implemented eco-friendly practices, including the use of total intravenous anesthesia (71.2% vs. 57.5%), regional anesthesia (74.1% vs. 64.0%), and reusable/recyclable devices (> 80% vs. < 20%). The most frequently reported barriers to sustainability application were lack of training (76.3%), resistance to change (66.4%), and absence of guidelines (54.7%). Italian anesthesiologists-intensivists demonstrate strong environmental awareness but variable implementation of sustainable practices. Strengthening formal education, institutional leadership, and guideline dissemination is essential to promote widespread adoption of sustainable anesthesia and intensive care practices.
13. Simulated aquatic aging exacerbates pulmonary toxicity of graphite nanoplatelets by mechanically and chemically induced surface oxidation, enhancing oxidative potential.
期刊: Particle and fibre toxicology 发表日期: 2026-Apr-18 链接: PubMed
摘要
Graphite nanoplatelets (GNPs) are increasingly used in advanced materials, yet their environmental transformation and resulting health impacts remain poorly understood. This study investigated how long-term aquatic aging alters the physicochemical properties and pulmonary toxicity of GNPs. Pristine GNPs (PGNPs) were aged for 26 months in water containing sand under constant agitation to simulate natural mechanical and chemical weathering, yielding aged GNPs (AGNPs) with increased surface oxidation level, smaller lateral dimensions, and improved hydrophilicity. These alterations enhanced the intrinsic oxidative potential of AGNPs by 1.28-1.40-fold relative to PGNPs. Following a single intratracheal instillation in mice (25-100 µg/mouse), AGNPs induced significantly stronger pulmonary inflammation at both 24 h and 7 days, characterized by elevated neutrophil infiltration, increased levels of lactate dehydrogenase, total protein, and pro-inflammatory cytokines in bronchoalveolar lavage fluid. Although both materials showed a similar clearance pattern, AGNPs showed a slightly prolonged retention compared to PGNPs (half-life: AGNPs 10 days, PGNPs 5.5 days). Differentiated THP-1 macrophages and A549 cells exposed to AGNPs showed higher cytotoxicity, intracellular reactive oxygen species (ROS) generation, and cytokine release than PGNPs, confirming the in vivo findings. Correlation analysis revealed that ROS levels were strongly associated with inflammatory and cytotoxic endpoints (Pearson r > 0.90), indicating that oxidative stress is a key mechanism of GNP-induced toxicity. These findings demonstrate that simulated aquatic aging enhances the oxidative potential and pulmonary toxicity of GNPs through mechanically and chemically induced surface oxidation, highlighting the need to consider environmental transformation in nanomaterial hazard assessment and life-cycle-based safety assessment.
14. Development of blueprint materials that strengthen and embed the infection control link nurse role in hospitals - an action research study.
期刊: Implementation science communications 发表日期: 2026-Apr-18 链接: PubMed
摘要
In hospitals, infection control link nurses (ICLNs) serve as a bridge between their peers and the infection prevention team, driving infection prevention measures through motivation, practical guidance, and knowledge sharing. The success of the ICLN role varies depending on how well it is supported and integrated into hospital structures. In this study, we co-created materials for infection control practitioners (ICPs), incorporating activities to support ICLNs with strategies to strengthen and embed the ICLN role in hospitals. We aimed to develop materials to support and implement the role, and evaluated how cocreation contributed to its normalization in participating hospitals. We used an action research approach with co-creation as a general guiding principle. Stakeholders and end-users from ten participating hospitals collaboratively developed blueprint materials, including a role description, training resources and strategies for hospital-wide integration of the ICLN role. ICPs tested these materials in their respective hospitals. To explore their experiences with both the application of materials and the collaborative process, focus group interviews were conducted. Normalization Process Theory (NPT) was used as a framework to guide the analyses and the collaborative process itself. Participants agreed upon the materials, but the extend to which their content became normalized in daily practice varied. In the interviews, ICPs mentioned that adoption and application of the materials depended on the implementation phase of the ICLN role. The collaborative process increased their confidence and intention to actively support ICLNs. It also helped them reflect on how to position the role within the organization, prompting them to consider various actions to embed the role structurally. Blueprint materials were considered helpful and provided practical strategies and hands-on activities and could be tailored to the local context. The collaborative process resulted in three practical, adaptable blueprint materials. The process helped ICPs reassess their own role in implementing the ICLN role, refine their training strategies, and strengthen their support for ICLNs at the ward level. Signs of normalization of the ICLN role varied across hospitals, influenced by both the stage of implementation and how ICPs interpreted and enacted their own role.
15. Association between metabolic syndrome, macular structures and retinal vascular calibres in the Northern Finland Birth Cohort Eye Study.
期刊: Acta ophthalmologica 发表日期: 2026-Apr-17 链接: PubMed
摘要
We aimed to evaluate the association of metabolic syndrome (MetS) with macular thickness and retinal vascular calibres in the population-based cohort (Northern Finland Birth Cohort). The population of 2242 individuals was divided into MetS (n = 344) and control groups (n = 1898). Cirrus HD-OCT 4000 was used to measure total macular thickness. Central retinal arteriolar equivalent (CRAE) and central retinal venular equivalent (CRVE) were calculated from the fundus images. The MetS was defined according to the National Cholesterol Education Program (Adult Treatment Panel III). A significant reduction in macular thickness was observed in subjects with MetS (279.4 ± 13.5 vs. 282.2 ± 14.1 μm, p < 0.001); the difference was greatest in the nasal and inferior subfields in the outer perimeter (-3.18 μm, p < 0.001 and - 3.68 μm, p < 0.001). Among the MetS components, waist circumference (WC) was particularly associated with thinning of the macula. Furthermore, subjects with MetS displayed decreased CRAE (139.8 ± 13.2 vs. 141.8 ± 14.0 μm, p = 0.014) and increased CRVE (221.7 ± 20.5 vs. 218.3 ± 19.0 μm, p = 0.007). The elevated systolic blood pressure and WC were associated with arterial narrowing, while dyslipidemia, hypertriglyceridemia and low HDL cholesterol were associated with venular widening. We detected a thinning of the macula in the MetS in our population-based cohort. The diameters of the retinal arteries decreased, and the venules increased in MetS. These findings suggest that obesity is related to structural changes in the eyes in middle-aged subjects, which may have implications for ocular health.
16. What are the experiences of people with psychosis, their carers and staff in inpatient mental healthcare services in the United Kingdom? A systematic review and meta-ethnography.
期刊: The British journal of clinical psychology 发表日期: 2026-Apr-17 链接: PubMed
摘要
UK inpatient mental healthcare services face ongoing challenges of safety and staff shortages. People experiencing psychosis account for around half of admissions, with over half readmitted within 7 years. Care is organized around the therapeutic alliance between patients, their carers and staff, yet no systematic review has synthesized the views of all three groups within UK inpatient settings. (i) To identify and appraise qualitative studies examining experiences of inpatient mental healthcare from the perspectives of patients with psychosis, carers and staff; (ii) To synthesize findings to deepen understanding of these experiences: METHOD: A systematic search of three databases identified 21 relevant studies. All were appraised using an adapted Critical Appraisal Skills Programme (CASP) tool. Data were extracted and synthesized using meta-ethnography. Study quality varied. Three key constructs emerged: (1) Power and Control in the Inpatient Setting; (2) Atmospheres of Care and (3) Connection and Recovery. Patients, carers and staff described multifaceted challenges within conflict-laden environments. Experiences ranged from confusion, disconnection, and threat to safety, understanding, and recovery, shaped by relational and communicative practises. Where patients felt informed, carers included and staff supported, experiences were more positive. Conversely, institutional routines may function as defences against emotional strain, risking relational detachment. Inpatient services support individuals experiencing acute distress and risk, underscoring the emotional intensity of these settings. Despite policy emphasis on deinstitutionalization, inpatient care remains essential. Future research should further explore staff and carer experiences to inform relationally attuned service design.
17. Economic burden of depressive disorders and HIV for people living with HIV in Uganda.
期刊: Health policy and planning 发表日期: 2026-Apr-17 链接: PubMed
摘要
Between 8-39% of people living with HIV (PLWH) in sub-Saharan Africa have a depressive disorder (DD). Despite considerable gains in the treatment of PLWH, DD is increasingly recognised as a threat to successful treatment and prevention. PLWH incur higher health-related costs than the general population due to chronic care management needs. We aimed to estimate the combined economic burden of DD and HIV amongst PLWH and explore their mechanisms of coping with high out of pocket (OOP) health expenditure. This was a cost of illness study nested in a cluster-randomised trial that assessed the effectiveness of integrating treatment of DD into routine HIV care in Uganda (HIV+D trial). The study used cross-sectional data collected from 1,115 PLWH across both trial arms at baseline, using the Patient Health Questionnaire (PHQ-9) to measure DD and a structured cost questionnaire. The mean monthly economic cost of HIV and DD amongst n=486 participants reporting at least one non-zero cost item was USD 11.72 (2022 prices), while the mean across the whole sample (including zeroes) was USD 5.05. Mean monthly OOP expenditure amongst participants reporting at least one non-zero item was USD 7.22, which is 4% of average monthly household income. It was USD 3.11 in the sample as a whole. Moderate DD symptoms (PHQ-9 between 15-19) and severe symptoms (PHQ-9 ≥ 20) were reported by 30% and 5% of respondents respectively, with the remainder experiencing mild symptoms. Social protection mechanisms combined with the integration of the management of DD into routine HIV care could help alleviate this burden.
18. Clinical case of a pregnant woman with arteriovenous malformation, hemorrhagic venous infarcts and epileptic seizures: a case report.
期刊: Journal of medical case reports 发表日期: 2026-Apr-17 链接: PubMed
摘要
Acute cerebrovascular incidents and epileptic seizures during pregnancy remain significant challenges for neurologists. The required neuroimaging techniques in both conditions and treatment options may have serious negative effects on the fetus. A 30-year-old pregnant white European woman at the 6th gestational week was hospitalized due to acute focal neurological symptoms from the left cerebral hemisphere. The patient conceived through an in vitro procedure and was on hormonal therapy with progesterone and estradiol. The brain CT showed suspicion of a venous infarct in the left cerebral hemisphere. Three days later, new acute neurological symptoms occurred, this time from the right cerebral hemisphere. The brain MRI revealed an arteriovenous malformation (AVM) in the left parietal lobe, superior sagittal sinus thrombosis, and hemorrhagic venous infarcts in both cerebral hemispheres. Ten days after the first symptoms, the patient developed an epileptic status characterized by focal clonic jerks on the right side of the face and right arm. Due to worsening health condition, a decision was made to perform an abortion. In addition, the patient was diagnosed with thrombophilia. Endovascular embolization of the arteriovenous malformation was not performed due to the high risk of complications. The patient was left on conservative treatment with levetiracetam and apixaban, but after two more hospitalizations because of epileptic status, the patient was referred for stereotactic radiosurgery. This clinical case presents interest due to the combination of medical conditions, which resulted in cerebrovascular incidents with different localizations and characteristics during pregnancy, complicated with epileptic seizures.
19. Measuring change in school-based practices that promote children's healthy eating and active living: a psychometric study.
期刊: The international journal of behavioral nutrition and physical activity 发表日期: 2026-Apr-17 链接: PubMed
摘要
20. Gender bias in the clinical reasoning steps of medical students: a critical examination.
期刊: BMC medical education 发表日期: 2026-Apr-17 链接: PubMed
摘要
Despite growing awareness of the importance of integrating gender knowledge into medical education, gender stereotypes persist and may influence patient assessment and management. This study investigates gender inequalities in clinical reasoning among medical students to identify areas for improvement in medical education. The study was conducted at the University of Lausanne in Spring 2021, using the Objective Structured Clinical Examination (OSCE) to assess fifth-year medical students. Students were evenly assigned to interactions with either a male or female standardised patient (SP) presenting with unintentional weight loss. Evaluation covered history taking, physical examination, and clinical management. A total of 105 students (57.1% female, 42.9% male) were assessed. Results indicate potential gender bias at various stages of clinical reasoning, with patterns depending on the gender of both the SP and the student. During history-taking, female students were less likely to ask female SPs about alcohol consumption than male SPs (56.3% vs. 78.6%, p = 0.07). Regarding occupational history, a compelling trend was also observed among male students, who asked female SPs less often (30.4% vs. 59.1%, p = 0.05), whereas female students showed more consistent rates. Additional compelling trends emerged during physical examinations: male students performed cardiac auscultation less often on female SPs (56.5% vs. 86.4%, p = 0.02). Although diagnostic hypotheses and differential diagnoses were similar, female SPs were more often prescribed laboratory tests (63.6% vs. 26.0%, p < 0.001). Gender bias permeates multiple stages of clinical reasoning among medical students, leading to under-recognition of key health risk factors, differences in examination thoroughness, and increased prescription of laboratory tests in female patients. Addressing gender bias through sustained integration of gender into core medical education is essential for diagnostic accuracy and high-quality patient care. Specifically, systematic inquiry into occupational and alcohol histories in female patients, improved cardiovascular auscultation, and enhanced communication with male patients are needed.
21. Expedient truth-telling in the ICU: a qualitative content analysis.
期刊: BMC nursing 发表日期: 2026-Apr-17 链接: PubMed
摘要
22. Gene-guided repurposing identifies dihydroergotamine as a candidate inhibitor of the BCL2-SIVA1 axis in advanced gastric cancer in vitro.
期刊: Biology direct 发表日期: 2026-Apr-17 链接: PubMed
摘要
23. Münchausen syndrome by proxy: a literary review and a reminder for every health care professional.
期刊: Italian journal of pediatrics 发表日期: 2026-Apr-17 链接: PubMed
摘要
24. On-site manual therapy for firefighters in Seoul: six-month utilization and outcome from a retrospective service analysis and web-based survey.
期刊: Chiropractic & manual therapies 发表日期: 2026-Apr-17 链接: PubMed
摘要
25. Association of changes in medication with the effectiveness of rehabilitation in older patients: a hospital-based observational study.
期刊: BMC geriatrics 发表日期: 2026-Apr-17 链接: PubMed
摘要
26. Characterisation of malaria and glucose-6-phosphate dehydrogenase deficiency in conflict-affected zones of southern and eastern Sudan.
期刊: BMC infectious diseases 发表日期: 2026-Apr-17 链接: PubMed
摘要
27. Effect of a digital educational intervention based on orem's self-care theory on improving self-care behaviors, self-efficacy, and reducing HbA1c in type 2 diabetes patients: a quasi-experimental study.
期刊: BMC primary care 发表日期: 2026-Apr-17 链接: PubMed
摘要
28. A large scale multimodal dataset for healthcare domain Ghanaian sign language translation and retrieval based synthesis.
期刊: Scientific reports 发表日期: 2026-Apr-17 链接: PubMed
摘要
29. Periodontal Diseases and Conditions in Children and Adolescents Associated With Systemic Disorders: A Systematic Review.
期刊: Journal of clinical periodontology 发表日期: 2026-Apr-17 链接: PubMed
摘要
To systematically evaluate congenital and acquired systemic diseases and conditions in children and adolescents, and their impact on periodontal tissues as well as influence on the onset and progression of gingivitis and periodontitis. A systematic search was performed in three electronic databases to identify studies reporting on the epidemiology, aetiology, risk factors, diagnosis, prevention and treatment of systemic diseases and conditions in children and adolescents < 18 years, affecting periodontal tissues and modifying the course/outcomes of periodontal diseases. A total of 463 studies were included in the qualitative analysis, reporting on 71 different diseases and conditions. The medical conditions identified were classified into two groups, based upon the nature of pathogenic mechanisms affecting the periodontium: (1) genetic, congenital and acquired systemic conditions that impact periodontal tissue structure, and (2) systemic diseases and conditions that impact the onset/progression of periodontal diseases. A vast group of systemic congenital and acquired diseases and conditions affecting children and adolescents was identified that may impact the morphology, function and/or pathophysiological processes of the periodontal tissues and affect the onset/progression of periodontal diseases, which in some cases leads to severe forms of gingival inflammation, premature loss of attachment and tooth loss.
30. Maternal-prenatal gut microbiome-systemic metabolome perturbations and TH2-skewed immunity link to offspring gut microbiome disruption and atopic dermatitis susceptibility.
期刊: Genome medicine 发表日期: 2026-Apr-17 链接: PubMed
摘要
31. Prenatal bisphenol A exposure perturbs sex-dependent transcriptomic regionalization of autism-associated genes in the developing brain.
期刊: Biology direct 发表日期: 2026-Apr-17 链接: PubMed
摘要
Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by deficits in communication, social interaction, and behavioral regulation. Its etiology arises from a combination of genetic vulnerabilities and environmental influences. Bisphenol A (BPA) is an endocrine-disrupting chemical found in plastic-containing materials, including micro- and nanoplastic pollutants. Recent studies have shown that prenatal BPA exposure can alter behavior and the expression of genes related to autism and neurodevelopment. This study integrated and reanalyzed published RNA sequencing datasets from the hippocampus and prefrontal cortex of rat offspring prenatally exposed to BPA through maternal intragastric administration during gestation to investigate the effects of prenatal BPA exposure on transcriptomic regionalization. Quantitative RT-PCR was performed to evaluate selected RNA-seq findings in individual, non-pooled biological samples. The associations between differentially expressed genes (DEGs) and ASD candidate genes were assessed via a hypergeometric distribution analysis. Prenatal BPA exposure was associated with altered transcriptomic profiles in the hippocampus and prefrontal cortex, together with sex-dependent changes in regional expression contrasts between these brain regions. Several ASD-relevant genes, including Msx2, Syncrip, Agtr2, and Myh9, showed altered regional expression patterns following prenatal BPA exposure. Genes showing altered regional expression contrasts after BPA exposure were annotated by IPA with functions, upstream regulators, and canonical pathways relevant to neurodevelopment and neurological disorders. Exploratory correlation analyses further identified region- and sex-dependent associations between disrupted regional gene-expression patterns and behavioral measures. This reanalysis suggests that prenatal BPA exposure is associated with altered regional transcriptomic patterning in the developing rat brain and identifies candidate genes and pathways for future mechanistic and replication studies.
32. Loss of maternal PADI6 disrupts DNA methylation and genomic imprinting maintenance in late preimplantation mouse embryos.
期刊: Epigenetics & chromatin 发表日期: 2026-Apr-17 链接: PubMed
摘要
33. The potential role of dietary patterns in modifying the association between ambient PM2.5 exposure and mortality in elderly Hong Kong Chinese.
期刊: Environmental health : a global access science source 发表日期: 2026-Apr-17 链接: PubMed
摘要
34. Prevalence of musculoskeletal disorders among police officers from an organizational unit of a German federal state police force.
期刊: Journal of occupational medicine and toxicology (London, England) 发表日期: 2026-Apr-17 链接: PubMed
摘要
35. Mental health and wellbeing interventions for uniformed service personnel: a mixed methods systematic review.
期刊: BMC medicine 发表日期: 2026-Apr-17 链接: PubMed
摘要
Uniformed service personnel are routinely exposed to occupational trauma in their roles which contribute to elevated rates of mental health conditions. A wide range of mental health and wellbeing interventions may help uniformed service personnel manage their psychological responses to challenging incidents at work. Previous reviews of those interventions have focused on single groups of professionals or intervention types, limiting cross-sector insights. This review uses a mixed methods approach to synthesise evidence associated with mental health and wellbeing interventions across uniformed services. The protocol was registered with PROSPERO (CRD42024605877). A mixed methods systematic review was conducted using the Joanna Briggs Institute (JBI) convergent segregated approach. Searches were conducted in Medline, CINAHL, Web of Science and PsycINFO (Dec 2024). Screening and quality appraisal (Mixed Methods Appraisal Tool) were performed independently by two reviewers. Due to heterogeneity, findings were narratively synthesised. Quantitative and qualitative results were integrated following the JBI approach. Eighty-six primary studies from 22 countries were included, covering a range of professions and intervention types. Synthesis of quantitative data from 82 studies showed that mindfulness-based training, resilience coaching, cognitive behavioural therapies and supported lifestyle activities demonstrated reduced symptoms of PTSD, anxiety and depression. However, interventions such as Critical Incident Stress Debriefing (CISD) and peer support yielded mixed results. Qualitative data from 9 studies were grouped into 5 categories: enhanced emotional insight, improved interpersonal relationships, perceived effectiveness, barriers to engagement and delivery challenges. Participants valued interventions that fostered self-awareness and support but cited stigma, guilt and logistical constraints as significant barriers. Integration of quantitative and qualitative findings revealed alignment in outcomes for several interventions, while highlighting evidence gaps, such as the lack of qualitative data for many interventions and limited exploration of cultural and organisational barriers. Mental health interventions for uniformed service personnel show promise but are influenced by delivery format, occupational culture and contextual factors. This review underscores the need for delivering interventions informed by ecological models, standardised outcome sets and deeper qualitative exploration into stigma and engagement barriers.
36. Proteomic profiling reveals immunologic mediators of endotoxin-related lung function decline: a longitudinal prospective study in textile workers.
期刊: Respiratory research 发表日期: 2026-Apr-17 链接: PubMed
摘要
37. Apolipoprotein E Polymorphism and Reproductive Patterns Among Postreproductive Women.
期刊: American journal of human biology : the official journal of the Human Biology Council 发表日期: 2026-Apr 链接: PubMed
摘要
Traits that are detrimental for health may persist in populations because they are advantageous for reproduction. Apolipoprotein E is a protein involved in lipid metabolism, and it is encoded by a polymorphic gene (ApoE) with three alleles: ApoE2, ApoE3, and ApoE4. ApoE4 allele is associated with elevated cholesterol levels, and increased risk of various metabolic and age-related diseases, such as cardiovascular disease and dementia. Because lipids are crucial for steroid hormone synthesis and thus the ovarian function, ApoE4 allele may be associated with enhanced fertility. Therefore, we hypothesize that women with different ApoE genotypes will exhibit differences in reproductive history traits. Participants included 360 postreproductive women aged 45-92 from a Polish rural population living at the Mogielica Human Ecology Study Site. General linear models were used to test differences in age at menarche, age at first reproduction, number of children born, mean interbirth interval and age at last reproduction across different ApoE genotypes. No significant differences were observed between ApoE genotypes in any of the tested reproductive history parameters. Although some of the previous research has suggested that carriers of ApoE4 have more successful reproduction, we found no evidence supporting such an association among postreproductive aged women from a traditional, agricultural community. It is possible that ApoE4 may confer reproductive advantages only under specific ecological or lifestyle conditions, such as high pathogen burden or low-energy diet.
38. Adolescent values and well-being: A large-scale two-wave longitudinal study in China.
期刊: Applied psychology. Health and well-being 发表日期: 2026-Apr 链接: PubMed
摘要
This longitudinal study investigates the structure, developmental trends, and well-being implications of values among Chinese adolescents - a large, culturally distinctive population undergoing rapid social change. We conducted a large-scale, two-wave longitudinal study (Wave 1: N = 69,115; M = 12.74 ± 2.25 years; 49.84% girls; Wave 2: N = 45,762; M = 12.98 ± 2.22 years; 50.53% girls; with 45,762 students participating in both waves) across a 6-month interval. A three-factor structure of adolescent values emerged: Collective Altruism, Individual Initiative, and Individual Hedonism. Results revealed distinct developmental trajectories: Collective Altruism declined slightly, while Individual Hedonism increased, both stabilizing around mid-adolescence (age~15)-a developmental inflection point in value orientation. Cross-lagged models demonstrated small but significant reciprocal positive associations between Collective Altruism, Individual Initiative, and well-being, while Individual Hedonism showed a small but significant negative association with subsequent well-being. These findings support the theoretical framework of contextually healthy values-value orientations that are culturally normative and developmentally adaptive. This study also provides valuable insights for promoting adolescent mental health and positive development in rapidly modernizing contexts.
39. Differences in Cancer Patient Experience by Race, Ethnicity, and Preferred Language: A Systematic Review.
期刊: Cancer medicine 发表日期: 2026-Apr 链接: PubMed
摘要
Patient experience ratings are tied to high quality patient-centered care and value-based health system metrics. Existing research has identified disparities in cancer care access and clinical outcomes. This systematic review summarizes findings on how the cancer patient experience differs by race, ethnicity, and preferred language. Using PRISMA guidelines, we searched PubMed, EMBASE, PsycINFO, CINAHL, and Cochrane CENTRAL through August 2023. Studies were included if the population consisted of White and racial and/or ethnic underrepresented patients who were receiving or had received cancer care; a comparison was made across racial, ethnic, and/or preferred language groups; and outcomes included patient experience ratings or related measures. Studies were excluded if they lacked cancer-specific populations, relative comparisons, or outcomes related to patient experience. Study quality was assessed using Joanna Briggs Institute critical appraisal tools, and data were independently extracted by two authors. Thirty-six studies (n = 292,345 cancer patients) met inclusion criteria. Twenty-three studies demonstrated worse experiential outcomes among racial and ethnic minority groups compared to non-Hispanic White patients. Among studies including language in their analysis, nine studies indicated cancer patients with a non-English language preference tended to report worse experiences compared to those who prefer to communicate in English. Cancer patients belonging to racial, ethnic, or preferred language minority groups are more likely to report worse care experiences than non-Hispanic White patients. Significant variation exists in how patient experience is defined and measured. These disparities must be addressed to optimize clinical outcomes and ensure equity in health system value-based metrics. PROSPERO: CRD42018102189.
40. Chip-Based Digital PCR Approach for Improved SARS-CoV-2 Quantification for Endemic Wastewater Surveillance.
期刊: Water environment research : a research publication of the Water Environment Federation 发表日期: 2026-Apr 链接: PubMed
摘要
The COVID-19 pandemic has revealed the importance of wastewater-based epidemiology (WBE) due to its advantages over traditional surveillance systems. However, low viral prevalence poses a significant challenge for reliable detection of SARS-CoV-2 in endemic wastewater settings. This study aimed to improve detection sensitivity of SARS-CoV-2 by applying the chip-based digital PCR (dPCR) approach targeting the CDC N1 and N2 genes to wastewater samples processed with a combined magnetic bead concentration method during a low-prevalence period in South Korea. Here, the evaluation results using dPCR combined with magnetic bead concentration showed higher viral loads and lower variability compared to the commonly used electronegative filtration method. Comparative analysis of the dual-target N1 + N2 and E-Sarbeco assays revealed that the N1 + N2 assay yielded significantly higher concentrations (4.73 ± 0.19 log10 GC/L) than the E gene assay (4.27 ± 0.25 log10 GC/L) in dPCR analysis (p < 0.01). PMMoV normalization increased the Pearson correlation coefficient between SARS-CoV-2 concentrations and clinical case data from R = 0.1 to R = 0.31; however, this was not statistically significant. These findings contribute to enhancing detection sensitivity for SARS-CoV-2 wastewater surveillance in endemic settings.
41. Romosozumab Versus Teriparatide for the Treatment of Postmenopausal Osteoporosis: An Overview of Systematic Reviews With Direct and Indirect Meta-Analyses.
期刊: International journal of rheumatic diseases 发表日期: 2026-Apr 链接: PubMed
摘要
To summarize the evidence of efficacy and safety of romosozumab compared to teriparatide for postmenopausal osteoporosis. A literature search was performed in Medline, the Cochrane Library, CRD, and LILACS until November 2023. We included systematic reviews with meta-analyses on the use of romosozumab compared to teriparatide in women with postmenopausal osteoporosis. Two authors performed study selection, data extraction, and quality assessment using AMSTAR-2 and GRADE tools. A total of 725 records were identified, and 13 studies fully met the eligibility criteria. Regarding efficacy, romosozumab did not show a significant difference in risk of falls (12/24 months), vertebral fractures (12/36 months), non-vertebral fractures (12/36 months), and hip fractures compared to teriparatide. For the safety profile, romosozumab did not show significant change compared to teriparatide for serious adverse events (12/26 months) and composite cardiovascular outcomes (3PMACE and 4PMACE). The overall quality of evidence in the reviews ranged from very low to moderate, primarily due to indirectness and imprecision in the outcomes. Additionally, the reviews were classified as having “low” or “critically low” methodological quality. Romosozumab demonstrated efficacy and safety similar to teriparatide. However, this overview revealed substantial overlap among primary studies, with most outcomes assessed through indirect comparisons and poor methodological quality. Future research should confirm these findings.
42. Changes in cardiovascular health and physical functioning in non-hospitalized, adult COVID-19 patients after 3 years of follow-up.
期刊: Physiological reports 发表日期: 2026-Apr 链接: PubMed
摘要
Long-term cardiovascular consequences of COVID-19 remain unclear, particularly in non-hospitalized individuals. We investigated longitudinal changes (~3 years) in cardiovascular risk factors, cardiac biomarkers, physical functioning, and activity in non-hospitalized COVID-19 individuals versus age- and sex-matched controls. Assessments were performed in 2021 (~6 months post-infection) and repeated 3 years after initial SARS-CoV-2 infection among 101 non-hospitalized COVID-19 participants and 101 healthy age- and sex-matched controls. Multiple imputation was adopted to adjust for missing data due to drop-out. Based on the absence (-) or presence (+) of infections during follow-up, four groups were created: COVID-19/- (n = 45), COVID-19/+ (n = 56), Control/- (n = 29), and Control/+ (n = 72). Additionally, sex-stratified analyses were performed. No changes were found in parameters related to cardiovascular risk factors, cardiac biomarkers, physical functioning and physical activity across the 3-year follow-up, showing no time × group effects for any of the outcomes (all p-values >0.05). Sex-stratified analyses and complete-case sensitivity analysis reinforced our results. Overall, we found no changes in cardiovascular risk factors, cardiac biomarkers, physical functioning and activity across a 3-year follow-up in non-hospitalized COVID-19 individuals compared to healthy controls, independent of infections during follow-up. This suggests that non-hospitalized COVID-19 did not induce long-term deleterious changes in cardiovascular health or physical characteristics.
43. Meta-Analysis of Median Survival Times With Inverse-Variance Weighting.
期刊: Statistics in medicine 发表日期: 2026-Apr 链接: PubMed
摘要
We consider the problem of meta-analyzing outcome measures based on median survival times. Primary studies with time-to-event outcomes often report estimates of median survival times and confidence intervals based on the Kaplan-Meier estimator. However, outcome measures based on median survival are rarely meta-analyzed, as standard inverse-variance weighted methods require within-study standard errors that are typically not reported. In this article, we consider an inverse-variance weighted approach to meta-analyze median survival times that estimates the within-study standard errors from the reported confidence intervals. We show that this method consistently estimates the standard error of median survival when applied to confidence intervals constructed by the Brookmeyer-Crowley method. We conduct a series of simulation studies evaluating the performance of this approach at the study level (i.e., for estimating the standard error of median survival) and the meta-analytic level (i.e., for estimating the pooled median, difference of medians, and ratio of medians) for commonly used confidence intervals for median survival, including the Brookmeyer-Crowley method and nonparametric bootstrap. We find that this approach often performs comparably to a benchmark approach that uses the true within-study standard errors for meta-analyzing median-based outcome measures when within-study sample sizes are moderately large (e.g., above 50). However, when the effective sample sizes are small, the method can yield biased estimates of within-study standard errors. We illustrate an application of this approach in a meta-analysis evaluating survival benefits of being assigned to experimental arms versus comparator arms in randomized trials for non-small cell lung cancer therapies.
44. Pain, Sleep Disturbance, and PTSD Symptoms in Women Sexual Trauma Survivors: A Cross-Lagged Panel Analysis.
期刊: Stress and health : journal of the International Society for the Investigation of Stress 发表日期: 2026-Apr 链接: PubMed
摘要
Posttraumatic stress disorder (PTSD) and pain are common following trauma exposure, highly comorbid, known to exacerbate one another, and together contribute to reduced quality of life. Sleep disturbance is likewise associated with both PTSD and pain and may partially explain the PTSD-pain link over time. Despite their well-documented co-occurrence, studies have yet to examine the bidirectional influences of PTSD symptoms, sleep disturbance, and pain (i.e., severity and interference) together over time among women in the acute post-trauma period. This is the aim of the present secondary analysis. Women (N = 203) recruited within 1 month of experiencing a sexual trauma completed online surveys at baseline (T1) and two follow-up periods each spaced 1 month apart (T2 and T3). Cross-lagged panel models (CLPMs) were used to test the directionality of associations between PTSD symptoms and pain over time as well as the mediating role of sleep disturbance on cross-lagged paths (between-person level). A sensitivity analysis using random-intercept cross-lagged panel models (RI-CLPMs) was conducted to isolate within-person effects. Findings from CLPMs demonstrated that PTSD symptoms at T1 predicted both sleep disturbance and pain interference (but not pain severity) at T2 (between-person level). Sleep disturbance did not mediate associations between PTSD symptoms and pain. No cross-lagged effects were observed from T2 to T3. No within-person cross-lagged effects were observed among PTSD symptoms, pain, and sleep in RI-CLPMs. Findings suggest that individuals with more severe PTSD symptoms in the month following sexual trauma experience worse physical health symptoms early-on in the post-trauma phase, including pain interference and sleep disturbance. Understanding the directionality and strength of co-occurring concerns can inform first-line treatment targets to prevent downstream negative physical and mental health sequelae following sexual trauma.
45. Racial disparity in microvascular function among non-Hispanic white and non-Hispanic black men with newly diagnosed prostate cancer.
期刊: Physiological reports 发表日期: 2026-Apr 链接: PubMed
摘要
Cardiovascular disease (CVD) is a leading cause of mortality in men with prostate cancer (PC), with non-Hispanic Black (NHB) men experiencing disproportionately higher CVD-related mortality compared to non-Hispanic White (NHW) men. Vascular endothelial dysfunction precedes overt CVD; however, the mechanisms underlying racial disparities in CVD among men with PC remain unclear. This study tested the hypothesis that NHB men with PC would exhibit impaired vascular health compared to NHW men. Thirty-four men (12 NHW and 22 NHB) with a clinical diagnosis of PC underwent comprehensive vascular assessment, including arterial stiffness (pulse wave velocity [PWV] and augmentation index at 75 bpm [AIx75]), conduit-vessel endothelial function (flow-mediated dilation [FMD]), and microvascular function (post-occlusive reactive hyperemia [PORH], local thermal heating [LTH], and acetylcholine iontophoresis). Clinical laboratory values, senescence-associated secretory phenotype (SASP), and allostatic load were also evaluated. NHW men were older (p = 0.050), with no differences in body mass index (BMI), laboratory values, allostatic load, or SASP (all p > 0.05). NHB men demonstrated significantly lower PORH, LTH, and acetylcholine responses (all p < 0.001), while PWV, AIx75, and FMD were similar between groups. Despite comparable conduit-vessel and arterial stiffness measures, NHB men exhibited impaired microvascular function, suggesting racial differences in vascular bed-specific dysfunction following PC diagnosis.
46. Incidence of Hodgkin and Non-Hodgkin Lymphomas: Comparison of the Military and General Population.
期刊: Cancer medicine 发表日期: 2026-Apr 链接: PubMed
摘要
Lymphoma risk varies by demographics, environmental/occupational exposures, and medical care between active-duty service members (ADSM) and the general US population (GUSP). This study compared age-adjusted incidence rates and trends of Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL) between these groups. Data were obtained from the Department of War’s Central Cancer Registry and the National Cancer Institute’s Surveillance, Epidemiology, and End Results database, including individuals aged 18-59 diagnosed with lymphoma between 1998 and 2014. Incidence rate ratio (IRR) and 95% CIs were calculated to compare the incidence of HL and NHL between ADSM and GUSP, with analyses stratified by sex, race, age, stage, and histology. Lymphoma incidence was lower in ADSM than GUSP (HL: 0.93 [0.86, 1.00]; NHL: 0.82 [0.77, 0.88]); specifically, for men (HL: 0.89 [0.82, 0.97]; NHL: 0.69 [0.64, 0.74]), White (HL: 0.87 [0.80, 0.95]; NHL: 0.80 [0.73, 0.86]), and Black individuals (HL: 0.82 [0.68, 0.99]; NHL: 0.61 [0.51, 0.73]). Incidence was lower among ADSM aged 18-39 (HL: 0.91 [0.84, 0.99]; NHL: 0.74 [0.68, 0.81]), but similar at ages 40-59. ADSM had lower HL (early-stage: 0.86 [0.77, 0.96]; nodular lymphocyte predominant: 0.88 [0.80, 0.97]) and NHL (early stage: 0.86 [0.77, 0.96]; advanced stage: 0.87 [0.78, 0.97]; diffuse large B-cell: 0.65 [0.58, 0.74]; other histologies: 0.83 [0.74, 0.93]) incidence. Lymphoma incidence was lower in ADSM than GUSP, particularly among men and younger individuals. Based on prior literature, this may be related to the healthier status of ADSM and earlier detection and treatment of medical conditions that can predispose to lymphoma. Diminished differences between the two populations for older individuals may reflect cumulated military-related exposures within a generally healthier population.
47. A Clinical-Radiomics Nomogram Predicts Early Tumor Necrosis After Transarterial Chemoembolization for Hepatocellular Carcinoma.
期刊: Technology in cancer research & treatment 发表日期: 2026 链接: PubMed
摘要
IntroductionWe introduce a standardized necrosis rate-percent reduction in enhancing tumor diameter normalized by baseline tumor diameter-with a threshold of ≥30%. This endpoint is derived from the mRECIST partial response criteria but is normalized to mitigate tumor size-dependent bias. A clinical-radiomics model was developed to assess necrosis in hepatocellular carcinoma (HCC) patients treated with transarterial chemoembolization (TACE).MethodsRetrospectively, 95 HCC patients undergoing TACE were included. Radiomics features were selected via LASSO regression, and clinical variables via logistic regression. Separate radiomics and clinical models were developed, and a combined model was constructed using multivariable logistic regression. The cohort was randomly split into training (70%) and validation (30%) sets, with all preprocessing, feature selection, and model training confined to the training set to prevent data leakage. Model performance was evaluated using discrimination (AUC), calibration, clinical utility (decision curve analysis), and a nomogram.ResultsFrom 1,316 extracted radiomics features, six were retained for Rad-score calculation. Key clinical predictors included hepatitis group, standardized viable tumor ratio, and vascular invasion. The integrated model achieved AUCs of 0.865 (95% CI: 0.768-0.961) in training and 0.853 (95% CI: 0.716-0.990) in validation (n=29), outperforming the clinical model (AUCs: 0.808 (95% CI: 0.695-0.922) and 0.666 (95% CI: 0.465-0.866), respectively). Decision curve analysis and calibration plots confirmed the combined model’s superior performance.ConclusionThe radiomics-clinical nomogram, based on a standardized necrosis rate, may enable early prediction of TACE response, offering potential insights for therapeutic decision-making, risk stratification, and liver transplantation management. External validation is warranted before clinical application.
48. Strengthening Care Through Food Is Medicine: Healthcare Provider-Patient Relationships and Provider Fulfillment in a Produce Prescription Program.
期刊: Journal of primary care & community health 发表日期: 2026 链接: PubMed
摘要
Produce prescription programs (PPRs) are evidence-based strategies increasingly used to address food insecurity and prevent or manage diet-related chronic disease. Fresh to Flourish is a PPR implemented in 2 Colorado-based practices within the CommonSpirit Health system. This qualitative study explored: (1) how implementing Fresh to Flourish impacts provider-patient relationships, and (2) the fulfillment experience of PPR referral providers. Virtual 1:1 key informant interviews were conducted with healthcare providers. Interviews were recorded, transcribed verbatim, and independently double coded using a deductive codebook aligned with the 7 constructs of the Theoretical Framework of Acceptability of Healthcare Interventions. Ten interviews were completed across 1 rural and 1 suburban Colorado practices. Four themes emerged: (1) providers perceived Fresh to Flourish as valuable to patient care; (2) discussions about financial strain and food insecurity prompted referrals; (3) providers appreciated the simple referral process and on-site program staff; and (4) providers shared insights about integrating Fresh to Flourish into clinical workflow and systems. As aligned with the supporting theory, providers demonstrated high affective attitude, ethical alignment, and perceived effectiveness of Fresh to Flourish, with minimal burden and strong self-efficacy. Overall, providers viewed Fresh to Flourish as impactful while emphasizing the need to expand access and reduce barriers.
49. Factors Influencing Engagement in Work-Related Activities Among People With Dementia or Mild Cognitive Impairment: A Cross-Sectional Study.
期刊: Occupational therapy international 发表日期: 2026 链接: PubMed
摘要
People with dementia or mild cognitive impairment (MCI) desire social connection and meaningful contribution, despite often being excluded from work-related activities. The impact of engagement in work-related activities on the mental well-being of people with dementia or MCI remains underexplored. The aim of this study is to investigate the factors influencing engagement in work-related activities among people with dementia or MCI. Cross-sectional study. Seven-day care centers in Japan. Sixty-three day care center members with dementia or MCI who had participated in work-related activities for at least 6 months. Well-being assessed by the World Health Organization-Five Well-Being Index (WHO-5); engagement evaluated by the Assessment of Quality of Activities (A-QOA), an occupational therapists-developed observational assessment tool; and confounders of engagement. Among the 63 participants (age: median: 83 years, interquartile range [IQR]: 61, 94; Mini-Mental State Examination-Japanese score: median: 19 points, IQR: 4, 27), 74.6% were female. A significant correlation was observed between the WHO-5 and A-QOA (ρ = 0.433, p < 0.001). Stepwise multiple regression analysis revealed a significant association between the A-QOA and WHO-5 (β = 0.480, p < 0.001), frequency of participation (β = 0.337, p = 0.003), and hearing loss-related social limitations (β = 0.286, p = 0.01). Greater engagement in work-related activities was associated with better well-being, higher frequency of participation, and hearing loss-related social limitations. Implementation of and support for personalized work-related activities, considering these factors for people with dementia or MCI, could enhance their engagement and promote their mental well-being.