公共卫生研究摘要 (2026-04-22)
共收录 56 篇研究文章
1. Association of the Mediterranean Diet With White Matter Integrity Among Hispanic or Latino Adults: Results From the SOL-INCA-MRI Study.
期刊: Neurology 发表日期: 2026-May-12 链接: PubMed
摘要
High adherence to the Mediterranean diet (MeDi) has been associated with slower age-dependent cognitive decline and better cardiovascular health (CVH). We examined the association between adherence to MeDi and white matter (WM) integrity in community-dwelling Hispanic or Latino adults. In secondary analysis, we assessed whether CVH and WM integrity were pathway variables between MeDi and global cognition (GC). Data from Study of Latinos-Investigation of Neurocognitive Aging-MRI Ancillary Study were analyzed. Dietary intake was collected during the baseline visit (2008-2011) using 24-hour recalls, from which a MeDi score ([MeDiS], range 0-9) was derived. Brain MRI scans with diffusion tensor imaging were obtained between 2017 and 2022. WM integrity was assessed using total WM volume (tWM), WM hyperintensity (WMH) volume, fractional anisotropy (FA), and free water (FW). GC was ascertained between 2015 and 2018 using a composite score derived from 4 standardized cognitive tests. CVH was evaluated at baseline using the Life’s Essential 7 score ([LE7], range 0-100), a modified version of the existing Life’s Essential 8 score, in which diet was excluded to avoid collinearity with our exposure. We used linear regression models that controlled for age, sex, and socioeconomic factors to investigate the association of MeDiS with WM integrity. We performed mediation analysis to explore whether CVH and WM integrity were pathway variables between diet and GC. A total of 2,642 participants with a mean age of 64.3 years (95% CI 63.4-65.1, 44% male) were included. The average MeDiS was 5.0 (95% CI 4.9 to 5.1), and the LE7 score was 66.6 (95% CI 65.-67.6). Higher MeDiS was associated with lower WMH volume (β = -0.08, 95% CI -0.11 to -0.04), higher tWM volume (β = 0.05, 95% CI 0.005-0.09), lower FW (β = -0.04, 95% CI -0.08 to -0.002), and higher fractional anisotropy (FA) (β = 0.09, 95% CI 0.05-0.13). WMH, tWM, and FA mediated the association between MeDiS and GC. In addition, there was serial mediation from MeDiS on GC through LE7 score, WMH, tWM, and FA. Higher adherence to MeDi is linked to better WM structural integrity, which, together with CVH, mediates the association between MeDi and GC.
2. PrEP surfing: HIV pre-exposure prophylaxis (PrEP) use of sex partners as HIV prevention strategy among men who have sex with men.
期刊: AIDS (London, England) 发表日期: 2026-Apr-22 链接: PubMed
摘要
Having condomless anal sex while relying on the HIV pre-exposure prophylaxis (PrEP) use of one’s sex partner is referred to as PrEP surfing. We aimed to estimate the proportion of MSM practicing PrEP surfing, their intention to practice it, and determinants of both. Open prospective cohort study. We included MSM participating in the Amsterdam Cohort Studies in 2021-2023. Biannually, participants completed questionnaires on recent (=preceding 6 months) sexual behaviour, including PrEP use, PrEP surfing, and intention for both in the coming 6 months (7-point Likert scale). We assessed determinants of PrEP surfing with logistic regression and determinants of intention with linear regression. We included 2,187 visits from 636 participants to analyse intention for PrEP surfing. Median age was 45 (IQR = 34-52) years, median number of recent sex partners 4 (IQR = 1-11), and 264 (41%) participants reported recent PrEP use. For recent PrEP surfing, 1,779 visits from 562/636 (88%) participants with event-driven/no PrEP use were analysed. Recent PrEP surfing was reported in 449/1,779 (25%) visits. Median intention for PrEP surfing was 4 (IQR = 1-6); in 588/2,187 (27%) visits, intention for PrEP surfing was high (=score 6-7). Recent PrEP use and high perceived probability of acquiring HIV were associated with recent PrEP surfing and higher intention, while age ≥45 and having a steady partner were inversely associated. Having ≥3 recent partners was associated with recent PrEP surfing. PrEP surfing is a common HIV prevention strategy among MSM in Amsterdam. Its effectiveness needs to be determined to optimize HIV prevention care.
3. Urinary Sodium Excretion and the Risk of Prevalent Anemia: Nationwide Population-Based Cross-Sectional Study.
期刊: JMIR public health and surveillance 发表日期: 2026-Apr-21 链接: PubMed
摘要
While excessive dietary sodium intake is an established risk factor for cardiovascular and renal complications, its potential association with anemia remains largely unexplored. We hypothesized that, based on the observed benefits of sodium-glucose cotransporter 2 inhibitors in correcting anemia through alterations in renal tubular metabolism and oxygen homeostasis, elevated urinary sodium excretion, as a surrogate of dietary sodium intake, may increase the risk of prevalent anemia. This nationwide cross-sectional study analyzed 54,802 adults from the Korea National Health and Nutrition Examination Survey (2014-2023). Participants were stratified by spot urine sodium-to-creatinine ratio (Na+/Cr) quartiles (first quartile [Q1], second quartile [Q2], third quartile [Q3], and fourth quartile [Q4]). Anemia was defined as hemoglobin <13 g/dL for men and <12 g/dL for women. Anemia prevalence increased progressively across spot urine Na+/Cr quartiles (Q1: 925/13,700, 6.8%, Q2: 1126/13,701, 8.2%, Q3: 1393/13,701, 10.2%, and Q4: 1893/13,700, 13.8%). Multivariable logistic regression demonstrated that participants in the highest quartile had 43% higher odds of anemia compared with the lowest quartile (adjusted odds ratio 1.429, 95% CI 1.269-1.610; P<.001). Each 1-unit log increase in spot urine Na+/Cr conferred a 67% increase in odds of anemia (adjusted odds ratio 1.674, 95% CI 1.452-1.930; P<.001). Sensitivity analyses using tertiles, quintiles, estimated 24-hour sodium excretion, and restriction to preserved kidney function consistently confirmed these associations. Higher urinary sodium excretion exhibits a robust, graded association with increased anemia prevalence in the general population. These findings suggest that dietary sodium restriction may provide additional benefits beyond cardiovascular protection.
4. Community PrEP delivery preferences among pregnant and breastfeeding women using oral PrEP in south africa and kenya.
期刊: AIDS (London, England) 发表日期: 2026-Apr-21 链接: PubMed
摘要
We evaluated preferences for differentiated service delivery of oral pre-exposure prophylaxis (PrEP) versus clinic pick-up among oral PrEP-experienced pregnant and breastfeeding women (PBFW) in South Africa and Kenya. From September 2021 to February 2022, we surveyed PBFW in oral PrEP studies in South Africa and Kenya. We asked participants about their PrEP delivery preferences and used logistic regression models adjusted for age and country to identify predictors of preferring community over clinic-based PrEP delivery. We surveyed 394 South African and Kenyan PBFW (73% postpartum, median age 28 years). Overall, 59.5% of South African participants (n = 113) and 24.5% of Kenyan participants (n = 50, p < 0.01) were interested in community PrEP delivery, most frequently due to convenience (n = 80, 49.1%) and lower transportation costs (n = 78, 47.9%). Participants preferred clinic PrEP pick-up due to privacy (n = 174, 75.3%) and desire to see a healthcare provider (n = 83, 35.9%). Preference for community PrEP delivery was positively associated with South African participants (aOR = 4.32, 95% CI = 2.80-6.67), PrEP stigma (aOR = 2.59, 95% CI = 1.58-4.23), completing secondary school or higher (aOR = 1.84, 95% CI = 1.17-2.92), and transportation cost to clinic (aOR = 1.39, 95% CI = 1.10-1.75). Preference of community PrEP delivery was negatively associated with age (aOR = 0.68 per 10-year increase, 95% CI = 0.49-0.95) and having one or more sexual partners versus no sexual partners (aOR = 0.34, 95% CI = 0.12-0.95). Oral PrEP-experienced PBFW in South Africa and Kenya described varied preferences for community PrEP delivery. Associations with community-based PrEP delivery preference identified in this analysis may be useful in the development of context-specific DSD interventions targeting PBFW.
5. Experiential Classes Plus Digital Logging in Antenatal Care for Pregnant Women in China: Mixed Methods Study.
期刊: Journal of participatory medicine 发表日期: 2026-Apr-21 链接: PubMed
摘要
Maternal health during the perinatal period is a global public health priority. While antenatal education is widely implemented, conventional lecture-based models often fail to achieve sustained behavior change. Innovative approaches that integrate experiential learning with digital support may enhance maternal knowledge, self-management, and pregnancy outcomes. The aim of this study is to evaluate the feasibility and preliminary effectiveness of a combined experiential class and online logging intervention for pregnant women in China and to explore the mechanisms underpinning its impact on health practices and service experiences. A mixed methods design was used in a district-level maternal and child health hospital in Beijing. In the quantitative arm, 40 women (intervention group, n=20; control group, n=20) were enrolled in a quasi-experimental comparison. Outcomes included knowledge-attitude-practice indicators, service satisfaction, and clinical birth outcomes. Given the limited sample size, a qualitative arm was conducted to complement statistical findings: semistructured interviews with 20 women (10 per group) were analyzed thematically. Quantitative and qualitative results were integrated during interpretation to provide a comprehensive evaluation. Compared with the experiential class alone, the combined intervention was associated with higher knowledge scores (mean difference 1.6 points, 95% CI 0.8-2.4), stronger adherence to recommended health practices (composite adherence score difference 1.0, 95% CI 0.4-1.6), and higher overall service satisfaction (mean difference 0.6, 95% CI 0.2-1.0). Across multiple domains, a higher proportion of participants in the intervention group met dietary, exercise, and supplementation recommendations. Clinical outcome differences were exploratory, as the study was not powered for these end points. Qualitative analysis revealed 3 mechanisms, such as empowerment and self-efficacy, practice and persistence, and systemic/environmental support, through which the intervention influenced experiences and practices. The experiential class plus online logging model is feasible and acceptable in a real-world antenatal setting. Although limited by a small sample size, findings suggest that the intervention improves maternal knowledge, health practices, and service experiences and may inform future adequately powered trials to evaluate pregnancy outcomes. Qualitative insights highlight mechanisms of health practice change and provide contextual depth, underscoring the value of mixed methods designs in maternal health research.
6. Engaging Hospital Staff to Identify Levers for Adoption of Clinical Decision Support: Protocol for a Single-Site Case Study Using System Dynamics Group Model Building.
期刊: JMIR research protocols 发表日期: 2026-Apr-21 链接: PubMed
摘要
Clinical decision support (CDS) tools that provide patient-specific and evidence-based information to clinicians and care managers regarding patient risk for adverse outcomes have been a part of health care for decades. However, modern CDS, which consists of automated predictions based on complex machine learning models and hundreds of complex input variables, faces obstacles to adoption related to health care providers’ perceptions of lack of transparency and utility. Often, the expertise of data scientists and clinical end users is not well integrated, creating implementation gaps from CDS development to adoption and ongoing implementation. This protocol describes the use of group model building (GMB) from the field of system dynamics to engage health system staff in identifying dynamic facilitators and barriers to implementing 1 class of CDS-early warning scores (EWSs)-in general medical-surgical wards. We aim to produce a causal model that reflects the insights and feedback shared during these sessions. We will also evaluate the GMB process as a potential strategy for CDS implementation and adoption more generally. The protocol consists of 3 sequential GMB sessions designed to elicit key variables for inclusion in the model, understand how changes in variable behavior over time affect adoption, and develop a causal loop diagram. Pre- and postsession questionnaires assess changes in perceived acceptability, appropriateness, and feasibility of the EWS and collect feedback on the GMB process. A stock-and-flow simulation model will be developed from the causal loop diagram to quantify how feedback loops influence variables over time and test assumptions. The project was funded in 2022-2025, and 3 GMB sessions and qualitative causal loop diagrams were completed during that time. Data analysis is ongoing. This analysis consists of translating the causal loop diagram from the GMB into a stock-and-flow simulation model to quantify how feedback loops influence variables over time. Results will include a causal loop diagram accompanied by a detailed narrative that together tell a story about system behavior surrounding EWS adoption that is supported by session transcripts, the simulation model and test results, and the data on GMB participants’ views about the EWS itself and the modeling process. These findings will have broader applicability beyond just EWSs. Future work will build on the EWS system dynamics model by incorporating multiple clinical use cases to fully capture multilevel factors that determine real-world adoption and sustainability of machine learning CDS.
7. Predicting Keratoconus Progression From a Single Visit: Is Machine Learning Successful?
期刊: Eye & contact lens 发表日期: 2026-Apr-21 链接: PubMed
摘要
To develop and evaluate a machine learning (ML)-based model for predicting keratoconus (KCN) progression in an Iranian cohort. This retrospective study included 1,000 eyes of 529 patients with KCN (mean age: 31.1±8.0 years; 63.3% male) with two ocular examinations at least six months apart (mean interval: 71.1±41.7 months) and no prior corneal surgery. Progression was defined by a composite criterion: ≥1.00 D increase in KmaxF or anterior astigmatism, ≥25 μm corneal thinning, or ≥0.42 increase in Belin/Ambrosio D-index. Three XGBoost-based algorithms were developed: (1) using baseline data plus interexamination change rates, (2) using only baseline data for three-class prediction (progressive/stable/regressive), and (3) a refined binary model (progressive vs. nonprogressive). Of the 1,000 eyes, 32.3% were progressive, 59.4% stable, and 8.3% regressive. The type 1 algorithm achieved near-perfect performance (AUC=0.999, accuracy=99%). However, the single-visit type 2 model showed limited accuracy (65%) and low sensitivity for progression (46%). The optimized type 3 binary model improved sensitivity to 69.1% and AUC to 0.72. Feature importance analysis identified combination of anterior maximum curvature more than 48.0 D and thinnest pachymetry less than 470 μm is the most identifier parameter. The Clinical Risk Score enabled stratification into low, moderate, and high-risk groups for progression. While ML models excel when longitudinal data are available, predicting KCN progression from a single visit remains challenging. Integrating engineered features and a clinical risk score enhances performance, but current accuracy is insufficient for standalone clinical use. Prospective validation and population-specific thresholds are needed before real-world implementation.
8. Temporal trends in viral SetPoint and peak CD4 cell count soon after HIV-1 seroconversion.
期刊: AIDS (London, England) 发表日期: 2026-Apr-21 链接: PubMed
摘要
To examine whether HIV-1 virulence, as measured by prognostic markers soon after seroconversion, has changed over time and across subgroups in the context of widespread ART availability. Observational cohort study of individuals with well-estimated HIV-1 seroconversion dates recruited from clinics in eight European countries and Canada (CASCADE Collaboration). We analyzed data from 21,933 participants who seroconverted 1980-2014, while ART-naïve and AIDS-free. Piecewise linear mixed models with one knot at 1 year after seroconversion for log10 HIV-1 RNA (setpoint viral load, SPVL) and 4 months for square-root CD4 cell count (peak CD4) were fitted. Models adjusted for age, sex/probable exposure route, region of origin, diagnosis during acute infection, and assay type. SPVL increased and peak CD4 declined over time until approximately 2000, then stabilized, with a mild reversal after 2005. Estimated (95% CI) average SPVL for those seroconverting on 1/1/1980, 1/1/1995, 1/1/2005, and 31/12/2014 was 3.2 (3.0-3.4), 4.0 (3.9-4.1), 4.3 (4.2-4.4), and 4.2 (4.1-4.3) log10 copies/mL, respectively. Corresponding estimates for peak CD4 were 960 (898-1025), 615 (584-648), 521 (492-551), and 560 (526-594) cells/μL. The increase in SPVL up to 2005 was less pronounced in European/North American MSM (1.0 log10 copies/mL) than in men and women with heterosexual exposure from the same region or from Africa (1.5 and 1.4 log10 copies/mL, respectively). SPVL and peak CD4 stabilized by 2000-2005, consistent with HIV-1 adaptation to the population. The subsequent trend reversal, most evident among MSM, warrants ongoing monitoring.
9. Association between expanded HIV testing and late diagnosis in older adults living with HIV: Evidence from Southwest China.
期刊: AIDS (London, England) 发表日期: 2026-Apr-21 链接: PubMed
摘要
We examined the characteristics and time trends of late diagnosis among people living with HIV (PLWH) aged ≥50 years in southwest China from 2010 to 2023, and assessed the impact of the expanded HIV testing strategy and associated factors. We retrospectively analyzed cross-sectional data from 26,233 newly diagnosed older PLWH in southwest China between 2010 and 2023, from the Chinese Comprehensive Response Information Management System for HIV/AIDS (CRIMS). A multilevel logistic regression model was used to identify factors associated with late diagnosis, with latent class analysis as a sensitivity analysis to test the robustness of the results. The late diagnosis rate declined from 2010 to 2023 (p for trend <0.05). Compared with the pre-strategy period (2010-2017), the post-strategy period (2018-2023) was associated with lower odds of late diagnosis (adjusted odds ratio [aOR] = 0.900, 95% CI: 0.854-0.950). Across all age groups (50-59, 60-74, and ≥75 years), primary education or below was associated with lower odds of late diagnosis (aOR range: 0.804-0.892). Late diagnosis rates were higher than the overall average for HIV testing approaches (i.e., the specific route or setting through which HIV was diagnosed) including testing of other patients (i.e., provider-initiated testing in general medical settings), testing at sexually transmitted infection clinics, and pre-testing of receiving blood/products. Targeted health education should focus on high-risk subgroups including males and married individuals, and community-based testing should be promoted. The higher odds with facility-based testing underscore the need to integrate routine HIV testing into healthcare services.
10. Integrating Mobile Text Messaging Pre-Exposure Prophylaxis Navigation Services Into a Home HIV and Sexually Transmitted Infection Self-Testing Program in the United States: Formative Work and Pilot Implementation Study.
期刊: JMIR formative research 发表日期: 2026-Apr-21 链接: PubMed
摘要
HIV testing is the gateway to the HIV prevention continuum and offers an important opportunity to provide HIV prevention services. TakeMeHome.org is an online program that enables state and local health departments to offer free in-home HIV and sexually transmitted infection self-testing. As few TakeMeHome users have used pre-exposure prophylaxis (PrEP), there is an opportunity to link TakeMeHome users to PrEP information and services. The aim of this study is to develop an implementation strategy to link HIV or sexually transmitted infection self-testers from online orders to PrEP services via direct digital linkage to a novel SMS text messaging navigation program. PrEPmate is an evidence-based bidirectional text-messaging platform that has demonstrated increased PrEP retention and adherence. We developed a novel program to link TakeMeHome testers to mobile SMS text messaging PrEP navigation via PrEPmate. We conducted focus groups among TakeMeHome users to elicit preferences for linkage from TakeMeHome to PrEPmate. Based on these focus groups, we revised the content and functionality of this linkage intervention. In October 2023, we launched a pilot implementation study in 2 US Ending the HIV Epidemic jurisdictions: Sacramento, California, and Tarrant, Texas. Thirteen TakeMeHome users participated in 4 focus groups (mean age 31.5 years; n=4, 31% Latinx, n=2, 15% Black; n=9, 69% never used PrEP). When shown wireframes of the TakeMeHome or PrEPmate linkage, most thought they were easy to navigate and user-friendly. They liked the privacy of connecting with a PrEP navigator using SMS text messaging. Participants recommended providing a clear description of PrEP and PrEPmate services and indicating that PrEP is low or no cost on the TakeMeHome website. On the PrEPmate landing page, they recommended adding language on confidentiality and the partnership with TakeMeHome to show that both services are connected. Once enrolled, they recommended weekly or biweekly check-ins to assist with PrEP navigation. Overall, 92% (12/13) of focus group participants were likely to use PrEPmate to learn more about PrEP and/or link to PrEP services. From October 2023 to May 2024, among 537 individuals who ordered test kits and were not on PrEP, 169 (31%) were linked to the PrEPmate page, and 86 (16%) enrolled in PrEPmate. PrEP navigation was provided via SMS text messaging or phone, with 46 (53%) receiving PrEP education and 26 (30%) in various stages of starting PrEP. In exit interviews, participants found the intervention easy to use and appreciated being connected with an experienced PrEP navigator who helped them access PrEP. Through user-centered design, we successfully developed a program to link TakeMeHome testers to PrEP navigation via PrEPmate, with high feasibility and acceptability of the intervention and a substantial number of clients starting PrEP. The next steps will involve evaluating the effectiveness of this program on a larger scale and, if successful, expanding PrEPmate navigation to all Ending the HIV Epidemic jurisdictions using TakeMeHome.
11. Evidence Over Eminence: Rethinking Specialty Guidelines Amid the ATS-IDSA Debate.
期刊: Clinical infectious diseases : an official publication of the Infectious Diseases Society of America 发表日期: 2026-Apr-21 链接: PubMed
摘要
12. Life Satisfaction Domains Among Older Adults: Patterns by Age, Gender, and Living Arrangement.
期刊: Journal of applied gerontology : the official journal of the Southern Gerontological Society 发表日期: 2026-Apr-21 链接: PubMed
摘要
This study examined age-related differences in total and domain-specific life satisfaction among older adults, stratified by gender and living arrangement. Cross-sectional data from 13,488 adults aged ≥65 years were analyzed across five domains: health, community environment, interpersonal relationships, society, and social roles. Using T-scores based on the 65-69 group, linear regression assessed associations between age and life satisfaction. Among men living with others, older age was linked to higher total life satisfaction and greater satisfaction with interpersonal relationships and social roles. No significant associations were found for men living alone, suggesting a different trajectory from typical psychological adaptation. Women living with others showed positive age-related trends across all domains. Women living alone also demonstrated significant increases in community environment, interpersonal relationships, and social roles, indicating that age-related improvements were present regardless of living arrangement.
13. Diagnostic validation and prognostic implications of serial 0/1/3h stratification in patients with suspected myocardial infarction using high-sensitivity troponin T.
期刊: European heart journal. Quality of care & clinical outcomes 发表日期: 2026-Apr-21 链接: PubMed
摘要
The European Society of Cardiology (ESC) recommends 0/1h-algorithms for triage of patients with suspected myocardial infarction (MI). Recently, cut-offs allowing 3h triage using high-sensitivity cardiac troponin T (hs-cTnT) have been derived, but their prognostic implications remain unclear, and external validation is lacking. To externally validate the diagnostic performance and assess the prognostic impact of the 0/1/3h algorithm for cardiovascular events in an all-comer cohort with suspected MI. We prospectively enrolled patients presenting to the emergency department with suspected MI. hs-cTnT was measured at presentation, 1h, and 3h. Patients were followed up to evaluate all-cause mortality and major adverse cardiovascular events (MACE). Diagnostic accuracy was assessed by stratifying patients using the 0/1/3h algorithm. Cox regression analyses compared cardiovascular risk at 90 days and three years between rule-in and rule-out groups. Among 2,514 patients (median age 64 years; 63.6% men), the algorithm demonstrated excellent rule-out safety (sensitivity 98.6% [95% CI, 96.8, 99.4]; NPV 99.7% [99.2, 99.9]) and moderate rule-in capacity (specificity 89.3% [87.9, 90.5]; PPV 60.8% [56.8, 64.7]). Over three years, 646 patients experienced MACE, and 256 died (68 cardiac deaths). Patients ruled-out at 3h had doubled MACE risk (HR 2.11 [1.44, 3.08]) and quadrupled mortality risk (HR 4.33 [1.85, 10.12]) compared to immediate rule-out (p<0.001). The 0/1/3h algorithm shows excellent diagnostic safety and adds prognostic value, with delayed rule-out associated with significantly increased long-term cardiovascular risk and mortality.
14. Usage and Perceptions of Electronic Patient Records Experienced by Users and Nonusers in the Canton of Vaud, Switzerland: Mixed Methods Study.
期刊: Journal of medical Internet research 发表日期: 2026-Apr-21 链接: PubMed
摘要
Electronic patient records (EPRs) have shown potential to improve health care delivery, coordination, and patient engagement. In Switzerland, the development of a national EPR is supported by the Confederation, while its deployment is carried out by the cantons through EPR communities. Since health policy and the organization of health systems are entrusted to cantonal governments, each of the 26 Swiss cantons must decide its strategy for the implementation and application of EPRs within its jurisdiction. The canton of Vaud has joined with other French-speaking cantons (Geneva, Valais, Fribourg, and Jura) in organizing the implementation of the EPR through the CARA association since 2018. By June 2025, approximately 32,350 individuals have opened an EPR (Dossier électronique du patient) through CARA, accounting for 28% of all EPRs opened nationwide at that time. This study aimed (1) to document patients’ use of EPR in the canton of Vaud and to examine the user profiles; and (2) to explore users’ and nonusers’ perceptions regarding EPR benefits and barriers. This mixed methods study was conducted in 2 phases. First, a quantitative questionnaire examined EPR user profiles (eg, demographics and health status). Health literacy and digital health literacy were assessed using the HLS19-Q12-CH (Health Literacy Survey 2019-2021) and HLS19-DIGI-CH (Digital Health Literacy) scales in French. Second, qualitative semistructured interviews explored experiences and perceptions of users and nonusers through thematic analysis. Data from both phases were integrated during interpretation. All analysis was conducted in French with quotes translated for publication. The population included 839 patients with EPRs (early adopters from December 2021 to December 2023) and a matched control group. Overall participation was 19.3% (324/1678), with higher participation among EPR users (255/839, 30.4%) than nonusers (69/839, 8.2%). Early adopters were predominantly male (185/255, 72.5%), highly educated (155/255, 60.8%), affected by chronic illness (204/255, 80%), and with extensive health care networks (80% consulted 2 or more health care professionals in the last 3 months). The vast majority (249/253, 98.4%) had a general practitioner. While only a minority (76/252, 30.2%) of early adopters were satisfied with the service provided by the EPR, a majority (172/254, 67.7%) would recommend it to their family and friends. Qualitative analysis identified themes that influence EPR adoption, including the contextual environment, level of health literacy, EPR as a tool, professionals’ resistance to EPR, and level of engagement with digitalization. This study identified early EPR adopters as predominantly highly educated males with chronic diseases and a regular general practitioner. Despite moderate satisfaction with the current implementation, most users recommend the system to others, suggesting a belief in its potential value. Important questions are raised regarding EPR accessibility, limited adoption by professionals, and potential digital health disparities in the general population.
15. Temporal Reproducibility of a Genetic Algorithm-Derived Health Risk Score: Standardized Out-of-Fold Validation Framework (2021-2023).
期刊: JMIR bioinformatics and biotechnology 发表日期: 2026-Apr-21 链接: PubMed
摘要
Genetic algorithm (GA)-based scoring has been proposed as a data-driven approach for health risk stratification . However, performance estimates may be inflated when preprocessing, optimization, and evaluation are not strictly separated within a prespecified validation framework. Demonstrating temporal reproducibility under a standardized out-of-fold (OOF) evaluation framework with transparent uncertainty quantification is therefore essential for ensuring translational reliability in preventive health screening. This study aimed to evaluate the temporal reproducibility of a GA-derived composite health risk score across three consecutive annual cohorts (2021-2023) under a standardized OOF validation pipeline and to assess robustness to policy-driven structural HbA1c missingness through a prespecified ON/OFF sensitivity analysis. Annual health examination datasets from 2021 (n=3744), 2022 (n=5153), and 2023 (n=5352) were analyzed using an identical preprocessing and modeling pipeline. Thirteen clinical indicators and eight lifestyle questionnaire variables were included as predictors. The outcome was based on an A-D grading framework and binarized using an OR rule across domains (grade ≥B in any domain). Continuous variables were median-imputed and standardized within each training fold to prevent information leakage. GA optimization was performed using fixed random seeds, and fitness estimation employed stratified K-fold cross-validation. Predicted probabilities were obtained by fitting logistic regression models to GA-derived composite scores within the OOF framework. Discrimination and overall predictive performance were quantified using the area under the receiver operating characteristic curve (AUC) and the Brier score calculated from OOF predicted probabilities. Uncertainty was estimated using 2,000-replicate percentile bootstrap resampling. A prespecified sensitivity analysis excluded HbA1c while maintaining an identical evaluation framework. OOF AUC values were stable across cohorts (2021: 0.810; 2022: 0.814; 2023: 0.812), with overlapping 95% percentile bootstrap confidence intervals. Brier scores ranged from 0.172 to 0.176. Exclusion of HbA1c resulted in small changes in discrimination (median ΔAUC was ≤0.007), consistent with the prespecified ON/OFF sensitivity analysis. Under a harmonized OOF validation framework, the GA-derived composite risk score showed stable temporal discrimination and consistent overall predictive performance across three consecutive annual cohorts. These findings underscore the methodological importance of prespecified, standardized evaluation procedures and transparent uncertainty quantification when assessing reproducibility of risk stratification models in routine health screening data.
16. Factors Affecting Acceptance of Life Education in Mainland China: National Cross-Sectional Study.
期刊: JMIR public health and surveillance 发表日期: 2026-Apr-21 链接: PubMed
摘要
In traditional Chinese culture, discussing death has always been taboo. The social environment characterized by fear, reluctance, and apprehension toward death significantly impedes the development of palliative care. Therefore, establishing a correct view of life and death and promoting life education are prerequisites for the successful implementation of palliative care. This study aimed to investigate the public acceptance of life education among individuals in China and analyze the explanatory variables. This national cross-sectional study was conducted from June 20 to August 31, 2022, encompassing 23 provinces, 5 autonomous regions, and 4 municipalities directly under the central government. A total of 21,875 participants were included. The generalized linear model was used to analyze influencing factors. Gender, major in medicine, place of residence, education level, family health, media use, etc, were analyzed as the potential variables. Acceptance scores were calculated based on a visual analog scale (VAS). Further subgroup analyses were carried out in different age and major subgroups. The median (P25, P75) acceptance score for life education in the survey was 71.00 (50.00-95.00) points. Compared with females, males had lower acceptance (β=-2.39; 95% CI -3.08 to -1.69). Respondents who were majoring in medicine (β=3.13; 95% CI 1.11-5.14), residing in urban areas (β=1.25; 95% CI 0.46-2.04), processing a bachelor’s degree or higher (β=4.05; 95% CI 2.97-5.12), or having higher scores on the media use (β=0.49; 95% CI 0.41-0.57) had higher acceptance. Compared with people aged 12-17 years, those aged 25-44 years (β=-6.00; 95% CI -7.34 to -4.66), aged 45-64 years (β=-4.55; 95% CI -5.88 to -3.22), and 65 years or older (β=-2.16; 95% CI -3.78 to -0.55) had lower acceptance. For people majoring in medicine, place of residence, family health, and media use were uniquely relevant factors. Higher scores on the Perceived Social Support Scale (PSSS) and Health Literacy Scale-Short Form (HLS-SF) were also significantly associated with greater acceptance of life education. Gender, place of residence, education level, age, media use, perceived social support, and health literacy were identified as key factors influencing acceptance of life education, providing important evidence to inform targeted policy and educational interventions.
17. Use of an AI-Based Tool (Human Experiences and Reflections Data Connector) to Improve Discovery and Reuse of Archived Qualitative Data: Protocol for an Algorithm Development and Validation Study.
期刊: JMIR research protocols 发表日期: 2026-Apr-21 链接: PubMed
摘要
Despite the growing emphasis on open science and equity in research, qualitative data capturing diverse human experiences and perspectives are rarely reused beyond the original study. Increasingly, data repositories are used to make these data publicly available, but it is unclear whether these data can be effectively identified by researchers interested in secondary data analysis. We describe a protocol for identifying and characterizing archived qualitative datasets in leading public repositories, developing an artificial intelligence-based tool to enhance qualitative data reuse, and validating that tool using existing data. We will search 4 leading repositories to assess the scope and identifiability of existing publicly available qualitative datasets. We will subsequently build the Human Experiences and Reflections (HEARs) Archive, a directory of deidentified study data that is only accessible indirectly through the use of the HEARs Portal. The HEARs Portal will be supported by large language model-based tools using the retrieval-augmented generation framework. The artificial intelligence tools’ performance will be assessed across 3 domains: relevance of identified studies, validity as evaluated by comparison with human qualitative data analysis, and robustness against the addition of irrelevant information. A preliminary review of existing data repositories has begun. The anticipated study completion date is December 31, 2026. The proposed project will provide evidence regarding the existing capacity for identifying and accessing qualitative data through leading repositories. It will also provide evidence on the validity of the HEARs Data Connector for identifying and describing qualitative datasets in ways that can assist researchers interested in secondary analysis. Establishing the validity of the HEARs Data Connector and developing an evidence-based ongoing improvement and monitoring strategy will be essential for establishing trust within the qualitative research community.
18. What Money Cannot Buy: Addressing the Socioeconomic Status Ceiling Effect for Black Patients Across Cancer Types.
期刊: Journal of clinical oncology : official journal of the American Society of Clinical Oncology 发表日期: 2026-Apr-21 链接: PubMed
摘要
19. Policy Effectiveness in Improving Air Quality in China: Insights from the Iron and Steel Industry.
期刊: Environmental science & technology 发表日期: 2026-Apr-21 链接: PubMed
摘要
In China, the intensive supervision mechanism (ISM) has been implemented to combat air pollution, yet its effectiveness remains under debate. This study systematically evaluated the effectiveness of the ISM using a multisource data set integrating the CHAP data set, meteorological factors, and ISM data, with the iron and steel industry as a case study. The results indicated that the number of issues identified and the number of enterprises involved from 2018 to 2024 exhibited spatiotemporal heterogeneity. The environmental issues identified by ISM data across different processes were grouped into three main categories: automatic monitoring of pollution sources and data management, pollutant emission control and compliance, and fugitive dust and particulate matter control. Linear regression model revealed that ISM contributed to air quality improvements, influenced by baseline pollutant concentrations, meteorological factors, and the implementation intensity of the ISM. Provincial-level spatial autocorrelation indicated positive clustering between ISM implementation intensity and reductions in pollutant concentrations, particularly in Hebei, Henan, Shanxi, and Shandong Provinces. Enterprise-level evaluation revealed that even in regions with overall strong performance, significant heterogeneity existed among individual enterprises, highlighting the need for refined enterprise-level assessment and differentiated management. These findings underscored ISM’s tangible effectiveness and provided empirical support for its long-term optimization.
20. Factors Associated With Evolution of the Use of Medical Assistance in Dying: Protocol for a Scoping Review.
期刊: JMIR research protocols 发表日期: 2026-Apr-21 链接: PubMed
摘要
As of June 2025, medical assistance in dying (MAiD) is allowed in over 25 jurisdictions across 12 countries, with varying rates of requests and provision. Hypotheses have been suggested to explain these variations, but they are rarely backed up by empirical evidence. As more jurisdictions consider legalizing MAiD, it is important to better understand what factors may explain the evolution of the use of MAiD worldwide with a systematic approach. This scoping review aims to map the available evidence regarding the factors associated with the evolution of the use of MAiD in jurisdictions where it is allowed. The scoping review will follow the Joanna Briggs Institute methodology and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. Ten electronic databases (including MEDLINE, Embase, CINAHL Complete, and APA PsycInfo) and additional gray literature sources will be searched from inception to the present. This scoping review will consider multiple types of publications (eg, primary studies, research syntheses, and government reports) and will report factors associated with the use of MAiD for people who have requested or died by MAiD in jurisdictions that have allowed it for at least 5 years. Publications in English, French, Spanish, German, or Dutch will be included. Screening for assessment against the inclusion criteria and data extraction will be carried out independently by pairs of reviewers. Findings will be presented in a narrative format and mapped into tables and graphs to address the review aims. The database search for scientific publications was completed in March 2025. A total of 8570 publications were identified after removing duplicates. As of October 2025, title and abstract screening is complete, with 216 articles retained for the next stage. The full-text review is underway and scheduled to be completed by December 2025, and results are expected to be submitted for publication in 2026. MAiD is gaining legal and policy attention worldwide, with wide variation in rates of request and provision over time across jurisdictions. This scoping review will contribute to mapping and synthesizing evidence on the factors that may explain these variations.
21. A global investigation of the Moral Incongruence Model of Pornography Use across genders, religions, and cultures.
期刊: Journal of behavioral addictions 发表日期: 2026-Apr-21 链接: PubMed
摘要
Millions of people struggle with compulsive/problematic pornography use (i.e., PPU) or self-perceived addiction (i.e., SPA) to pornography. Despite pornography’s global availability and PPU’s recent official recognition as a manifestation of compulsive sexual behavior disorder, these problems remain poorly understood, primarily due to a lack of rigorous research beyond small, homogeneous samples. To address this gap and provide evidence that is both robust and generalizable, we tested the applicability of the Moral Incongruence Model of Pornography Use across diverse populations. This model posits that individuals develop problems with their pornography use due to behavioral dysregulation (i.e., PPU) and/or when their use conflicts with their moral values (i.e., moral incongruence), often influenced by religious beliefs, resulting in SPA. Using data from the International Sex Survey (N = 66,994; 50.8% women), we examined the associations between religiosity, pornography use frequency, PPU, and SPA, considering moral incongruence as a moderator. We employed multi-group structural equation models across 34 countries, three genders, and seven religious affiliations. Results indicated that the model was invariant across all countries, genders, and religious affiliations, with weak and positive associations between religiosity and PPU/SPA, and moderate-to-strong associations between pornography use frequency and PPU/SPA. Moral incongruence moderated the relationship between pornography use frequency and PPU/SPA, with stronger associations at higher levels of moral disapproval. These findings suggest that, regardless of cultural background, gender, or religion, the same mechanisms may underlie PPU/SPA, supporting the generalizability of the Moral Incongruence Model and its relevance to current international diagnostic guidelines.
22. Linking the Sustainable Development Goals to Standardized Nursing Language: An Educational Strategy Using the Nursing Interventions Classification (NIC).
期刊: International journal of nursing knowledge 发表日期: 2026-Apr-21 链接: PubMed
摘要
PurposeThis study explores an educational strategy designed to bridge the perceived abstraction of the United Nations Sustainable Development Goals (SDGs) by linking them directly to standardized nursing interventions through the Nursing Interventions Classification (NIC). The aim was to enhance nursing students’ understanding of global health and reinforce their professional agency.MethodsA cross-sectional descriptive study with exploratory comparative analysis was conducted at a School of Nursing in Spain. A total of 164 undergraduate nursing students across four academic years participated in a structured classroom activity. Each student group was assigned one SDG, selected a relevant target, and aligned it with an appropriate NIC intervention and related nursing activities. Data were analyzed thematically using Atlas.ti.FindingsAll 17 SDGs were represented in student submissions. A total of 68 NIC interventions were selected, corresponding to 42 unique codes. Thematic analysis revealed four dominant clusters: (1) community and environmental health, (2) health promotion and education, (3) protection and advocacy for vulnerable populations, and (4) systems thinking and interprofessional collaboration. Clear patterns emerged by academic level: early-year students focused on individual-level care, while final-year students selected system-level and policy-oriented interventions.ConclusionsStudents effectively translated global goals into context-specific nursing actions using standardized language. The integration of NIC helped them conceptualize nursing’s contribution to sustainable development in structured, measurable terms.Implications for Nursing PracticeThis study offers an original contribution to international nursing education by linking the SDGs with NIC, a standardized nursing taxonomy. This alignment provides a structured, discipline-specific strategy for operationalizing sustainability through nursing practice. By using NIC as both a pedagogical and conceptual bridge, this intervention reinforces the value of standardized language and supports nursing’s leadership in advancing the 2030 Agenda through evidence-based, context-sensitive action.
23. A Paradigm Shift in Addressing Threats to Science.
期刊: Health care analysis : HCA : journal of health philosophy and policy 发表日期: 2026-Apr-21 链接: PubMed
摘要
24. Correction: From sick care to healthspan: educating the longevity physician for health maintenance and health promotion.
期刊: Biogerontology 发表日期: 2026-Apr-21 链接: PubMed
摘要
25. Barriers and facilitators for online genetic care for hereditary cancer in Japan: findings from surveys of both clients and medical professionals.
期刊: International journal of clinical oncology 发表日期: 2026-Apr-21 链接: PubMed
摘要
Online genetic care can offer a promising solution to the shortage of qualified medical professionals in genetic medicine, which leads to regional disparities in access. However, despite global adoption, its use in Japan remains limited. Two questionnaire surveys were conducted to investigate potential needs and barriers regarding online genetic care: one involving 858 medical professionals (738 physicians and 120 genetic counselors or nurses), and the other involving 443 clients who received in-person genetic counseling. Only 14.0% of the medical professionals had experience with online genetic care, although 85.9% of the professionals engaged in cancer genetics were willing to consider providing it in the future. Notably, a discrepancy was found regarding hospital selection: clients prioritized access to specialized medical care, whereas professionals assumed clients valued accessibility for family members. Professionals expressed greater concerns about adequacy of online communication, client environments and internet security. Among clients, 89.1% estimated they would sufficiently understand and accept total content of counseling session if were conducted online. Older age and infrequent internet use were associated with lower acceptance and higher anxiety regarding online methods. Concerns about ability to use the necessary technology affected clients’ willingness to encourage online care for their relatives. Online genetic care shows high potential for client acceptance and can effectively address regional disparities in Japan. To bridge the gap between client needs and professional perceptions and to overcome the digital divide, it is necessary to develop secure, accessible systems and provide education for both patients and healthcare providers.
26. Gearing in the human medial gastrocnemius: effects of contraction conditions, tissue stiffness, and echo intensity.
期刊: European journal of applied physiology 发表日期: 2026-Apr-21 链接: PubMed
摘要
In isolated animal muscles, contraction intensity and tissue stiffness have been shown to be related to gearing. However, these relationships remain poorly understood in humans. This study aimed to clarify how contraction intensity and velocity impact gearing and their relationship with tissue properties in humans. Fifty-two healthy young adults participated in this study. We measured the shear elastic modulus of the medial gastrocnemius muscle, its aponeurosis, and the Achilles tendon, as well as muscle echo intensity. The shear elastic modulus of the aponeurosis was used for analysis as the ratio of transverse to longitudinal directions. Belly segment gear was quantified using ultrasound images of the medial gastrocnemius during isokinetic and isometric plantarflexion. During isometric contraction, belly segment gear under 60% MVC (1.054 ± 0.029) was significantly greater than that under 20% MVC (1.029 ± 0.044). In contrast, during isokinetic contraction, no significant difference between belly segment gear under 100°/s (1.053 ± 0.024) and that under 20°/s (1.056 ± 0.021) was observed. During lower-intensity, higher-velocity isokinetic contractions, greater belly segment gear was associated with a higher transverse to longitudinal stiffness ratio of the superficial aponeurosis (β = 0.274, p = 0.038), lower tendon stiffness (β=-0.312, p = 0.021), and lower echo intensity (β=-0.308, p = 0.021). Furthermore, mediation analysis revealed that the effect of aponeurosis stiffness on torque through belly segment gear was significant (indirect effect = 4.35; 95% confidence interval, 0.11-10.09). Belly segment gear was associated with contraction intensity and connective tissue properties.
27. Data Science at the Interface of Air Pollution and Lung Health: Toward Precision Health.
期刊: Annual review of biomedical data science 发表日期: 2026-Apr-21 链接: PubMed
摘要
Air pollution is a leading cause of death, commonly linked to respiratory diseases, such as asthma, chronic obstructive pulmonary disease, and lung cancer. With a view toward precision health, efforts have been made to ascertain the relationships between air pollution and molecular dysregulation to direct risk management and prevention of pollution-promoted respiratory diseases. To this end, there have been several analyses aimed at uncovering how air pollution drives disease through dysregulation of the methylome, transcriptome, metabolome, proteome, genome, and microbiome. Here we review these studies, assess their current limitations, and discuss their contributions to research at the interface of air pollution and lung health. We highlight how large-scale analyses have elucidated the role of air pollution in dysregulating genomic stability, inflammation, and apoptotic pathways to promote respiratory diseases. Finally, we summarize opportunities for future research that may be facilitated by ongoing improvements in exposure estimates and multiomic integration strategies.
28. Clinical Model Autophagy: The Risk of Interpretative Drift in Recursive Medical AI.
期刊: JMIR medical informatics 发表日期: 2026-Apr-21 链接: PubMed
摘要
The rapid integration of large language models into electronic medical record systems introduces a critical theoretical vulnerability. Drawing on foundational computer science proofs of “model collapse,” this viewpoint introduces the concept of “Clinical Model Autophagy”-a systemic degradation of diagnostic integrity that occurs when clinical artificial intelligence (AI) models are recursively trained on unverified, AI-generated synthetic data. As these recursive models may progressively regress toward statistical means, they undergo “Interpretative Drift,” a clinically concerning phenomenon where rare pathological variances are systematically erased and complex diseases are homogenized into benign averages. To prevent the irreversible contamination of health care data ecosystems, the author urgently proposes the Data Purity Standard (DPS). The DPS mandates the cryptographic watermarking of all AI-assisted clinical entries for provenance tracking, alongside the establishment of “Human Vaults.” These physically segregated repositories of physician-verified heritage data will serve as immutable biological anchors to safely guide future AI training, ensuring the long-term reliability of digital health infrastructure.
29. Lipodystrophy Look-Alikes: Navigating Diagnostic Overlap with Endocrine Diseases.
期刊: European journal of endocrinology 发表日期: 2026-Apr-21 链接: PubMed
摘要
Lipodystrophy syndromes are rare and heterogeneous disorders characterized by partial or generalized absence of subcutaneous adipose tissue. These conditions are associated with severe metabolic complications, including insulin resistance, diabetes, dyslipidemia, and hepatic steatosis. Because of their rarity and clinical variability, lipodystrophies are often underrecognized and may be mistaken for more common endocrine disorders, leading to misdiagnosis and delayed treatment. Several endocrine diseases share overlapping clinical manifestations with lipodystrophy, such as abnormal fat distribution, hyperandrogenism, growth disturbances, or metabolic dysfunction. Such overlap poses significant diagnostic challenges, especially for non-specialist clinicians. A precise differential diagnosis is crucial as management strategies differ substantially between lipodystrophies and other endocrine conditions. This review explores the main diagnostic pitfalls encountered when assessing patients with suspected lipodystrophy and offers practical guidance on the clinical, biochemical, and imaging features useful for distinguishing these conditions from other endocrinological disorders. Recognizing lipodystrophy early is crucial to prevent severe complications and initiate targeted treatments, including lifestyle interventions, insulin-sensitizing drugs, lipid-lowering therapies, and, when appropriate, recombinant leptin (metreleptin) therapy. By outlining key clinical clues and common areas of overlap, this review aims to help clinicians avoid misdiagnoses and ensure timely, accurate identification of lipodystrophy syndromes. Lipodystrophies are a heterogeneous group of rare disorders characterized by marked phenotypic variability, which contributes to significant clinical overlap with common endocrine diseases and frequent misdiagnosis. This phenotypic heterogeneity represents a major challenge in routine practice. As endocrinologists are the specialists who most frequently establish the diagnosis of lipodystrophy, awareness of this disease is essential. This review highlights both the overlapping and distinguishing features of lipodystrophies and endocrine “look-alikes,” aiming to support accurate recognition and management. By integrating clinical, biochemical, and imaging features, and aligning with structured diagnostic approaches, including decision-tree-based and photography-based tools, this work provides a practical framework to reduce diagnostic delays and improve clinical outcomes.
30. Impact of multicomponent exercise training in older individuals with and without heart failure with reduced ejection fraction - the role of functional capacity and novel biomarkers.
期刊: European journal of heart failure 发表日期: 2026-Apr-21 链接: PubMed
摘要
Exercise training is recommended for patients with heart failure (HF), however its efficacy in older individuals (≥80 years) with HF is less clear. From the cluster-randomised controlled Bestform-trial (NCT04207307) in older residents of senior care facilities the effects of 6-month multicomponent machine-based exercise training were assessed for those with and without HF. Functional capacity using the Short Physical Performance Battery (SPPB), Chair-Stand-Test (CST), handgrip strength, and 6-Minute-Walk-Test (6MWT) as well as inflammatory, catabolic and anabolic biomarkers were analysed pre- and post-training using linear mixed models. A total of 57 participants (mean 84.4±6.7 years) were included in the analysis, of whom 24 had HF. Baseline data revealed significantly lower 6MWT-distance (mean difference [MD] -71.3, 95%-confidence interval [95% CI] -119.5 to -23.2 m) and handgrip strength (MD -4.3, 95%CI -8.4 to -0.3 kg). Moreover, significantly higher GDF-15 concentrations were observed in participants with HF compared to No HF (MD 544.2, 95%CI: 39.1 to 1049.4 pg/mL). Post-training, SPPB (β=0.60, 95%CI 0.22 to 0.98), CST (β=0.37, 95%CI 0.15 to 0.58), and 6MWT-distance (β=15.22, 95%CI 3.47 to 26.97) significantly improved in the whole analysis population. Among biomarkers, TNF-α decreased significantly (β=-0.22, 95%CI -0.43 to -0.01), and P3NP declined (β=-0.23, 95%CI -0.38 to -0.08) with a Time×Group interaction (β=0.41, 95%CI 0.11 to 0.70) indicating a reduction only in the No HF-group. Six months of multicomponent exercise training enhanced functional capacity and reduced circulating TNF-α in older individuals, irrespective of HF status, while P3NP declined only in those without HF.
31. Digital and Remote Health for Older Adults in Rural or Underserved Settings: Systematic Review of Clinical, Behavioral, and Implementation Outcomes.
期刊: JMIR aging 发表日期: 2026-Apr-21 链接: PubMed
摘要
Older adults in rural or underserved settings face persistent access barriers. Digital and remote health interventions may mitigate these gaps. The aim of this study is to assess technologies, effectiveness, and implementation challenges of digital or remote health interventions for adults ≥60 years old in rural or underserved contexts. A systematic search was conducted in 4 electronic databases, such as PubMed, Scopus, Web of Science, and Embase (inception: April 2025), under dual screening by 2 reviewers. The tool Cochrane Risk of Bias 2.0 was used to assess the risk of bias for randomized trials, and Risk Of Bias In Non-randomized Studies-of Interventions (ROBINS-I) was used for nonrandomized trials. For observational studies, we used the National Institutes of Health quality assessment tool, and a narrative synthesis was performed. Fourteen studies met the inclusion criteria (randomized and nonrandomized designs; median follow-up ~12 mo). Ten of 14 (71%) reported significant improvements in at least 1 clinical end point (eg, hemoglobin A1c, blood pressure, and weight), 11 of 14 (79%) improved behavioral or psychosocial outcomes, and 5 of 9 (56%) reduced hospitalizations or acute episodes. Risk-of-bias concerns most frequently related to missing data and selective reporting. Digital literacy and broadband access were the most consistent barriers, while multicomponent, nurse-supported models achieved higher adherence. Equity-related dimensions (place, gender, and socioeconomic status) were variably reported, with limited attention to language, cultural tailoring, or social capital. No study included a formal cost-effectiveness analysis. Digital and remote health interventions can benefit older adults in rural and underserved settings by improving selected clinical and behavioral outcomes. However, heterogeneity, small sample sizes, and the absence of economic evaluations temper certainty. Importantly, gaps in equity reporting and persistent barriers to digital inclusion highlight the need for future trials to integrate PROGRESS-Plus (place of residence, race/ethnicity, occupation, gender, religion, education, socioeconomic status, social capital, plus other context-specific determinants of health equity) dimensions, embed cost-effectiveness assessments, and design interventions that are both sustainable and accessible to the most underserved populations.
32. Nuclear SnRK1 Activity Delays Clubroot Development in Arabidopsis by Reducing Sink Strength.
期刊: Plant, cell & environment 发表日期: 2026-Apr-21 链接: PubMed
摘要
Clubroot, caused by the soil-borne protist Plasmodiophora brassicae, is a major disease of Brassica crops, resulting in severe root malformations and yield losses. While most research has centred on immune signalling and hormone dynamics, plant-pathogen interactions also dramatically reshape primary metabolism, often modifying source activity and converting infected tissues into strong metabolic sinks. The SnRK1 (SNF1-related kinase 1) protein kinase acts as a cellular fuel gauge in plants, integrating metabolic status and environmental and developmental cues to maintain carbon and energy homoeostasis. Here, we explored SnRK1-mediated quantitative resistance against clubroot disease in the related crucifer model Arabidopsis thaliana. Both soil- and hydroponics-based disease assays revealed how especially increased nuclear SnRK1α1 activity antagonizes clubroot development, suggesting a pivotal role for transcriptional regulation. qRT-PCR analysis and quantification of soluble sugar contents and invertase activity in roots indicate that SnRK1-mediated resistance coincides with reduced sucrose transporter expression as well as cell wall invertase expression and activity, likely limiting clubroot development by reducing sink strength. Consistently, cellular assays indicate that the recently identified SnRK1α1-targeting P. brassicae effector PBZF1 interferes with SnRK1α1 nuclear translocation. Our study thus corroborates that SnRK1 is a primary effector target and shows that SnRK1-mediated reprogramming of gene expression and sink activity is an effective mechanism against clubroot disease development.
33. Valvular Heart Disease Mortality in the United States, 2023.
期刊: JACC. Advances 发表日期: 2026-Apr-20 链接: PubMed
摘要
34. Antibiotic residues in reservoir-adjacent soils: Drivers, sources, and ecological risks.
期刊: Journal of environmental management 发表日期: 2026-Apr-20 链接: PubMed
摘要
Reservoirs are vital drinking-water sources, yet research has largely overlooked antibiotic accumulation in surrounding soils, which can act as terrestrial sinks and secondary sources that reintroduce contaminants into surface waters, pose latent ecological and public-health risks. This study investigated the occurrence, spatial heterogeneity, and ecological risks of soil antibiotics across three land-use types (cropland, forest land, and construction land) surrounding the Jinze Reservoir, Shanghai. A mixed-effects model and a Positive Matrix Factorization (PMF) model were applied to identify key environmental drivers and dominant pollution sources. The results indicated that fluoroquinolones and tetracyclines were the predominant contaminants, with detection frequencies of 97.0% and 77.8% and mean concentrations of 14.17 μg/kg and 4.84 μg/kg, respectively. Antibiotic composition and distribution differed significantly across land-use types (p < 0.05), with cropland exhibiting the highest contamination levels. Spatial distribution analysis indicated that surface runoff and irrigation return flows promote antibiotic transfer between adjacent land parcels. Mixed-effects modeling revealed that soil pH and organic carbon are key factors shaping antibiotic distribution (p < 0.05). PMF analysis identified agricultural manure application (44 %) and aquaculture effluents (56%) as the main contributors to soil antibiotic residues. Risk assessment indicated that most antibiotics posed low to medium ecological risks (RQ < 1). These findings highlight the need for class-specific monitoring and management for reservoir-adjacent soils, prioritizing soil physicochemical properties for fluoroquinolones (FQs), heavy metals for tetracyclines (TCs), and nutrients for sulfonamides (SAs), particularly in hotspot and near-shore areas, to strengthen drinking-water source protection, with clear implications for environmental management.
35. Sexual victimization and risk factors among school-aged children in Colombia: A cross-sectional study.
期刊: Child abuse & neglect 发表日期: 2026-Apr-20 链接: PubMed
摘要
Child sexual assault (CSA) is a critical public health issue that disproportionately affects children in environments marked by family instability and limited school protection. Empirical evidence from Latin American school settings remains scarce. To examine individual, familial, digital, and school-related factors associated with sexual victimization among students in Itagüí, Colombia. A total of 205 students aged 8-17 years from three public schools participated in the study. A cross-sectional analytical design was used. Sexual victimization was operationalized as a binary composite outcome based on four items capturing non-consensual sexual contact, coercion or threats, requests to expose intimate body parts, and grooming-like situations indicating imminent sexual risk. Descriptive statistics and logistic regression models were employed to estimate associations. Overall, 32.1% of students endorsed at least one indicator of sexual Victimization or risk. Exposure to physical violence or threats was strongly associated with sexual victimization (OR 7.38; 95% CI 1.68-32.45). Knowing someone who had been victimized and family alcohol consumption also increased risk. Perceived school safety (OR 0.12; 95% CI 0.03-0.55) and knowledge of children’s rights (OR 0.08; 95% CI 0.01-0.47) emerged as significant protective factors. Sexual victimization in this school population was significantly associated with household violence and specific environmental vulnerabilities, whereas perceived school safety and knowledge of children’s rights emerged as protective correlates. These findings highlight key factors relevant for early identification and prevention.
36. Shellfish and elasmobranch as sentinel vector for microplastic contamination: Species and tissue-specific variability, ATR-FTIR polymer spectral fingerprint, pollution indices and health implications.
期刊: Marine pollution bulletin 发表日期: 2026-Apr-20 链接: PubMed
摘要
Microplastic (MP) pollution affects marine ecosystems and filter-feeding shellfish. This study assessed MP contamination in commercial shellfish and elasmobranchs from the Thoothukudi coast, South India, using hydrogen peroxide digestion and ATR-FTIR to identify MPs. MPs in shellfish (muscle) and organs ranged from 2.1 to 3.1 MPs/5 g of tissue, and 2.1 to 3.7 and 3.0 to 7.8 MPs/individual in the gills and gut, respectively. M. gladiator (3.19 MPs/5 g) and C. natator (2.9 MPs/5 g) exhibited the highest concentrations, whereas shrimps, P. indicus (2.9) and P. semisulcatus (2.1) showed elevated levels. MPs abundance in shellfish was: M. gladiator > C. natator > P. indicus > P. sanguinolentus > P. pelagicus > P. semisulcatus > P. merguiensis. The gut showed higher MP contamination than the gills and muscle. Minimum and maximum MP concentrations in gills were in P. pelagicus (2.1 MPs) and C. natator (3.7 MPs). In contrast, in the gut, P. merguiensis and C. natator had the highest concentrations (3.0 and 7.8 MPs). ATR-FTIR spectra showed polyethylene (37.3%), polypropylene (25.27%) and polyvinyl chloride (18.08%) as predominant polymers. The MPs’ burden was highest in the gills and gut due to environmental interactions and diet. Daily intake through seafood consumption was 0.70-1.16 MP particles/kg/day, with M. gladiator and P. indicus showing the highest exposure. The hazard and pollution risk indices rated most species as low to medium risk, indicating that MP contamination does not pose immediate severe health risks. This study demonstrates the prevalence of MPs in shellfish/elasmobranchs and their safety implications, highlighting the need to reduce coastal pollution.
37. Plastisphere-driven pollutant enrichment and harmful bacteria proliferation: Emerging ecological risks to Danjiangkou reservoir's water security.
期刊: Marine pollution bulletin 发表日期: 2026-Apr-20 链接: PubMed
摘要
Plastispheres host unique microbial communities linked to biogeochemical cycling and ecological risks, yet their responses to pollutant enrichment and seasonal dynamics in the Danjiangkou (DJK) Reservoir, China’s core South-to-North Water Diversion water source, are poorly understood. We sampled plastispheres and ambient water at seven DJK tributary estuaries (August 2024/wet, January 2025/dry), characterizing pollutant enrichment, microbial assembly (16S rRNA sequencing), functional gene expression (qPCR), and harmful microbial enrichment, with quantitative microbial risk assessment (QMRA). Results demonstrated that the plastisphere serves as a critical sink for aquatic pollutants, leachate from the plastisphere contains 181.20 ± 27.35%, 875.98 ± 77.61%, and 286.21 ± 32.47% higher concentrations of total nitrogen (TN), ammonium (NH₄+), and lead, respectively, than ambient water, and no significant seasonal variation in plastic adsorption capacity. Plastisphere microbes had higher alpha diversity (Chao1: +172.41%; Shannon: +28.07%) and network stability, with Proteobacteria (e.g., Pseudomonas) enriched in summer and Flavobacteria dominating winter plastispheres. Functional genes linked to nitrogen cycling (nitrogen fixation: nifH; denitrification: nirS, nirK) and carbon metabolism (rTCA cycle: aclA, pflD; methane formation: mtaABC, mtbA, cdhCDE) were significantly upregulated in the plastisphere, with total RPKM values 30.49 ± 18.64% higher than in ambient water (p<0.05), with water temperature and DO as primary drivers. Notably, plastics selectively enriched harmful microbes, cyanobacterial taxon SIO2C1_sp010672925 (18.80 ± 5.14%) dominated winter plastispheres, and 524 pathogenic OTUs (e.g., Deinococcus_B, 6.70 ± 3.88%) were more abundant on plastispheres, posing non-negligible risks of algal blooms and pathogen dissemination. Our findings reveal that plastics mediate pollutant accumulation, microbial assembly, and functional gene enrichment in tributary estuaries, with seasonal dynamics shaping harmful bacteria proliferation. This study provides critical insights into the ecological impacts driven by plastic pollution in key freshwater reservoirs, supporting targeted water quality management and ecological risk mitigation.
38. [Not Available].
期刊: Archivos de prevencion de riesgos laborales 发表日期: 2026-Apr-20 链接: PubMed
摘要
Agradecemos la carta enviada por Alatrista Huertas, por cuanto anima al debate que buscaba nuestra editorial, además de por señalar algunos puntos críticos en la aplicación de la normativa comentada que nos parecen de mucho interés. Entre ellos, coincidimos especialmente con la dificultad de incluir los exámenes de salud laboral en la cobertura que prestan los servicios de atención primaria a las empleadas de hogar informales (sin contrato ni alta en la seguridad social). La formalidad es una premisa sin la cual no se puede aplicar la normativa. Un objetivo que compete a la inspección de trabajo, sabiendo lo difícil que es fiscalizar las irregularidades en este ámbito de las empleadas de hogar, donde quien contrata es una persona en el ámbito del hogar familiar. Hay que persistir, pero no hay milagros….
39. [Not Available].
期刊: Archivos de prevencion de riesgos laborales 发表日期: 2026-Apr-20 链接: PubMed
摘要
Con gran entusiasmo se ha leído el editorial de Benavides et al. titulado “La vigilancia de la salud en el servicio del hogar familiar, ¿un ejemplo a seguir para otras ocupaciones?”. Los autores mencionan con atino un hito muy importante en la salud laboral española: Se registro el derecho a la vigilancia de la salud para un sector laboral normalmente invisible, feminizado y frágil. No obstante, como personal de salud con formación en salud ocupacional, creo que se debe enfatizar en puntos operativos que podrían interferir el buen desempeño de esta medida.
40. [Not Available].
期刊: Archivos de prevencion de riesgos laborales 发表日期: 2026-Apr-20 链接: PubMed
摘要
La reciente inclusión de Archivos de Prevención de Riesgos Laborales en el Diamond Discovery Hub (DDH) representa la verificación pública de un compromiso que esta revista ha mantenido desde sus orígenes: que el conocimiento sobre salud y seguridad en el trabajo sea accesible sin barreras económicas ni institucionales….
41. Uridine diphosphate glucose reduces embryonic and diet-induced hepatic lipid accumulation in chickens.
期刊: Research in veterinary science 发表日期: 2026-Apr-18 链接: PubMed
摘要
Fatty Liver Hemorrhagic Syndrome (FLHS) is a prevalent metabolic disease in poultry, marked by severe fat buildup in the liver that compromises health and productivity. To investigate the effects of uridine diphosphate glucose (UDPG) on hepatic lipid metabolism in chickens, this study employed online software to predict UDPG binding to the lipid synthesis regulator site-1 protease (S1P) protein. Subsequent administration via allantoic membrane injections (AMI) and amniotic cavity injections (ACI) during embryonic development demonstrated that UDPG significantly reduced hepatic triglyceride (TG) and total cholesterol (TC) levels by downregulating key lipogenic genes. Furthermore, in adult chickens subjected to high-fat diet (HFD), UDPG injection significantly lowered plasma and hepatic TG concentrations, suppressed the expression of key lipogenic genes, enhanced hepatic antioxidant capacity, and inhibited pro-inflammatory cytokine expression. These findings demonstrate that UDPG reduces hepatic lipid accumulation and improves lipid metabolism disorders in chickens, indicating its potential as a therapeutic candidate for alleviating hepatic steatosis and FLHS.
42. Comparative and subtractive genomics reveals novel therapeutic targets in cystic fibrosis-associated multidrug-resistant Pandoraea sputorum.
期刊: Diagnostic microbiology and infectious disease 发表日期: 2026-Apr-10 链接: PubMed
摘要
Despite increasing clinical reports of its emergence and multidrug resistance, particularly in cystic fibrosis (CF) patients, comprehensive genomic insights and effective therapeutic strategies targeting P. sputorum remain scarce. This study aimed to elucidate the evolutionary relationships and genomic characteristics of P. sputorum and to identify potential therapeutic targets and repurposable drugs via integrated computational approaches. Phylogenetic relationships were reconstructed via 16S rRNA gene sequences retrieved from the NCBI GenBank database, followed by comprehensive whole-genome-based comparative genomic analyses. Functional pathway and resistance gene profiling were conducted to characterize virulence and antimicrobial resistance traits. A subtractive genomics pipeline integrating Orthofinder, the Database of Essential Genes, BLASTp against the human proteome, and KEGG pathway analysis was applied to identify essential, non-host homologous drug targets. Structural modeling, binding pocket characterization, molecular docking, and protein-ligand interaction analyses were employed to screen and evaluate repurposable drug candidates. The results demonstrated that P. sputorum is closely related to Burkholderia species and shares a conserved genomic backbone while exhibiting notable genomic diversification. Functional profiling revealed shared antimicrobial resistance mechanisms, including efflux pumps and β-lactamases. Subtractive genomics prioritized three conserved cytoplasmic targets, LpxC, MurA, and DnaE. Structure-based molecular docking identified ten FDA-approved drugs with strong and stable binding affinities toward these targets. Notably, lumacaftor is a drug currently used in cystic fibrosis therapy. This study provides a comprehensive genome-guided framework for understanding P. sputorum and identifying therapeutic opportunities. The identified drug targets and repurposed candidates offer promising avenues for combating multidrug-resistant P. sputorum infections, particularly in CF and immunocompromised patients.
43. Cadmium-induced apoptosis via ROS/JNK pathway in chicken primary kidney cells and antagonism of taxifolin.
期刊: Poultry science 发表日期: 2026-Apr-09 链接: PubMed
摘要
Cadmium (Cd) is a toxic environmental pollutant that can induce reactive oxygen species (ROS)-mediated apoptosis in kidney cells. Taxifolin (Tax), a dihydroflavonol with notable antioxidant activity, has recently attracted attention, but its effect on Cd-induced kidney cell apoptosis remains unclear. This study aimed to investigate the protective mechanism of Tax against Cd-induced apoptosis in chicken primary kidney cells. We combined network pharmacology, network toxicology, and molecular docking to identify potential key targets, and then conducted in vitro verification. We hypothesized that Tax alleviates Cd-induced apoptosis by suppressing oxidative stress and inhibiting the JNK pathway, thereby modulating mitochondrial pathway-related apoptotic genes. AO/EB and Hoechst 33258 staining showed that Tax significantly reduced Cd-induced apoptosis. Detection of antioxidant enzyme mRNA levels and ROS confirmed that Tax alleviated Cd-induced oxidative stress. qRT-PCR and western blotting revealed that Cd activated the JNK pathway and increased expression of pro-apoptotic genes (Bad, Bid, Bax, Bak, DIABLO, Caspase-3, Caspase-9) while decreasing anti-apoptotic genes (Bcl-2, XIAP). Notably, Tax specifically inhibited Cd-induced JNK activation and reversed these apoptotic effects. Molecular docking confirmed interactions between Tax and JNK. The use of the JNK pathway inhibitor SP600125 also further confirmed this view. We conclude that Tax antagonizes Cd-induced apoptosis in chicken primary kidney cells by inhibiting the ROS/JNK pathway and modulating mitochondrial apoptosis-related gene expression.
44. Private Practice Dietetics Workforce Development: What 45 Thought Leaders Agree On.
期刊: Journal of human nutrition and dietetics : the official journal of the British Dietetic Association 发表日期: 2026-Apr 链接: PubMed
摘要
The growth of private practice dietetics has been driven by intrinsic and extrinsic factors. This expansion highlights the importance of appropriate training, preparation and support for new graduates entering private practice, yet existing literature identifies deficiencies across these areas. The aim of this study was to develop consensus amongst a panel of Australian Private Practice Workforce Development Thought Leaders on private practice dietetics workforce development aspects, including the challenges, function, training and preparation needs, support, and solutions. Previously published literature informed a modified Delphi questionnaire conducted amongst private practice workforce development Thought Leaders, who had extensive private practice experience or substantial standing in the profession with regard to private practice, to seek agreement on private practice dietetics workforce development aspects. Content validity assessment was used to determine their rating. Items scoring excellent (index > 0.78) were added to the framework for the development of evidence-based recommendations. Forty-six Thought Leaders consented and completed round one, 45 completed two-rounds of the modified-Delphi questionnaires and represented all states of Australia. After two rounds of iterative review, 116 items around workforce development aspects achieved excellent scale-content validity. These included the key function and entry-level competencies required for success in private practice dietetics, challenges and strategies to support training of current and future private practitioners. Key findings highlight that accrediting training programs should include more private practice placements and business training for dietetics students. Structured post-graduation support is essential for new graduates entering private practice. This study provides expert agreement on workforce development aspects of private practice dietetics. A united approach to workforce development is needed, involving regulatory bodies, universities and private practitioners for capacity building. This work provides an evidence-based framework to inform recommendations to support the training and preparation, policy development and strategic workforce capacity building planning for this crucial workforce.
45. A Fluorogenic Biosensor for Direct Detection of Vibrio vulnificus, a Climate Change Biomarker.
期刊: MicrobiologyOpen 发表日期: 2026-Apr 链接: PubMed
摘要
Vibrio vulnificus, a marine pathogen and climate change biomarker, poses serious risks to human and animal health through seafood consumption and seawater exposure. Rapid detection methods are urgently needed for both vibriosis diagnosis and surveillance in warming coastal waters. We report a fluorogenic biosensor based on nanoporous anodic alumina loaded with rhodamine B and capped with an oligonucleotide probe targeting a unique sequence of the vvhA cytolysin gene, specific to V. vulnificus. In the presence of the target DNA, the probe is displaced, pores open, and the fluorophore is released, generating a measurable signal. The biosensor exhibited high sensitivity and selectivity across diverse matrices, including fish mucus and serum, human serum, sterilized brackish water, and-critically-unprocessed natural lake and seawater samples, without DNA extraction or amplification. Detection limits ranged between 10² and 5 × 10² CFU mL⁻¹, comparable in sensitivity to state-of-the-art qPCR assays. The biosensor outperformed conventional approaches in speed, simplicity, and cost-effectiveness, while maintaining accuracy. These findings underscore the potential of this platform for integrated One Health applications, bridging environmental monitoring with rapid diagnosis of vibriosis in humans and animals. Preliminary results from this study were previously made available as a preprint in SSRN (DOI: https://ssrn.com/abstract=5032822).
46. Implementing Systematic Assessment of Physical Function in Hospitalised Medical Patients: Description and Evaluation Guided By the Quality Implementation Framework.
期刊: Journal of evaluation in clinical practice 发表日期: 2026-Apr 链接: PubMed
摘要
Although older adults comprise 16%-22% of the population, they account for up to 75% of hospital admissions and nearly half of related costs. Frailty, multimorbidity and reduced physical function are common, requiring assessment and follow-up. Systematic assessment of physical function using the Cumulated Ambulation Score (CAS), 30-second sit-to-stand test (30s-STS), and handgrip strength (HGS) has shown predictive value for outcomes such as length of hospital stay, complications, readmission and survival in hospitalised older patients. This underscores the importance of early intervention in rehabilitation. The successful integration of evidence-based practices necessitates the use of an evidence-based implementation model, such as the Quality Implementation Framework (QIF), which clearly outlines what to address and which actions to take to secure the quality of the implementation process and patient outcomes in the clinical setting. This study aims to describe and evaluate the implementation process of systematic assessment of physical function in hospitalised medical patients using QIF. A prospective implementation study, incorporating both quantitative and qualitative methods, was conducted at two medical wards in a Danish hospital. QIF was employed to guide the implementation and the evaluation of the systematic assessment. Implementation of the systematic assessment showed that early stakeholder engagement and leadership support ensured ownership and staff buy-in. A structured implementation plan clarified roles and accountability. Process evaluation revealed high penetration and acceptability, with improved fidelity over time. Workflow challenges remained, and adoption into daily practice among therapists was limited due to time constraints and documentation burden. Expansion to new departments demonstrated scalability. A structured QIF-based approach to implementing systematic assessments in hospitalised medical patients proved feasible, acceptable, and potentially scalable. Stakeholder engagement, management support and strengthened cross-sector collaboration were key to success. Sustainability depends on workflow integration, timely data-driven feedback and continued training.
47. Quality of antenatal and delivery care and postnatal care use: A multi-country observational study of 400,000 births.
期刊: PLoS medicine 发表日期: 2026-Apr 链接: PubMed
摘要
Postnatal care (PNC) plays a crucial role in averting newborn mortality, yet its use remains low, particularly in regions with the highest mortality. While demographic and social determinants of PNC use have been well studied and have informed current strategies focused on changing care-seeking behaviors, the stagnating decline in neonatal mortality highlights the need for upstream and system-wide approaches to increase PNC uptake. Limited evidence exists to guide system-level reforms; therefore, we investigated whether health systems that ensure high-quality perinatal care are associated with increased use of PNC. We performed a cross-sectional observational study using Demographic and Health Survey data from 38 countries that had not met SDG neonatal mortality targets by 2020. The study population comprised women aged 15-49 years whose most recent live birth occurred within five years preceding the survey. We employed logistic regression models with country fixed effects to examine associations between: (1) perinatal service utilization, (2) service quality; and their relationship with postnatal checkups for newborns within 28 days. We analyzed utilization-quality interactions to determine how the effects of service coverage on PNC use varied by care quality and conducted wealth-stratified analyses to assess how quality effects on PNC use differed across socioeconomic groups. High-quality perinatal care was associated with a 2-fold increase in the probability of postnatal checkups within 28 days (0.406 in the highest quality tertile versus 0.221 in the lowest quality tertile). For mothers who received the lowest tertile of service quality, full utilization of perinatal services yielded negligible changes in postnatal checkup probability (0.217 to 0.216). Conversely, for mothers who received the highest quality of antenatal and perinatal care, full access to perinatal care improved the probability of postnatal check-ups (0.392 to 0.428). Notably, women in the lowest wealth quintile experienced a substantial increase in postnatal checkup probability from 0.224 to 0.481 between low and high-quality care cohorts, while this differential was less pronounced in the highest wealth quintile (0.236 to 0.450). Key limitations include restricted quality indicators, potential recall bias from self-reported measures, limited information on follow-up care, and the cross-sectional nature of the data, which limits causal interpretation. Our interaction analysis reveals a critical insight: high-quality care substantially enhanced the magnitude of the association between expanded perinatal service use and PNC use, whereas increased utilization alone was not linked to higher PNC uptake. Notably, the impact of improved care quality was most pronounced among the lowest wealth groups, highlighting its potential as a mechanism for promoting equity. By demonstrating the central role of care quality in promoting PNC utilization, particularly among disadvantaged populations, our findings suggest that improving health system quality could be a more effective strategy for achieving universal maternal healthcare coverage than traditional access-focused approaches.
48. The National Pancreatic Cancer Audit: Reducing Variation in Clinical Practice.
期刊: Clinical oncology (Royal College of Radiologists (Great Britain)) 发表日期: 2026-Mar-28 链接: PubMed
摘要
49. Loss of PPARα-UGT1 axis exacerbates triclosan-induced steatohepatitis in humanized UDP-glucuronosyltransferase 1 mice.
期刊: Drug metabolism and disposition: the biological fate of chemicals 发表日期: 2026-Mar-26 链接: PubMed
摘要
Triclosan (TCS) is an antimicrobial toxicant found in a wide range of consumer products and has been detected in human tissues at concentrations ranging from 0.001 to 5 ppm. Hepatotoxic chemicals such as TCS can cause steatotic liver disease, a condition referred to as toxicant-associated steatotic liver disease. Once TCS enters the body, it induces liver UDP-glucuronosyltransferase (UGT) 1A proteins, leading to the formation of TCS glucuronides, which are biologically inactive metabolites. The induction of UGT1A proteins by TCS is regulated by the nuclear receptor peroxisome proliferator-activated receptor α (PPARα). In this study, we evaluated the impact of TCS on the PPARα-UGT1 axis in steatohepatitis and hepatocellular carcinoma using humanized UGT1 (hUGT1) male mice. We have demonstrated that TCS exposure promotes liver tumorigenesis and induces human UGT1A1 and other human UGT1A proteins in the liver. Furthermore, our results demonstrate that UGT1A gene induction in the liver is dependent on PPARα. When PPARα-deficient hUGT1 mice (hUGT1/Pparα-/-) were exposed to TCS for 5 months, steatohepatitis was exacerbated, accompanied by increased fibrosis, immune cell infiltration, lipid accumulation, and hepatocyte ballooning. Finally, we assessed whether disruption of the PPARα-UGT1 axis contributes to liver tumorigenesis. Our data indicate that deletion of PPARα and consequent impairment of UGT1A gene induction in the liver have no effect on tumor progression and malignancy. Our hUGT1/Pparα-/- mouse model was a suitable model to study the TCS metabolism and how ablation of UGT1A proteins worsens TCS-induced metabolic dysfunction-associated steatohepatitis. SIGNIFICANCE STATEMENT: Triclosan strongly induces hepatic UGT1A gene expression through a PPARα-dependent mechanism in humanized UGT1 (hUGT1) mice. Loss of PPARα in hUGT1 mice augments triclosan-induced steatohepatitis, characterized by increased fibrosis, lipid accumulation, immune cell infiltration, and hepatocyte ballooning.
50. [Not Available].
期刊: Archivos de prevencion de riesgos laborales 发表日期: 2026-Jan-15 链接: PubMed
摘要
Introducción: La salud mental en el entorno laboral es una problemática creciente. El objetivo de este trabajo fue sintetizar la mejor evidencia disponible sobre la efectividad de intervenciones digitales basadas en la terapia cognitivo-conductual (TCC), mindfulnees y gestión del estrés, identificando sus beneficios clínicos, limitaciones metodológicas y áreas prioritarias de investigación para optimizar la implementación y evaluación de programas digitales e instrumentos psicométricos de salud mental en el trabajo. Metodología: Revisión narrativa de artículos publicados entre 2014 y 2024, consultando bases como PubMed, Web of Science, MEDLINE, PsycINFO y Cochrane Library. Se incluyeron 20 artículos y 4 documentos realizados sobre adultos mayores de 18 años. La evaluación metodológica de los artículos se realizó con GRADE y SANRA, para valorar la robustez y calidad de la evidencia. Resultados: Los artículos analizados mostraron una correlación positiva entre calidad metodológica (SANRA) y robustez de evidencia (GRADE). Instrumentos psicométricos como GHQ, PHQ-9 y MBI mostraron adecuada validez y fiabilidad. La efectividad varía en función de factores individuales y del contexto laboral. Las intervenciones implementadas de forma digital, especialmente la TCC y mindfulness, mostraron ser efectivas para reducir síntomas de ansiedad, depresión y burnout, especialmente cuando se personalizan y cuentan con acompañamiento profesional. Conclusiones: Las intervenciones digitales constituyen estrategias prometedoras para mejorar el bienestar psicológico laboral. Se recomienda su integración en programas preventivos estructurados, con diagnóstico riguroso, liderazgo firme, formación continua y evaluación sistemática. Futuras investigaciones deberían emplear metodologías más estandarizadas y explorar nuevas tecnologías para optimizar el impacto en la salud mental laboral.
51. [Not Available].
期刊: Archivos de prevencion de riesgos laborales 发表日期: 2026-Jan-06 链接: PubMed
摘要
La certificación médica marítima es esencial para proteger la salud de la gente de mar y cumplir con convenios internacionales. En Costa Rica no existe una guía técnica oficial, lo que genera vacíos normativos, ético-legales y formativos, además de heterogeneidad en los criterios clínicos aplicados. Este estudio cualitativo y descriptivo, realizado entre mayo y octubre de 2023, incluyó una revisión documental de los convenios STCW y MLC 2006, guías OMI/OIT, normativa nacional y literatura científica, junto con entrevistas a 25 personas médicas. Los hallazgos evidenciaron ausencia de lineamientos nacionales, falta de capacitación especializada y variabilidad en la emisión del Certificado Médico Marítimo. La triangulación de datos permitió elaborar una propuesta de guía técnica con cuatro componentes: marco legislativo y administrativo, formación del médico evaluador, protocolo clínico estandarizado y formato del certificado. Esta propuesta busca estandarizar la evaluación, fortalecer la seguridad jurídica y mejorar la protección de la gente de mar.
52. [Not Available].
期刊: Archivos de prevencion de riesgos laborales 发表日期: 2026-Jan-06 链接: PubMed
摘要
Introducción: Las medidas de protección frente a la COVID-19 impactaron en las condiciones de empleo y trabajo. El objetivo de este estudio fue explorar las percepciones de las mujeres asalariadas de la Comunidad Valenciana sobre sus condiciones laborales durante la pandemia de la COVID-19 y su influencia en su salud. Método: Se empleó el enfoque cualitativo basado en 17 entrevistas semiestructuradas y 3 grupos focales a mujeres trabajadoras entre 25-74 años residentes en la Comunidad Valenciana. Se realizó un muestreo teórico y por bola de nieve. Los datos se analizaron según la aproximación de análisis de contenido cualitativo. Resultados: Se identificaron las siguientes categorías: 1) Percepciones sobre la profundización de la precariedad en sectores tradicionalmente feminizados y desfavorecidos; 2) Elementos estresores identificados que afectan la salud auto percibida de las trabajadoras 3) Experiencias laborales y percepciones de malestar en la salud mental y musculoesquelética, y 4) Estrategias de afrontamiento y factores protectores para la salud frente al estrés vivido. Las medidas de protección contra la COVID-19 afectaron sectores ya precarios. Conclusiones: La crisis sanitaria agravó la precariedad laboral de las mujeres y empeoró su salud, especialmente en sectores ya precarizados como limpieza y trabajo doméstico. Este estudio resalta la urgencia de reformas laborales que promuevan la corresponsabilidad y protejan los derechos laborales de las mujeres, también en contextos de crisis como la pandemia de la COVID-19.
53. Determinants and policy approaches to healthcare professional retention in Iran: A mix of scoping review and qualitative evidence.
期刊: PloS one 发表日期: 2026 链接: PubMed
摘要
Ensuring the long-term retention of healthcare professionals has become a central priority for strengthening the resilience and quality of Iran’s health system. A comprehensive understanding of the diverse factors influencing retention, alongside those that may contribute to outward mobility, is essential for informed policymaking. This study adopts a multi-method approach, integrating qualitative inquiry with a scoping review, to explore the determinants shaping healthcare professionals’ decisions to remain in or leave the national health system, the implications for workforce stability, and the effectiveness of current policy responses. By examining both individual and systemic dimensions, and by incorporating insights from migrant professionals, domestic policymakers, and existing evidence, this research contributes a nuanced perspective to the broader discourse on human resources for health in developing contexts. The originality of this study lies in combining first-hand qualitative data with a systematic synthesis of literature, allowing for an in-depth understanding of locally grounded drivers of retention and opportunities for strengthening Iran’s health workforce. The research employed a qualitative, multi-phase design. In the first phase, semi-structured interviews were conducted with 15 Iranian healthcare professionals residing in countries such as the United States, Germany, Switzerland, Turkey, and Oman to understand their professional trajectories. In the second phase, interviews with 16 Iranian health administrators, policymakers, and senior professionals were undertaken to capture institutional and policy-level perspectives on retention challenges and opportunities. All interviews were transcribed verbatim and analyzed thematically. Complementing this, a scoping review was conducted to synthesize existing evidence, policy documents, and expert assessments related to the retention and mobility of Iran’s health workforce. Data sources included PubMed, Scopus, and gray literature obtained through institutional repositories and local websites. Findings highlight several interrelated factors influencing workforce retention. Economic considerations including income stability, purchasing power, and access to research funding remain important determinants of professional commitment. Institutional dynamics such as transparent promotion pathways, supportive management, and opportunities for professional development also play a critical role. Importantly, Iran’s integrated system of medical education and service delivery emerged as a key structural strength, providing early clinical exposure, strong professional identity formation, and continuity between training and practice advantages less commonly available in many other health systems. Participants noted that when financial incentives are combined with accessible professional development programs, equitable workload distribution, and recognition of professional contributions, retention outcomes improve substantially. While destination countries may offer expanded career pathways, the sense of belonging, family ties, and cultural identity were identified as influential factors supporting continued service in Iran. Governmental initiatives including compensation adjustments, training reforms, and targeted retention programs have yielded positive outcomes, though further coordination and sustained implementation are needed. Strengthening the retention of healthcare professionals in Iran requires a holistic strategy that integrates economic, organizational, educational, and governance reforms. Enhancing remuneration structures, investing in professional development and research capacity, reinforcing the advantages of Iran’s integrated educational service system, and engaging with the healthcare diaspora can collectively support workforce stability. A multi-sectoral, evidence-informed approach has the potential to improve long-term retention, mitigate the need for outward mobility, and promote a more resilient and sustainable health system.
54. Prevalence of and factors associated with depressive symptoms among the working population in Thimphu, Bhutan: A cross-sectional study.
期刊: PloS one 发表日期: 2026 链接: PubMed
摘要
The working population contributes significantly to the economic and social development of a country. Despite an increase in mental health concerns in the working population, research on the mental health of Bhutan’s workforce is lacking. To evaluate the prevalence of depressive symptoms and identify associated factors in the working population in Thimphu, Bhutan. A cross-sectional study was used to collect information from employees working in both the government and private sectors. The participants (aged 18-60 years) were selected using a stratified random sampling technique. A self-administered validated questionnaire was used to collect information. Depressive symptoms were assessed using the Patient Health Questionnaire (PHQ-9). A total of 379 participants were recruited. The overall prevalence of depressive symptoms among the working population in Thimphu, Bhutan was 45.9%. Participants with primary school, high school, or a bachelor’s degree or higher education had significantly lower odds of depressive symptoms than those with no education. Likewise, those in supervisory and operational roles had lower odds than executives. Lower odds of depressive symptoms were also found among those without kidney disease, those with a family history of severe mental illness, and those whose job needs were understood to a limited or great extent. In contrast, moderate-to-severe anxiety and high levels of depersonalization were strongly associated with increased odds of depressive symptoms. Depressive symptoms were highly prevalent among formal-sector workers in Thimphu, Bhutan, indicating a substantial burden of mental health concerns within this specific urban workforce. The findings suggest the need for targeted workplace mental health interventions, particularly those that address supervisory support and individual vulnerabilities related to health and psychosocial stressors. While this study contributes valuable insights, it reflects an urban, formal employment context, limiting its generalizability to Bhutan’s broader or informal labor force. These findings highlight the critical need for incorporating mental health promotion into workplace policies, particularly within urban employment settings. Moreover, a national mental health policy should formally recognize the role of occupational settings in promoting psychological well-being and allocating resources accordingly.
55. Prevalence of antimicrobial resistance in Tanzania: A systematic review and meta-analysis.
期刊: PloS one 发表日期: 2026 链接: PubMed
摘要
Antimicrobial resistance (AMR) threatens global health, and understanding resistance patterns aids in effective treatment and promotes responsible antimicrobial use. Despite the urgency of resistant pathogens, systematic reviews focusing specifically on Tanzania are limited, and while several studies report resistance patterns for individual pathogens, a consolidated analysis of overall prevalence is needed to inform policymaking and public health interventions. Therefore, this review and meta-analysis assessed the prevalence of antimicrobial resistance among clinically relevant pathogens in Tanzania, providing a comprehensive overview to support surveillance, infection control, and stewardship efforts. A total of 1865 studies identified from Google Scholar (1600), PubMed (13), and Science Direct (252) underwent screening and full article review. Finally, 28 studies were included. A subgroup analysis was performed to evaluate the resistance patterns within antibiotic classes for specific pathogens. Descriptive statistics were used to describe the characteristics of the studies, while the prevalence of antimicrobial resistance was estimated through Meta-analysis. Inconsistency and heterogeneity between studies were quantified by the I2 index. Among the included studies, most isolates (25.0%) were obtained from urine samples. Of these studies, 75% were cross-sectional studies and 92.9% were conducted in hospital settings. The analysis revealed high resistance to penicillin, particularly amoxicillin-clavulanic and ampicillin, with Klebsiella pneumoniae (0.96 [0.83-0.99]), Acinetobacter baumannii (0.94 [0.67-0.99]) and Escherichia coli (0.90 [0.81-0.95]). Similarly, erythromycin resistance was most prevalent in Campylobacter spp. (0.85 [0.80-0.89]). Ciprofloxacin resistance was highest in Acinetobacter baumannii (0.54 [0.33-0.73]), whereas amikacin resistance was highest in Proteus spp. (0.86 [0.35-0.99]). Ceftriaxone resistance was particularly high in Acinetobacter baumannii (0.91 [0.70-0.98]) and Pseudomonas aeruginosa (0.85 [0.74-0.92]). Meropenem resistance was lowest among Escherichia coli (0.04 [0.01-0.10]) and Klebsiella spp. (0.07 [0.03-0.15]), while the pooled resistance across ESKAPE-E pathogens was (0.11[0.06-0.19]). Imipenem and clindamycin each had an overall pooled resistance of (0.06[0.02-0.14]) against both Escherichia coli and Klebsiella pneumoniae. The findings highlight widespread resistance among bacterial pathogens, ESKAPE-E, particularly in the Access and Watch groups of antibiotics. The variability in resistance patterns underscores the need for the Ministry of Health to re-evaluate empirical treatment protocols (STG/NEMLIT) to ensure effective treatment regimens, strengthen antimicrobial stewardship, enhance surveillance systems, and promote rational antibiotic use.
56. Physical activity in the workplace: recent evidence on its benefits for health and productivity.
期刊: Archivos de prevencion de riesgos laborales 发表日期: 2025-Oct-15 链接: PubMed
摘要
The increase in the prevalence of chronic noncommunicable diseases (NCDs), together with physical inactivity in the workplace, poses a public health challenge that requires structural responses from workplace promotion. Various international organizations have highlighted that the workplace is a privileged setting for intervening in sedentary lifestyles and promoting protective behaviors. In this regard, during the working day, physical activity has been shown to be an effective strategy for health and functional performance, as demonstrated by scientific evidence in relation to institutional policies and corporate commitments linked to health and sustainability.