公共卫生研究摘要 (2026-04-23)
共收录 58 篇研究文章
1. The Relationship Between Sleep, Cognition, and Dementia Risk in People With Focal Epilepsy.
期刊: Neurology 发表日期: 2026-May-26 链接: PubMed
摘要
Sleep disruption and cognitive impairment are important comorbidities of focal epilepsy. However, the nature to which sleep affects cognition and long-term dementia risk in focal epilepsy, compared with other brain conditions, remains unclear. We examined the relationship between sleep, cognition, and dementia risk in patients with focal epilepsy compared with healthy controls and stroke patients. We conducted an analysis of the prospective UK Biobank cohort study, with baseline assessments performed between 2006 and 2010 and follow-up until 2021. Study groups were mutually exclusive participants with focal epilepsy and stroke at baseline assessment and healthy controls. Sleep characteristics included reports of sleep duration, obstructive sleep apnea, insomnia, napping, and dozing. Main outcomes were risk of incident all-cause dementia and Alzheimer disease from Cox proportional hazard modeling and comparison of executive function measures and brain total hippocampal and gray matter volumes using generalized linear modeling. We examined a sample of 482,207 participants, aged between 38 and 72 years (mean [SD] 57.6 [8.1] years; 53.8% female), without dementia at baseline and a nested imaging subsample of 42,345 participants. Optimal sleep duration (6-8 hours) was associated with better executive function in control, focal epilepsy, and stroke groups. The impact of optimal sleep was significantly higher in individuals with focal epilepsy compared with controls (interaction term, p = 0.009), but not in the stroke group (interaction term, p = 0.574). Nonoptimal sleep was associated with worse executive function up to 8 years before the diagnosis of focal epilepsy. A 5-fold increased risk of developing dementia was seen in individuals with focal epilepsy and nonoptimal sleep (hazard ratio [HR] 5.15, 95% CI 3.77-7.04, p < 0.001) compared with healthy controls with optimal sleep. This was greater than in stroke individuals with poor sleep (HR 3.48, 95% CI 2.82-4.26, p < 0.001). Optimal sleep compared with nonoptimal sleep modified the dementia risk in in individuals focal epilepsy, with a significantly greater improvement compared with healthy controls (interaction term p = 0.017), while no significant difference was seen in the stroke group (interaction term p = 0.991). Optimal sleep modified both cognitive performance and dementia risk in individuals with focal epilepsy compared with stroke patients and healthy controls. Based on self-reported sleep data, these findings suggest that improving sleep may be an impactful intervention to improve cognition and reduce dementia risk particularly in focal epilepsy.
2. Sleep Apnea Screening and Neuropsychiatric Symptoms in Former Professional American-Style Football Players.
期刊: Neurology 发表日期: 2026-May-12 链接: PubMed
摘要
Former professional American-style football (ASF) players may be at increased risk of sleep apnea (SA) compared with the general population. However, SA may be underdiagnosed or undertreated in former ASF players and be associated with cardiovascular, cognitive, and psychological health. The aim of this study was to characterize former professional ASF players self-reporting SA diagnoses, as well as undiagnosed players who screened positively on a validated SA instrument. A cross-sectional survey was administered as part of the Football Players Health Study at Harvard University between 2017 and 2020. Former ASF players who signed a professional contract after 1960 were eligible to enroll. Data included demographics and football-related exposures (e.g., position and career duration), self-reported SA diagnosis, and STOP-BANG screening scores. Head injury exposure was measured using the number of concussion symptoms accrued during football practice or play. Outcomes included self-reported cognitive functioning, depression, anxiety, and pain. Multivariable logistic and linear regression was used to identify associations between sleep outcomes and (1) demographic and football characteristics and (2) recent mood, cognitive, and pain symptoms, respectively. Among 1,951 participants, 31.8% self-reported SA diagnoses (n = 621), which were associated with older age, Black race, lineman status, and higher numbers of football-accrued concussion symptoms. Only 39.8% (n = 247) of the SA group reported using their positive airway pressure therapy 4+ times per week. Of those without a current diagnosis of SA (n = 1,330), 74.6% (n = 992) scored in the intermediate or high range on the STOP-BANG. In multivariable models adjusted for demographic and football-related exposures, SA diagnosis and intermediate/high STOP-BANG scores were associated with more pain, anxiety, depression, and cognitive symptoms. Data showed that participants with diagnosed but untreated SA reported the highest symptom burden (all p < 0.001). This study identified that many former professional ASF players may be at risk of not being appropriately screened or treated for SA. These results estimate that the actual proportion of former professional ASF players with SA may be as high as 69%. Mood, pain, and cognitive symptoms may be exacerbated in those with treated, undertreated, or suspected SA.
3. Rosemary Collaboratory: A Policy, Systems, and Environmental Approach to Understanding and Addressing Health Inequities for People With Intellectual and Developmental Disabilities, United States.
期刊: American journal of public health 发表日期: 2026-May 链接: PubMed
摘要
Individuals with intellectual and developmental disabilities (IDD) face significantly poorer health outcomes and experience greater health disparities compared with people without IDD, in part because of health system failures. This article summarizes health system assessments completed in the United States at the national level and in 3 states (Pennsylvania, Washington, and Wisconsin) to identify existing barriers and gaps. To reflect the US health architecture, there is also a discussion of particularly relevant national or federal policy features that influence health equity for people with IDD. Despite existing federal legislation, there are significant opportunities for improvement across all components of the health system, at both federal and state levels. One of the areas of most significant state-level innovation has to do with supported decision-making and alternatives to guardianship, demonstrating that there is precedent for state leadership. States should continue to treat federal legislation as the floor of protection, rather than the ceiling, and pursue further reforms that promote health equity for people with IDD. (Am J Public Health. 2026; 116(S2):S103-S111. https://doi.org/10.2105/AJPH.2026.308452).
4. Special Olympics PATH to Health Equity for People With Intellectual and Developmental Disabilities.
期刊: American journal of public health 发表日期: 2026-May 链接: PubMed
摘要
Despite numerous efforts by health systems, health care professionals, public health professionals, and various policy advocates, health disparities persist for people with intellectual and developmental disabilities (IDD). Achieving health equity for these individuals requires continued efforts to address health disparities and improve access to adapted health services. This includes building capacity in health care systems, governments, and the health care workforce to deliver high-quality, inclusive care. Special Olympics Health employs a comprehensive 4-pronged approach called the PATH to Health Equity, which focuses on prevention, assessment, training, and health systems to address the health disparities that individuals with IDD experience. Each key component of this approach is highlighted with examples of evidence-based programming and outcomes. Although achieving true health equity for this population requires further collaboration, partnership, and resources across health systems, academia, policy, advocacy, and public health sectors, Special Olympics Health is making significant strides in improving health outcomes and quality of life for individuals with IDD. (Am J Public Health. 2026; 116(S2):S94-S102. https://doi.org/10.2105/AJPH.2026.308436).
5. Health Promotion Across the Life Span for Special Olympics Athletes.
期刊: American journal of public health 发表日期: 2026-May 链接: PubMed
摘要
A life span approach to health promotion serves as a foundational strategy in Special Olympics programming for individuals with intellectual and developmental disabilities (IDD). This global approach integrates two key interventions-Young Athletes and fitness programming-to address barriers to health equity and promote healthy lifestyles for people with IDD. Evaluations demonstrate improvements in motor development and cardiovascular health. Success across programming highlights the use of scalable models to improve health outcomes for people with IDD. (Am J Public Health. 2026; 116(S2):S66-S69. https://doi.org/10.2105/AJPH.2026.308502).
6. A magnesium efflux transporter required for seed development and eating quality in rice.
期刊: Proceedings of the National Academy of Sciences of the United States of America 发表日期: 2026-Apr-28 链接: PubMed
摘要
As a staple food for half the world’s population, rice is an important dietary source of magnesium (Mg), an essential mineral for human health. Enhanced Mg accumulation in rice grains has also been linked to eating quality. However, the mechanisms underlying Mg transport to the grains remains poorly understood. Here, we report that OsMGR2, a member belonging to Magnesium Release (MGR) family, is required for Mg accumulation in rice grains. OsMGR2 encodes a plasma membrane-localized transporter that mediates Mg efflux. OsMGR2 is constitutively and highly expressed in the stele tissues of roots, the phloem region of both enlarged and diffused vascular bundles in nodes, and the ovular vascular trace of caryopses. Knockout of this gene results in decreased root-to-shoot translocation and altered distribution of Mg to different organs; less Mg is allocated to the second newest leaf with high Mg requirement for active photosynthesis. The osmgr2 mutants exhibit decreased Mg accumulation in the grain, which are smaller, lighter, and shriveled, but show increased accumulation in the husk. The eating quality of the mutant grains is significantly decreased compared with the wild-type rice. These results indicate that OsMGR2 plays multiple roles within the rice; facilitating the root-to-shoot Mg translocation, mediating phloem-to-xylem Mg transfer at nodes for preferential distribution to the most active leaf, and exporting Mg from maternal vascular tissues of the caryopsis to the grains, processes essential for grain development and eating quality in rice.
7. Spinal Epidural Abscess.
期刊: The New England journal of medicine 发表日期: 2026-Apr-23 链接: PubMed
摘要
Spinal epidural abscess is an infection in the epidural space. Patients typically present with localized back or neck pain (or both) that is accompanied by fever or neurologic symptoms. Magnetic resonance imaging with contrast enhancement is the diagnostic test of choice. An accurate microbiologic diagnosis is important and can be made with blood cultures, with tissue and fluid cultures obtained by image-guided needle aspiration or biopsy, or at the time of surgery. Staphylococcus aureus is the most frequent pathogen, causing more than 50% of infections. All patients with spinal epidural abscess should be promptly evaluated by a spine surgeon and an infectious-disease specialist. Many patients with spinal epidural abscess undergo surgery, although antimicrobial therapy alone may be curative in carefully selected patients.
8. Oral Nirmatrelvir-Ritonavir for Covid-19 in Higher-Risk Outpatients.
期刊: The New England journal of medicine 发表日期: 2026-Apr-23 链接: PubMed
摘要
Nirmatrelvir-ritonavir has been shown to reduce progression to severe illness from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in unvaccinated high-risk outpatients. The effectiveness of nirmatrelvir-ritonavir in persons who have been vaccinated, infected naturally, or both is unclear. In two open-label platform trials (PANORAMIC in the United Kingdom and CanTreatCOVID in Canada), we enrolled higher-risk adults (≥50 years of age or ≥18 years of age with coexisting conditions) in the community who tested positive for SARS-CoV-2 and had been unwell for 5 days or less. The participants were randomly assigned to receive usual care plus nirmatrelvir (300 mg)-ritonavir (100 mg) twice a day for 5 days or to receive usual care alone. The primary outcome was hospitalization or death from any cause within 28 days after randomization. From December 8, 2021, to September 30, 2024, a total of 3516 participants in the PANORAMIC trial and 716 participants in the CanTreatCOVID trial underwent randomization. In the PANORAMIC trial, 14 of 1698 participants (0.8%) in the nirmatrelvir-ritonavir group and 11 of 1673 participants (0.7%) in the usual-care group were hospitalized or died (adjusted odds ratio, 1.18; 95% Bayesian credible interval, 0.55 to 2.62; probability of superiority, 0.334). In the CanTreatCOVID trial, 2 of 343 participants (0.6%) in the nirmatrelvir-ritonavir group and 4 of 324 participants (1.2%) in the usual-care group were hospitalized or died (adjusted odds ratio, 0.48; 95% Bayesian credible interval, 0.08 to 2.23; probability of superiority, 0.830). In a substudy involving 634 participants, viral load was reduced by the end of treatment with nirmatrelvir-ritonavir. Serious adverse events with nirmatrelvir-ritonavir were reported in 9 participants in the PANORAMIC trial and in 4 participants in the CanTreatCOVID trial. In two open-label trials, nirmatrelvir-ritonavir did not reduce the incidence of hospitalization or death among vaccinated higher-risk participants with SARS-CoV-2 infection. (Funded by the National Institute for Health and Care Research, and others; PANORAMIC ISRCTN number, 2021-005748-31; CanTreatCOVID ClinicalTrials.gov number, NCT05614349.).
9. Three Low-Dose Antihypertensive Agents in a Single Pill after Intracerebral Hemorrhage.
期刊: The New England journal of medicine 发表日期: 2026-Apr-23 链接: PubMed
摘要
Blood-pressure reduction is the only proven treatment to prevent stroke. Whether a single pill that combines three antihypertensive drugs at low doses, in addition to standard antihypertensive treatment, can lower blood pressure more than standard care alone and reduce the risk of recurrent stroke after intracerebral hemorrhage is uncertain. We conducted a multinational, double-blind, randomized, placebo-controlled trial involving patients with a history of intracerebral hemorrhage. Patients were eligible for the trial if they had a systolic blood pressure of 130 to 160 mm Hg at baseline and were in clinically stable condition. After a 2-week active run-in phase during which all the patients received a once-daily pill containing three antihypertensive agents at low doses (telmisartan at 20 mg, amlodipine at 2.5 mg, and indapamide at 1.25 mg; the triple pill), the patients were randomly assigned to continue receiving the triple pill or to receive matching placebo. The primary outcome was the first recurrent stroke. Secondary outcomes included blood-pressure control, major cardiovascular events, death from cardiovascular causes, and safety. Of 1670 patients who underwent randomization, 833 were assigned to receive the triple pill and 837 to receive placebo. The mean age of the patients was 58 years. At a median follow-up of 2.5 years, recurrent stroke had occurred in 38 patients (4.6%) in the triple-pill group and 62 (7.4%) in the placebo group (hazard ratio, 0.61; 95% confidence interval [CI], 0.41 to 0.92; P = 0.02). The mean systolic blood pressure during follow-up was 127 mm Hg and 138 mm Hg, respectively. The incidence of major cardiovascular events was lower with the triple pill than with placebo (6.6% vs. 9.8%; P = 0.04). Serious adverse events occurred in 23.2% of the patients in the triple-pill group and 26.0% of those in the placebo group. Early discontinuation of the trial regimen due to an adverse event occurred in 13.6% and 6.0%, respectively. The most common adverse event leading to discontinuation was an increase of 20% or more in the serum creatinine level. Among patients with intracerebral hemorrhage, treatment with a combination of three low-dose antihypertensive agents in a single pill, in addition to standard care, was associated with a lower incidence of recurrent stroke and major cardiovascular events than placebo. (Funded by the National Health and Medical Research Council of Australia and the Brazilian Ministry of Health; TRIDENT ClinicalTrials.gov number, NCT02699645; Australian New Zealand Clinical Trials Registry number, ACTRN12616000327482.).
10. Evolocumab for Primary Prevention of Cardiovascular Disease. Reply.
期刊: The New England journal of medicine 发表日期: 2026-Apr-23 链接: PubMed
摘要
11. Evolocumab for Primary Prevention of Cardiovascular Disease.
期刊: The New England journal of medicine 发表日期: 2026-Apr-23 链接: PubMed
摘要
12. Evolocumab for Primary Prevention of Cardiovascular Disease.
期刊: The New England journal of medicine 发表日期: 2026-Apr-23 链接: PubMed
摘要
13. Evolocumab for Primary Prevention of Cardiovascular Disease.
期刊: The New England journal of medicine 发表日期: 2026-Apr-23 链接: PubMed
摘要
14. Evolocumab for Primary Prevention of Cardiovascular Disease.
期刊: The New England journal of medicine 发表日期: 2026-Apr-23 链接: PubMed
摘要
15. Evaluating the Impact of Short-Notice Accreditation Assessment on Hospitals' Patient Safety and Quality Culture: Protocol for a Mixed Methods Study.
期刊: JMIR research protocols 发表日期: 2026-Apr-22 链接: PubMed
摘要
Accreditation programs are used by hospitals and health services to be independently reviewed against established safety and quality standards and have been a feature of global health systems for over a century. While evidence that accreditation programs directly improve patient safety and quality outcomes exists, the findings of various researchers remain mixed. Inefficiencies and a culture of “gaming” the system have also been observed, raising questions about the overall effectiveness of accreditation programs and assessment processes. Consequently, exploration of other formats of accreditation assessment, such as short-notice accreditation assessment, has arisen. From July 1, 2023, the Australian Commission on Safety and Quality in Healthcare mandated that Australian public and private hospitals must engage in short-notice accreditation assessment. This study aims to explore the impact of short-notice accreditation assessment on hospitals, both in terms of safety and quality indicators, and organizational culture. A mixed methods design will be used to investigate these impacts. Quantitative safety and quality indicators will be drawn from a regional health service prior to and following its first short-notice accreditation assessment cycle. From the same site, staff will be invited to complete the Patient Safety Culture Survey and participate in semistructured interviews. Using Schein’s Culture Framework as an organizational culture model, the study will examine observable outcomes (artifacts, behaviors, and indicators) alongside staff perceptions and experiences (norms and values) to form an understanding of underlying assumptions and beliefs about short-notice accreditation assessment processes. Quantitative data will be analyzed through cross-tabulation, trend analysis, and other statistical techniques, while qualitative data will be synthesized to provide a comprehensive understanding. This protocol outlines the planned evaluation of short-notice accreditation assessment and its influence on patient safety and quality culture within a regional health service. Data collection is underway, with preintervention surveys being completed, and recruitment open for postintervention interviews. The study is expected to generate new knowledge on how this accreditation assessment process affects patient safety and quality culture of a regional and a rural hospital. The findings will inform health policy on the suitability and long-term viability of short-notice accreditation assessment as an approach to ensuring safe, high-quality health care.
16. Exploring User Experiences of an Augmented Reality Smartphone App Prescribing Exercise for Children and Young People With Cancer: Results From a Qualitative Study.
期刊: JMIR formative research 发表日期: 2026-Apr-22 链接: PubMed
摘要
Mobile health (mHealth), and specifically smartphone apps, have grown exponentially in both functionality and accessibility and are becoming an important component of health care. Research exploring the use of mHealth for managing or treating chronic diseases, such as cancer, has shown promising effects. Yet, comparatively little work has examined how such technologies can enhance exercise interventions for young people with cancer. To optimize the effectiveness of mHealth in these contexts, it is essential to build a stronger evidence base on user experience. This study aimed to investigate how healthy children and young people engaged with an augmented reality (AR) app developed specifically for children and young people undergoing cancer treatment, and to identify design features that may support engagement and behavior change in the intended clinical population. School and university students, aged 8-21 years, were eligible to participate in the study. Practical workshops allowed participants to engage with the AR exercise app before taking part in focus groups to explore user experiences. Data were analyzed using qualitative content analysis, which also involved a critical friend approach using 2 researchers (HM and KS). Suggested improvements were mapped against the motivational affordances’ taxonomy. A total of 39 participants aged 8-21 years took part in the focus group study. Participants found the demonstrations and varied exercises useful but expressed some concerns regarding data safety and functionality of the novel AR avatar. It was proposed that additional educational components, challenges, and rewards, as well as a customizable avatar, social support features, and audio instructions for a more inclusive design would be desirable and could enhance user experience. When mapped against the motivational affordances taxonomy, the suggested improvements aligned primarily with mechanisms of user education, challenges, feedback, cooperation, and comparison. This study provides an understanding of how apps that prescribe exercise can be optimized to enhance motivation and user experience. By assessing feedback and suggestions for improvements, the findings highlight key design features that may support engagement. While this initial work focused on healthy, age-matched participants, further evidence specifically in children and young people with a childhood cancer diagnosis is needed.
17. Temperature-Dependent Bioaccumulation of Metals in Marine Mollusks: Integrating Thermal Performance Curves, Machine Learning, and Toxicokinetic Modeling.
期刊: Environmental science & technology 发表日期: 2026-Apr-22 链接: PubMed
摘要
Temperature regulates mollusk physiology and can alter metal bioaccumulation through filtration, uptake, growth dilution, and elimination. Yet many toxicokinetic (TK) applications treat temperature as a simple correction to a subset of rates and rarely account for trait- and context-dependence, limiting transferability across studies, seasons, and warming scenarios. Here we synthesize experimental evidence for marine univalve and bivalve mollusks and develop a temperature-aware framework that couples one-compartment mass-balance TK with temperature-dependent filtration and growth, while statistically linking absorption efficiency and elimination to temperature, species traits (e.g., body size), and metal chemical properties. Thermal responses in filtration and growth were captured with unimodal performance functions; machine learning was used for predictor screening. Evaluated against an independent data set, the framework reproduced internal concentrations across multiple orders of magnitude with good agreement (R2 ≈ 0.73). Across the compiled evidence, filtration and growth showed strong species-specific thermal sensitivity, while metal chemistry primarily structured uptake. In the limited multitemperature TK calibration data set, a positive association between temperature and elimination was observed, but this relationship should be regarded as provisional pending additional multitemperature uptake-depuration data sets. By explicitly representing temperature-sensitive filtration and turnover pathways, the approach enables scenario testing for warming and heat extremes and provides a practical basis for improving the interpretation of bioaccumulation factors, seasonal biomonitoring, and temperature-aware risk assessment under climate change.
18. Psychometric Properties of Digital Divide Measurement Instruments in Health Contexts: Systematic Review.
期刊: JMIR human factors 发表日期: 2026-Apr-22 链接: PubMed
摘要
The digital divide constitutes a growing form of social inequality, influencing access to, use of, and benefit from digital health technologies. Accurate assessment of this phenomenon requires psychometrically sound measurement instruments, especially in health care contexts. This systematic review aimed to identify and evaluate the psychometric properties of instruments developed to measure the digital divide, with a particular focus on their application in health-related settings. A systematic review was conducted following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 and COSMIN (Consensus-Based Standards for the Selection of Health Measurement Instruments) guidelines. Literature searches were performed in PubMed, Scopus, Dialnet, and Web of Science for studies published between 2015 and 2025. Inclusion criteria required studies to report a psychometric evaluation of instruments measuring the digital divide. Four studies met the inclusion criteria (ranging from 875 to 1337 participants). The identified scales primarily measured digital skills and capital. All studies reported adequate internal consistency, with Cronbach α coefficients ranging from 0.70 to 0.94. Structural validity was confirmed through factor analysis in all studies. However, data on temporal stability and responsiveness were absent. Existing instruments show potential for assessing digital inequality in health, but further psychometric validation and cultural adaptation are required. Nursing professionals are encouraged to lead efforts in developing and validating context-sensitive instruments to promote digital health equity.
19. A Review of Medical Data Sharing Initiatives With a Focus on the Use of Blockchain Technologies: Qualitative Comparative Analysis.
期刊: Journal of medical Internet research 发表日期: 2026-Apr-22 链接: PubMed
摘要
Medical data sharing initiatives are crucial for advancing research, improving patient outcomes, and fostering innovation in health care. With the advent of blockchain technology, there has been significant interest in exploring its potential to enhance the security, transparency, and efficiency of medical data sharing. This study aimed to examine a selected set of blockchain-based medical data sharing initiatives, focusing on their governance, incentive structures, ownership models, business approaches, transaction mechanisms, and sustainability strategies. The analysis explored patterns in operational status and longevity, providing insight into the factors shaping these initiatives. The objective was to identify common characteristics and contextual factors that may influence their development and persistence. The study used snowball sampling to identify a selection of primarily blockchain-based medical data sharing initiatives, drawing from academic literature, web searches, and expert consultations. To examine structural and operational patterns, initiatives were selected based on the availability of sufficient public documentation for systematic classification. Each initiative was categorized by governance, incentives, ownership, business models, transaction mechanisms, and sustainability strategies. A follow-up assessment examined operational status over time. The analysis applied qualitative comparative analysis to identify common structural features and relationships between governance, incentives, and sustainability. The survey identified 42 initiatives, categorizing them based on ownership, governance, business, incentive, transaction, and sustainability models. These categories were systematically identified and assigned numerical values to facilitate fuzzy-set qualitative comparative analysis. The base model, run at an inclusion threshold of 0.65, identified multiple configurations associated with sustained initiative activity, highlighting the role of governance mechanisms and transaction structures in supporting long-term viability. The sensitivity analysis, conducted across multiple thresholds, demonstrated that while several configurations remained stable, higher thresholds led to more restrictive solutions. At 0.80, only two configurations remained, representing the most consistent pathways to sustained activity, reinforcing the importance of governance and transaction models in initiative sustainability. The analysis revealed a range of governance, ownership, business, and sustainability models, with no single structural configuration guaranteeing long-term viability. The findings suggest that governance and transaction mechanisms are particularly influential in sustaining initiatives, often compensating for the absence of strong business or sustainability models. The scope was limited to initiatives identified through available documentation and snowball sampling, and the results underscore the need for further research into the interplay between governance structures, financial models, and long-term sustainability in medical data sharing.
20. Effectiveness of Mobile Health Interventions in Pediatric Cancer: Systematic Review and Meta-Analysis of Randomized Controlled Trials.
期刊: JMIR mHealth and uHealth 发表日期: 2026-Apr-22 链接: PubMed
摘要
Cancer poses a significant threat to children’s health, and mobile health (mHealth) is emerging as a key tool for remote disease management, health education, and follow-up. However, evidence of its effectiveness remains limited. This study aimed to summarize the effects of mHealth interventions for pediatric cancer compared with usual care, providing evidence-based support for optimizing intervention models and improving patient outcomes. A systematic search of 14 databases identified randomized controlled trials (RCTs) on mHealth apps for pediatric patients with cancer from inception to August 1, 2025. Two reviewers independently screened studies, extracted data, assessed bias risk, and graded evidence quality. The meta-analysis was conducted using RevMan 5.4 and Stata 15. A total of 24 RCTs involving 2645 patients were included. This review found that mHealth interventions significantly reduced infection rates (odds ratio [OR] 0.25, 95% CI 0.10-0.60; P=.002) and the overall incidence of peripherally inserted central catheter (PICC) complications (OR 0.16, 95% CI 0.10-0.24; P<.001), while improving quality of life (standardized mean difference [SMD] 1.34, 95% CI 0.13-2.55; P=.03), self-management ability (SMD 6.39, 95% CI 1.26-11.53; P=.01), and treatment adherence (OR 2.83, 95% CI 1.41-5.66; P=.003). However, mHealth interventions had no significant effect on PICC catheter displacement (OR 0.44, 95% CI 0.15-1.29; P=.13) or health knowledge (SMD 4.44, 95% CI -2.40 to 11.29; P=.20). Further high-quality studies are needed to verify their impact in these areas. The intervention components covered 9 behavior change techniques: goals and planning, feedback and monitoring, social support, shaping knowledge, repetition and substitution, reward and threat, comparison of outcomes, natural consequences, and regulation. This systematic review and meta-analysis synthesized evidence from RCTs. The findings support the use of mHealth to reduce infections and PICC-related complications among pediatric patients with cancer while improving quality of life, self-management capabilities, and treatment adherence. These results underscore the importance of incorporating mHealth strategies into pediatric cancer care and guide the development and enhancement of future mHealth interventions.
21. Effect of angiopoietin-like protein 3 inhibitors on lipid profile and other biomarkers: a meta-analysis of randomized controlled trials.
期刊: European journal of preventive cardiology 发表日期: 2026-Apr-22 链接: PubMed
摘要
Inhibition of angiopoietin-like protein 3 (ANGPTL3) has been proposed as a promising approach to reduce residual cardiovascular risk. We conducted a meta-analysis of randomized controlled trials (RCTs) to provide a comprehensive evaluation of the metabolic effects of ANGPTL3 inhibitors. Databases (PubMed, EMBASE, Web of Science, CENTRAL, ClinicalTrials.gov) were searched from inception to July 2025. Eligible studies were RCTs comparing ANGPTL3 inhibitors against placebo. Outcomes included triglycerides (TG), LDL-C, apolipoprotein B (ApoB), non-high-density lipoprotein cholesterol (non-HDL-C), high-density lipoprotein cholesterol (HDL-C), total cholesterol (TC), very-low-density lipoprotein cholesterol (VLDL-C), apolipoprotein A1 (ApoA1), apolipoprotein C3 (ApoC3), lipoprotein(a) (Lp(a)), remnant cholesterol (RC), ANGPTL3 and C-reactive protein (CRP). Pooled estimates of percentage change from baseline were obtained using fixed- and random-effects models. Subgroup analysis was performed based on the mechanism of action: monoclonal antibodies (mAbs, evinacumab), antisense oligonucleotides (ASOs, vupanorsen), and small interfering RNAs (siRNA, zodasiran and solbinsiran). Nine RCTs (1,254 participants) were included. ANGPTL3 inhibition significantly reduced TG (-47.1%), LDL-C (-21.6%), ApoB (-19.9%), non-HDL-C (-31.5%), TC (-32.8%), VLDL-C (-40.6%), and RC (-72.7%). Modest but consistent reductions were also observed in Lp(a) (-11.5%), ApoA1 (-18.3%), and ApoE (-16.4%). ANGPTL3 inhibitors markedly reduced circulating ANGPTL3 protein (-70.7%), with no significant effect on high-sensitivity CRP. Subgroup analyses demonstrated greater reductions in LDL-C, ApoB, non-HDL-C, and TC with evinacumab compared to the other groups, whereas small interfering RNAs produced more pronounced VLDL-C lowering compared with vupanorsen. ANGPTL3 inhibition offers broad lipid-lowering benefits, with particularly marked reductions in TG-rich lipoproteins. This meta-analysis shows that ANGPTL3 inhibitors consistently improve multiple lipid parameters, offering a promising therapeutic option for patients with dyslipidemia who respond poorly to conventional lipid-lowering treatments, although their impact on cardiovascular outcomes remains to be established.ANGPTL3 inhibitors produce significant and consistent reductions in triglycerides and moderate but clinically meaningful decreases in LDL-C through an LDL receptor–independent mechanism, confirming their broad lipid-modifying effects.These lipid improvements are particularly relevant for high-risk populations such as patients with familial hypercholesterolemia or severe hypertriglyceridemia, but evidence from large, long-term cardiovascular outcome trials is still needed to confirm clinical benefit.
22. Care Pathways and Patient Experiences Among Patients With Post COVID-19 Condition: Study Protocol for a Mixed-Methods Study in Germany.
期刊: JMIR research protocols 发表日期: 2026-Apr-22 链接: PubMed
摘要
The COVID-19 pandemic has a lasting impact on health care utilization, as both the acute infection and post COVID condition (PCC) can lead to increased demand for medical services due to ongoing symptoms. The aim of this study is to systematically examine health care utilization among individuals after acute SARS-CoV-2 infection in Bavaria, Germany, with a particular focus on PCC. The study combines claims data analysis with qualitative interviews to improve the understanding of objective care pathways and patients’ subjective experiences within the health care system. The research project ‘SOLongCOVID’ employs a mixed-methods design consisting of two subprojects: (1) a retrospective cohort study using claims data from the Bavarian Association of Statutory Health Insurance Physicians (KVB) to analyze care pathways through state sequence analysis, (2) a qualitative study based on semistructured interviews and focus groups with patients with PCC concerning their subjective care experiences. A synthesis process involving a focus group discussion will combine the information from the two subprojects, providing a comprehensive understanding of the care processes of patients with PCC. The study was funded by the German Federal Joint Committee Innovation Fund in October 2024. Statutory health insurance claims data cover the period from 2019 to 2022, and qualitative interview data collection is planned from May 2025 to August 2026. As of manuscript submission, study preparation and ethics approvals have been completed, and 14 participants have been recruited for the qualitative interviews. Study findings are anticipated to be published from July 2026 to August 2027. The results are expected to enhance the understanding of existing barriers and challenges and to support evidence-based recommendations for improving care pathways for patients with specific care needs.
23. How I Read a Clinical Trial Report? A Primer for Busy Clinicians.
期刊: JCO oncology practice 发表日期: 2026-Apr-22 链接: PubMed
摘要
24. Shaping Digital Health Policy-Career Pivots, an AJR Podcast Series (Episode 10).
期刊: AJR. American journal of roentgenology 发表日期: 2026-Apr-22 链接: PubMed
摘要
How can radiologists help shape digital health policy? Krishna Juluru, MD, speaks with host Siddhant Dogra, MD, about his career in informatics, the Presidential Innovation Fellows program, service at the FDA Digital Health Center of Excellence, and partnering across government, academia, and industry to advance safe, effective digital health innovation.
25. Review no. 3: handling of longitudinal creatinine data to define acute kidney injury.
期刊: Clinical and experimental nephrology 发表日期: 2026-Apr-22 链接: PubMed
摘要
Acute kidney injury (AKI) is characterized by a sudden decline in kidney function. The Kidney Disease: Improving Global Outcomes (KDIGO) clinical practice guidelines define AKI based on an increase in serum creatinine (SCr) levels as well as a decrease in urine volume. For clinical researchers of AKI, the ability to handle longitudinal SCr data and flag AKI status and stage in individual patients is a fundamental skill. This article provides a practical guide for identifying AKI episodes from longitudinal SCr data using R programming. The methods described in this article are based on a hands-on seminar presented at the 68th Annual Meeting of the Japanese Society of Nephrology in 2025.
26. Impact of SGLT2 Inhibitors on Clinical Outcomes in Patients with Diabetes Mellitus Following Heart Transplantation: A Meta-analysis.
期刊: Diabetes therapy : research, treatment and education of diabetes and related disorders 发表日期: 2026-Apr-22 链接: PubMed
摘要
In this new era, heart transplantation (HT) is rapidly gaining popularity worldwide. Patients with end-stage heart disease are often candidates for HT. However, studies have shown that more than 30% of patients who undergo HT have pre-existing diabetes mellitus (DM), which is associated with a higher risk of graft failure and death. In this analysis, we aimed to assess the impact of sodium-glucose co-transporter 2 (SGLT2) inhibitors on clinical outcomes in patients with DM following HT. Online databases were searched for relevant publications. The statistical analysis was performed using the RevMan software version 5.4. The clinical outcomes included rejection post-HT, mortality, sepsis, weight reduction, change in body mass index (BMI), change in serum creatinine level, glomerular filtration rate (eGFR), and improvement in glycated hemoglobin (HbA1c). For dichotomous data, risk ratios (RR) with 95% confidence intervals (CI) were used to summarize the analysis. However, for continuous data, weight mean difference (WMD) with 95% CI was used. Eight studies with a total number of 2755 participants were included in this analysis. Our current results showed that rejection risk post HT was significantly lower in the SGLT2 inhibitor group (RR: 0.85, 95% CI: 0.78-0.93; P = 0.0001). The mortality risk was not significantly different (RR: 0.64, 95% CI: 0.32-1.29; P = 0.21). Similarly, sepsis following HT was similar in both groups (RR: 1.62, 95% CI: 0.13-20.11; P = 0.71). No significant differences were observed in weight reduction, BMI, change in serum creatinine level, change in eGFR, or improvement in HbA1c following HT. In participants with DM following HT, SGLT2 inhibitors significantly reduced rejection post transplantation. However, its impact on other important clinical outcomes, including mortality, should be further assessed with more data in future studies.
27. Access to Phones and Use of International Numbers Among Farmworkers in North Carolina, 2023-2024.
期刊: Journal of agromedicine 发表日期: 2026-Apr-22 链接: PubMed
摘要
Communication barriers can hinder health promotion and healthcare services. Migrant and seasonal farmworkers face substantial challenges to healthcare access. We used a mixed-methods approach to assess access to phones and use of international numbers among agricultural workers, specifically migrant and seasonal farmworkers, and to explore potential implications for healthcare, emergency services, and public health outreach. First, we surveyed migrant and seasonal farmworkers working in North Carolina, USA, about their ability to send text messages and make phone calls at their housing, including use of international phone numbers, in 2023. A total of 1,034 farmworkers participated in the survey, which used time-venue sampling. In 2023, we also interviewed farmworkers (n = 19) about their technology use and digital literacy skills. In 2024, as part of a statewide community assessment, we conducted listening sessions (n = 19) with farmworkers (n = 146), community health workers (n = 32), and healthcare team members (n = 34). Among survey respondents, 19% reported being unable to consistently make phone calls at their housing, and 10% reported using a phone with a number from another country. Interviews and listening sessions revealed three themes related to farmworkers’ cell phone use during the agricultural season, including use of international numbers, challenges with cell phones, and the utility of phones. Healthcare providers, emergency services, and public health practitioners should be aware that farmworkers may face barriers to making and receiving phone calls as well as sending text messages. Healthcare systems should consider how to ensure access to care for farmworkers using phones with numbers from their country of origin. While most farmworkers have access to phones, a meaningful minority cannot consistently make a phone call to coordinate care, report an emergency, or access health promotion services.
28. Racial Differences in the Longitudinal Association Between Perceived Neighborhood Disorder and Allostatic Load.
期刊: The Gerontologist 发表日期: 2026-Apr-22 链接: PubMed
摘要
Neighborhood disorder represents an environmental stressor that contributes to physiological wear and tear on the body, known as allostatic load. This study examines racial differences in the longitudinal associations between perceived neighborhood disorder and allostatic load among middle-aged and older adults. Utilizing a nationally representative sample from six waves of the Health and Retirement Study (2006-2016, N = 14,769), we constructed allostatic load using eight biomarkers indicative of physiological dysregulation. Perceived neighborhood disorder was assessed with a four-item scale. Using a machine learning-based generalized boosted regression tree model to generate inverse probability weights, we performed inverse probability weighted mixed effects models to assess racial differences in the longitudinal association between perceived neighborhood disorder and allostatic load, adjusting for covariates and residential selection bias. Black respondents exhibited a 26% higher baseline allostatic load compared to their White counterparts. Longitudinal analyses further revealed a significantly steeper trajectory of allostatic load among Black respondents (B = 0.132, 95% confidence interval [CI]: 0.069-0.195). Perceived neighborhood disorder was positively associated with allostatic load only among Black respondents (B = 0.047, 95% CI: 0.001-0.092), with no significant association observed in White respondents. This study highlights perceived neighborhood disorder as a critical risk factor for elevated allostatic load among Black older adults. These results underscore the importance of considering the racially stratified nature of neighborhoods in understanding place-based health disparities.
29. Assessing the Toxicity of Lead from Recreational Fishing Gear to Daphnia Magna.
期刊: Environmental toxicology and chemistry 发表日期: 2026-Apr-22 链接: PubMed
摘要
The presence of lead (Pb) sinkers and jigs lost to waterbodies from recreational fishing serves as a potential risk to aquatic ecosystem health. Assessing the toxicity of Pb released from fishing gear poses several challenges, and one proposed approach is to use Pb salts as a surrogate. However, it remains unclear how the toxicity of Pb salts compares to that of Pb derived directly from fishing gear. To test this, we measured Pb release from different concentrations of fishing sinkers (e.g., bell sinkers and split shot sinkers), at 4ᵒC and 30ᵒC for 48 hr. Further, we compared the overt toxicity of Pb sinkers and jigs against lead nitrate (Pb(NO3)2) toxicity using Daphnia magna. Water Accommodated Fractions (WAF) were generated by suspending Pb sinkers (100 g/L) in water for 48 hr, which caused Pb dissolution exceeding Water Quality Guidelines by ∼35-100x with additional impurities of zinc and cadmium in both the split shot and bell sinkers, as well as iron, arsenic, nickel, copper in the bell sinkers. These sinker types were not acutely toxic to D. magna, however chronic exposure to WAFs released from both types of sinkers significantly impacted reproduction (number of neonates produced over 21 days per D. magna) and growth. Therefore, discarded fishing gear may represent a notable source of environmental Pb as well as other metals. This study offers valuable baseline data to support future discussions on regulating Pb-based fishing gear in Canada and highlights the importance of developing cost-effective alternatives.
30. Neuroprotection Against a Panel of Toxicants via a Novel Analog of the Natural Product Fraxinellone.
期刊: Chemical research in toxicology 发表日期: 2026-Apr-22 链接: PubMed
摘要
Humans are exposed to a myriad of environmental pollutants, with recent evidence indicating several of these toxicants serve as risk factors for neurodevelopmental disorders and neurodegenerative diseases. Given this, there is a need for both interventional and protective strategies; however, of concern, the mechanistic targets of these environmental pollutants are variable or unknown in some cases. A prior report indicated that analogs of the natural product fraxinellone act as potent NRF2 activators, mitigating excessive reactive oxygen species (ROS) generation and Glu toxicity in vitro. Using one of the most effective fraxinellone analogs (i.e., analog 2) for NRF2 activation identified, we sought to determine the range of protection, in vitro, against a panel of neurotoxicants with varying mechanisms for adverse effects, including 6-hydroxydopamine (6-OHDA), organochlorine pollutants, and a fungicide. The data for analog 2 were compared to those for a structurally similar but inactive analog (i.e., analog 1). The dose-response for each toxicant with PC12 and SH-SY5Y cell lines was determined. Interestingly, the fraxinellone analog provided significant protection against all agents screened: 6-OHDA, dieldrin, benomyl, PCB52 hydroxy and sulfate metabolites, and rotenone. The extent to which the fraxinellone analog mitigated toxicity varied for each toxicant. In all cases, pretreatment with analog 2 significantly decreased total cellular ROS production, and in addition, generation of mitochondrial ROS via rotenone was mitigated. Furthermore, analog 2 provides some degree of restoration of cell viability following rotenone insult. In summary, our data indicate that an analog of the natural product fraxinellone potently inhibited ROS production and toxicity, thereby protecting cells against a panel of agents with varying mechanisms from adverse outcomes.
31. Emerging trends in the management of difficult-to-treat rheumatoid arthritis: targeted treatments and non-pharmacological interventions.
期刊: Rheumatology (Oxford, England) 发表日期: 2026-Apr-22 链接: PubMed
摘要
Patients with rheumatoid arthritis (RA) often require alterations of their therapeutic regimen throughout the course of their illness, guided by specific outcomes in line with the treat-to-target principle. Importantly, a significant portion of the RA population fails to achieve sufficient disease control in the long term. Several years ago, the umbrella notion of difficult-to-treat (D2T) RA was introduced to facilitate more structured care and research efforts for patients who remain symptomatic despite having received multiple courses of targeted medications. D2T RA represents a heterogeneous condition sustained by a complex interplay of underlying factors. Biological therapies and Janus kinase inhibitors have demonstrated efficacy in alleviating disease activity in patients refractory to conventional treatments. The use of tailored non-pharmacological therapies (physiotherapy, psychological interventions, etc.) to complement pharmacotherapy chiefly addresses symptoms unrelated to ongoing inflammation. In this narrative review, we examine the current use and relevance of pharmacological and non-pharmacological approaches for D2T RA.
32. Predicting Emotional Exhaustion with Multimodal Sensor Data During Return-to-Work Trajectories: A 6-Month Longitudinal Study.
期刊: Journal of occupational rehabilitation 发表日期: 2026-Apr-22 链接: PubMed
摘要
Emotional exhaustion is a core component of burnout and impacts return-to-work trajectories following sick leave due to burnout or stress. Previous research identified links between emotional exhaustion and sleep, physical activity, mobility, and smartphone usage, yet little is known about how these associations vary within and between individuals over time. This study examined how emotional exhaustion can be monitored and predicted using multimodal data from smartphones and smart rings during return-to-work trajectories. Eighteen employees on sick leave in the Netherlands due to stress or burnout symptoms were recruited via occupational physicians. For six months, participants completed daily Ecological Momentary Assessments (EMAs) of emotional exhaustion and provided multimodal sensor data on sleep and physical activity (Oura ring), mobility, and phone usage patterns (Avicenna app). Between- and within-person associations were examined using correlational analyses and linear mixed models. Subject-dependent Random Forest (RF) models were trained to assess the predictive performance of multimodal features. Subject-dependent RF models achieved an average Spearman’s ρ̄ of 0.38 (range: 0.10-0.72). Sleep and physical activity features showed more consistent associations with emotional exhaustion than mobility and smartphone usage patterns, which were more heterogeneous. The strength and direction of associations, as well as the most predictive features, varied substantially between participants. Multimodal device data can modestly predict emotional exhaustion, with performance varying by individual. Results indicate that emotional exhaustion patterns are highly variable among employees, necessitating individualized approaches to return-to-work counselling. Future research should incorporate longer monitoring periods and examine inter- and intra-individual variability.
33. Dietary patterns and metabolic syndrome in US adults: Moderation by food security and sex.
期刊: Nutrition and health 发表日期: 2026-Apr-22 链接: PubMed
摘要
BackgroundMetabolic syndrome (MetS) comprises a cluster of cardiometabolic risk factors that are associated with dietary patterns and social conditions. Examining how dietary patterns and MetS are associated and whether assocations are moderated by food security and sex may inform targeted nutrition strategies for MetS prevention.AimTo examine associations between data-driven dietary patterns and MetS in a nationally representative sample of US adults and to assess whether associations differed by sex and household food security status.MethodsThis cross-sectional study analyzed data from 1333 adults aged ≥18 years in the 2015-2018 National Health and Nutrition Examination Survey. Dietary intake was assessed using two non-consecutive 24-h recalls, and survey-weighted principal components analysis identified dietary patterns from energy-adjusted intakes of 26 food groups. MetS was defined using National Cholesterol Education Program Adult Treatment Panel III criteria (≥3 of: Elevated waist circumference, blood pressure, fasting glucose, triglycerides, or reduced high-density lipoprotein cholesterol). Survey-weighted logistic regression estimated odds of MetS across tertiles of dietary pattern adherence, adjusting for potential confounders.ResultsThree major dietary patterns were identified in the overall sample, with greater adherence to a Prudent Seafood and Plant-Based pattern associated with lower MetS z-scores (p = 0.0019) and a lower odds of MetS (p = 0.0069). Among males, a Refined Grain, Tomato and Cheese pattern was associated with lower odds of MetS (p = 0.04), while an Oils, Nuts and Processed Meats pattern was associated with higher odds (p = 0.03). Food security status modified the association between the Whole Grain, Produce and Low-Fat Dairy pattern and MetS (p < 0.0001).ConclusionsIn a sample of US adults, data-driven dietary patterns showed differential associations with MetS, varying by sex and food security status. These findings indicate effect modification by sex and food security in the relationship between dietary patterns and MetS.
34. Culture-Negative Infective Endocarditis: The Target Is in the Crosshairs.
期刊: Journal of the American College of Cardiology 发表日期: 2026-Apr-22 链接: PubMed
摘要
35. Which Psychosocial Job Demands Matter Most for Parasympathetic Heart Rate Variability - A Dominance Analysis Study.
期刊: Journal of occupational health 发表日期: 2026-Apr-22 链接: PubMed
摘要
Prolonged reduced heart rate variability (HRV) is associated with impaired health and chronic diseases. Despite this connection, it remains unclear which psychosocial job demands are the strongest predictors of reduced HRV and poorer health outcomes. This study aimed to determine the most relevant psychosocial job demands that predict reduced HRV. The study participants were 163 municipal employees (86% females, mean age 47) who responded to a survey on psychosocial job demands and measured their electrocardiography-based HRV over four consecutive nights during a normal work week. The root mean square of successive RR intervals (RMSSD) was used as an indicator of autonomic nervous system activity mediated by the vagus nerve. Hierarchical mixed model regression analysis included psychosocial job demands and the most relevant individual factors and occupational sector as a nested random effect. Dominance analysis (DA) was used to assess all the variable combinations to identify the most significant determinants of HRV across the regression models. The participants’ RMSSD was stable over the measurement period. The DA ranked the participants’ age as the factor that most affected RMSSD. The psychosocial job demands that seem to be the most relevant for RMSSD are encountering bullying, violence at work, ethically challenging situations at work, and effort-reward imbalance. Gender was ranked as the fourth factor. These results need to be confirmed in further studies, but they suggest that workplace bullying and violence as well as ethically challenging situations at work might have the greatest effect on HRV among public sector employees.
36. Safety and efficacy of allogeneic umbilical cord-derived mesenchymal stem cell infusion for frailty: a phase 2, single-centre, randomised, open-label controlled trial.
期刊: EBioMedicine 发表日期: 2026-Apr-21 链接: PubMed
摘要
Frailty syndrome in older adults is a growing public health concern associated with increased vulnerability and adverse outcomes. Umbilical cord-derived mesenchymal stem cell (UC-MSC) therapy shows promise in improving physical function and quality of life. This study evaluated the safety and efficacy of intravenous UC-MSC infusion in older frail adults. A phase 2 randomised controlled trial at Vinmec Times City International General Hospital (2021-2024) enrolled 147 frail adults aged 60-85 (Modified Fried Criteria ≥3). Participants were randomly assigned to receive two intravenous UC-MSC infusions (1.5 × 106 cells/kg, three months apart) plus oral supplements, or supplements alone, with nine months of follow-up. Safety was assessed by adverse events (AEs) and serious adverse events (SAEs). Efficacy outcomes included Short Physical Performance Battery (SPPB), handgrip strength, physical activity (CHAMPS), fatigue (MFI), knee function (WOMAC), and quality of life (SF-36). No UC-MSC therapy-related SAEs occurred. Twelve mild AEs (headache, dizziness, chest discomfort) resolved spontaneously. At nine months, the UC-MSC group showed higher SPPB scores than controls (least-squares mean difference 1.1 points, 95% CI: 0.6-1.6). In this study, UC-MSC infusion was associated with no safety concerns and was associated with higher SPPB scores than in the control group. These findings provide the necessary rationale and foundation for larger, double-blind, multicentre phase 3 trials. Vingroup Joint Stock Company, grant ISC.21.11.
37. Delisting for clinical improvement as a proxy for recompensated cirrhosis on the U.S. liver transplant waitlist: A retrospective cohort study.
期刊: Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society 发表日期: 2026-Apr-21 链接: PubMed
摘要
Recompensation is emerging as a concrete outcome for patients with effective disease-modifying treatments for cirrhosis. Delisting due to clinical improvement (DCI) from the liver transplant (LT) waitlist may serve as a proxy for recompensation. This study investigated factors associated with time on the waitlist and risk of relisting. This was a retrospective cohort study of patients listed for LT between 1/1/2005-12/31/2024 using the Organ Procurement and Transplantation Network (OPTN) database. Timing of DCI was categorized as: <1 year, 1-3 years, and ≥3 years. Of 127,168 patients, 6.9% achieved DCI. The proportion of patients experiencing DCI was highest for hepatitis B virus (9.9%), alcohol-associated liver disease (8.3%), and autoimmune hepatitis (8.2%). Median time to DCI was 2.5 years: 19% were delisted in <1 year, 39% in 1-3 years, and 42% in ≥ 3 years. Among patients waitlisted as Child-Turcotte-Pugh (CTP) class B or C, only 40.6% improved to CTP A at DCI. Relisting after DCI occurred in 9.6%, with 33% of these driven by hepatocellular carcinoma. In multivariable analysis, only patients with both MELD score improvement ≥3 points and CTP class improvement had significantly lower relisting risk after DCI (adjusted HR 0.52; p<0.001), but not those meeting either criterion individually. Additional relisting predictors included albumin <3.5 g/dL at DCI, male sex, and cirrhosis etiology (all p<0.001). The occurrence of DCI is variable across disease etiologies. Achieving combined improvement in MELD and CTP class may better identify durable clinical improvement and guide safe waitlist removal decisions.
38. From inflammation to malignancy: the dynamic evolution of cancer-associated fibroblasts in IBD-CRC.
期刊: Neoplasia (New York, N.Y.) 发表日期: 2026-Apr-21 链接: PubMed
摘要
Inflammatory bowel disease-associated colorectal cancer (IBD-CRC) represents a distinct clinical and molecular entity characterized by long-standing inflammation and a unique “dysplasia-carcinoma” sequence. While epithelial genetic alterations are well-documented, the role of the mesenchymal stroma as a dynamic driver of malignant transformation remains underappreciated. In this review, we propose a conceptual framework where intestinal fibroblasts contribute significantly to niche construction as key components of the Tumor Microenvironment (TME) architecture. These cells are not merely passive scaffolds but dynamically co-evolve with the epithelium and immune compartment, transitioning into active orchestrators of the pre-malignant niche. We highlight the emerging concept of “stromal inflammatory memory,” which is hypothesized to be encoded through stable epigenetic imprinting and persistent metabolic reprogramming, characterized by a PFKFB3-mediated glycolytic shift. This metabolic priming sustains a pro-tumorigenic environment even during clinical remission. We further delineate how the loss of apical polarity regulators, such as aPKC, triggers a cascade of epithelial-stromal crosstalk involving chronic microbial sensing and hyaluronan-driven signaling. This co-evolution leads to the diversification of cancer-associated fibroblast (CAF) subsets, including inflammatory (iCAF), myofibroblastic (myCAF), and antigen-presenting (apCAF) populations. These subsets collectively orchestrate immune evasion via T-cell exhaustion and physical immune exclusion. Finally, we discuss the clinical implications of the “Reverse Warburg Effect” and exosome-mediated chemoresistance. We emphasize that effective therapeutic strategies must transcend epithelial-centric models to target the stromal axis. By integrating recent advances in single-cell and spatial transcriptomics, we identify novel opportunities for “stromal reprogramming” through metabolic, epigenetic, and senomorphic interventions to prevent and treat IBD-CRC.
39. Syphilis in the South Summit: An Impact on Practice Change and Jurisdictional Priorities.
期刊: Sexually transmitted diseases 发表日期: 2026-Apr-21 链接: PubMed
摘要
In May 2023, the Denver and Southeast Prevention Training Centers hosted the Syphilis in the South Summit (SiSS) for key leaders in the southern United States to share barriers and identify opportunities to address syphilis within the region. The one-day summit addressed the rising rates of syphilis by enhancing program implementation strategies for southern jurisdiction. The one-day summit, SiSS, began with an invitation to healthcare and public health leaders in the southern region to attend. Attendees received an online post-course evaluation immediately after the summit to measure satisfaction, change in knowledge and skills, and intent to change. At eight months, a long-term evaluation was conducted to assess actual changes made, successes, and barriers. The summit was attended by 58 individuals representing leadership from 29 organizations from 10 states within the southern region. The post-course evaluation had a response rate of 59% (n=34), with most respondents 85% (n=29) indicating an intention to make practice changes. The long-term evaluation had a completion rate of 50% (n=22), with nearly all respondents 91% (n=20) identifying new approaches to address syphilis. A one-day summit was an effective way to influence practice changes within sexually transmitted infection clinics and jurisdictions to identify new approaches to address syphilis.
40. [Policies and programs to support home caregivers: A scoping review].
期刊: Ciencia & saude coletiva 发表日期: 2026-Mar 链接: PubMed
摘要
The objective was to map policies and programs supporting home caregivers. A scoping review was conducted following the methodological recommendations of the Joanna Briggs Institute (JBI), with a search for studies across 13 databases. The processes of selection, eligibility, and data extraction were independently conducted by two reviewers. The search retrieved 4,216 articles, of which 30 were included, describing 35 policies. Additionally, 44 policies were identified in official documents from 38 records obtained from ministerial websites. The articles highlighted psychosocial support, educational initiatives, and the promotion of caregiver self-care as the primary strategies, while financial support was the most prevalent strategy in official documents. Despite the review’s limitations, such as not analyzing the effectiveness of the strategies, gaining a better understanding of support programs and policies for caregivers can strengthen the discourse on the need for a dedicated and robust policy to support caregivers. O objetivo foi mapear as políticas e programas de apoio ao cuidador domiciliar. Foi desenvolvida uma revisão de escopo, de acordo com as recomendações metodológicas do JBI, com busca por estudos em 13 bases de dados. Os processos de seleção, elegibilidade e extração foram realizados por duas revisoras independentemente. As buscas recuperaram 4.216 artigos, dos quais 30 foram incluídos e descreveram 35 políticas. Além disso, 44 políticas foram levantadas nos documentos oficiais de 38 registros recuperados dos sites ministeriais. Os artigos apresentaram como principais estratégias o apoio psicossocial, ações educativas e a promoção do autocuidado do cuidador, já nos documentos oficiais as estratégias mais predominantes eram as de apoio financeiro. Apesar das limitações da revisão, como não analisar as questões de efetividade das estratégias, conhecer e compreender melhor programas e políticas de apoio ao cuidador podem fortalecer o diálogo sobre a necessidade de uma política própria e forte para apoiar os cuidadores domiciliares. El objetivo fue mapear las políticas y programas de apoyo a los cuidadores domiciliarios. Se realizó una revisión de alcance, siguiendo las recomendaciones metodológicas del JBI, buscando estudios en 13 bases de datos. La selección, elegibilidad y extracción de datos fueron realizadas de forma independiente por dos revisores. Las búsquedas recuperaron 4216 artículos, de los cuales 30 fueron incluidos y describieron 35 políticas. Además, se identificaron 44 políticas en documentos oficiales a partir de 38 registros recuperados de sitios web ministeriales. Los artículos presentaron el apoyo psicosocial, las acciones educativas y la promoción del autocuidado de los cuidadores como las principales estrategias, mientras que en los documentos oficiales las estrategias más predominantes fueron las de apoyo financiero. A pesar de las limitaciones de la revisión, como la falta de análisis de la efectividad de las estrategias, conocer y comprender mejor los programas y políticas de apoyo a los cuidadores puede fortalecer el diálogo sobre la necesidad de una política específica y sólida de apoyo a los cuidadores domiciliarios.
41. [Government spending on antiretrovirals in Brazil and its main determinants].
期刊: Ciencia & saude coletiva 发表日期: 2026-Mar 链接: PubMed
摘要
The development of public policies for the prevention and treatment of HIV/AIDS in Brazil is a history of struggle that has united public health officials, researchers and activists since the 1980s. An important part of this journey is linked to the production and distribution of antiretroviral drugs (ARVs), initiatives to reduce the price of ARVs and civil society mobilizations to guarantee rights, which have contributed to creating one of the most successful programs to combat the disease in the world. Based on this history, this study aimed to analyze government spending on the acquisition of selected ARVs between 2005 and 2020, comparing prices with international prices, in the light of factors related to patent disputes, voluntary licensing, PDPs and initiatives to reduction ARV prices. Among other results, it was possible to observe that there was no immediate relationship between the end of the patent concession and price reductions. The filing of other patent applications and the absence of nationally registered competitors, even after patent expired, may be significant factors in maintaining high prices. A construção de políticas públicas para a prevenção e tratamento do HIV/Aids no Brasil é uma história de luta que une sanitaristas, pesquisadores e ativistas desde os anos 1980. Parte importante desse caminho está ligado à produção e distribuição de medicamentos antirretrovirais (ARV), iniciativas de redução do preço dos ARV e mobilizações da sociedade civil pela garantia de direitos, que contribuíram para criar um dos programas mais bem-sucedidos de combate à doença no mundo. Com base nesse histórico, este trabalho teve por objetivo analisar os gastos governamentais na aquisição de ARV selecionados no período entre 2005 e 2020, fazendo uma comparação com preços internacionais, à luz dos determinantes relacionados às disputas patentárias, ao licenciamento voluntário, às PDP e às iniciativas para redução de preços de ARV. Entre outros resultados, foi possível observar que não houve uma relação imediata entre o fim da concessão patentária e a redução de preços. Depósitos de outros pedidos de patente e a inexistência de concorrentes registrados nacionalmente, mesmo após a expiração da patente, podem ser fatores significativos para a manutenção de altos preços. El desarrollo de políticas públicas para la prevención y el tratamiento del VIH/SIDA en Brasil es una historia de lucha que ha unido a funcionarios de salud pública, investigadores y activistas desde la década de 1980. Una parte importante de esta trayectoria está vinculada a la producción y distribución de medicamentos antirretrovirales (ARV), las iniciativas para reducir su precio y las movilizaciones de la sociedad civil para garantizar los derechos, lo que contribuyó a la creación de uno de los programas más exitosos para combatir la enfermedad en el mundo. Con base en esta historia, este estudio tuvo como objetivo analizar el gasto público en la adquisición de ARV seleccionados entre 2005 y 2020, comparándolos con los precios internacionales, a la luz de los determinantes relacionados con las disputas de patentes, las licencias voluntarias, las PDP y las iniciativas para reducir los precios de los ARV. Entre otros resultados, se observó que no existía una relación inmediata entre la finalización de la concesión de la patente y la reducción de precios. La presentación de otras solicitudes de patente y la falta de competidores registrados a nivel nacional, incluso tras el vencimiento de la patente, pueden ser factores importantes que mantienen los precios altos.
42. Meanings produced by dentists in caring for patients with mental disorders: a qualitative study.
期刊: Ciencia & saude coletiva 发表日期: 2026-Mar 链接: PubMed
摘要
Mental health care in Brazil has advanced considerably over the last few decades, moving away from a mental institution model towards a community care model. However, advances in oral health care for these patients are still incipient, with a lack of promotion strategies, which leaves these patients with high level of vulnerability to developing oral diseases. The aim is to understand the meanings produced by Primary Health Care Dental Surgeons about the dental care offered to patients with mental disorders. A qualitative study was carried out with Primary Health Care Dentists. Data was produced through semi-structured interviews and analyzed using the Grounded Theory of Data and interpreted based on ideas presented by Caguilhem in his work “The normal and the pathological”. From the analysis using open and axial coding, six categories were drawn up: 1) care focused on spontaneous demand; 2) “we don’t have this training; 3) complexity of care; 4) a “normal” patient; 5) A special patient; 6) need for family support. Dental Surgeons understand that care for people with mental disorders is poor, which for them stems from a lack of training and knowledge about people with mental disorders. A atenção em saúde mental no Brasil avançou notavelmente nas últimas décadas, migrando do modelo manicomial para o cuidado comunitário. Contudo, o avanço no cuidado em saúde bucal é incipiente e soma-se à falta de estratégias que incluam prevenção e promoção de saúde, mantendo esse grupo vulnerável às doenças bucais. O objetivo é compreender significados produzidos por Cirurgiões-Dentistas da Atenção Primária à Saúde sobre o cuidado odontológico ofertado a pacientes com transtorno mental. Foi realizada uma pesquisa qualitativa com Cirurgiões-Dentistas da Atenção Primária em Saúde. Os dados foram produzidos por meio de entrevistas semiestruturadas, analisados pela Teoria Fundamentada de Dados e interpretados com base em ideias expostas por Canguilhem em “O normal e o patológico”. A partir da análise pela codificação aberta e axial foram elaboradas seis categorias: 1) atendimento focado na demanda espontânea; 2) “a gente não tem esse treinamento”; 3) complexidade do atendimento; 4) um paciente “normal”; 5) Um paciente especial; 6) necessidade de suporte da família. Cirurgiões-Dentistas compreendem que o cuidado às pessoas com transtorno mental é deficiente, para eles decorrente da falta de treinamento e desconhecimento sobre a pessoa com transtorno mental. La atención a la salud mental en Brasil ha avanzado notablemente en las últimas décadas, pasando del modelo de asilo a la atención comunitaria. Sin embargo, el progreso en la atención a la salud bucodental es incipiente y, sumado a la falta de estrategias que incluyan la prevención y la promoción de la salud, mantiene a este grupo vulnerable a las enfermedades bucodentales. El objetivo es comprender los significados que los odontólogos de atención primaria producen en relación con la atención odontológica ofrecida a pacientes con trastornos mentales. Se realizó un estudio cualitativo con odontólogos de atención primaria. Los datos se recopilaron mediante entrevistas semiestructuradas, se analizaron mediante la Teoría Fundamentada y se interpretaron con base en las ideas presentadas por Canguilhem en “Lo Normal y lo Patológico”. A partir del análisis mediante codificación abierta y axial, se desarrollaron seis categorías: 1) atención centrada en la demanda espontánea; 2) “No contamos con esta formación”; 3) complejidad de la atención; 4) un paciente “normal”; 5) un paciente con necesidades especiales; 6) necesidad de apoyo familiar. Los odontólogos comprenden que la atención a las personas con trastornos mentales es deficiente, lo que, según ellos, se debe a la falta de formación y conocimiento sobre estas personas.
43. Temporal trend and epidemiological profile of exogenous poisonings in Brazil: an ecological study from 2007 to 2019.
期刊: Ciencia & saude coletiva 发表日期: 2026-Mar 链接: PubMed
摘要
Poisonings are a global public health problem. With the aim of describing their epidemiological profile in Brazil, an ecological time series study was conducted from 2007 to 2019, characterizing individual demographic variables (sex; age), exposure variables (circumstance; toxic agents), health indicators (incidence; mortality; fatality), and temporal trends. Data concerning notifications were extracted from the Notifiable Diseases Information System (SINAN) and stratified by macro-region, sex, age, circumstance, and toxic agents. The indicators of incidence, fatality, and mortality were calculated, and the temporal trend was analyzed using the Prais-Winsten model. Our search obtained 1,166,299 notifications, the majority of which were female individuals (55.6%). The preponderance of cases that resulted in death were referent to male individuals (59.6%). The adult age group was the most reported (60.4%), yet the incidence (50.49/100,000 inhabitants) was higher among children. Medication was the main agent (43.7%), and attempted suicide was the main circumstance related to notifications, deaths, incidence, and mortality. Our findings show a low fatality rate (1.0%) and an increasing trend in incidence and mortality. Thus, the results can guide health promotion and prevention actions in the country. As intoxicações são um problema de saúde pública global. Com o objetivo de descrever o perfil epidemiológico no Brasil, realizamos um estudo ecológico de séries temporais de 2007 a 2019, caracterizando variáveis demográficas individuais (sexo; idade), variáveis de exposição (circunstância; agentes tóxicos), indicadores de saúde (incidência; mortalidade; letalidade) e a tendência temporal. Extraímos os dados sobre as notificações pelo Sistema de Informação de Agravos de Notificação (SINAN) e os estratificamos por macrorregiões, sexo, idade, circunstância e agentes tóxicos. Foram calculadas incidência, letalidade, mortalidade e analisada a tendência temporal pelo modelo Prais-Winsten. Foram obtidas 1.166.299 notificações, sendo majoritárias no sexo feminino (55,6%). A maioria dos casos que evoluíram para óbito eram do sexo masculino (59,6%). A faixa etária dos adultos foi a mais notificada (60,4%), mas a incidência (50,49/100.000 habitantes) foi maior nas crianças. Medicamento foi o principal agente (43,7%), e a tentativa de suicídio, a principal circunstância relacionada a notificações, óbitos, incidência e mortalidade. Observamos baixa letalidade (1,0%) e tendência crescente da incidência e mortalidade. Assim, os resultados poderão nortear ações de promoção e prevenção de saúde no país. Las intoxicaciones son un problema de salud pública mundial. Para describir el perfil epidemiológico en Brasil, realizamos un estudio de series temporales ecológicas de 2007 a 2019, caracterizando las variables demográficas (género; edad), de exposición (circunstancia; agentes tóxicos), indicadores de salud (incidencia; mortalidad; letalidad) y la tendencia temporal. Se extrajeron los datos de notificaciones del Sistema de Información de Enfermedades de Declaración Obligatoria (SINAN) por macrorregión, sexo, edad, circunstancia y agentes tóxicos. Se calculó la incidencia, letalidad y mortalidad y se analizó la tendencia temporal mediante el modelo de Prais-Winsten. Se obtuvo un total de 1.166.299 notificaciones, siendo la mayoría de sexo femenino (55,6%). La mayoría de los casos fallecidos fueron hombres (59,6%). Los adultos fueron los más notificados (60,4%), pero la incidencia (50,49/100.000 habitantes) fue mayor en los niños. La medicación fue el principal agente (43,7%) y el intento de suicidio la principal circunstancia asociada con las notificaciones, los fallecimientos, la incidencia y la mortalidad. Se observó una baja letalidad (1,0%) y una tendencia creciente de la incidencia y mortalidad. Los resultados indican la necesidad de acciones de promoción y prevención de la salud en el país.
44. [Sampling and monitoring plan for pesticide residues in drinking water in the state of São Paulo, Brazil].
期刊: Ciencia & saude coletiva 发表日期: 2026-Mar 链接: PubMed
摘要
Brazil is the world leader in pesticide consumption, according to the report from the Food and Agriculture Organization of the United Nations (FAO). The control and surveillance of drinking water against these contaminants involves the responsibilities of sanitation service providers and the Surveillance bodies of the Unified Health System (SUS). The objective was to describe the surveillance sampling plan and the results of pesticide monitoring in drinking water in the state of São Paulo., A total of 137 municipalities was selected for analysis of 91 pesticides, using the liquid chromatography technique associated with mass spectrometry between 2020 and 2023. The selection considered agricultural activity around the water supply system catchments, the population supplied, history of residues in water and food, largest agricultural area, agricultural establishments that use pesticides and number of exogenous poisonings. All samples presented results below those established in Ordinance GM/MS 888/2021. Pesticides including 2,4-D, Diuron, Tebuconazole, Bentazone and Atrazine were detected more frequently during the rainy season. The conclusion drawn is that it is important for surveillance monitoring to consider the characterization of the territory to define an opportune collection period. O Brasil é líder mundial no consumo de agrotóxicos, conforme o relatório da Organização das Nações Unidas para Alimentação e Agricultura (FAO). O controle e vigilância da água para consumo humano desses contaminantes envolvem responsabilidades dos prestadores de serviços de saneamento e dos órgãos de Vigilância do Sistema Único de Saúde (SUS). O objetivo foi descrever o plano de amostragem de vigilância e os resultados do monitoramento de agrotóxicos em água para consumo humano no estado de São Paulo. De 2020 a 2023, foram selecionados 137 municípios para análise de 91 agrotóxicos, utilizando a técnica de cromatografia líquida associada à espectrometria de massas. A seleção considerou: atividade agrícola no entorno das captações dos sistemas de abastecimento de água, população abastecida, histórico de resíduos em água e alimentos, maior área agrícola, estabelecimentos agrícolas que utilizam agrotóxicos e número de intoxicações exógenas. Todas as amostras apresentaram resultados abaixo dos estabelecidos na Portaria GM/MS 888/2021. Foram detectados com maior frequência no período chuvoso: 2,4-D, Diuron, Tebuconazol, Bentazona e Atrazina. Verificou-se a importância de o monitoramento de vigilância considerar a caracterização do território para definição de período oportuno de coleta. Brasil es líder mundial en consumo de plaguicidas, según un informe de la Organización de las Naciones Unidas para la Alimentación y la Agricultura (FAO). El control y la vigilancia de estos contaminantes en el agua potable involucran las responsabilidades de los prestadores de servicios de saneamiento y las agencias de vigilancia del Sistema Único de Salud (SUS). El objetivo fue describir el plan de muestreo de vigilancia y los resultados del monitoreo de plaguicidas en agua potable en el estado de São Paulo. De 2020 a 2023, se seleccionaron 137 municipios para el análisis de 91 plaguicidas, mediante cromatografía líquida acoplada a espectrometría de masas. La selección consideró la actividad agrícola en las proximidades de las tomas del sistema de abastecimiento de agua, la población servida, el historial de residuos en agua y alimentos, la mayor área agrícola, los establecimientos agrícolas que utilizan plaguicidas y el número de intoxicaciones exógenas. Todas las muestras mostraron resultados por debajo de los establecidos en la Ordenanza GM/MS 888/2021. Los siguientes plaguicidas se detectaron con mayor frecuencia durante la temporada de lluvias: 2,4-D, diurón, tebuconazol, bentazona y atrazina. Es importante que el monitoreo considere la caracterización del territorio para definir el período oportuno de recolección.
45. Health and environmental licensing: analysis of an Environmental Impact Study on oil wells in Northeast Brazil.
期刊: Ciencia & saude coletiva 发表日期: 2026-Mar 链接: PubMed
摘要
The interrelation between health and the environment lies at the core of the environmental licensing process. Economic development impacts human health, as seen in the oil industry, known for pollution, illness, chemical spill accidents, and their implications for public health. This article presents the findings of research that analyzed the inclusion of human health in an Environmental Impact Study (EIS) for oil well drilling in northeastern Brazil. Using a method that applied a matrix of health and environmental indicators categorized, systematized, and critically assessed, it found a lack of basic indicators for protecting, preventing, and mitigating health-related damages. The study concludes with an urgent call to include health monitoring in environmental licensing for areas subject to risks associated with the oil production chain. The method highlights the absence of public health considerations in the EIS and reaffirms the principles of Brazil’s Unified Health System (SUS). A inter-relação saúde e ambiente está no centro do processo de licenciamento ambiental. O desenvolvimento econômico gera impactos sobre a saúde humana, como os da indústria do petróleo, que é conhecida por poluição, adoecimento e acidentes químicos de derrames, com implicações para a saúde coletiva. Este artigo apresenta os resultados de uma pesquisa que analisou a inserção da saúde humana em um Estudo de Impacto Ambiental de perfuração de poços no Nordeste do Brasil. A partir de um método em que se aplicou uma matriz de indicadores de saúde e meio ambiente, com categorização, sistematização e crítica, verificando-se a ausência de indicadores básicos para a proteção, prevenção e mitigação de danos à saúde. Conclui-se que é urgente incluir no licenciamento ambiental o monitoramento da saúde nos territórios submetidos às situações de riscos relacionados à cadeia produtiva do petróleo. Destaca-se que o método contribui para explicitar ausências de cuidados para a saúde coletiva no EIA para reafirmar os princípios do Sistema Único de Saúde. La interrelación entre salud y medio ambiente está en el centro del proceso de licenciamiento ambiental. El desarrollo económico genera impactos sobre la salud humana, como los de la industria del petróleo, conocida por la contaminación, las enfermedades, los accidentes químicos por derrames, con implicaciones para la salud colectiva. Este artículo presenta los resultados de una investigación que analizó la incorporación de la salud humana en un Estudio de Impacto Ambiental de perforación de pozos en el noreste de Brasil. A partir de un método que aplicó una matriz de indicadores de salud y medio ambiente, con categorización, sistematización y crítica, se verificó la ausencia de indicadores básicos para la protección, prevención y mitigación de daños a la salud. Se concluye que existe una urgencia de incluir en el licenciamiento ambiental el monitoreo de la salud en los territorios sometidos a situaciones de riesgo relacionadas con la cadena productiva del petróleo. Se destaca que el método contribuye a la explicitación de las ausencias de cuidados para la salud colectiva en el EIA, reafirmando así los principios del Sistema Único de Salud.
46. The most 'valuable' letter in research: is 'P' over-rated or under-rated?
期刊: Reproductive biomedicine online 发表日期: 2026-Feb-18 链接: PubMed
摘要
Among the many symbols that appear in the medical literature, few have received as much attention as the letter ‘P’. It is printed in almost every table, discussed in every result section and often treated as the final word in the interpretation of scientific findings. In reality, the P-value is neither over-rated nor under-rated. It is simply misunderstood. It is an important tool, but it is not the main factor that determines the value of a study. What matters is not the number itself, but how we think about it and what it truly represents. This manuscript revisits the ‘value’ of the P-value in reproductive medicine.
47. Epidemiological study of the injuries associated with the use of electric scooters in Malaga.
期刊: Revista espanola de cirugia ortopedica y traumatologia 发表日期: 2026-Jan-16 链接: PubMed
摘要
To describe the epidemiology of injuries resulting from accidents related to the use of electric scooters in Malaga and to analyse their economic and occupational impact. Retrospective and descriptive study of accidents attended in the emergency department of the Hospital Regional Universitario de Malaga between January 2018 and December 2023. A total of 640 patients were included. The number of cases showed an upward trend, with a higher incidence especially during the summer (45.16%). Of these, 53.28% were men and 46.72% were women. The average age was 29.41 years. The most frequent injuries were contusions (72.34%), of a minor nature (77.97%) and treated with analgesia (73.75%). The predominant mechanism was the driver’s fall, mostly associated with low helmet use. One fatality was recorded. The total estimated cost of the injuries was €974,670.32 between 2018 and 2023, reaching €460,760.29 in the last year. This figure includes both healthcare costs from the Andalusian Health Service and work incapacities covered by Social Security. The use of electric scooters has increased substantially, becoming a common mobility alternative. Nevertheless, it is not without risks, as evidenced by the rising number of accidents in recent years, which have notable implications on both associated morbidity and the resulting economic costs.
48. Understanding exacerbation risk in BLVR: A logistic regression approach to complication prediction.
期刊: Chronic respiratory disease 发表日期: 2026 链接: PubMed
摘要
BackgroundChronic obstructive pulmonary disease (COPD) with emphysema is associated with persistent airflow limitation and frequent exacerbations. Bronchoscopic lung volume reduction (BLVR) with endobronchial valves (EBVs) improves lung function and quality of life but carries a risk of postprocedural complications, including acute exacerbations and pneumonia. Predictors of these adverse events remain incompletely defined.PurposeTo identify clinical and inflammatory factors associated with postprocedural exacerbations in patients undergoing BLVR with EBVs, aiming to support individualized risk stratification.Patients and MethodsWe retrospectively analyzed 320 patients with advanced emphysema treated with EBVs between 2015 and 2022. Patients underwent comprehensive preprocedural evaluation, including pulmonary function testing, imaging, perfusion scintigraphy, 6-minute walk test and COPD Assessment Test. Postprocedural exacerbations within 8 weeks were documented clinically and radiographically. Binary logistic regression, including multivariable modeling, was used to identify independent predictors.ResultsThirty-five patients (10.9%) developed post-BLVR exacerbations, six of whom had pneumonia. Exacerbation risk was independently associated with diabetes mellitus type II (OR 11.0, p < 0.001), elevated C-reactive protein >1 mg/dL (OR 9.35, p < 0.001), WBC >11 cells/nL (OR 5.46, p = 0.002), prior exacerbation frequency (OR 2.94, p < 0.001) and low BMI (OR 0.78, p < 0.001). Residual volume showed a trend toward significance (p = 0.058). The final model demonstrated excellent discriminative ability (AUC = 0.923). While lung function improvement was attenuated in the exacerbation group, quality of life gains were comparable.ConclusionElevated inflammatory markers, diabetes, frequent prior exacerbations and low BMI were independently associated with early postprocedural exacerbations following BLVR with EBVs. Comprehensive preprocedural assessment and targeted management of these risk factors may enhance patient safety and improve outcomes.
49. Evaluating the quality and reliability of endometrial cancer related videos on Chinese short-video platforms: A cross-sectional study.
期刊: Health informatics journal 发表日期: 2026 链接: PubMed
摘要
ObjectiveTo conduct a multidimensional evaluation of endometrial cancer (EC)-related videos on major Chinese short-video platforms.MethodsA cross-sectional study conducted on May 8, 2025 analyzed 226 eligible EC-related videos from TikTok, Rednote, and Bilibili. Video quality was assessed using Global Quality Scale (GQS) and Video Information and Quality Index (VIQI), reliability using modified DISCERN (mDISCERN), and understandability and actionability using Patient Education Materials Assessment Tool (PEMAT).ResultsAmong 226 videos, TikTok emphasized symptoms/risk factors and scored highest in engagement, reliability (mDISCERN=2.0, P=0.002), and understandability (88%). Bilibili led in VIQI (median=17.0) but had the lowest understandability (67%). Professional videos outperformed patient-generated content (all P<0.05). Video length correlated positively with quality but negatively with engagement and understandability (all P<0.01).ConclusionsEC-related videos vary widely in quality and lack consistent actionability. Strategic content design and platform-level verification are needed to improve reliability and public health impact.
50. Silenced stories: contributions of nurses to the Psychiatric Reform in Rio Grande do Sul.
期刊: Revista gaucha de enfermagem 发表日期: 2026 链接: PubMed
摘要
To highlight the work of the nurses who worked at the São Pedro Psychiatric Hospital between 1960 and 1992. Qualitative study with genealogical inspiration and based on a post-structuralist framework. The data collection took place at the Cultural Memory Service of the São Pedro Psychiatric Hospital, a location dedicated to preserving materials about the institution’s history and included interviews with seven nurses and one male nurse who worked at the institution. Concepts from Michel Foucault were used in the analysis. The São Pedro Psychiatric Hospital was a space of exclusion, where patients were dehumanized and neglected. With the inclusion of nurses, a process of transformation began, and the actions of these professionals were fundamental in driving the Psychiatric Reform, making Rio Grande do Sul a national reference in mental health. This is a silenced history that, when narrated, becomes an act of resistance and a means of valuing the history of nursing.
51. Endorsement of the 32-item Consolidated Criteria for Reporting Qualitative (COREQ) and Standards for Reporting Qualitative Research (SRQR) by Chinese journals of nursing: A survey of editors and review of journal instructions for authors.
期刊: PloS one 发表日期: 2026 链接: PubMed
摘要
To investigate the endorsement of the 32-item Consolidated Criteria for Reporting Qualitative (COREQ) and Standards for Reporting Qualitative Research (SRQR) in the instructions for authors (IFA) of Chinese nursing journals. The awareness of Chinese editors of the COREQ and SRQR, together with their application and requirements for following the standards, were also investigated. These findings would assist as the endorsement, application, and promotion of the COREQ and SRQR in Chinese nursing journals, and improve the reporting quality of qualitative research in nursing. Nursing journals were identified from the National Press and Publication Administration. The IFA and applications of the COREQ and SRQR were assessed. The editors of the journals were asked about their awareness of and demand for the COREQ checklist and SRQR standards, as well as their implementation at different stages of the publication process, including manuscript submission, editing, and peer review. A total of 29 nursing journals were included, and only 2 journals (6.9%, 2/29) mentioned the COREQ and SRQR in their IFA. Among the 24 surveyed editors, only 45.83% (11/24) and 33.33% (8/24) were aware of the COREQ and SRQR, respectively. None of the surveyed editors required authors to follow the COREQ/SRQR at the submission stage, editors to follow COREQ/SRQR in the journal editing and processing stage, and reviewers to use the COREQ/SRQR in the expert review stage. Nursing journals in China endorsing the COREQ and SRQR constitute a small percentage of the total. In addition, both awareness and application of the COREQ and SRQR were poor among nursing journal editors. Therefore, we strongly recommend that the China Periodicals Association undertake measures to encourage and support the endorsement of biomedical research reporting guidelines in nursing journals. Also, the education and training of journal editors, researchers, and medical students on biomedical research reporting guidelines should be strengthened.
52. Silicone toothbrushes: A scoping review of an underutilized tool in global oral health.
期刊: PLOS global public health 发表日期: 2026 链接: PubMed
摘要
Oral diseases are the most prevalent non-communicable diseases worldwide, affecting 3.5 billion people, with a disproportionate impact on those living in low- and middle-income countries. Despite being largely preventable through proper oral hygiene, current oral health promotion strategies rely heavily on plastic and nylon toothbrushes, which present both environmental and accessibility challenges. In response to the growing need for sustainable and affordable preventive oral health solutions, there has been increasing interest in alternatives to conventional toothbrushes. This scoping review aimed to summarize the global literature on silicone toothbrushes, an underutilized tool in preventive oral care. A systematic search of five databases, supplemented by reference screening, identified ten English-language studies investigating silicone toothbrushes. Findings suggest that silicone toothbrushes are effective in plaque removal, have a lower risk of gingival trauma, are well-suited for specific populations, and perform better in environmental impact assessments. This review also demonstrated that silicone toothbrushes remain under-researched and underutilized, highlighting the need for further high-quality studies to evaluate their effectiveness, safety, and broader implementation.
53. Addition of Lippia sidoides Essential Oil to Tilapia Diet: Performance Analysis, Blood Parameters, and Challenges of Air Exposure and Experimental Infection.
期刊: Anais da Academia Brasileira de Ciencias 发表日期: 2026 链接: PubMed
摘要
This study evaluated the effects of Lippia sidoides essential oil (LSEO) as a growth and health promoter for juvenile tilapia subjected to stress induced by air exposure and experimental infection with Aeromonas hydrophila. Juvenile were allocated to 15 tanks (in triplicate) and fed diets containing 0.0% (Control), 0.05%, 0.1%, 0.2%, or 0.4% LSEO for 33 days. For the air exposure challenge, five fish from each tank were exposed to air for five minutes after the feeding period. Blood samples were collected for hematological analysis. For the infection challenge, six fish from each tank were intraperitoneally inoculated with 100 µL of A. hydrophila and monitored for ten days. Hematological and histomorphometric parameters were assessed. The results indicated that the 0.4% LSEO supplementation reduced feed conversion ratios (P < 0.05). Before the challenges, LSEO concentrations influenced total counts of neutrophils, basophils, and monocytes (P < 0.05). After the air exposure and infection challenges, no significant differences were observed among treatments for these parameters (P > 0.05). Regarding hematimetric indices, all parameters were affected by LSEO concentrations prior to the challenges (P < 0.05). Although LSEO supplementation improved feed conversion, it did not mitigate the hematological alterations caused by the stress challenges.
54. Protective effect of latex proteins from Plumeria pudica against acetaminophen-induced acute liver injury.
期刊: Anais da Academia Brasileira de Ciencias 发表日期: 2026 链接: PubMed
摘要
The protein fraction from Plumeria pudica latex (LPPp) was evaluated against APAP-induced liver injury in mice. Key measurements included total leukocyte count, liver weight, AST, ALT, liver levels of MDA, GSH, SOD, MPO, NO3/NO2 concentration, cytokines TNF-α, IL-β, IL-6, IL-10, IFN- γ, and CXCL1. Histopathological and immunohistochemical analysis were conducted, and proteins in LPPp were identified by mass spectrometry. Molecular docking analyses were performed with LPPp proteins and APAP, NAPQI, TNF-α, and IFN-α. LPPp reduced liver weight, ALT, and AST levels, and prevented the decrease in total leukocyte count, indicating protection against liver injury. It also reduced MDA levels and preserved GSH and SOD levels, showing its antioxidant properties. LPPp significantly inhibited MPO and NO3/NO2 levels, reducing inflammation. LPPp decreased levels of TNF-α, IL-β, IL-6, IFN-γ, and CXCL1, while IL-10 levels remained elevated, suggesting an anti-inflammatory response. Histological analysis showed preserved liver tissue, and anti-Ly6C immunostaining indicated reduced neutrophil accumulation. Molecular docking revealed that latex cysteine proteases had a higher affinity for APAP and NAPQI, while a proteinase inhibitor showed affinity for CYP2EI, TNF-α, and IFN-α. These findings suggest that LPPp protects against APAP hepatotoxicity by interfering with APAP and NAPQI metabolism, reducing oxidative stress and inflammation, thus preventing hepatocyte damage.
55. Phlebotomine sand flies (Diptera: Psychodidae, Phlebotominae) fauna in Unaí, State of Minas Gerais, Brazil.
期刊: Revista da Sociedade Brasileira de Medicina Tropical 发表日期: 2026 链接: PubMed
摘要
Leishmaniasis, a neglected disease caused by Leishmania protozoa, is transmitted by phlebotomine sand flies and has a significant public health impact. The municipality of Unaí, Minas Gerais, reports human and canine cases of leishmaniasis; however, entomological data remain limited. This study aimed to describe the local phlebotomine sand fly fauna and environmental and climatic factors influencing its occurrence. Sampling was conducted monthly from January to December 2024 in ten households distributed across seven neighborhoods of Unaí. HP light traps were installed in both intradomestic and peridomestic regions. The captured specimens were morphologically identified and statistically analyzed to assess their association with environmental and climatic variables using mixed-effects linear models. Overall, 504 phlebotomine sand flies, representing 11 species, were captured. Lutzomyia longipalpis (39.7%) was the most abundant species, followed by Ev. lenti (33.3%) and Ny. intermedia (15.3%). The peridomestic areas exhibited greater species diversity and abundance, particularly in the presence of chicken coops, organic matter, and vegetation. Temperature is positively associated with Lu. longipalpis and Ev. lenti, whereas precipitation negatively affected Ny. intermedia. Males comprised 69.8% of captured specimens, suggesting the presence of active breeding sites near the households. This study provides the first record of the phlebotomine sand fly fauna in Unaí. Environmental conditions favor vector species in settings with close human-animal interactions, increasing the risk of domiciliary transmission. These findings highlight the importance of sustained entomological surveillance and environmental management measures as complementary strategies to control leishmaniasis.
56. Ethnobotanical knowledge and utilization of Goniothalamus macrophyllus among local communities in the lowland forests of Kuningan, West Java.
期刊: Brazilian journal of biology = Revista brasleira de biologia 发表日期: 2026 链接: PubMed
摘要
Goniothalamus macrophyllus is a tropical forest species known for its bioactive compounds, particularly anticancer activity. Despite this, information regarding its traditional uses and community conservation perspectives remains scarce. This study explores the ethnobotanical knowledge of local communities related to G. macrophyllus, emphasizing traditional knowledge, utilization, and conservation views. Semi-structured interviews were conducted with residents living near lowland forests, and data were analyzed descriptively. Results reveal that only a limited number of respondents recognized G. macrophyllus, with knowledge transmitted orally and through practical experience. The species was reported to occur in forests, yet most respondents were unaware of its population status or regeneration capacity. Traditional utilization was minimal, with the most notable practice being the use of stems as snake repellents-newly recorded ethnobotanical knowledge, as the plant has previously been documented mainly for its anticancer properties. From a conservation perspective, respondents acknowledged the cultural, medicinal, and economic importance of the species. However, awareness of potential population decline due to overexploitation was lacking. This study underscores the gap between local knowledge and scientific understanding, highlighting the urgent need for documentation, education, and community-based conservation strategies to ensure the sustainable use of G. macrophyllus.
57. The impact of muscle energy technique and aromatherapy on pain, disability, and sleep quality in office workers with nonspecific neck pain: randomized controlled study.
期刊: Revista da Associacao Medica Brasileira (1992) 发表日期: 2026 链接: PubMed
摘要
The aim of this study was to look at the effects of muscular energy technique method and aromatherapy on pain levels and neck disability in office workers with nonspecific neck pain. This study involved 45 women diagnosed with nonspecific neck pain. Participants were randomized into three groups: aromatherapy (n=15), muscle energy technique (n=15), and control (n=15). Outcome measures included Visual Analog Scale for pain, Neck Disability Index, and Pittsburgh Sleep Quality Index. All measurements were conducted before and after the study. Neck pain, disability, and sleep quality improved in both the aromatherapy and muscle energy technique groups (p<0.001), with no significant between-group difference. In addition, both aromatherapy and muscle energy technique were significantly better at improving neck pain and sleep quality, and reducing neck disability when compared to the control group (p<0.017). This study provides evidence that both aromatherapy and muscle energy technique are safe and practical treatments, which are efficacious in the reduction of pain, disability, and sleep quality in nonspecific neck pain.
58. Precarious work and Covid-19: repercussions on the health of primary health care workers.
期刊: Revista de saude publica 发表日期: 2026 链接: PubMed
摘要
To analyze how the Covid-19 pandemic influenced the working conditions and health of primary health care professionals in a health district of a capital city in Northeast Brazil. This was a qualitative study using the theoretical framework of the health work process, part of the formative research of the project “Expansion of testing, quarantine, e-health and telemonitoring strategies in the fight against Covid-19 in Brazil” (TQT Project). Data were collected between December 2021 and March 2022 in a health district of a capital city in Northeast Brazil to support the implementation of the aforementioned project. Twenty-two interviews and three focus groups with 19 participants, all health care professionals from the health district under study, were analyzed for their content. The pandemic context caused repercussions on working conditions and health, with the effects of precarious working conditions and the implementation of protective measures being highlighted as key elements in the dimension of working conditions. Mental suffering, the impact of gender issues, and post-Covid-19 conditions were identified as the main elements contributing to the illness of the professionals. The evidence set gathered in this study indicates that various stressors emerge or worsen intensely and inseparably among health care professionals, clearly demonstrating the relationship between the pandemic and the health-disease process of these workers. Therefore, it is imperative to reverse the situation of illness among workers in the post-pandemic period to mitigate its effects in the medium and long term.