公共卫生研究摘要 (2026-04-24)

2026年04月24日

公共卫生研究摘要 (2026-04-24)

共收录 57 篇研究文章

1. [THE HEALTH PROTECTION OF FEMALE SAILORS IN ISSUES OF GENDER CONDITIONED VIOLENCE. PART I. THE MAGNITUDE OF THE PROBLEM AND FACTORS OF VULNERABILITY].

期刊: Problemy sotsial’noi gigieny, zdravookhraneniia i istorii meditsiny 发表日期: 2026-Dec-15 链接: PubMed

摘要

The article considers the characteristics of manifestation of gender conditioned violence in the maritime industry, taking into account the specific of workplace of ships: isolation of the crew, prolonged cohabitation in a limited space, hierarchy, deficiency of privacy and limited access to channels of complaints and support. The typology of forms of violence that is applied to female sailors is described. The results of sociological survey carried out among female sailors (n=62) is presented. It established high prevalence of sexist jokes, significant rates of unwanted physical contacts and social isolation and low level of reporting to official authorities. The analysis demonstrate that “soft” forms of aggression contribute to lowering of the threshold of permissibility and to increasing of risk of escalation of more “hard” manifestations. The consequences include psychological traumas, decreased team unity and threats to operational security. On the basis of comparison of empirical data and normative legal base, the conclusion is made that there are gaps in institutional mechanisms of protection and that such comprehensive measures are needed as the implementation of accessible and confidential complaint procedures, training and prevention programs, expansion of medical and psychological support, increased representation of women at leadership positions and enhancement of accountability for violations. В статье исследуются особенности проявлений гендерно-обусловленного насилия в морской отрасли с учетом специфики рабочей среды судна: замкнутости экипажа, длительного совместного пребывания в ограниченном пространстве, иерархичности, дефицита приватности и ограниченного доступа к каналам жалоб и поддержке. Описана типология форм насилия, применимая к женщинам-морякам. Основываясь на эмпирических данных, представлены результаты социологического опроса, проведенного среди женщин-моряков (n=62), которые показывают высокую распространенность сексистских шуток, значительный уровень нежелательных физических контактов и социальной изоляции, а также низкий уровень информированности официальных властей. Анализ показывает, что «мягкие» формы агрессии способствуют снижению порога допустимости и повышают риск эскалации более тяжелых проявлений. Последствия включают психотравмы, снижение командной сплоченности и угрозы операционной безопасности. На основе сопоставления эмпирических данных и нормативной правовой базы сделаны выводы о пробелах в институциональных механизмах защиты и необходимости комплексных мер: внедрения доступных и конфиденциальных процедур жалоб, обучения и превентивных программ, расширения медицинской и психологической поддержки, повышения представительства женщин в руководстве и усиления ответственности за нарушения.

2. [The Design of Systems of Efficient Usage of Labor Potential of Workers in the Field of Health Care].

期刊: Problemy sotsial’noi gigieny, zdravookhraneniia i istorii meditsiny 发表日期: 2026-Dec-15 链接: PubMed

摘要

The development of Russia rests in implementation of the National goals, one of which is “preservation of population, promotion of health and increase of peoples well-being”. The modern development of health care is directly related to modernization and expansion of sphere of provision of medical services to population, including socially significant services. For that, qualified workers are needed as well the improvement of indicators of efficient usage of labor potential of workers in conditions of digital economics. This is the reason to design on qualitatively innovative level new systems of efficient usage of labor potential of workers in the field of health care, considering technologization of all processes in the sphere of health care. Развитие России опирается на реализацию Национальных целей, одной из которых является «сохранение населения, укрепление здоровья и повышение благополучия людей». Современное развитие сферы здравоохранения непосредственно связано с модернизацией и расширением сферы предоставления медицинских услуг населению, в том числе социально значимых услуг. Для этого нужны квалифицированные работники, а также необходимо улучшение показателей эффективного использования трудового потенциала работников в условиях цифровой экономики. По этой причине на качественно инновационном уровне следует проектировать новые системы эффективности использования трудового потенциала работников с учетом технологизации всех процессов в сфере здравоохранения.

3. [THE SOCIAL POLICY OF ST. PETERSBURG IN THE FIELD OF HEALTH CARE].

期刊: Problemy sotsial’noi gigieny, zdravookhraneniia i istorii meditsiny 发表日期: 2026-Dec-15 链接: PubMed

摘要

The article presents results of systematic consideration of characteristics of implementation of St. Petersburg social policy in the field of health care as an important institution of economic policy. The key direction of development of St. Petersburg are sectors oriented on human needs, including health care, which requires large-scale investments in human resources. The comprehensive analysis of publications of Russian and foreign scientists was implemented. The methodological framework is represented by systemic and situational approach. The methods of structural and functional research, of scientific abstraction, of induction and deduction, of economical statistical information gathering were applied. The results of overview of studies in the field of social policy and health care permitted to establish characteristics of social policy of St. Petersburg policy in the field of health care and to determine its prospective directions. Thus, for Russian society one of the key tasks is promotion of positive agenda of development of the individual, the society and the state, based primarily on human potential. St. Petersburg acquires image of a region of social well-being. So, the task to preserve and to enhance it is on the agenda. One of the most important functions of the state is to provide public services (goods), first of all qualitative and accessible health care. Статья посвящена системному рассмотрению особенностей реализации социальной политики Санкт-Петербурга в области здравоохранения как важного института экономической политики. Ключевым направлением развития Санкт-Петербурга являются отрасли, ориентированные на нужды человека, в том числе здравоохранение, требующее масштабных инвестиций в человека. Проведен комплексный анализ работ российских и зарубежных ученых. Методологический аппарат представлен системным и ситуационным подходом, применены структурный и функциональный методы исследования, метод научной абстракции, методы индукции и дедукции и экономико-статистические методы сбора информации. Приведен обзор исследований в области социальной политики и здравоохранения, на основании чего выявлены особенности социальной политики Санкт-Петербурга в области здравоохранения и определены ее перспективные направления. Так, для российского общества одной из ключевых задач является продвижение позитивной повестки развития личности, общества и государства с опорой прежде всего на человеческий потенциал. Санкт-Петербург приобретает имидж региона социального благополучия, а на повестку дня встает задача его сохранения и усиления. Одной из важнейших функций государства является предоставление общественных услуг (благ), в первую очередь качественного и доступного здравоохранения.

4. [THE PUBLICATION OF "THE SHORT REPORT ON SANITARY ORGANIZATIONS OVER GUBERNIAS OF THE FAR EAST AND THE PROJECT OF ESTABLISHMENT OF NEW ORGANIZATIONS IN CURRENT [1924] YEAR" WITH SCIENTIFIC COMMENTARIES].

期刊: Problemy sotsial’noi gigieny, zdravookhraneniia i istorii meditsiny 发表日期: 2026-Dec-15 链接: PubMed

摘要

The article presents the publication of the archival document which is stored in the funds of the State Archive of the Khabarovsk Krai, and is accompanied by scientific commentaries. In the text of the document from 1924 the question is about difficult legacy inherited by the Soviet medicine. The heads of the Department of the Health Care of the Far Eastern Revolutionary Committee, responsible for social engineering and implementation of the principles of the new medicine, wrote about inherited from their predecessors devastation and desolation and reported about immediate tasks of their work. Статья представляет собой публикацию архивного документа, который хранится в фондах Государственного архива Хабаровского края, с научными комментариями. В тексте документа 1924 г. речь идет о тяжелом наследстве, полученным советской медициной. Руководители отдела здравоохранения Дальневосточного революционного комитета, ответственные за социальный инжиниринг и внедрение принципов новой медицины, писали об унаследованных от предшественников разрухе и запустении, сообщали о первоочередных задачах своей деятельности.

5. [THE PROFESSIONAL OCCUPATIONAL HYGIENE: ASSESSMENT OF GENDER SEGREGATION].

期刊: Problemy sotsial’noi gigieny, zdravookhraneniia i istorii meditsiny 发表日期: 2026-Dec-15 链接: PubMed

摘要

The article considers aspects of professional occupational hygiene from the point of view of gender segregation on labor market. It is demonstrated, on the basis of analysis of statistical data, that males and females are unevenly distributed by industries and types of harmful production factors. The males predominate in conditions related to physical load, noise, vibration, chemical and ionizing effects. The females more often are exposed to biological factors and work in conditions of high neuro-psychic stress. These revealed differences are conditioned by both social stereotypes and sectoral structure of employment. The necessity to consider gender-specific factors under development of standards of occupational safety, design of personal protective equipment and organization of medical supervision are emphasized. The results of the study can be applied in formation of gender policy in the field of occupational safety and improvement of conditions of professional environment for all workers. Рассмотрены аспекты профессиональной гигиены труда с точки зрения гендерной сегрегации на рынке труда. На основе анализа статистических данных показано, что мужчины и женщины неравномерно распределены по отраслям и видам вредных производственных факторов. Мужчины преобладают в условиях, связанных с физическими нагрузками, шумом, вибрацией, химическими и ионизирующими воздействиями, тогда как женщины чаще подвергаются биологическим факторам и работают в условиях высокой нервно-психической напряженности. Выявленные различия обусловлены как социальными стереотипами, так и отраслевой структурой занятости. Подчеркнута необходимость учета гендерной специфики при разработке нормативов охраны труда, проектировании средств индивидуальной защиты и организации медицинского наблюдения. Результаты исследования могут быть использованы для формирования гендерной политики в области охраны труда и улучшения условий профессиональной среды для всех работников.

6. Lung microbiota dysbiosis mediates PM2.5-induced pulmonary inflammation through antibiotic-reversible mechanisms.

期刊: Journal of immunotoxicology 发表日期: 2026-Dec 链接: PubMed

摘要

Fine particulate matter (PM2.5) exposure contributes to over 4 million premature deaths annually, yet the mechanistic role of lung microbiota in PM2.5-induced pulmonary inflammation remains poorly understood. In collaboration of 16S rRNA and single-cell RNA multi-omics analysis and in vivo/in vitro experimental validation with antibiotic intervention strategies, the study here examined PM2.5-microbiota interactions in murine PM2.5 exposure models and cellular systems. It was found that PM2.5 exposure induced lung microbiota dysbiosis characterized by Gram-negative bacterial expansion, particularly Proteobacteria dominance, accompanied by reduced microbial diversity. scRNA analysis revealed coordinated activation of TLR4/MyD88/NLRP3 inflammatory signaling pathways and p53/p21/p16-mediated cell cycle arrest. Moreover, PM2.5 exposure activated NLRP3 inflammosome-dependent macrophage pyroptosis as evidenced by increased interleukin (IL)-1β, IL-18, caspase-1, and GSDMD expression. In vitro studies demonstrated that the inflammatory changes induced by PM2.5 exposure were statistically indistinguishable from those of LPS-positive controls, confirming endotoxin-like mechanisms. Critically, antibiotic pretreatment effectively attenuated PM2.5-induced inflammatory responses, cell cycle arrest, and tissue pathology, which established causality between microbiota disruption and pulmonary dysfunction. In conclusion, this study revealed lung microbiota dysbiosis as a critical mediator of PM2.5-induced pulmonary inflammation through Gram-negative bacterial expansion and subsequent endotoxin-like activation of inflammatory cascades, thereby providing novel mechanistic insights and potential microbiome-targeted therapeutic strategies for air pollution-associated respiratory diseases.

7. Comparative risk of psychiatric comorbidities associated with codeine and tramadol in patients with hip osteoarthritis: a nationwide population-based cohort study.

期刊: Journal of global health 发表日期: 2026-Apr-24 链接: PubMed

摘要

Weak opioids are often prescribed for osteoarthritis (OA), yet their comparative psychiatric risks are not well established. We aimed to comprehensively compare the composite psychiatric risks associated with codeine and tramadol in patients diagnosed with hip OA. We conducted a nationwide, population-based retrospective cohort study, using Korean Health Insurance Review and Assessment Service database on patients diagnosed with hip OA between 2014 and 2017. We included patients who received either opioid, with a total of 22 651 patients (of whom 4533 codeine and 18 118 tramadol users) after 1:4 propensity score matching (PSM). We applied Cox proportional hazards models to estimate adjusted hazard ratios (aHR) and 95% confidence intervals (CIs) for incident psychiatric outcomes. Codeine use was associated with a significantly lower hazard of composite psychiatric disorders (aHR = 0.86; 95% CI = 0.78-0.96), particularly anxiety (aHR = 0.81; 95% CI = 0.69-0.95), and showed a borderline reduction in sleep disorders (aHR = 0.81; 95% CI = 0.65-1.00, P = 0.048) after adjustment for age, sex, comorbidities, and concomitant medications. Subgroup analyses revealed consistently lower psychiatric risk among patients with a high comorbidity burden (Charlson’s comorbidity index ≥3), cardiovascular disease, or those without concomitant psychotropic medications. Sensitivity analyses using inverse probability treatment weighting and 1:1 PSM demonstrated broadly similar patterns, although statistical significance varied across models. No clear duration-response relationship was observed. Codeine was associated with lower hazards of anxiety and sleep disorders in several analyses. These findings suggest that strengthening opioid stewardship through structured psychiatric risk assessment and individualised prescribing may enhance patient safety. Further controlled studies incorporating detailed clinical data are warranted to validate these associations and to better define their implications for long-term opioid management and policy development.

8. Enhancing health professional clinical performance through supervision strategies: from 5311 facilities across eight countries in sick child healthcare.

期刊: Journal of global health 发表日期: 2026-Apr-24 链接: PubMed

摘要

Supervision remains a widely implemented strategy to improve clinical quality, but its independent impact and the means to enhance its effectiveness remain uncertain. We investigated the effectiveness of supervision alone and, in combination with feedback or training, on clinical quality in child healthcare, and explored the relationship between supervision alone and performance across different organisational contexts. Data were sourced from the Service Provision Assessment survey, covering 5311 health facilities, 6722 health providers, and 20 880 sick children across eight low- and middle-income countries (LMICs). We assessed health worker performance using 20 clinical quality indicators. We examined various supervision modalities, including supervision alone, supervision with feedback, and supervision with training. We considered organisational factors, such as quality assurance activities and data collection systems and applied multilevel regression models, adjusting for relevant covariates. Supervision alone was not significantly related to clinical performance (coefficient = 0.101; 95% confidence interval (CI) = -0.00, 0.20). However, supervision combined with feedback (Coefficient = 0.171; 95% CI = 0.07, 0.27) or training (coefficient = 0.514; 95% CI = 0.41, 0.62) were both significantly associated with better performance. Organisational support, particularly through quality assurance activities (coefficient = 0.290; 95% CI = 0.14, 0.44) or data collection systems (coefficient = 0.130; 95% CI = 0.02, 0.24), transformed otherwise ineffective supervision into effective ones. The positive impact was stronger when both quality assurance and data collection systems were present (coefficient = 0.319; 95% CI = 0.17, 0.47). Supervision alone is inadequate in relation to better clinical quality in sick child healthcare services. A combination of supervision strategies, including feedback and training, along with institutional support, is likely to be associated with better health worker performance, particularly in LMICs. These findings highlight the need for integrated approaches to supervision, emphasising the role of institutional support in driving quality improvements in child health services.

9. Time in target range for body mass index and risk of new onset multimorbidity in middle-aged and older adults: a landmark analysis of two prospective cohorts.

期刊: Journal of global health 发表日期: 2026-Apr-24 链接: PubMed

摘要

Static body mass index (BMI) measurements overlook longitudinal weight dynamics. We examined the association between time in target range for BMI (TTR-BMI), which integrates stability and target attainment, and incident multimorbidity. We performed a landmark analysis using the English Longitudinal Study of Ageing and China Health and Retirement Longitudinal Study. We included participants aged ≥45 years free of multimorbidity. We calculated TTR-BMI via linear interpolation based on the trapezoidal rule to quantify continuous exposure to a target weight range. We used stratified Cox proportional hazards models to estimate hazard ratios (HRs) for incident multimorbidity. To address proportional hazards violations, we employed time-dependent coefficient analysis to examine temporal heterogeneity (≤3 years vs. >3 years). Lastly, we used negative binomial regression to assess secondary outcomes (disease accumulation). Among 6935 participants, there were 2483 incident cases. Higher TTR-BMI was inversely associated with multimorbidity risk in a dose-response manner. In fully adjusted models, each one standard deviation increase in TTR-BMI reduced risk by 6% (HR = 0.94; 95% confidence interval (CI) = 0.90-0.99). Time-dependent analysis revealed this protection was specific to the late (>3 years) follow-up phase (HR = 0.91; P = 0.003), with no significant effect in the early phase. Furthermore, higher TTR-BMI was associated with a lower rate of disease accumulation (incidence rate ratio = 0.97; 95% CI = 0.95-1.00, P = 0.046). We found that TTR-BMI is an independent predictor of incident multimorbidity. Maintaining a higher TTR-BMI serves as a protective factor against disease onset. Maximising time spent in a healthy weight range offers a precise, longitudinal target for primary prevention in older adults.

10. Rethinking Microbiome of the Built Environment (MoBE) Management: From Pathogen-Centric Control to Microbiome-Informed Engineering.

期刊: Environmental science & technology 发表日期: 2026-Apr-23 链接: PubMed

摘要

11. Classifying Post-COVID "Brain Fog" Patients and Identifying Key ROIs via Graph Neural Network Model.

期刊: IEEE journal of biomedical and health informatics 发表日期: 2026-Apr-23 链接: PubMed

摘要

Brain fog has raised significant public health concerns as a common neurocognitive impairment in the post-COVID-19 condition, involving memory loss, poor concentration, and language difficulties. However, their neural mechanisms remain unclear, and objective resting-state fMRI-based diagnostic tools are still lacking. To address these challenges, we first recruited 72 patients who experienced persistent brain fog symptoms following COVID-19 infection, along with 68 post-COVID participants without brain fog (PC-noBF), and collected resting-state functional magnetic resonance imaging (rs-fMRI) data from all participants. The interpretable graph neural network model BrainGNN was employed to model and classify individual brain networks, utilizing functional connectivity graphs constructed from the Automated Anatomical Labeling (AAL) atlas. Using out-of-fold predictions from 5-fold cross-validation, BrainGNN achieved an accuracy of 75.71% (Bootstrap 95% CI: 68.57%-82.86%) and an area under the ROC curve (AUC) of 76.07% (Bootstrap 95% CI: 73.93%-88.48%). Furthermore, on an independent test set, BrainGNN outperformed traditional machine learning methods and other GNN models, achieving an accuracy of 82.14% and an AUC of 82.82% (classification threshold: 0.5). Moreover, the model identified several key brain regions-bilateral insula, bilateral Heschl’s gyri, and the left superior temporal gyrus-as potential neurobiological markers. Notably, in post-hoc analyses, the ALFF and ReHo values of the left insula were significantly associated with scores related to language and memory symptoms. These findings collectively underscore the effectiveness and interpretability of the proposed approach in identifying functional markers of brain fog. This study not only demonstrates the potential of individual-level identification of brain fog using resting-state fMRI empowered by interpretable GNN, but also reveals its capacity to provide novel insights into the neurobiological mechanisms underlying COVID-19-related cognitive impairment.

12. LLM-Enhanced Knowledge Distillation for Sequence-Based Protein-Ligand Interaction Prediction.

期刊: IEEE journal of biomedical and health informatics 发表日期: 2026-Apr-23 链接: PubMed

摘要

Accurate prediction of protein-ligand interactions is essential for drug discovery, supporting critical stages from lead optimization to therapeutic development. Many existing methods depend on high-resolution protein-ligand complex structures, which limits scalability and reduces robustness in structure-limited settings. To address these challenges, we introduce Multi-Combinatorial Knowledge Distillation (MCKD), a sequence-based framework that predicts protein-ligand interactions without requiring explicit three-dimensional structures at inference time. MCKD represents proteins and ligands as two-dimensional molecular graphs derived from their sequences and physicochemical properties, enabling effective learning from readily available inputs. To incorporate structural knowledge beyond sequence information, MCKD employs a hybrid distillation strategy that combines cross-modal distillation from a structure-based teacher with self-distillation to improve representation consistency across layers. To model protein-ligand interactions explicitly, MCKD integrates a bilinear attention network that captures residue-atom level associations and supports both binding affinity regression and binary interaction classification. Evaluations on multiple public benchmark datasets show that MCKD consistently outperforms existing sequence-based methods and achieves performance comparable to structure-based approaches. The model also generalizes well to unseen proteins and novel ligand scaffolds, while providing interpretable insights into key molecular interaction regions. These results suggest that MCKD offers a scalable and effective solution for protein-ligand interaction prediction, particularly for structure-free and data-limited drug discovery applications.

13. Cybersecurity in eHealth: A Scoping Review of Current Research and Trends.

期刊: IEEE journal of biomedical and health informatics 发表日期: 2026-Apr-23 链接: PubMed

摘要

Healthcare ranks among the most vulnerable sectors to cybersecurity threats, experiencing widespread security incidents and substantial data breach costs. Despite growing global cybersecurity expenditures, health care systems remain distinctively vulnerable. This paper presents a scoping review of research on cybersecurity in eHealth. Following PRISMA-ScR guidelines, we searched and analyzed literature across four major databases: ACM Digital Library, IEEE Xplore, PubMed, and Web of Science. From an initial 3,146 identified papers, 567 met inclusion criteria and underwent detailed analysis. The analysis iden tifies blockchain as the most researched technical solution, with system and communication protection dominating cybersecurity categories. Geographically, research output has shifted significantly toward India and China. However, the study highlights critical gaps in real-world implemen tations, user-centric perspectives, and evaluation studies. This comprehensive review offers insights for researchers, healthcare professionals, and policy makers to develop targeted, evidence-based cybersecurity strategies that protect sensitive health data and ensure the integrity of digital health systems.

14. Clinician Perspectives on Commonly Used Online Sexual and Reproductive Health Resources for Adolescents: Qualitative Analysis.

期刊: JMIR pediatrics and parenting 发表日期: 2026-Apr-23 链接: PubMed

摘要

In this interview study with 24 adolescent-serving clinicians, participants described current online sexual and reproductive health resources they share with adolescents and highlighted areas of improvement to better meet the developmental needs of this age group.

15. Developing consensus on competency-based educational standards in orthopaedic manual physical therapy fellowship training: findings from a modified Delphi part 4: systems-based practice and patient management.

期刊: The Journal of manual & manipulative therapy 发表日期: 2026-Apr-23 链接: PubMed

摘要

Competency-based education (CBE) emphasizes mastery of defined competencies rather than time-based progression. Within orthopedic manual physical therapy (OMPT), the evolving evidence supports person-centered, evidence-informed care, requiring fellowship training standards that reflect this shift. Among the seven proposed domains of competence, Systems-Based Practice (SBP) and Patient Management (PM) are essential. SBP focuses on navigating healthcare systems, interprofessional collaboration, and advocacy, while PM emphasizes delivering comprehensive, value-based care through evidence-informed, person-centered approaches. Consensus on competencies for these domains in OMPT fellowship training remains unclear. To achieve an international consensus on competencies and graduation milestones for OMPT fellowship training in SBP and PM. A modified three-Round Delphi study was conducted. In Round I, nine content experts drafted competencies and milestones. Rounds II and III invited stakeholders from the International Federation of Manual and Musculoskeletal Physical Therapists (IFOMPT) member organizations via web-based surveys. Consensus was defined a priori as ≥ 80% agreement. Descriptive statistics and composite scores were used to assess the strength of agreement. The reporting in this study follows guidelines from the Accurate Consensus Reporting Document (ACCORD). Systems-Based Practice (SBP): Five competencies and 19 milestoneswere proposed; four competencies achieved consensus (health screening, healtheducation, healthcare system navigation, health policy and advocacy). PatientManagement (PM): Six competencies and 17 milestones achieved consensus,with the strongest support for evidence-informed treatment implementation,person-centered care, cultural and social sensitivity, and outcomeoptimization. Lesser support was observed for applying the human movementsystem framework. Findingsunderscore the importance of competencies that promote leadership, advocacy,and evidence-informed, person-centered care in OMPT fellowship training. Gapsin consensus regarding quality improvement and the application of movementsystems highlight areas for future study or development. These resultscontribute to a global framework for advanced OMPT fellowship-level education.

16. Screening for Cervical Cancer: A Recommendation From the Women's Preventive Services Initiative.

期刊: Obstetrics and gynecology 发表日期: 2026-Apr-23 链接: PubMed

摘要

The Women’s Preventive Services Initiative (WPSI) expanded its previous cervical cancer screening recommendation for average-risk women by including patient-collected high-risk human papillomavirus (hrHPV) screening tests and additional follow-up testing needed to complete the screening process. To update the previous recommendation, the WPSI identified new evidence demonstrating that primary hrHPV screening increases detection of precancerous lesions compared with cytology screening. New studies indicate that patient-collected hrHPV testing has similar test accuracy for precancer detection compared with clinician-collected samples and may reduce barriers to screening. Consistent with the previous recommendation, the WPSI recommends cervical cancer screening for average-risk women aged 21-65 years. For women aged 21-29 years, screening using cervical cytology (Pap test) every 3 years is recommended; co-testing with cytology and hrHPV testing is not recommended for those younger than 30 years. For women aged 30-65 years, primary hrHPV testing (preferred method) or co-testing (cytology with hrHPV) every 5 years is recommended; if hrHPV testing cannot be performed, cytology every 3 years is acceptable. Women at average risk should not be screened more than once every 3 years. Patient-collected hrHPV is an appropriate screening method for average-risk women aged 30-65 years. The new recommendation-including additional testing to follow up on findings on the initial screening-was recently approved by the Health Resources & Services Administration, U.S. Department of Health and Human Services, for coverage without co-pay or deductible charges for most eligible women beginning in 2027.

17. Expected Competencies and Personal Attributes of Digital Health Navigators to Support Digital Mental Health Care: Focus Group and Interview Study With Patients and Health Care Professionals.

期刊: JMIR mental health 发表日期: 2026-Apr-23 链接: PubMed

摘要

Digital mental health apps (DMHAs), and in particular digital therapeutics (DTx), offer promising opportunities to support mental health care. However, their effective use in outpatient settings in Germany remains limited. To overcome this gap, the role of digital health navigators (DHNs) has been introduced. DHNs are trained individuals who support patients and health care professionals in selecting, using, and integrating DMHAs into care. Despite increasing interest in this role, there is limited evidence on the competencies, knowledge, and personal attributes required for DHNs to work effectively in mental health settings. The study aims to explore the expected competencies, knowledge areas, and personal attributes that DHNs need to effectively support the implementation and use of DTx in outpatient mental health care. As part of the prestudy of the Digital Navigators for Acceptance and Competence Development with Mental Health Apps (DigiNavi) study, a qualitative study was conducted involving 35 participants (7 general practitioners, 8 patients in general practice, 11 outpatient psychiatrists/psychologists, and 9 patients in psychiatric outpatient clinics) from different general practices and psychiatric outpatient clinics in Germany. A total of 17 semistructured interviews and 4 focus groups were conducted to explore expectations of DHNs. Data were analyzed using qualitative content analysis. Participants emphasized that DHNs should combine strong interpersonal skills (empathy, patience, and sensitive communication) with technical and basic clinical competencies. Most favored DHNs as integrated clinical team members (eg, medical assistants), citing their existing patient relationships, but noted time and training constraints. Key expectations included the ability to support patients with DTx use, adapt communication to individual needs, and convey data privacy information clearly. Foundational knowledge of mental health conditions and sensitivity to crises were considered important for identifying warning signs and escalating concerns. While DHNs were seen as essential intermediaries between patients, health care professionals, and DTx, participants highlighted the necessity for clearly defined roles, structured training, and realistic expectations to prevent role overload and enable sustainable implementation in outpatient mental health care. DHNs require a specialized skill set that bridges clinical understanding, digital expertise, and interpersonal competence. Our results lay the groundwork for developing training curricula and implementation strategies that align with real-world expectations for the DHN role. Defining these core competencies is essential for supporting the sustainable and effective integration of DMHAs into mental health care.

18. Health Care Providers' Perspectives on Early Warning Systems for Acute Respiratory Infections in Canada: Qualitative Study.

期刊: JMIR public health and surveillance 发表日期: 2026-Apr-23 链接: PubMed

摘要

Acute respiratory infections (ARIs) remain a significant global health challenge and are the second leading cause of disease burden and mortality. Early warning systems (EWS) play a key role in detecting clinical deterioration, alerting health care providers (HCPs), and supporting pandemic surveillance. While existing literature highlights HCPs’ positive experiences with EWS in confirming clinical assessments and guiding escalation, perspectives on how these systems can be optimized for ARI management remain underexplored. As Canada continues to develop and operationalize EWS for outbreak and pandemic preparedness, this study aims to explore the experiences and insights of primary care providers, emergency department (ED) physicians, and researchers regarding the use of EWS for ARI management in Canada. Eleven participants, including primary care providers, ED physicians, and researchers from urban and rural settings across 5 Canadian provinces (Ontario, Newfoundland and Labrador, Quebec, British Columbia, and Manitoba), were recruited in 2024. All participants regularly managed patients with ARIs or played key roles in pandemic response. A codebook thematic analysis was conducted to identify patterns and themes, with subthemes organized under broader thematic categories. Data saturation was assessed during the analysis phase. The study adhered to the COREQ (Consolidated Criteria for Reporting Qualitative Research) guidelines. Among the 11 participants, there was approximately equal representation across gender and age groups, and more than 90% had over ten years of experience in ARI management. Three overarching themes emerged. First, participants demonstrated general awareness of the use of EWS in ARI management, including outbreak detection, screening and triage support, and informing clinical decision-making. Technologies and surveillance tools used during the COVID-19 pandemic were frequently referenced; however, understanding of specific EWS and their application to ARI management was often limited. Second, participants identified key attributes of an effective EWS as accuracy, timeliness, integration, and equity, emphasizing the need for seamless integration into existing Canadian health care workflows without increasing administrative burden. Third, anticipated challenges were described across 4 stages of EWS development, including initiation (funding and privacy concerns), implementation (outdated data systems and limited legislation), use (staff shortages and capacity constraints), and evaluation (lack of standardized and innovative evaluation approaches). This study engaged 11 experienced HCPs and researchers who were directly involved in patient care and public health response to ARI outbreaks and qualitatively explored their perspectives on EWS for ARI management and pandemic preparedness. The findings identified 3 overarching themes regarding the general knowledge, desired attributes, and anticipated challenges of EWS in ARI management, highlighting the importance of co-designing EWS with clinicians, researchers, and other key stakeholders to improve their effectiveness and integration into clinical practice and pandemic preparedness across Canada.

19. The Association Between Family Health and Proactive Health Risk Management With the Mediating Role of Health Literacy: Nationwide Cross-Sectional Study.

期刊: JMIR public health and surveillance 发表日期: 2026-Apr-23 链接: PubMed

摘要

Modifiable unhealthy behaviors account for over two-thirds of new cases of noncommunicable diseases. Behavioral risk factor reduction is a potentially cost-effective means to improve long-term health outcomes. Although family serves as a pivotal cornerstone for fostering and maintaining individuals’ health, the associations between family health (FH) and the proactive health risk management index (PHRMI) remain unclear. This study aimed to construct a comprehensive index to measure the PHRMI and examine the mediating effect of health literacy on the association between FH and the PHRMI, as well as the moderating effect of family communication on the associations among the PHRMI, health literacy, and FH. A cross-sectional questionnaire survey was conducted with 30,044 participants from 34 provinces or regions in China who were recruited using a multistage stratified sampling strategy from June 20, 2023, to August 31, 2023. This study constructed the PHRMI for the general population by encompassing BMI, physical activity (International Physical Activity Questionnaire-Short Form), depression (Patient Health Questionnaire-9), sleep quality (Brief version of the Pittsburgh Sleep Quality Index), smoking behavior, and drinking behavior. Further, we assessed FH (Short Form of the Family Health Scale), health literacy (Short-Form Health Literacy Questionnaire-4), and family communication (Family Communication Scale-Short Form). In addition, we collected the sociodemographic characteristics of the participants. We used model 4 of the IBM SPSS macro PROCESS to verify the mediating effect of health literacy between FH and the PHRMI, while model 7 was adopted to test the moderated mediation of family communication among the PHRMI, health literacy, and FH. Higher levels of FH were significantly associated with higher PHRMI levels (β=.710, 95% CI 0.669-0.752). Health literacy significantly mediated the association between FH and the PHRMI (β=.207, 95% CI 0.168-0.245), playing a partial mediating role. Family communication significantly moderated the association between FH and health literacy (β=.117, 95% CI 0.105-0.130). The simple slope analysis showed that higher levels of family communication exacerbated the effects of FH on health literacy. Subsequently, we performed a sensitivity analysis, and the main results aligned with the findings of prior studies. Nevertheless, the subgroup analysis revealed that the mediating effect of health literacy was not significant in the group aged >60 years (β=.066, 95% CI -0.024 to 0.157). FH can be an important target that appears to be positively linked to proactive health risk management and health literacy. FH promotion for older adults should pay more attention to family or intergenerational communication.

20. Dyadic relationship between caregiving burden and perceived stress among people with HIV: moderated mediation analysis.

期刊: Psychology, health & medicine 发表日期: 2026-Apr-23 链接: PubMed

摘要

People with HIV (PWH) and their family members (FM) function as an interdependent system, where the experience and resources of one member may shape the psychological outcomes of the other. While existing studies have shown caregiving burden of FM might negatively affect mental health of PWH, few research examined the underlying mechanism of this association at a dyadic perspective. This study aimed to examine the association between FM’s caregiving burden and PWH’s perceived stress, and the potential mediating role of FM’s resilience and moderating effect of FM’s HIV status. Study data were extracted from the baseline survey of an ongoing clinical trial in Guangxi, China. A total of 800 PWH-FM dyads were included in this study. FM’s caregiving burden, resilience, HIV status and PWH’s perceived stress were measured by self-reported instruments. A moderated mediation model was conducted to explore whether FM’s resilience mediated the effect of FM’s caregiving burden on PWH’s perceived stress and whether such mediation effect varied by FM’s HIV status, adjusting for demographic characteristics. The results showed that when FM experienced more caregiving burden, PWH reported higher levels of perceived stress. This relationship was partially explained by FM’s resilience; that is, greater caregiving burden reduced FM’s resilience, which in turn increased the perceived stress of PWH. This pathway differed by FM’s HIV status. Specifically, the indirect effect of FM’s resilience existed only in FM with HIV-positive status, while no significant indirect effect was found among FM without HIV. These findings underscore that FM’s caregiving burden and PWH’s mental health are not isolated variables; interventions should consider PWH and their families as interdependent systems. Effective family-based interventions targeting improving PWH’s mental health might consider placing greater emphasis on reducing the caregiving burden and improving family resilience, especially for HIV-seroconcordant families.

21. Recognizing the Importance of Design, Content, and Delivery Features of Health Animations for Preventive Health Behaviors: Realist Review.

期刊: Journal of medical Internet research 发表日期: 2026-Apr-23 链接: PubMed

摘要

Animated messages designed to promote preventive health behaviors (health animations) are a prevalent form of digital health communication globally and are used across a variety of health behaviors. Health animations are visual and can be less reliant on language, helping to reduce health literacy barriers and inequities. Being easily and inexpensively shared, they are a potentially powerful tool for disease prevention. Evidence suggests that animations can be effective in health and non-health care settings. Despite a plethora of health animations in existence and their potential reach and scale, evidence underpinning their design and application, including the potential causal mechanisms at work, is often limited or unknown. This realist review aimed to understand why, how, for whom, to what extent, and when health animations designed to promote preventive health behaviors work. The review was conducted in accordance with the Realist and Meta-narrative Evidence Syntheses: Evolving Standards (RAMESES). Peer-reviewed publications identified through database searching from inception until April 27, 2025, as well as gray literature, were considered for inclusion. Animations designed to promote preventive health behaviors in any population and evaluations using any design were included. Animations that could not be viewed, were designed to treat illness or disease, or were part of multicomponent interventions were excluded. Data were appraised for their relevance, rigor, and richness. Data syntheses sought to produce context-mechanism-outcome configurations, contributing to a program theory of health animations. International stakeholder workshops with professionals and members of the public were used to sense check findings and refine the program theory. This review synthesized data from evaluations of 48 health animations. Within the data, design, content, and delivery constructs were identified, including audience or challenge representation, using storytelling, evoking emotion, accessibility, and other contexts. These contexts enabled the triggering of key mechanisms, such as identification, transportation into a story, attention, building self-efficacy, and cognitive processes. The evidence available for synthesis in the building of our program theory of health animations was limited by a lack of data on behavioral outcomes, meaning that the theory is largely derived from evidence of the contexts and mechanisms influencing key determinants known to affect behavior. These key determinants include behavioral intentions, skills and attitudes, and knowledge as a key factor in raising awareness of the need to change behavior. This realist review advances the understanding of the impact of health animations designed to promote preventive health behaviors by providing insight into the design, content, and delivery features at work. Our program theory describes the specific contexts and mechanisms that influence evidence-based determinants of behavior and behavior change. These contexts and mechanisms, therefore, should be considered during health animation design and development processes. A set of 10 recommendations is provided to this end.

22. Phenology of the elongate hemlock scale (Hemiptera: Diaspididae) on Fraser fir Christmas trees in western North Carolina.

期刊: Journal of economic entomology 发表日期: 2026-Apr-23 链接: PubMed

摘要

Understanding the seasonal phenology of an insect pest in a specific region on a specific host is fundamental to the timing of management actions. The elongate hemlock scale, Fiorinia externa Ferris (Hemiptera: Diaspididae), is an invasive insect from Japan known to infest various conifer hosts in its invasive range in eastern North America. The phenology of the scale has been studied on hemlock (Tsuga spp.) hosts in its native range and portions of its invasive range in the northeastern and mid-Atlantic regions of the United States; similar studies are lacking for the southeastern region. In the Southern Appalachians, this scale poses a significant management and regulatory challenge for Fraser fir (Abies fraseri [Pursh] Poir.,) Christmas tree production. The objective of this study was to examine the seasonal phenology of the scale in the western North Carolina production region. Biweekly samples were collected from Fraser fir at three sites over 2 years and analyzed for abundance of each life stage. We found all life stages present at all locations throughout the year. Large variability in egg abundance was observed across 2 years. There was little variability in the abundance of life stages between sampling locations. Substantially more scale eggs, crawlers, 2nd instar nymphs and adult females were observed on the 2 most recent years’ needles as opposed to older needles. These findings can help optimize the timing of management practices to control the elongate hemlock scale more effectively.

23. Strengthening Actions for Menstrual Health and Hygiene Interventions for Promotion of Women's Health in Nepal (SAMIP): Protocol for a Participatory Intervention Development Study Using Realist Synthesis, Human-Centered Design, Intervention Mapping, and Arts-Based Methods.

期刊: JMIR research protocols 发表日期: 2026-Apr-23 链接: PubMed

摘要

Menstrual restrictions remain widespread in Nepal, where approximately 90% of women and girls follow at least one restriction. One of the most harmful practices, chhaupadi (severe menstrual seclusion), requires women and girls to isolate in huts during menstruation and is associated with substantial physical and psychological risks, including injury, assault, smoke inhalation, and social exclusion. Although interventions have attempted to address chhaupadi, effectiveness has varied, and no comprehensive assessment has identified which components work, for whom, and under what conditions. Few prior efforts have meaningfully engaged communities in intervention design to ensure contextual relevance and sustainability. This protocol describes a three-aim study designed to (1) elucidate mechanisms underlying the success or failure of chhaupadi interventions; (2) co-design a culturally grounded, theory- and evidence-informed intervention in partnership with communities; and (3) pilot and evaluate the intervention using a controlled trial design. This multiphase study integrates realist synthesis, intervention mapping, human-centered design, and arts-based research. In aim 1, we will conduct a realist synthesis of published and gray literature, complemented by knowledge-sharing workshops and expert interviews to identify underlying mechanisms explaining chhaupadi intervention success or failure. In aim 2, synthesis findings will inform participatory intervention development. Using the intervention mapping framework, we will convene a co-design workshop incorporating human-centered design and arts-based research methods (eg, asset mapping, impact ladder, concept posters, and communal storytelling) with women, adolescents, and community collaborators to develop intervention components and implementation strategies. In aim 3, the co-designed intervention will be piloted in a controlled trial comparing intervention communities (full community-designed intervention) with control communities (menstrual health education only). Quantitative measures will assess knowledge, attitudes, and practices related to chhaupadi, self-efficacy, mental health, and reproductive health outcomes. Implementation indicators (eg, enrollment, acceptability, appropriateness, and feasibility) will also be assessed. Qualitative interviews and discussions will examine implementation processes, barriers, facilitators, and contextual influences. The study was funded in September 2023. Aim 1 activities began in April 2024. To date, 69 materials met the inclusion criteria, and a workshop with 8 organizations and 44 interviews has been conducted. Analysis was completed in February 2026, with results expected in the summer of 2026. Aim 2 co-design workshops began in March 2025; eleven women participated in the workshop, and an additional 123 community members have been consulted. This has resulted in a draft intervention called “Our Voice: Transforming Lives through Ending Chhaupadi.” Aim 2 results are expected in Fall 2026. Aim 3 data collection will begin in Winter 2027. By systematically identifying effective intervention mechanisms and embedding community leadership throughout design and implementation, this study aims to develop a sustainable strategy to reduce harms associated with chhaupadi and improve women’s and girls health. This integrated framework may also inform interventions addressing other socially embedded health practices in low-resource settings.

24. Centering Reproductive and Migrant Justice: Dismantling Inequities in Newcomer Pregnancy Care.

期刊: Obstetrics and gynecology 发表日期: 2026-Apr-23 链接: PubMed

摘要

Forced displacement has profound detrimental consequences on reproductive health, including maternal morbidity and mortality. Pregnant newcomers are a particularly high-risk group and are susceptible to adverse reproductive health outcomes due to the interplay of migration, sexual violence, trauma, disrupted care, racism, and xenophobia. Newcomers have higher rates of preventable pregnancy-related risk factors such as delayed prenatal care, malnutrition, and exposure to infectious diseases, in addition to structural, socioeconomic, language, and cultural barriers to accessing comprehensive pregnancy and abortion care. Perinatal mental health conditions are more prevalent among newcomers (particularly refugees and asylees), but they face greater barriers to accessing mental health care. In this perspective piece, we share two clinical cases that demonstrate how-at the intersection of reproductive justice and migrant justice-dismantling inequities in newcomer reproductive health requires interdisciplinary, trauma-informed, culturally responsive, and linguistically accessible care. We present best practices from an interdisciplinary model for newcomer pregnancy care. We end with a call to action for improving birth outcomes and experiences for newcomer patients.

25. Challenges and Opportunities in Estimating the Mortality Burden Related to Heat Exposure: Maricopa County, Arizona, 2019-2023.

期刊: American journal of public health 发表日期: 2026-Apr-23 链接: PubMed

摘要

Objectives. To estimate the mortality burden attributable to daily mean temperatures during the heat season (April through October) in Maricopa County, Arizona. Methods. We examined the effects of heat exposure on 126 854 deaths that occurred in Maricopa County during the 2019 to 2023 heat seasons. Using a quasi-Poisson regression with distributed lag nonlinear models, we estimated the cumulative relative risk (relative to 77°F) between population-weighted daily mean temperatures and all-cause mortality over a lag period of 3 days. Results. At 99°F (the 95th percentile of the population-weighted daily mean temperature), we observed an 11% (95% confidence interval [CI] = 7%, 16%) increase in daily all-cause mortality relative to 77°F. Overall, 3036 (95% empirical CI = 968, 4887) deaths were attributable to heat, which is 57% more deaths than identified through epidemiological heat surveillance. Conclusions. The mortality burden increases with increasing population-weighted daily mean temperatures, indicating that the effects of heat on mortality can be indirect and incompletely captured by routine surveillance. Public Health Implications. Statistical approaches can help estimate the mortality burden associated with heat exposure, complementing countywide surveillance efforts that provide actionable insights into enhancing heat prevention strategies. (Am J Public Health. Published online ahead of print April 23, 2026:e1-e4. https://doi.org/10.2105/AJPH.2026.308443).

26. Total Clinical Event Burden with Edoxaban Monotherapy versus Dual Antithrombotic Therapy in Atrial Fibrillation and Stable Coronary Artery Disease: Insights from the EPIC-CAD Trial.

期刊: Journal of the American Heart Association 发表日期: 2026-Apr-23 链接: PubMed

摘要

Oral anticoagulation (OAC) is essential for stroke prevention in atrial fibrillation (AF), whereas antiplatelet therapy remains standard for coronary artery disease (CAD), raising concerns about bleeding when both are combined. The effect of these regimens on recurrent events, reflecting cumulative disease burden, has not been fully evaluated. This post-hoc analysis of the EPIC-CAD (Edoxaban vs. Edoxaban with antiPlatelet agent In patients with atrial fibrillation and Chronic stable Coronary Artery Disease) trial included 1,040 patients with AF and stable CAD randomized to edoxaban monotherapy or edoxaban plus a single antiplatelet agent. The primary endpoint was the total number of net adverse clinical events at 12 months. Over a median follow-up of 12.1 months, 155 total events occurred (123 first, 32 subsequent). Event rates were lower with edoxaban monotherapy than with dual therapy (9.4 vs. 19.8 per 100 person-years; incidence rate ratio [IRR], 0.47; 95% CI, 0.34-0.67). Monotherapy reduced first events (IRR, 0.46; 95% CI, 0.32-0.68) and showed a lower cumulative hazard of total events (hazard ratio, 0.48; 95% CI, 0.32-0.71; P<0.001). Bleeding was the predominant event type in both groups but occurred more often with dual therapy (85.7% vs. 55.3%; P<0.001). Rates of ischemic events and mortality were similar between groups. Edoxaban monotherapy significantly reduced the overall burden of clinical events compared with dual antithrombotic therapy in patients with AF and stable CAD. Bleeding complications were more frequent than ischemic events, emphasizing the need to minimize bleeding risk in this population.

27. Influenza Vaccination Coverage Among Nursing Home Residents and Health Care Personnel - United States, 2024-25 Influenza Season.

期刊: MMWR. Morbidity and mortality weekly report 发表日期: 2026-Apr-23 链接: PubMed

摘要

Nursing home residents and health care personnel (HCP) are at increased risk for exposure to influenza; in addition, residents of nursing homes who acquire influenza are at increased risk for severe disease. The Advisory Committee on Immunization Practices recommends routine annual seasonal influenza vaccination for persons without contraindications, including HCP and those at increased risk for severe influenza. Nursing homes report influenza vaccination among residents and HCP to CDC’s National Healthcare Safety Network. This report describes influenza vaccination coverage among nursing home residents and HCP working in nursing homes during the 2024-25 influenza season (October 1, 2024-March 31, 2025). At the end of the 2024-25 influenza season, influenza vaccination coverage was 61.3% among nursing home residents and 42.1% among HCP who work in nursing homes; coverage among HCP varied by employment type. This study is the first comprehensive, national assessment of influenza vaccination coverage among nursing home residents and HCP who work in nursing homes in the United States. Monitoring of influenza vaccination coverage in this population at high risk for influenza exposure and severe influenza disease, along with implementation of a combination of influenza vaccination, administration of influenza antiviral medications, and other recommended practices to control the spread and severity of influenza in nursing home settings, can help protect nursing home residents and HCP against severe influenza-associated outcomes.

28. Post-Synthetic Modification of Cd-MOF with Dual Emission as a Ratiometric Probe for Visual Detection.

期刊: Inorganic chemistry 发表日期: 2026-Apr-23 链接: PubMed

摘要

In contemporary society, heavy metal ions have posed significant threats to water systems and human health, for which timely and accurate detection is of much significance. In this work, a new metal-organic framework, CUST-1022, [Cd(H2BPDC)(phen)]CH3OH was synthesized via the solvothermal method. Due to the existence of uncoordinated carboxyl sites in CUST-1022, Eu3+ was introduced into CUST-1022 through the postsynthesis modification method to construct a ratiometric fluorescence sensing material, Eu3+@CUST-1022. Eu3+@CUST-1022 demonstrates exceptional performance in detecting Fe3+, CrO42-, and Cr2O72-, with detection limits of 8.63 μM, 1.26 μM, and 1.91 μM, respectively, which represent a significant improvement (lower detection limits) over pristine CUST-1022 (15.72 μM for Fe3+, 5.46 μM for CrO42-, and 2.86 μM for Cr2O72-). Moreover, the sensing process was accompanied by a distinct color change, enabling visual discrimination. A portable fluorescent sensor was fabricated by using cotton swabs, offering a novel strategy for the direct detection of heavy metal ions in aqueous solutions. The potential fluorescence quenching mechanism was found to be energy competition absorption and dynamic quenching. The ratio-type fluorescent sensor prepared by the postsynthesis modification method reduces the detection limit, which represents an effective strategy for constructing MOF-based sensors for ion detection in practical environmental applications.

29. Where to Plant Trees? Designing Net-Zero Industrial Landscapes that Promote Public Health.

期刊: Environmental science & technology 发表日期: 2026-Apr-23 链接: PubMed

摘要

To contribute to the development of holistic sustainability strategies, we present a computational sustainable design framework for techno-ecological systems that integrates ecosystem coservices into the pursuit of carbon neutrality and net-positive industries. Public-health impacts of land-based pollution mitigation strategies are explicitly modeled and implemented within an integrated optimization framework, enabling the simultaneous evaluation of climate mitigation and local health outcomes. This nature-positive and people-positive approach identifies where land-use changes (LUCs) can most effectively reduce pollutant exposure and health-related incidences, providing practical guidance for prioritizing locations for nature-based solutions. A power generation case study is presented to compare this health-based social benefit approach with conventional and prior techno-ecological approaches. Highlighting LUC spatial importance, our study shows that 97% of averted mortalities may be lost between best- and worst-case scenarios. Our results suggest that cost-benefit analyses of land-use changes focused solely on carbon uptake overlook substantial opportunities to simultaneously improve public health. This approach highlights increased economic value for ecological restoration and supports more informed decision-making and investment in nature-based strategies that address climate change while delivering local benefits to ecosystems and communities.

30. All-Hazards Vulnerability and Adaptation Assessment of Canadian Kidney Care Systems: Protocol for a Qualitative Study.

期刊: JMIR research protocols 发表日期: 2026-Apr-23 链接: PubMed

摘要

Health and health care systems are progressively challenged by more frequent natural and human-caused hazards. A hazard becomes a disaster when vulnerability and exposure interact in complex ways with system capacity to trigger major disruptions in the functioning of a community or society. Patients with kidney diseases, especially those on dialysis, are particularly vulnerable. We will conduct a vulnerability and adaptation assessment (VAA) of Canadian provincial health systems and individual kidney care networks (KCNs) with respect to natural and human-caused disasters and emergencies. Our research aims to map existing KCNs across Canada, contextualize the current and future vulnerability of health systems and patients to disasters and emergencies, and identify and prioritize adaptation measures in partnership with key interest holders. We are conducting a bottom-up VAA following a qualitative descriptive approach and using the framework previously developed as an operational guide. We started by conducting an environmental scan and document review and identified 75 KCNs across Canada. After collecting directives and policies on disaster management from these KCNs, we will conduct a content analysis guided by our framework in disaster management. We are now conducting semistructured interviews with kidney health care professionals across Canada recruited using purposive and snowballing techniques to better understand their perspectives, expertise, and lived experiences. We will conduct thematic analysis using an inductive-deductive approach guided by the framework. Findings from these multiple data sources will then be triangulated to generate a robust VAA. We want to identify the existing operational and human vulnerabilities and the risks associated, as well as explore lessons learned, to develop needed adaptations. Emerging data reflect a variety of experiences across programs and provinces. The findings will explore analysis at the program, provincial, and health system levels. The environmental scan was initiated in November 2024, and the semistructured interviews started in February 2025. We have recruited 71 participants from 55 KCNs. Interviews are ongoing, and coding has been initiated simultaneously. The first VAA focusing on in-center hemodialysis services is expected to conclude in April 2026. These findings are projected to be written up by May 2026, and manuscripts are expected to be submitted for publication to peer-reviewed journals. Thereafter, similar analyses will be conducted focusing on other kidney replacement therapies and pediatric programs. This is the first VAA of KCNs across Canada. Findings will provide a critical foundation for understanding vulnerability, supporting strategic planning, and guiding adaptation measures that can strengthen health system resilience and mitigate associated risks of disasters and emergencies to patients with kidney diseases.

31. A Rapid and Ultrasensitive Detection of Coxsackievirus A16 Using Reverse Transcription Multiple Cross Displacement Amplification Combined with the CRISPR-Cas12a-Based Biosensing System.

期刊: ACS infectious diseases 发表日期: 2026-Apr-23 链接: PubMed

摘要

Coxsackievirus A16 (CVA16) is one of the primary viral etiological agents of hand, foot, and mouth disease (HFMD) in infants and children under five years of age. Prompt and reliable detection of CVA16 is crucial for guiding immediate therapeutic interventions and for implementing effective epidemic prevention and control strategies, particularly in settings with limited resources. Herein, a diagnostic platform for CVA16 (CVA16-RT-MCDA-CRISPR) was developed by combining reverse transcription multiple cross displacement amplification (RT-MCDA) with CRISPR-Cas12a-based detection. In this system, the CVA16 VP1 gene was preamplified using RT-MCDA technology. The resulting amplicons were then specifically recognized and cleaved by the CRISPR-Cas12a-based detection system. MCDA primers, an engineered CP1 primer, and a specific guide RNA (gRNA) were designed to target the VP1 gene of CVA16. The assay achieved a limit of detection of 2.8 × 10-1 copies per microliter for CVA16 RNA standard templates and showed no cross-reactivity against non-CVA16 pathogens. Furthermore, the CVA16-RT-MCDA-CRISPR assay’s feasibility was validated using 96 clinical samples. Taken together, these results demonstrate that the CVA16-RT-MCDA-CRISPR assay is a reliable diagnostic tool for rapidly and sensitively detecting CVA16.

32. [Psychiatric challenges in Prader-Willi syndrome].

期刊: Der Nervenarzt 发表日期: 2026-Apr-23 链接: PubMed

摘要

Prader-Willi syndrome (PWS) is highly associated with psychiatric comorbidity. This article investigates the prevalence of mental disorders in PWS, explores their association with neurobiological foundations, and outlines the resulting clinical recommendations. An evaluation of the scientific literature in the context of clinical experience from the special outpatient clinic for mental health in rare syndromic disorders at Hannover Medical School. Psychiatric manifestations are present in 44-89% of PWS patients, with disruptive behavior, skin picking, psychosis, compulsive symptoms, and affective disorders being the most common. PWS psychosis differs from schizophrenic psychosis and can be difficult to treat in some cases. Treatment approaches exist for disruptive behavior, affective symptoms, and compulsive symptoms. Knowledge of the neurobiological basis of PWS is necessary for the adequate treatment of psychiatric disorders. In addition to pharmacological therapies, behavioral interventions and environmental control should also be included. HINTERGRUND: Das Prader-Willi-Syndrom (PWS) ist in hohem Maße mit psychiatrischen Komorbiditäten verbunden. Darunter finden sich disruptives Verhalten, Zwangsstörungen, obsessive Manipulation an der Haut (Skin Picking) und psychotische Störungen. Im vorliegenden Beitrag werden bestehende pharmakologische Ansätze in Kombination mit strukturierten Verhaltensinterventionen vorgestellt; dabei wird auf die klinischen Implikationen eingegangen. Es wird die Frage beantwortet, mit welcher Prävalenz psychische Störungen bei PWS vorliegen. Die grundlegenden neurobiologischen Zusammenhänge werden beschrieben, sich daraus ergebende klinische Empfehlungen diskutiert. Auswertung der wissenschaftlichen Literatur im Kontext klinischer Erfahrungen aus der Spezialambulanz für seelische Gesundheit bei selteneren syndromalen Erkrankungen an der Medizinischen Hochschule Hannover. Psychiatrische Manifestationen liegen bei 44–89 % der von PWS Betroffenen vor, am häufigsten treten disruptives Verhalten, Skin Picking, Psychosen, Zwangssymptome und affektive Störungen auf. PWS-Psychosen unterscheiden sich von schizophrenen Psychosen und sind teils schwer behandelbar. Für disruptives Verhalten sowie affektive und Zwangssymptome bestehen Behandlungsansätze. Für die suffiziente Behandlung psychiatrischer Störungen ist die Kenntnis neurobiologischer Grundlagen des PWS erforderlich. Neben pharmakologischen Therapien sollten Verhaltensinterventionen und Umweltkontrolle einbezogen werden.

33. "Let's Cope Together": An Evidence-based Approach to Caring for Patients Living With Autism in the Perioperative Setting.

期刊: Journal of perianesthesia nursing : official journal of the American Society of PeriAnesthesia Nurses 发表日期: 2026-Apr-23 链接: PubMed

摘要

To determine if an individualized coping plan for pediatric patients with autism, available in the electronic health record, could improve their safety and comfort, and family satisfaction in the perioperative setting. Evidence-based practice project. The Iowa Model Revised: Evidence-Based Practice to Promote Excellence in Health Care was used as a framework for the development and implementation of a program to create individualized perioperative coping plans in the electronic health record for pediatric patients living with autism. Evidence reviews of the literature informed the process, which included environmental and care modifications to achieve an optimal patient experience. Collaboration among nurses, physicians, and child life specialists was integral to project implementation. During the implementation period of the pilot project, perioperative coping plans were documented for 60% of surgical patients living with autism. Incorporating the creation of the coping plan within the usual nursing preoperative phone call increased the coping plan documentation rate to 90%. Tools and visual reminders built into the electronic health record facilitated the sustainment of the program. The surgical services team was able to make accommodations to perioperative processes and environment when team members had awareness of the child’s individual needs. Creation of a perioperative coping plan was a feasible intervention when incorporated into the preoperative phone call. In addition to the coping plan, environmental modifications engaged the health care team to provide individualized care and work toward the goal of an optimal perioperative experience for all.

34. Virtual Reality Techniques in Workplace Design and Ergonomic Assessment.

期刊: IEEE transactions on visualization and computer graphics 发表日期: 2026-Apr-23 链接: PubMed

摘要

This literature review examines the use of virtual reality in ergonomic risk assessment in workplace design using a rigorous methodology to evaluate literature from seven databases and journals. The review identified 4,377 records, of which nineteen used virtual reality to simulate complex work environments, such as manufacturing floors and office spaces, utilizing motion tracking and risk assessment methods, including the Ergonomic Assessment Worksheet (EAWS) or CUELA (German acronym for Computer-aided recording and long-term analysis of musculoskeletal system loads). The research suggests that integrating virtual reality with established ergonomic assessment methods holds promise for enhancing their efficacy. However, it also highlights the limitations of current virtual reality simulation tools in implementing realistic interactions with the working environment. The importance of this review lies in its capacity to synthesize and structure a previously fragmented field, providing researchers and practitioners with a comprehensive overview of current approaches, challenges, and opportunities in VR-based ergonomic risk assessment. It concludes that virtual reality has high potential but requires further research to fully realize its benefits in designing ergonomic workplaces, conducting thorough ergonomic evaluations, and being integrated into occupational health and safety on a large scale.

35. Examining Relationships Between Caregiver Concerns and Family and Child Characteristics in Kindergarten Children at Risk for Language and Literacy Disorders.

期刊: Language, speech, and hearing services in schools 发表日期: 2026-Apr-23 链接: PubMed

摘要

Identification of children with language impairments often relies on caregivers raising concerns. However, caregivers may find it difficult to identify language impairment. This study examined how child and family characteristics were related to the likelihood that caregivers reported concerns about oral language and literacy to understand the possible underlying factors influencing identification. In a larger longitudinal study, kindergarten children (N = 385) completed a battery of oral language and literacy assessments. The caregivers completed a questionnaire including demographic information (e.g., caregiver education level) and reported concerns in the areas of oral language, literacy, speech, and attention/memory. We used two multiple logistic regressions to evaluate the predictors of caregivers’ concern about (a) oral language and (b) literacy. Among the children with language difficulties, less than 40% of caregivers reported oral language concerns. Among the children with word reading difficulty, just over half of the caregivers reported literacy concerns. Oral language scores and attention concerns were significant predictors of caregivers’ oral language concerns. Word reading scores, caregiver education, speech concerns, and attention concerns were significant predictors of literacy concern. Although interpretations of caregivers’ concerns may vary according to our provided checklist, these concerns appear to be meaningful indicators of child language and literacy difficulties. These difficulties-particularly in oral language-often go unrecognized. Our findings underscore the need for universal language screening in early education and expanded caregiver education regarding language impairment. Relying solely on caregiver concern may lead to missing children in need of services.

36. Risk Factors for Persistent Preserved Ratio Impaired Spirometry.

期刊: Respiratory care 发表日期: 2026-Apr-23 链接: PubMed

摘要

Preserved ratio impaired spirometry (PRISm) is a common lung function impairment associated with morbidity and mortality. It is characterized by a volatile pattern, with different subsets of PRISm trajectories having different clinical implications. Persistent PRISm, defined as FEV1 < lower limit of normal (LLN) with FEV1/forced vital capacity (FVC) ≥ LLN at multiple time points, is associated with higher risk of hospitalization and mortality compared to nonpersistent PRISm. The factors that predispose patients to the development of persistent PRISm remain unclear. Our objective was to identify the prevalence of persistent PRISm and its associated risk factors in a retrospective spirometry database. We performed an analysis that included individuals with multiple spirometries and at least one finding of PRISm. Using race-neutral Global Lung Function Initiative (GLI) equations, we identified the prevalence, and compared the characteristics, between individuals with persistent or nonpersistent PRISm. We created parsimonious multivariable logistic regression models to identify factors associated with persistent PRISm. Persistent PRISm was identified in 40% (191/479) of individuals with multiple spirometries and at least one PRISm spirometry. In the adjusted analysis, a referral for restrictive respiratory disease was associated with higher odds of persistent PRISm (odds ratio [OR] = 3.60, 95% CI 1.74-7.64) in comparison to having no disease diagnosis. Moderate (OR = 2.64, 95% CI 1.67-4.20) and severe (OR = 3.89, 95% CI 1.07-18.02) lung function impairment based on FEV1 Z score were associated with higher odds of persistent PRISM in comparison to mild or no impairment. Persistent PRISm was associated with referral for restrictive respiratory disease and lower lung function.

37. When pursuing hedonic experiences leads to less hedonic outcomes: Hedonic sampling drives the persistence of false beliefs in reward-rich food environments.

期刊: Journal of experimental psychology. Applied 发表日期: 2026-Apr-23 链接: PubMed

摘要

Existing research explains the widespread belief that unhealthy food is tastier than healthy food by how food is portrayed in the media and social networks and by the notion that food cannot serve two purposes (health and pleasure) at the same time. However, these explanations cannot explain why people do not change this belief despite the increasingly large variety of healthy and tasty food options. We argue that it is the abundance of tasty foods in the environment, combined with people’s motivation to eat palatable foods, that prevents individuals from changing their beliefs. In three online studies and one taste experiment (total N = 976), we show that individuals’ food choices in reward-rich environments with many tasty foods, but not in reward-poor environments with few tasty foods, led to a consolidation of initial beliefs, even when there was no relationship between food healthiness and taste or a relationship that contradicted their beliefs in the experimental food environment. Our findings suggest that a basic hedonic sampling mechanism contributes to the persistence of food beliefs, such as the belief that unhealthy food tastes better, and should be considered when trying to change unhealthy diets. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

38. A novel multidimensional dynamic difficulty adjustment algorithm: Use case in a cognitive training video game.

期刊: Psychological methods 发表日期: 2026-Apr-23 链接: PubMed

摘要

This study introduces a novel methodological framework for cognitive control training, embedded in a video game that incorporates action-based gameplay and a multidimensional dynamic difficulty adjustment (DDA) system. This system adapts to individual player performance in real time, ensuring a personalized and engaging experience. The game architecture is modular, including a configurable set of cognitive training modules that are tailored according to one’s training goals. Transitioning between modules occurs through an action-based central hub following the literature on action video games and their positive impact on brain plasticity. Analysis of data from 34 players demonstrates how they progress through each module, with most players reaching their zone of proximal development after approximately 30-45 min of playing a module. Once players stabilize in their skill progression, the DDA system maintains variability in gameplay, a feature that has been suggested to promote the transfer of skills to novel situations. This analysis also highlights how our novel multidimensional DDA system accommodates to a wide range of skill levels, offering a seamless onboarding experience across a variety of players. Together, this novel architecture and DDA framework provide a new, rigorous methodological blueprint for the design of computerized cognitive training tools. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

39. Five-year longitudinal changes in social, economic, and psychosocial wellbeing among young women with breast cancer in Mexico.

期刊: Journal of cancer survivorship : research and practice 发表日期: 2026-Apr-23 链接: PubMed

摘要

Young women with breast cancer (YWBC) face long-term challenges during career building, partnership formation, and childrearing. Most survivorship research has been conducted in high-income countries, with limited longitudinal evidence from low- and middle-income countries (LMICs). We aimed to characterize 5-year longitudinal changes across sociodemographic and financial, relational, fertility, family and caregiving, psychosocial, and health-related domains among YWBC in Mexico. We analyzed 526 participants in the Joven and Fuerte prospective cohort (stage I-III breast cancer, age ≤ 40 years) in Mexico. Surveys were completed at baseline, 6 months, as well as 1, 2-3, and 4-5 years post-diagnosis. GEE assessed changes in binary and multinomial outcomes. Global chi-squared or Fisher’s exact tests were used descriptively. Participants experienced sustained occupational disruption and economic strain; 75.8% reported a change in occupation and nearly 50% decreased income at 4-5 years. Partnership status was stable; 67.9% remained with the same partner, yet unmet partner support needs persisted. Desire for future children declined from 38.5 to 20.2% at 4-5 years. New comorbidities increased, particularly psychological disorders. While the need for psychological support declined from 66.6 to 42.4%, interest in support groups remained substantial. Health behaviors showed partial recovery; participants meeting recommended exercise levels (≥ 150 min/week) increased from 25.9 to 32.7%. Mexican YWBC experiences dynamic survivorship trajectories characterized by partial recovery alongside persistent financial, caregiving, and supportive care needs. Survivorship care in LMICs should integrate financial and occupational support, family-centered psychosocial services, and long-term health monitoring for young survivors.

40. Impact of timing of menopause on musculoskeletal disorders and associated pain in community-dwelling women: the Yakumo study.

期刊: International orthopaedics 发表日期: 2026-Apr-23 链接: PubMed

摘要

Premature ovarian insufficiency (POI) and early menopause (EM) lead to prolonged estrogen deficiency, which can affect musculoskeletal disorders (MSDs) and pain, including neuropathic pain. This study investigated the impact of POI/EM on MSDs, pain, and physical function in community-dwelling women. We conducted a cross-sectional study using data from 172 postmenopausal women who participated in a community-based health checkup in Yakumo town, Japan. Participants were categorized by age at menopause: control (45-50 years, n = 118), POI (< 40 years, n = 19), and EM (40-44 years, n = 35). We evaluated MSDs (knee osteoarthritis, spinal alignment, and osteoporosis), pain (Visual Analogue Scale for low back, lower limb, and knee pain; and painDETECT scores), and physical function (muscle strength, walking ability, locomotive syndrome). Locomotive syndrome was evaluated using the stand-up test, two-step test, and the 25-question Geriatric Locomotive Function Scale (GLFS-25). The POI group exhibited a significantly higher prevalence of knee osteoarthritis and severe knee pain compared to the control and EM groups. The prevalence of neuropathic pain was also significantly higher in the POI group. Regarding physical function, no significant differences were observed in muscle strength or walking ability among the groups. However, the POI group had significantly higher scores on the GLFS-25 pain subscale and total score, indicating worse locomotive function. Women with POI had a higher prevalence of knee osteoarthritis, knee pain, and neuropathic pain. Although objective physical performance was preserved, subjective locomotive function was impaired. Therefore, early therapeutic intervention and a multifaceted approach addressing not only physical function but also pain are necessary for women with POI/EM.

41. Exercise addiction: A review and evaluation of current research and theory.

期刊: Journal of behavioral addictions 发表日期: 2026-Apr-22 链接: PubMed

摘要

While regular physical activity provides many health benefits, exercise can cause more harm than good when done excessively to the point where a person loses control. This condition has been called various names, but the most accurate term is ‘exercise addiction’ (EA) because it reflects both compulsive behavior and dependence. EA is classified as a non-substance-related addictive disorder, or behavioral addiction, and has been the subject of research for over fifty years. However, it is not officially recognized in major diagnostic systems, mainly due to significant conceptual and measurement challenges. This paper provides an overview of current knowledge on EA, including its causes, assessment issues, epidemiology, associated conditions, negative effects, and options for treatment and prevention. An evaluation-driven narrative review was conducted which synthesized findings from empirical research and theoretical models adopted across EA research. It critically examined prevailing conceptualizations, methodological challenges, and potential treatment approaches. Epidemiological findings are inconsistent and report inflated prevalence rates, partly due to reliance on self-report instruments that often fail to distinguish pathological exercise from passion. Etiological models emphasize the complex interplay between biological, psychological, and behavioral factors. Negative consequences include physical injury, emotional distress, and social strain. Evidence for effective interventions remains sparse. Despite growing interest, progress remains slow. There is a need for larger, longitudinal, and experimental studies to advance understanding. Though not included in the DSM-5, greater clinical awareness is vital for early detection and prevention. EA is clinically relevant but still poorly defined, requiring robust empirical and theoretical work.

42. Mapping National Definitions, Classifications, and Policy Approaches to Poor-Prognosis Cancers Across the G7 Cancer Initiative Countries.

期刊: JCO global oncology 发表日期: 2026-Apr 链接: PubMed

摘要

In 2023, the G7 Cancer Initiative was launched by Australia, Canada, France, Germany, Japan, the United Kingdom, and the United States with the aim of enhancing global cancer control, and with poor-prognosis cancers as a priority. To facilitate effective collaboration among G7 Cancer, we aimed to address the lack of standardized definitions and coordinated initiatives across countries. We examined how the G7 Cancer Initiative countries defined poor-prognosis cancers, objectively classified them, quantified their burden, and assessed national response strategies. A review of national cancer plans was conducted together with an expert email survey to evaluate definitions and classifications. Poor-prognosis cancers were identified based on 5-year net survival (NS) below 30% and a mortality-to-incidence (M/I) ratio over 0.75 using CONCORD-3 and Global Cancer Observatory 2022 data. Pancreatic cancer was consistently categorized as a poor-prognosis cancer, while some countries also included liver, esophageal, stomach, and some brain cancers. For lung cancer, classification varied depending on the definition used. These six cancers accounted for a major share of cancer deaths, with lung (18%-23%) and pancreatic (6%-10%) cancers contributing the most. National strategies differed, with Australia, France, and Japan implementing specific policies for poor-prognosis cancers, while others addressed them indirectly or not at all. To enhance cancer outcomes for poor-prognosis cancers, the G7 Cancer Initiative should coordinate efforts through joint programs focused on early detection, treatment, and policy alignment. Standardized definitions and collaborative action are essential to strengthening the global poor-prognosis cancer response.

43. Contemporary HIV-1 envelope pseudovirus panels for detecting and assessing B cell lineages with broadly neutralizing antibody potential.

期刊: PLoS pathogens 发表日期: 2026-Apr 链接: PubMed

摘要

Although a protective HIV-1 vaccine has not yet been realized, significant progress has been made in vaccine designs that trigger B cell lineages with potential to produce broadly neutralizing antibodies (bnAbs). Advancing these strategies by optimizing vaccine boosting regimens requires early detection of maturing antibodies with neutralizing activity against native envelope glycoprotein (Env) trimers and streamlined strategies to identify antibodies as they begin to manifest desired levels of breadth and potency. Thus, we designed three types of pseudovirus screening panels based on Envs of contemporary HIV-1 isolates to facilitate detection of bnAb lineages that are on favorable trajectories during a vaccination course. The panels were selected from Tier 2 Transmitted Founder Lineage (TFL) HIV-1 Envs from placebo participants in the Antibody Mediated Prevention (AMP) efficacy trials. Using 15 bnAbs to evaluate the neutralization sensitivity of the viruses, we selected 8-member bnAb class-specific panels most sensitive to bnAbs representing their class: V2-apex, V3-glycan, CD4-receptor binding site (CD4bs), Membrane-Proximal External Region (MPER), or fusion peptide (FP). Next, we combined the most sensitive viruses among the class-specific panels to create a 12-virus panel to enable optimal detection of low-titer bnAb activity across epitope specificities. Finally, as HIV-1 continues to evolve greater levels of antigenic diversity and as current global pseudoviruses bnAb panels rely on viruses collected more than twenty years ago, we showed the importance of using contemporary viral panels to assess bnAb breadth and potency and designed a 12-virus panel representative of the spectrum neutralization profiles among AMP placebo viruses. We characterized pseudoviruses bearing each selected Env using standardized human sera to confirm their Tier 2 status and biological relevance. These updated panels enable sensitive screening of neutralization activity in vaccine studies and can also provide a realistic assessment of the expected breadth and potency of maturing responses against contemporary HIV-1 Envs.

44. Extensively drug-resistant gram-negative sepsis in a neonatal intensive care unit from western India: A retrospective cohort study.

期刊: The Indian journal of medical research 发表日期: 2026-Mar 链接: PubMed

摘要

Background and objectives Extensively drug-resistant (XDR) Gram-negative bacterial sepsis is an emerging threat in neonatal intensive care units (NICU). We aimed to determine the epidemiology, pathogen profile, and outcome of neonates with XDR Gram-negative sepsis. Methods This retrospective cohort study was conducted in a newly established NICU in Western India. Data of all neonates admitted between July 2016 and June 2021 were analysed. Standard CDC definitions were used to classify antimicrobial resistance. Results Among 1230 neonates, 31.4% (n=387) had clinically suspected sepsis and 11.5% (n=141) had culture-positive sepsis, accounting for 194 sepsis episodes. Gram-negative sepsis occurred in 117 neonates, of whom 38.4% (45/117) had XDR Gram-negative sepsis. One-third of these isolates were XDR, predominantly Klebsiella (n=21,44%), Acinetobacter (n=18,37%), and Escherichia species (n=6, 13%). Nearly 60% (28/48) of XDR Gram-negative isolates were obtained from outborn neonates, and 60% (n=17) were isolated within 48 h of admission. Mortality was significantly higher in neonates with XDR sepsis (21/45, 46.7%) compared with multidrug-resistant (13/41, 31.7%) and drug-sensitive Gram-negative sepsis (4/31, 12.9%) (P=0.009). Interpretation and conclusions The high burden of extensively drug-resistant Gram-negative sepsis and its association with increased mortality underscore the urgent need for strengthened antimicrobial stewardship and surveillance in neonatal intensive care units.

45. A community-based study of antibiotic consumption in an urban health training centre area of Ahmedabad city.

期刊: The Indian journal of medical research 发表日期: 2026-Mar 链接: PubMed

摘要

Background and objectives The rise of antibiotic resistance is a global health crisis, and the irrational use of antibiotics is the major contributing factor. Therefore, it is essential to understand the antibiotic usage in the community to estimate the prevalence of antibiotic usage and its association with various co-variates and to evaluate the consumption pattern of antibiotic usage in the catchment areas of the Urban Health Training Centre of a medical college in Ahmedabad City. Methods An observational, community-based cross-sectional study was conducted in 3 phases during May-Aug 2024. Estimated sample size was 315 individuals who were ill anytime in last three months or consumed drugs and were selected from 15 clusters identified by cluster sampling method. Information was gathered on a structured questionnaire, and statistical parameters such as prevalence, prevalence ratios, confidence interval, and chi-square test were calculated in MS Excel. Results The screening of 2278 participants yielded 349 eligible participants as per inclusion criteria and 117 (33.5%) of them consumed 152 antibiotics during the previous three months. Sociodemographic determinates like age, sex and qualification of treatment provider showed significant association with antibiotic usage. Use of antibiotics was higher 55 (42.6%) in children than in adults 62 (28.1%). As per AWaRe classification (WHO), 3/4th of the participants (59.9%) consumed the watch group, more than half (50.4%) consumed the Access group and 2 (1.7%) consumed the Reserve group of antibiotics. Antibiotics are prescription only drugs, still in 37.5% of cases, antibiotics, even those from the Watch group, were obtained without a prescription. Interpretation and Conclusions Overall, a concerning trend of antibiotic use without prescriptions was witnessed, specifically in the ‘Watch’ category of antibiotics. It highlights the need for improved prescribing practices and public education to prevent misuse of antibiotics.

46. Diagnostic accuracy and safety of Cy-Tb for detection of tuberculosis infection: A multicentric study from India.

期刊: The Indian journal of medical research 发表日期: 2026-Mar 链接: PubMed

摘要

Background and objectives Only 10% of the individuals infected with Mycobacterium tuberculosis (MTB) manifest active tuberculosis. Interferon-γ release assay (IGRA) and tuberculin skin test using purified protein derivative (PPD) are used to identify tuberculosis (TB) infection. We aimed to study the comparative performance of Cy-Tb (the SIILTIBCY skin test) and PPD with IGRA as the reference standard. Methods In step-I, 30 TB patients and 32 IGRA-negative health controls; in step-II, 2651 participants aged 1 to 85 yr; and in step- III, 647 household contacts of TB patients aged 1-18 years old were enrolled. Blood for IGRA was drawn immediately prior to intra-dermal administration of Cy-Tb (the SIILTIBCY skin test) or PPD. The size of induration of Cy-Tb ≥5 mm or PPD ≥ 10mm after 48 to 72 h were considered positive. Combined Data from step II and step III were analysed for sensitivity, specificity, agreement, and kappa-coefficient with IGRA as the reference standard using Stata version 14.2. Results The step-I results for Cy-Tb showed 90% specificity, 93.8% specificity, and an agreement of 91.9% with IGRA and a Cohen’s kappa coefficient of 0.83. Combined analysis of step-II and step-III data revealed sensitivity of 82.6% (95% CI 79.1-85.8), specificity of 71.1% (95% CI 68.2-73.8), agreement of 74.8%, and kappa of 0.5 for Cy-Tb. PPD showed sensitivity and specificity of 71.0% (95% CI 66.7-75.0) and 71.9% (95% CI 69.0-74·6), respectively with 71.6% agreement and kappa of 0.4 with IGRA. Interpretation and conclusions Performance of Cy-Tb was comparable to that of PPD with IGRA as reference standard. Cy-Tb skin test can be used for diagnosis of TB infection.

47. Surveillance and assessment of medical device-associated adverse events in a tertiary care hospital: An observational study.

期刊: The Indian journal of medical research 发表日期: 2026-Mar 链接: PubMed

摘要

Background and objectives Medical devices are essential in hospitals for diagnosis and treatment but may also cause unintended adverse events. Materiovigilance plays a crucial role in detecting, reporting, and preventing such events to safeguard patients. This study aimed to monitor, assess, and report medical device-associated adverse events (MDAEs) in a tertiary care hospital and to identify the devices most frequently implicated. Methods A prospective observational study was conducted at a tertiary care hospital in Bengaluru, India, from May 2023 to January 2024. Daily ward rounds were carried out in collaboration with the biomedical team to identify device-related issues. Confirmed MDAEs were documented using the standard reporting forms of the Materiovigilance Programme of India (MvPI). Results Among 1,100 medical devices in use, 31 (2.81%) were associated with adverse events. Most affected patients were females, with an average age of 61 years. Frequently implicated devices included disposable syringes and intravenous (IV) cannulas. The common events included thrombophlebitis, blocked or damaged needles, and elevated serum creatinine following contrast use. Most adverse events involved Class B devices. Causality assessment classified the majority as probable or possible. Interpretation and conclusions The overall frequency medical device associated of adverse events associated was low. However, the findings underscore the importance of continuous device surveillance. Strengthening awareness and structured reporting under MvPI can improve early detection, timely intervention, and long-term patient safety in clinical practice.

48. Epidemiology of vaso-occlusive crisis among sickle cell disease patients in India: A community-based multi-centric study.

期刊: The Indian journal of medical research 发表日期: 2026-Mar 链接: PubMed

摘要

Background and objectives Morbidity burden of sickle cell disease (SCD) in India has been underestimated till now due to a lack of nationwide data on the prevalence of clinical outcomes, including the most prevalent clinical manifestations like vaso-occlusive crises (VOCs). This multi-centric study reports the epidemiological characteristics of VOCs among SCD patients in India. Methods This is a prospective, community-based, multi-centre cohort study with fortnightly home visits conducted over 12 months in five SCD-endemic districts of India. A cohort of 252 patients was followed up, and data regarding any illness related to SCD and its management in the previous fortnight were collected using a structured questionnaire. Results Out of the total 252 SCD patients followed up, 223 (88.5%) patients reported 2118 crises in a year [8404 episodes per 1000 patients-year; 95% confidence interval (CI): 8040-8760]. Pain anywhere in the body was the most prevalent symptom [97.3% (n=217) of the participants, with 7 (3-13) median (IQR) episodes per patient in a year]. Among total crisis episodes, 48.7% (n=1031) of the episodes were treated at a health facility. Interpretation and conclusions A higher number of crisis episodes reported among the majority of the patients demystifies the notion that SCD is milder and less severe in India. The lower utilization of healthcare resources among SCD patients raises a serious concern.

49. Association of GCKR and GLIS3 gene polymorphisms with gestational diabetes mellitus: A case-control study.

期刊: The Indian journal of medical research 发表日期: 2026-Mar 链接: PubMed

摘要

Background and objectives Gestational diabetes mellitus (GDM) increases the chances of negative consequences for both the mother and the foetus. It shares genetic and physiological characteristics with type 2 diabetes mellitus (T2DM), particularly insulin resistance and impaired insulin secretion. While gene variants involved in glucose metabolism, such as those in glucokinase receptor (GCKR) and GLI similar 3 (GLIS3), have been linked to diabetes risk, their association with GDM in South Indian populations remains underexplored. Methods This study comprised 195 patients with GDM and 195 normoglycemic pregnant women of South Indian ethnicity. GDM diagnosis was recognised using an oral glucose tolerance test. Genotyping of GCKR (rs780094) and GLIS3 (rs701847, rs7020673, rs10814916) were performed using Tetra-ARMS PCR and validated through Sanger sequencing. Associations between genotypes and the risk of GDM were assessed using logistic regression. Results Women with GDM exhibited significantly higher age, body mass index, blood pressure, and adverse metabolic profiles. There was a strong genotype-specific correlation between GDM and the GCKR rs780094 CT genotype. When dominant models and the AG genotype were used, rs701847 exhibited the strongest correlation with GLIS3. rs10814916 was linked through the AC genotype, whereas rs7020673 only demonstrated a connection under the recessive model. In women with GDM, HOMA-IR was significantly higher (P<0.001). Interpretation and conclusion This study highlights significant associations between GCKR and GLIS3 polymorphisms and the risk of GDM in South Indian women, supporting the role of ethnicity-specific genetic screening in predicting GDM risk.

50. Prevalence of chronic pain in the general population: A systematic review and meta-analysis.

期刊: The Indian journal of medical research 发表日期: 2026-Mar 链接: PubMed

摘要

Background and objectives Chronic pain represents a significant health concern affecting a large segment of society. To date, no systematic review and meta-analysis has evaluated the prevalence of chronic pain in the general population aged 18 to 95 years. The present study aimed to assess prevalence of chronic pain in this age group and examine its variation across age, sex, geographical regions, and psychosocial factors. Methods Cochrane Library, PubMed, and MEDLINE, were searched by combining combination of two categories of keywords (prevalence, chronic pain, epidemiology, population-based study, meta-analysis) in the general population till May 2024. Results A total of 52 studies with 2,89,490 participants were included to ascertain the global prevalence of six types of chronic pain: non-specific chronic pain, fibromyalgia, chronic lower back pain, chronic back pain, chronic widespread pain, and chronic musculoskeletal pain. The overall pooled random-effect prevalence percentage of chronic pain was 26.99%. The chronic pain prevalence percentage was significantly higher in those above 45 yr of age (46.7%), compared to 24.2% in those between 18-45 yr (P<0.001). The prevalence of chronic pain was higher in women as compared to men (31.42% vs. 21.63%) (P=0.07). Interpretation and conclusions The present global meta-analysis of chronic pain across the age group of 18-95 yr, observed a higher prevalence in women and in those alone 45 years of age. There was no geographical difference.

51. Barriers and facilitators to cancer care in the Northeast region, India: A scoping review.

期刊: The Indian journal of medical research 发表日期: 2026-Mar 链接: PubMed

摘要

Background and objectives Cancer is a major health issue globally, and in India’s Northeast Region (NER), it is experiencing the highest incidence, particularly among rural and tribal communities. However, screening rates are low, awareness is limited, and access to care is challenged by isolation, poor infrastructure, financial constraints, and dependence on traditional medicine. To address these gaps, this scoping review aimed to synthesise evidence on the multidimensional barriers to cancer care in the NER, examine how socioeconomic, cultural, health system, logistical, and geographical factors influence care-seeking behaviour, and identify facilitators that could improve access to screening, diagnosis, and treatment. Methods A scoping review was conducted following the Arksey and O’Malley framework and reported in accordance with PRISMA-ScR guidelines. PubMed, Scopus, Web of Science, and EMBASE were searched for studies published from January 2010 to June 2025. Eligible studies that examined barriers or facilitators to cancer care in the 8 Northeastern States were thematically synthesised. Results Twelve studies were included; barriers were categorised into socioeconomic, health system, cultural, logistical, and geographical domains. Key issues included financial hardship, low health literacy, inadequate infrastructure, transport difficulties, and limited insurance coverage. Facilitators included family support, trust in community health workers, health education, outreach services, and financial incentives. Interpretation and conclusions Cancer care access in the NER is constrained by multidimensional barriers but supported by community and system- level facilitators. Decentralised services have expanded financial protection, and culturally tailored interventions are critical to strengthening cancer care in the region.

52. Evolutionary analysis and immunoinformatic-based epitope prediction of dengue virus serotype 2 strains from Sri Lanka.

期刊: The Indian journal of medical research 发表日期: 2026-Mar 链接: PubMed

摘要

Background and objectives To investigate the phylogenetic and evolutionary relationships of dengue virus 2 (DENV-2) strains in Sri Lanka and identify probable antigenic B and T cell epitopes in the envelope gene region. Methods Phylogenetic analysis was conducted on the envelope gene region of Sri Lankan DENV-2 strains alongside globally homologous sequences. Selection pressure analysis identified codons under diversifying and purifying selection. Epitope prediction was performed to detect probable antigenic B and T cell epitopes. Results The sequences belonged to two major lineages of the cosmopolitan genotype: major lineage A and F from various geographical regions. Phylogenetic analysis showed segregation into distinct clades, with close sub-clustering of Sri Lankan strains with those from China, Malaysia, Myanmar, Taiwan, and Reunion Island. Selection pressure analysis revealed two sites under diversifying selection, with numerous sites under purifying selection. Epitope prediction detected several linear B and T cell epitopes with probable antigenicity within the envelope gene region. Interpretation and conclusions This study highlights the widespread dominance of the cosmopolitan genotype in Sri Lanka and underscores the role of air travel and human migration in viral transmission and global strain introduction. The presence of diversifying selection at two E gene sites alongside widespread purifying selection suggests evolutionary pressures on viral fitness. The identified B and T cell epitopes represent potential targets for universal vaccine development and therapeutic interventions.

53. Are HRP2/3 deletions silently crippling malaria rapid diagnostic tests?

期刊: The Indian journal of medical research 发表日期: 2026-Mar 链接: PubMed

摘要

Background and objectives The gold standard for diagnosing malaria is peripheral smear. Histidine-rich protein 2 (HRP2)-based rapid diagnostic tests (RDTs) are particularly used for P. falciparum (pf) infections. These tests are easily accessible and are simple to use. The rising incidence of pfhrp2 and pfhrp3 gene deletions has put malaria diagnostics through RDT kit at risk, leading to false-negative results that may affect patient management. Methods The search string used was: ‘pfhrp2’ OR ‘pfhrp3’ OR ‘HRP2’ OR ‘HRP3’ OR ‘hrp2/3’ AND ‘malaria’ OR ‘Plasmodium falciparum’ AND deletion OR ‘deletion rate’ OR prevalence OR ‘RDT failure’. A total of 148 studies were gathered from PubMed and Google scholar. After screening, a total of 28 published studies and the WHO documents were included. Results High rates of gene deletion have been reported, ranging from 2.4 to 57.8%, with low range in Chhattisgarh, India (3.8%) and Brazil (∼18.3% dual deletions), to extreme levels in Southern Ethiopia (57.8%). These deletions are believed to be the result due to the widespread use of HRP2-based RDTs. The diagnostic performance of RDTs considerably declines in regions where the WHO-recommended 5% threshold for deletion prevalence is exceeded. Surveillance techniques like PCR, whole-genome sequencing, and digital droplet PCR (ddPCR) are needed for effective detection and monitoring in these regions. Interpretation and conclusions The widespread and regional variation of pfhrp 2/3 gene deletions stance a serious challenge to malaria diagnosis using HRP-based RDTs. Alternatives to HRP-based tests in high-deletion areas and adopting novel diagnostic tools are essential for effective malaria detection and elimination strategies.

54. Procedures to implement the Supreme Court of India directives to withdraw/withhold life-sustaining medical treatment.

期刊: The Indian journal of medical research 发表日期: 2026-Mar 链接: PubMed

摘要

In 2018, the Supreme Court of India legally recognised the rights of patients with terminal illness through the judgement in Common Cause (A Registered Society) v. Union of India and Another, (2018) 5 SCC 1. The processes prescribed to withhold or withdraw artificial life-support medical treatments became practical after the 2023 amendment. The law aimed to ensure the dignified dying of sick individuals whose condition was deemed terminal and irreversible. Healthcare institutions can comply with the Court’s guidelines in their entirety only after the concerned State Governments activate specific processes. Karnataka state activated the legal mandates by early 2025. Using an implementation case study, we describe the institutional processes to uphold the ethical and legal mandates when withholding/withdrawing life-support treatment (WH/WD-LST) in a mentally incompetent, terminally ill elderly patient, admitted to a tertiary care hospital in Karnataka. It aims to clarify, (i) validation of ‘Advance-Medical-Directive’, or the living will; (ii) sequential institutional processes for WH/WD-LST as per ethical and legal mandates; (iii) constitution of the primary, secondary medical boards (PMB, SMB); (iv) reporting formats for PMB, SMB evaluations, and (v) the templates relevant to institutional administrators to convey the mandated details of WH/WD-LST to their jurisdictional judiciary magistrate of first class. The impressions and impact of activating the living will and WH/WD-LST on the family, on patient care, for the professionals, and for the institution are described in brief.

55. Use of health communication materials by health-care providers for health education in low- and middle-income countries: A scoping review.

期刊: PloS one 发表日期: 2026 链接: PubMed

摘要

Health communication materials (HCMs) are widely used to support health education and promotion activities in clinical and community settings. However, evidence regarding their use by healthcare providers in low- and middle-income countries (LMICs) remains inconsistent. This scoping review aims to systematically map and describe the existing literature on the utilization of health communication materials by healthcare providers in low- and middle-income countries (LMICs). This scoping review was conducted in accordance with the PRISMA-ScR reporting guideline and the Joanna Briggs Institute (JBI) framework for scoping reviews. The studies were searched from database inception to September 2025 using electronic databases (PubMed, ScienceDirect, Cochrane, and Hinari) were searched, and studies were selected based on predefined inclusion and exclusion criteria aligned with the Population-Concept-Context framework. Data extraction was performed using a standardized form, and findings were narratively synthesized spreadsheet by two independent reviewers. Findings were synthesized using descriptive numerical analysis and thematic analysis. A total of 728 records were identified. 715 were screened after removing duplicates. Following title/abstract and full-text review, 18 studies were included. HCMs, including printed, audiovisual, and electronic tools, were covered in these studies. NGO support, perceived utility, and material accessibility were facilitators, while organizational limitations, patient disengagement, limited availability, and inadequate training were major obstacles. The use of health communication materials by healthcare providers in LMICs is influenced by contextual, institutional, and individual factors. While HCMs are widely available in many settings, their use remains inconsistent and is influenced by systemic challenges. Strengthening accessibility, provider training, culturally appropriate content, and integration into routine care may support improved implementation.

56. Risk prediction of combined fibrinogen degradation products, thrombomodulin, and maximum amplitude for assessing association with venous thromboembolism in patients with post-traumatic fractures.

期刊: PloS one 发表日期: 2026 链接: PubMed

摘要

Venous thromboembolism (VTE) is a globally prevalent severe disease associated with high morbidity and mortality. Currently, thrombomodulin (TM), fibrinogen degradation product (FDP), thromboelastography have been the subject of several research pertaining to VTE; However, the combined diagnostic efficacy of these tests for VTE remains unclear. Therefore, we proposed to investigate the diagnostic efficacy of TM, FDP, thrombelastography in predicting VTE. The patients with traumatic fracture included in the study were divided into a VTE group (n = 44) and a control group (n = 56) based on imaging diagnosis. Spearman correlation was employed to analyze the relationship between coagulation-related markers and thromboelastography indices. Variables were analyzed using multifactorial logistic stepwise regression. Statistically significant indicators were included in the receiver operating characteristic curve to evaluate their diagnostic efficacy for VTE. The VTE group showed significantly higher levels of multiple coagulation-related parameters and thromboelastography indices compared to the control group. Specifically, D-dimer levels were 8.87 (4.77, 15.07) mg/L in the VTE group versus 2.36 (1.07, 5.73) mg/L in the control group (P < 0.001), and FDP levels were 36.45 (11.34, 73.75) μg/mL versus 7.96 (4.57, 12.73) μg/mL (P < 0.001). TM levels were also elevated in the VTE group at 11.74 (9.26, 13.27) TU/mL compared to 8.60 (7.20, 11.60) TU/mL in controls (P = 0.001). Among thromboelastography parameters, maximum amplitude (MA) was 72.06 ± 7.61 mm in the VTE group versus 67.03 ± 7.21 mm in controls (P = 0.001), and clot intensity (G) was 13,259.75 (9,346.48, 18,545.83) d/sc versus 9,659.70 (8,009.33, 13,480.40) d/sc (P = 0.004). Conversely, the blood clot formation rate was lower in the VTE group (1.25 [0.83, 1.40] vs. 1.30 [1.10, 1.58], P = 0.037). Linear correlation analysis revealed significant positive associations between platelet counts and both MA (r = 0.612, P < 0.001) and G (r = 0.588, P < 0.001). Multivariate logistic stepwise regression identified FDP (OR = 1.047, 95% CI: 1.025-1.070, P < 0.001), TM (OR = 1.215, 95% CI: 1.033-1.429, P = 0.019), and MA (OR = 1.104, 95% CI: 1.026-1.188, P = 0.008) as independent risk factors for VTE. ROC curve analysis demonstrated that the combined model of these three markers achieved the highest diagnostic efficacy, with an area under the curve (AUC) of 0.860 (95% CI: 0.789-0.931), sensitivity of 70.5%, and specificity of 85.7%. Combined testing of FDP, TM, and MA holds clinical significance for clinicians to early predict the risk of VTE in post-traumatic fracture patients and implement preventive measures.

57. Plasma-activated water: Mechanism and treatment duration for postharvest disease control and shelf-life enhancement of mango under ambient storage.

期刊: PloS one 发表日期: 2026 链接: PubMed

摘要

In Bangladesh, a large quantity of mango is lost every year due to post-harvest diseases, particularly anthracnose and stem-end rot. Therefore, sustainable post-harvest management is crucial for reducing the losses. In this study, we investigated the effects of plasma treatments on mango to mitigate post-harvest losses. The mangoes were submerged in distilled water (DW), and then DW-submerged mangos were treated for 10 minutes employing multi-capillary bubble discharged plasma jet system using air and oxygen gases separately. Plasma treatments significantly influenced disease incidence, severity, and physio-chemical properties of mangoes. On the 10th day, the Khirsapat mango, treated with a 10-minute air-discharge plasma, exhibited a significant (≤0.05) reduction in anthracnose incidence (20%) and severity (2.33%) compared with control (incidence 80% and severity 61.67%). Similarly, the 10-minute air-discharge plasma treatment consistently reduced the incidence (20%) and severity (15%) of stem-end rot. For the Fazlee variety, the incidence (22%) and severity (3.67%) of anthracnose were reduced compared with the control (89% and 56.67%), while stem-end rot was completely inhibited for up to 10 days under the 10-minute air-plasma treatment. In addition, both mango varieties showed increased total soluble solid (18% and 19%), retained good moisture content (77.82% and 85.34%), but reduced physiological weight loss (3.12% and 8.36%), and extended shelf life (6 days). Firmness degradation was lowest in air plasma treatment (4.20% in Khirsapat and 4% in Fazlee) compared to control (5.76% and 5.79%). It is interesting to note that the plasma treatment of both varieties showed higher mineral contents (K, Ca, Mg, and P), while Vit C declined modestly (16.0 and 25.10 mg/100g) compared to control. Therefore, a 10-minute air-discharge plasma treatment effectively reduced disease incidence and severity through enhancing TSS, mineral contents, physiological properties, and overall storage life that highlighting its potentiality as an eco-friendly postharvest technology.