公共卫生研究摘要 (2026-04-25)
共收录 58 篇研究文章
1. Value, Access, and High-Quality Medical Oncology Care: Can We Have It All?
期刊: American Society of Clinical Oncology educational book. American Society of Clinical Oncology. Annual Meeting 发表日期: 2026-Jun 链接: PubMed
摘要
Health systems, oncologists, and patients face a crisis in value of cancer care that has several components: interpretation of meaningful benefit, cost, and affordability that limits access to treatment and effective delivery of evidence-based care. Value in health care has several definitions but can be defined as benefit/cost, which can be explicitly measured using cost-effectiveness analyses and used to shape coverage decisions for health systems. In addition to drug costs, costs can also include physical costs (ie, clinical toxicities and harm), productivity losses (from inability to work because of treatment effects), and time away from family and friends. Low-value treatments include those that offer limited clinical benefit and score poorly on scales such as the European Society of Medical Oncology Magnitude of Clinical Benefit Scale and the overuse, misuse, or underuse of therapies that provide clinical benefit. Opportunity costs are what is given up when one intervention is chosen over another. Opportunity costs of low-value care translate into patient and societal harm and limit access to more effective treatments. Solutions to the value crisis require recognition of low-value care and quality improvement programs to prevent its use and support high-level care. Drug substitution and dose and schedule reduction when supported by evidence can also improve the value of care.
2. Tech That Scales: A Practical Framework for Artificial Intelligence-Enabled Cancer Care in Low- and Middle-Income Countries and Underserved US Counties.
期刊: American Society of Clinical Oncology educational book. American Society of Clinical Oncology. Annual Meeting 发表日期: 2026-Jun 链接: PubMed
摘要
Cancer outcomes remain starkly unequal: 5-year survival rates for common malignancies in low- and middle-income countries (LMICs) often lag 20-40 percentage points behind high-income benchmarks, and similar disparities persist between well-resourced metropolitan centers and rural or safety-net settings within high-income countries. The gap is driven less by the absence of effective interventions than by workforce shortages, fragmented referral pathways, limited infrastructure, and loss to follow-up after abnormal screens. Technologies that scale must therefore function as deployable workflows integrating staffing, logistics, quality assurance (QA), governance, and monitoring not merely as stand-alone algorithms or devices.1 This review synthesizes evidence across four complementary technology families that address these constraints across the continuum of care: artificial intelligence (AI)-supported screening and triage as the population entry-point layer; Project ECHO telementoring as the workforce-capacity layer; electronic patient-reported outcomes and remote symptom monitoring as the longitudinal continuity layer; and AI-powered clinical trial prescreening hubs as the access-to-innovation layer. The technologies do not carry equal evidentiary weight, and they should not be deployed identically in every setting. Our aim is to show how oncology leaders can sequence them pragmatically inside a common operating logic while adapting to local infrastructure and governance. We organize the framework in patient journey order entry into care through screening, workforce support through telementoring, continuity through remote monitoring, and access to innovation through trial prescreening, and draw examples from both LMIC programs and underserved US settings. We therefore present a practical implementation playbook, including a 90-day launch checklist, staffing models, QA frameworks, equity and bias monitoring metrics, and a program outcomes dashboard designed for oncology leaders seeking to move beyond pilots toward durable, monitored deployment.
3. Evaluation of a Multidimensional Occupational Therapy Environmental Checklist for People Experiencing Delirium During Hospital Admission: A Quasi-Experimental Study.
期刊: Australasian journal on ageing 发表日期: 2026-Jun 链接: PubMed
摘要
Delirium, an acute medical emergency, significantly impacts older adults, increasing morbidity, mortality and healthcare costs (estimated at $8.8 billion annually in Australia). Environmental modifications in hospital wards are underexplored despite their potential to mitigate delirium’s effects. This study evaluated a multidimensional occupational therapy environmental checklist’s impact on functional and service outcomes for hospitalised delirium patients compared to standard care. A quasi-experimental design was employed, collecting pre- and post-intervention data from 100 electronic medical records (50 comparison, 50 intervention) on a Geriatric Evaluation and Management ward in Melbourne, Australia. The checklist, implemented by occupational therapists and allied health assistants, targeted orientation, object accessibility, daily routines and safety. Outcomes included length of stay, adverse events (e.g., falls, pressure injuries) and Functional Independence Measure (FIM) scores. Descriptive statistics, t-tests and χ2 tests were conducted using SPSS Statistics 28 (p < 0.05). The intervention group showed a 27% reduction in total adverse events (comparison: n = 37; intervention: n = 27) and significantly higher FIM scores at discharge (motor: t = -2.38, p = 0.02; cognitive: t = -2.62, p = 0.01; total: t = -3.24, p < 0.001). However, length of stay (comparison: M = 28.2 days; intervention: M = 29.36 days; t = -0.20, p = 0.84) and adverse event rates (χ2 = 1.48, p = 0.22) did not differ significantly. The intervention group had a higher fall admission rate (36% vs. 2%; χ2 = 20.38, p < 0.001). The checklist enhances functional recovery in older adults with delirium, reducing adverse events. Larger, multi-site studies are needed to confirm efficacy and generalisability, supporting occupational therapy’s role in delirium management.
4. IgD from atypical-like memory B cells and plasma cells targets commensal and environmental antigens.
期刊: The Journal of experimental medicine 发表日期: 2026-May-04 链接: PubMed
摘要
Human tonsils from the nasopharyngeal mucosa mount frontline antibody responses, including IgD secretion by IgD+IgM- plasma cells (IgD-PCs). The developmental origins and functional significance of these IgD responses remain poorly understood. Here, we show that most IgD-PCs clonally emerge from a heterogeneous population of IgD class-switched IgD+IgM- memory (IgD-ME) B cells that reside within the epithelial, subepithelial, and interfollicular areas of the nasopharyngeal mucosa and share transcriptional and phenotypic properties with atypical B cells. These IgD-ME B cells arise from a mutation-intensive pathway that involves integrated innate and adaptive signals and engenders reactivities to respiratory commensal bacteria, common environmental antigens, and allergens. Such reactivities weaken in germline IgD revertants. Thus, the secreted IgD response heavily relies on nasopharyngeal mucosal IgD-ME B cells via a germinal center-imprinted mutational program that presumably enhances mucosal homeostasis and environmental tolerance.
5. Bluetongue Virus in Cervids in Piedmont During the 2024-2025 Outbreak.
期刊: Veterinary medicine and science 发表日期: 2026-May 链接: PubMed
摘要
The mid-end of 2024 witnessed a significant outbreak of bluetongue virus (BTV) in the Piedmont region of Italy, affecting a wide range of species including domestic ruminants and wild cervids. From the beginning of August 2024 to the end of March 2025, 1081 samples were confirmed positive for BTV, of which 1066 were from routinely monitored domestic species (632 from sheep, 405 from cattle, 23 from goats, one from a camel, four from alpacas and one from yak across 687 outbreak sites), while 15 were collected from cervids. This report focuses on the identification of the 15 cases of BTV in red deer and fallow deer during this outbreak; all animals were harvested throughout hunting sessions, and spleen samples were analysed to detect the virus by real-time RT-PCR. The study describes the detection of BTV-8 in wild ruminants, in Piedmont, amid the 2024 outbreak and explores the broader implications of BTV transmission dynamics in wildlife populations together with its potential impact on livestock. Continued surveillance in both wildlife and domestic species along with a more integrated approach to managing BTV outbreaks will be essential in the future.
6. A Systematic Review and Meta-Analysis on Campylobacter Species Prevalence in Chicken in Italy.
期刊: Veterinary medicine and science 发表日期: 2026-May 链接: PubMed
摘要
Campylobacter is responsible for campylobacteriosis, the most reported foodborne gastrointestinal infection in humans in the European Union, and broiler meat was the food primarily associated with outbreaks with stronger evidence. This study aimed to revise the literature and estimate the pooled prevalence of Campylobacter spp. in three different chicken matrices in Italy from 2003 to 2023, as well as potential subgroup moderators to the observed value. The total number of eligible studies was 48. On the basis of the meta-analysis, skin and faeces matrices exhibited a high pooled proportion of Campylobacter spp., 0.62 and 0.67, respectively, whereas meat had the lowest proportion of 0.20%, with high heterogeneity detected in the three matrices I2 = 97.5%-98.8%. As for the moderator subgroup analysis, Campylobacter spp. prevalence in meat was higher in the published literature (0.38) than in the national zoonoses country reports (0.10), whereas no significant difference was observed for skin matrix (p-value = 0.6). Moreover, Campylobacter spp. prevalence in the meat matrix was two times more in samples collected at the slaughterhouse step than those collected at the retail step (pvalue < 0.05). In the case of faeces, no significant differences (p-value > 0.5) were detected comparing sampling point (farm or slaughterhouse) and sample types (cloacal or caecal content). This result highlights that Campylobacter spp. is frequently inhabits the intestines of chickens, and it is detectable with a comparable frequency on the skin following the slaughtering process. Moreover, not only Campylobacter spp. persist along the food chain but also cross-contamination occurring after the primary production steps can determine a relevant prevalence of the microorganism in meat sold at retail in Italy. The outcome of this meta-analysis could be beneficial as input for future quantitative risk assessment. SUMMARY: This systematic review summarizes the prevalence of Campylobacter spp. in different chicken matrices in Italy over the last 20 years, which may be useful for conducting quantitative microbial risk assessment (QMRA) in the future. Higher Campylobacter spp. prevalence rate was observed in faeces (67%) and skin (62%) compared to the meat matrix (20%), suggesting frequent cross-contamination events during slaughtering, processing and handling. The result showed that Campylobacter spp. are isolated from meat at retail (10%) and most of them belong to pathogenic species for the consumers.
7. The Role of Nurses in Alcohol and Substance Use Disorder Treatment: A Scientific Analysis of Global Research Activities.
期刊: Journal of psychosocial nursing and mental health services 发表日期: 2026-Apr-28 链接: PubMed
摘要
To examine the quantitative and qualitative characteristics of publications on alcohol and substance use disorders in the field of nursing as well as the roles of nurses in this context from a bibliometric perspective. The Web of Science database was used for this study. Bibliometric analysis was used to determine the scope of knowledge in a specific field and to measure productivity. Data were collected by searching with the keyword combination “alcohol” OR “substance” OR “drugs” OR “narcotics” OR “cocaine” AND “addiction,” covering studies published up to June 20, 2025, the date of the study, without any time limitation. The data search identified 721 alcohol and substance addiction research and review articles conducted in the field of nursing between 1989 and 2025, and the process was completed using 643 studies in accordance with the exclusion criteria. The analysis revealed that 2,083 authors contributed to the publications, including 596 research articles and 47 reviews/systematic reviews, and each publication received an average of 8.7 citations. Findings highlight the critical need for ongoing research, policy development, and practical interventions to ensure the safety and well-being of nurses and individuals with addiction in mental health settings, and progress has been made in understanding and addressing the roles of nurses regarding alcohol and substance dependence.
8. Predictors of Posttraumatic Growth in Individuals With a Parent With Chronic Mental Illness: Personal Characteristics, Resilience, Life Orientation, and Sense of Family Cohesion.
期刊: Journal of psychosocial nursing and mental health services 发表日期: 2026-Apr-28 链接: PubMed
摘要
To examine variables that predict posttraumatic growth (PTG) in individuals with parents with chronic mental illness. The current cross-sectional study included 87 individuals whose parents were registered patients at the community mental health center of a training and research hospital in Kocaeli, Türkiye. Data were collected using a Demographic Information Form, the Posttraumatic Growth Inventory, Resilience Scale for Adults, Life Orientation Test, and Family Sense of Cohesion Scale. Life orientation and family sense of cohesion were determined to be variables that significantly predicted PTG among participants. PTG was significantly influenced by life orientation and family sense of cohesion. Providing psychosocial support to individuals with parents with chronic mental illness from early childhood onward is crucial for preventive mental health.
9. Positive Psychology Intervention Effects on Emotions and Well-Being in Depression: A Systematic Review and Meta-Analysis.
期刊: Journal of psychosocial nursing and mental health services 发表日期: 2026-Apr-28 链接: PubMed
摘要
The current systematic review and meta-analysis evaluated the effectiveness of positive psychology intervention (PPI) on emotional well-being and depression in adults. The objective was to assess whether PPI improves happiness, life satisfaction, and psychological well-being, and whether it serves as a viable alternative to standard or no treatment in managing depression. A systematic search was conducted in five electronic databases. Seventeen randomized controlled trials involving 2,579 participants were included. Standardized mean difference (SMD) or mean difference (MD) with 95% confidence intervals (CIs) were calculated. PPI significantly improved happiness (SMD = 0.25; 95% CI [0.06, 0.43]), positive affect (MD = 2.41; 95% CI [0.27, 4.54]), life satisfaction (MD = 2.18; 95% CI [0.81, 3.54]), and environmental mastery (SMD = 0.28; 95% CI [0.02, 0.54]). Depression scores showed no significant change (SMD = -0.27; 95% CI [-0.61, 0.08]). PPI enhances positive mental health indicators, including happiness, positive affect, and well-being, but has limited effect on depression severity. PPI may serve as a complementary tool alongside standard treatment.
10. Author's Reply: Conceptual Confusion about "Processed" Meat.
期刊: Nutrition reviews 发表日期: 2026-Apr-24 链接: PubMed
摘要
11. Trauma Patient Survival Times in a Resource-Limited South African Trauma System: Implications for Combat Casualty Evacuation Timelines.
期刊: Military medicine 发表日期: 2026-Apr-24 链接: PubMed
摘要
Future United States military conflicts may involve near-peer adversaries and large-scale combat operations resulting in mass casualties with delayed evacuation. Health service support planning for such conflicts will require data informing patterns of survival among injured combatants. We determined the probability of survival to 24 hours post injury for trauma patients with blunt or penetrating non-compressible torso hemorrhage (NCTH) in a relatively resource-constrained environment. We hypothesized that the conditional probability of 24-hour survival would rise with survival to intermediary timepoints of progressively increasing duration. This secondary analysis of trauma patients treated in South Africa’s Western Cape leveraged data collected during the Epidemiology and Outcomes of Prolonged Trauma Care (EpiC) study. EpiC captures data from point-of-injury through either hospital discharge or patient death. Patients must survive to reach ambulance or facility care to be included in EpiC. Inclusion criteria for this analysis included patients with NCTH, defined as an abbreviated injury scale (AIS) severity score of 2+ in the chest, abdomen, and/or pelvis body regions without AIS 3+ in any other body region. The primary outcome was survival at 24 hours post injury. We considered intermediary timepoints at: 1, 2, 3, 6, 12, and 18 hours post injury. We calculated unadjusted conditional Kaplan-Meier curves, visually describing crude overall 24-hour survival trajectories conditional on survival to the prespecified set of intermediary timepoints. To adjust for potential confounding, we generated an adjusted 24-hour survival curve using a Cox proportional hazards model adjusting for age, sex, new injury severity score (NISS), and triage early warning score (TEWS). Using the adjusted survival curve, we estimated conditional probabilities of 24-hour survival given survival to each of the intermediary timepoints individually. We plotted the linear trend line of conditional 24-hour survival probability versus intermediary timepoints, using segmented regression trendlines to account for changes in the relationship. We included 2,685 patients: 111 (4.1%) died within 24 hours. Survival probability estimates consistently demonstrated that survival to intermediary timepoints of increasing duration was associated with higher probability of 24-hour survival. An inflection point in 24-hour survival trajectory occurred at 3.6 (95% CI: 2.8-4.3) hours. For every hour that a patient survived up to the first 3.6 hours after injury, the probability of 24-hour survival increased by 0.53% (95% CI: 0.38%-0.69%). For every additional hour of survival after 3.6 hours and before 24 hours post injury, the probability of 24-hour survival increased by 0.07% (95% CI: 0.05%-0.10%). Among civilian patients with blunt force injury or penetrating NCTH injuries who survived to ambulance retrieval (role 1 equivalent) or health facility (role 2 equivalent), the overall 24-hour mortality was 4.1%. Conditional survival probability estimates consistently demonstrated that survival to intermediary timepoints of increasing duration was associated with higher probability of 24-hour survival. We identified 3.6 hours from time of injury as a threshold beyond which patients derive relatively less additional 24-hour survival benefit progression to subsequent intermediate time points. Military medical doctrine should acknowledge increased risk of casualty deaths when evacuation timelines exceed three and a half hours.
12. Conceptual Confusion About "Processed Meat".
期刊: Nutrition reviews 发表日期: 2026-Apr-24 链接: PubMed
摘要
13. Editorial. Intraoperative neuromonitoring for intramedullary spinal cord tumors: are we asking the right questions?
期刊: Journal of neurosurgery. Spine 发表日期: 2026-Apr-24 链接: PubMed
摘要
14. Surgical management of myelomeningocele in low-income and lower-middle-income countries: a systematic review.
期刊: Journal of neurosurgery. Pediatrics 发表日期: 2026-Apr-24 链接: PubMed
摘要
Myelomeningocele (MMC) is one of the most severe forms of a neural tube defect, resulting in lifelong disability for children and their families. The lowest-income countries are thought to carry the highest burden of disease and have the greatest disparities in national folic acid fortification policies. Despite carrying the greatest burden, the surgical management and patient-related outcomes of MMC in these countries have not yet been described. The objective of this systematic review was to summarize clinical outcomes following surgical MMC closure among patients in the lowest-income countries, and to compare these findings with country-level preventative measures that improve patient outcomes. Seven databases (PubMed MEDLINE, Embase, Scopus, Web of Science, Global Index Medicus, Latin American and Caribbean Health Science Literature, and Scientific Electronic Library Online) were searched from inception to June 2024 according to a priori study criteria. Inclusion criteria were studies that 1) were published in or translated into the English language, 2) had the full text available, 3) reported on surgical closure of MMC in a lower-middle-income country (LMIC) or low-income country (LIC), and 4) provided surgical outcomes. The proportion or risk of each outcome was estimated using disaggregated data from each paper. The findings were then compared to the national folic acid fortification policy status. Of 4640 studies, 27 met the inclusion criteria. Twelve of 80 (15%) LICs and LMICs reported postoperative outcomes for a total of 2967 patients who underwent postnatal surgery. The median age at surgery was 21 days (IQR 16-77 days). The median overall complication rate was 13% (IQR 8%-21%). Frequent 30-day postoperative complications included infection (median 16%, IQR 8%-24%), CSF leakage (median 12%, IQR 6%-18%), and wound dehiscence (median 8%, IQR 4%-17%). The median rate of any hydrocephalus was 64% (IQR 34%-77%). The median 30-day postoperative mortality rate was 9% (IQR 3%-9%), and the rates for 1-year, 5-year, and 10-year mortality were 17%, 29%, and 43%, respectively. The most commonly reported functional outcomes were ambulatory status and bladder function. In the lowest-income countries, among published studies all MMC closures occurred postnatally with delayed timing to surgical intervention, resulting in a higher risk of complications and mortality. Data regarding postoperative MMC outcomes were published for only 15% of LICs and LMICs. Global priorities should focus on identifying the highest-risk populations to prevent and effectively treat MMC.
15. Evaluation of School Health Policies and Practices in Brazil and Portugal: Protocol for Mixed Methods Research.
期刊: JMIR research protocols 发表日期: 2026-Apr-24 链接: PubMed
摘要
School health policies and practices are key components of health promotion for children and adolescents and play a central role in shaping healthy school environments, reducing health inequities, and fostering intersectoral collaboration between education and health systems. Despite their relevance, systematic and comparable assessments of how these policies and practices are implemented across different national contexts remain limited, particularly in low- and middle-income countries. Internationally comparable data are essential to identify strengths, gaps, and priorities for investment in school health. The aim of this study is to describe the protocol of a mixed methods study evaluating and comparing school health policies and practices in Brazil and Portugal. An explanatory sequential mixed methods design (QUAN → qual → [qual] → [qual]) will be adopted. The quantitative phase (phase I) consists of a cross-sectional survey conducted with school administrators using the Global School Health Policies and Practices Survey, which assesses multiple domains of school health policies, coordination, services, and practices. Quantitative findings will inform the subsequent qualitative phases. Phase II involves semistructured interviews with school principals or head teachers to explore institutional decision-making and policy implementation. Phase III includes interviews with school nurses to examine health service organization, intersectoral collaboration, and professional practices. Phase IV comprises participatory research with adolescents using the photovoice technique to capture youths’ perspectives on school health environments and practices. The study will be conducted in elementary and secondary schools and related health services in selected cities in Brazil and Portugal. Data integration will occur sequentially through connected analyses and joint displays, enabling the development of meta-inferences that link quantitative patterns with qualitative explanations. The study has secured funding from 2 funding agencies, with project activities initiated in 2025. Quantitative data collection and analysis began in October 2025 in the city of Cuiabá, Brazil. The expansion of data collection to additional Brazilian and Portuguese cities is planned for the first half of 2026. The qualitative phases, including interviews and photovoice activities, are scheduled to take place throughout 2026. The final integrated mixed methods analysis and manuscript preparation are planned for 2027, with dissemination of findings through peer-reviewed journals and national and international scientific conferences by the end of the project cycle. This study is expected to generate context-sensitive and comparative evidence to support intersectoral actions and inform the development and strengthening of school health promotion policies and practices in different national settings.
16. An Exploratory Content Analysis of Alcohol-Related Posts on Social Media by Influencers in India: Implications for Public Health in Low and Middle-Income Countries.
期刊: Journal of studies on alcohol and drugs 发表日期: 2026-Apr-24 链接: PubMed
摘要
Social media influencers significantly shape alcohol consumption norms, particularly in Low and Middle-Income Countries (LMICs) where regulatory frameworks lag behind digital marketing innovations. This study analyzed alcohol-related content posted by social media influencers in India. Thematic content analysis was conducted on 3,442 alcohol-related posts from 50 influencer accounts on Instagram and Facebook over 5 months (January-May 2025). A hybrid deductive-inductive approach identified underlying narratives and implicit meanings beyond surface-level coding. Five major themes emerged: (1) Alcohol as Social Capital and Lifestyle Enhancement, (2) Cultural Integration and Normalization, (3) Aspirational Consumption and Peer Influence, (4) Commercial Disguise and Transparency Deficit, and (5) Gender-Specific Targeting and Regional Concentration. Foreign brands dominated content (65%), with whiskey most featured (32.0%). High engagement patterns (maximum: 487,251 likes) revealed strong audience resonance with lifestyle-aspirational content, while 86% of influencers failed to disclose commercial partnerships. Social media influencers construct sophisticated narratives positioning alcohol as integral to social success and aspirational lifestyles. These marketing strategies extend beyond product promotion to embed alcohol consumption within fundamental social needs, representing significant public health concerns in LMICs with underdeveloped digital regulatory frameworks.
17. Active shooter training in university settings: a call for disability inclusive protocols.
期刊: Journal of American college health : J of ACH 发表日期: 2026-Apr-24 链接: PubMed
摘要
In a climate where fear of on campus shootings is high, universities often provide active shooter training. However, these trainings are often inherently ableist and largely ignore the needs of disabled people. Many universities offer these trainings under the umbrella of “Run, Hide, Fight.” The foundational steps of the training imply elements of individual physical ability and does not directly indicate actions to be taken by disabled individuals. The purpose of this commentary is to describe current active shooter training practices in higher education and call for revised protocols that are inclusive of disabled people.
18. Persistence-Dependent Effectiveness of Tirzepatide on the Cardio-Metabolic-Kidney Syndrome Outcomes in Obesity: Real-World Evidence from the United Arab Emirates.
期刊: Diabetes therapy : research, treatment and education of diabetes and related disorders 发表日期: 2026-Apr-24 链接: PubMed
摘要
Tirzepatide has been associated with significant reductions in body weight in randomized clinical trials. However, real-world evidence evaluating the multisystemic effects of tirzepatide across the cardio-metabolic-kidney (CKM) continuum remains limited. The aim of this study was to assess the real-world persistence-driven cumulative benefits of tirzepatide beyond weight reduction in adults with obesity but without type 2 diabetes mellitus (T2DM). This single-center observational cohort study evaluated in the United Arab Emirates adults with obesity (body mass index [BMI] ≥ 30 kg/m2) treated with tirzepatide. Participants were stratified by treatment persistence: ≤ 1 year (short-term) and > 1 year (long-term). Anthropometric, glycemic, lipid, hepatic, and renal outcomes were assessed at baseline and follow-up. One hundred participants (25 women; mean age 37.6 ± 10.0 years; baseline BMI 35.0 [33.0-39.0] kg/m2) were included. Median weight reduction was - 8.1% in the short-term group and - 22.6% in the long-term group (p < 0.001). 62% of long-term treated individuals achieved > 15% weight loss versus 20% among short-term users. Significant between-group differences were observed in BMI (- 8.3% vs. - 19.1%), waist circumference (- 4.0% vs. - 9.2%), and glycated hemoglobin (HbA1c) (- 5.0% vs. - 7.2%). Total cholesterol decreased by - 10.1% vs. - 18.7% (p = 0.005), low-density lipoprotein cholesterol (LDL-C) by - 9.6% vs. - 30.5% (p < 0.001), and triglycerides by - 11.2% vs. - 32.5% (p < 0.001). Liver enzymes, aspartate aminotransferase (SGOT) and alanine aminotransferase (SGPT) declined by - 11.3% and - 13.2%, respectively, in long term group with no significant improvement in short term group (between-groups p values for both liver enzymes < 0.05). Serum creatinine declined significantly in the long-term group (- 6.6%, p < 0.001), estimated glomerular filtration rate (eGFR) increasing by + 3.2% (p = 0.001), and blood urea nitrogen (BUN) decreasing by - 7.8% (p = 0.006) while microalbuminuria showed no meaningful changes. Weight loss correlated with improvements in LDL-C, triglycerides, and SGOT, and inversely with high-density lipoprotein cholesterol (HDL-C) changes. Tirzepatide showed greater cumulative benefits across CKM syndrome outcomes during the second treatment year, highlighting the need to overcome adherence barriers in real-world settings.
19. Altered astrocyte-neuron crosstalk in progressive supranuclear palsy: integrated evidence from proteomics and magnetic resonance spectroscopy.
期刊: Acta neuropathologica 发表日期: 2026-Apr-24 链接: PubMed
摘要
The anterior cingulate cortex (ACC), crucial for executive function, is frequently impaired in progressive supranuclear palsy (PSP), yet mechanisms underlying this selective vulnerability remain unclear. Given the integration of astrocytes into neural circuits, we hypothesized that astrocyte dysfunction and altered astrocyte-neuron crosstalk contribute to functional abnormalities in the ACC in PSP. To test this hypothesis, we conducted a multimodal analysis integrating SWATH-MS-based proteomics, histopathology, and in vivo magnetic resonance spectroscopy (MRS) in postmortem and living brains of patients with PSP and healthy controls (HCs). The astrocytic markers glial fibrillary acidic protein (GFAP) and aquaporin-4 (AQP4) were significantly elevated in the ACC of patients with PSP compared with those in HCs. Enhanced astrocytic Ca2⁺ signaling through the IP3-Ca2⁺ cascade was suggested in the ACC of patients with PSP, consistent with elevated myo-inositol levels on MRS. Proteomic data revealed reduced expression of pyruvate dehydrogenase complex components (DLD and PDHX) and oxidative phosphorylation-related proteins, including astrocyte-enriched genes such as ETFDH and UQCRC1. MRS also revealed significantly increased levels of lactate and glutamate in the ACC of patients with PSP compared with those in HCs. Notably, myo-inositol, lactate, and glutamate levels were positively correlated, indicating astrocyte-associated metabolic dysfunction. Expression of glutamate-glutamine cycle-related molecules and neuronal markers was negatively correlated with GFAP and AQP4 levels, suggesting that astrocytic dysfunction is associated with alterations in the excitatory/inhibitory balance in the ACC of patients with PSP. These findings demonstrate that multiple aspects of astrocyte-neuron crosstalk, including AQP4-mediated glymphatic clearance, energy metabolism, and neurotransmitter cycling, are altered in the ACC of patients with PSP. Such disruptions may contribute to neuronal dysfunction. Our study highlights astrocyte dysfunction as a central feature of the PSP pathophysiology.
20. Peripheral Artery Disease Burden in Different Development Regions: Based on GBD 2021.
期刊: Vascular and endovascular surgery 发表日期: 2026-Apr-24 链接: PubMed
摘要
BackgroundPeripheral artery disease (PAD) is a major global health problem with marked regional disparities. Updated estimates are needed to better characterize these differences and inform priority-setting in prevention and management.MethodsUsing GBD 2021 data, we estimated PAD prevalence, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life years (DALYs) in High-income North America (HINA), the Caribbean, and Sub-Saharan Africa (SSA). Outcomes were reported as counts, crude rates, and age-standardized rates (ASRs), with stratification by sex, socio-demographic index (SDI), and age. Temporal trends from 1990 to 2021 and risk factor-attributable DALYs were also assessed.ResultsFrom 1990 to 2021, PAD cases increased by 72% in HINA, 127% in the Caribbean, and 137% in SSA, while DALYs increased by 84%, 168%, and 203%, respectively. Prevalence and DALY ASRs declined slightly in HINA, increased moderately in the Caribbean, and rose more markedly in SSA. Women showed higher prevalence and YLD burden, whereas men had higher YLL and mortality. Tobacco use and high fasting plasma glucose contributed more prominently to the attributable burden in HINA and the Caribbean, whereas high systolic blood pressure and kidney dysfunction were more prominent in SSA. PAD burden increased substantially after age 60 and peaked in the oldest age groups.ConclusionPAD burden continues to rise, with SSA showing the least favorable age-standardized trends. These findings highlight substantial regional heterogeneity and may help identify priorities for earlier detection, risk-factor control, and long-term PAD management, particularly in lower-resource settings.
21. Prion shedding is reduced by chronic wasting disease vaccination.
期刊: PLoS pathogens 发表日期: 2026-Apr-24 链接: PubMed
摘要
Chronic wasting disease (CWD) is a strictly fatal and highly contagious prion disease of wild and farmed cervids currently expanding in North America. Prion diseases are caused by conversion of the cellular prion protein to its pathological isoform PrPSc. Vaccination is considered a promising strategy to contain CWD, even though prion diseases do not show classical immune responses. For CWD containment, it is important that vaccines reduce shedding of prions in excreta, a major contributor to transmission. Here, we tested the effect of vaccines on prion shedding in feces and urine by vaccinating and prion infecting knock-in mice that recapitulate CWD pathogenesis as found in cervids. Vaccination reduced or even prevented CWD shedding in feces and urine collected between 30-90% of incubation time to disease. This is the first report showing that prion shedding can be blocked in a prion disease. For CWD specifically it may reduce the environmental prion burden and break the disease transmission cycle.
22. Effect of a WeChat Intervention Based on the Common-Sense Model on Breast Cancer-Related Lymphedema Preventive Behaviors: Quasi-Experimental Study.
期刊: JMIR formative research 发表日期: 2026-Apr-24 链接: PubMed
摘要
Breast cancer-related lymphedema is the most prevalent postoperative complication among breast cancer survivors. Although mobile health tools are increasingly used for patient education, evidence supporting their efficacy in lymphedema prevention remains limited. This study aimed to evaluate the effectiveness of a WeChat-based intervention grounded in the common-sense model (CSM) in improving preventive behaviors, modifying illness perceptions, and reducing lymphedema incidence among breast cancer survivors and to validate the targets of the intervention. This study used a quasi-experimental design. Participants (N=192) were recruited from the breast cancer department of a cancer hospital in Guangzhou, China. The control group (n=98) received routine care. The intervention group (n=94) participated in a 3-month CSM-guided WeChat mini-program (“Nantian e-Care”) delivering tailored educational articles, exercise tutorials, arm circumference monitoring, and real-time nurse consultations. Outcomes, including preventive behaviors, illness perceptions, and lymphedema incidence, were assessed 1, 3, and 6 months post surgery. Generalized estimating equations were used for the analysis. The intervention group exhibited significant improvements in lifestyle adjustments (Wald χ22=6.9, P=.03) and physical exercise adherence (Wald χ22=6.9, P=.03) compared with the control group. Illness perception, including identity (Wald χ23=8.1, P=.04), timeline cyclical (Wald χ23=8.5, P=.04), personal control (Wald χ23=9.3, P=.03), illness coherence (Wald χ23=29.8, P<.001), and behavioral (Wald χ23=19.5, P<.001) and physical factors (Wald χ23=24.1, P<.001) were markedly enhanced. Mechanistically, skin care improvements were driven by intervention effects, personal control, illness coherence, and behavioral attribution. Lifestyle changes were correlated with intervention and illness coherence. Adherence to physical exercise was not statistically significantly affected by the intervention, although a trend was observed. Critically, the intervention group demonstrated a lower incidence of lymphedema at 6 months (7.50% vs 16.48%, χ21=3.9, P=.048). The CSM-guided WeChat intervention effectively promoted preventive behaviors, optimized illness perceptions, and reduced lymphedema risk. These findings underscore the value of integrating theory-driven mobile health tools into postoperative care and highlight scalable strategies for chronic disease management in resource-limited settings.
23. The Role of Perfluorinated Acyl Fluoride Hydrolysis in Regional-Scale Model Predictions of Per- and Polyfluoralkyl Substance (PFAS) Chemistry, Transport, and Fate.
期刊: Environmental science & technology 发表日期: 2026-Apr-24 链接: PubMed
摘要
Per- and polyfluoroalkyl substances (PFAS) have been released into the environment for decades and are a concern for human and environmental health. PFAS are considered largely inert, but studies show that some PFAS can undergo chemical reactions that can impact their environmental behavior. In this work, the hydrolysis in particle and cloud water of three perfluorinated acyl fluorides, an important class of emissions from a global manufacturer, to perfluorinated carboxylic acids is added into a PFAS atmospheric model built upon the Community Multiscale Air Quality model (CMAQ-PFAS). Nearly all of the hydrolysis is predicted to proceed in the clouds, with minimal occurrence in particles. Henry’s law constants increase by three or more orders of magnitude when acyl fluorides hydrolyze into carboxylic acids, increasing the predicted domain-wide annual deposition for these compounds. A larger relative increase in deposition is observed further from the facility, although predicted deposition 110 km away from the facility is lower than measurements by a factor of ∼20 or more. The reasons for this underprediction are discussed, and future research needs to better simulate and understand PFAS in the atmosphere are proposed.
24. Best Practices in GC-MS and GC × GC-MS-Based Metabolomics and Volatile Analyses: An International Survey.
期刊: Analytical chemistry 发表日期: 2026-Apr-24 链接: PubMed
摘要
Standardized quality assurance and quality control (QA/QC) practices are essential for reproducible GC-MS metabolomics, yet systematic documentation of current laboratory practices has been lacking. Here, as part of the Metabolomic Quality Assurance and Quality Control Consortium (mQACC), we surveyed 85 laboratories from 27 countries to characterize QA/QC implementation and establish evidence-based recommendations. Respondents represented diverse applications, with 79% performing untargeted analysis, 60% conducting targeted analyses, and 44% conducting both. While single column chromatography is clearly the norm, 24% of the participants used multidimensional chromatography to improve the separation of complex mixtures. Electron ionization with autotuning dominated >95% of the respondents, but more than 30% of the laboratories at least occasionally also used chemical ionization. While most laboratories used low-resolution mass spectrometers, almost half of the laboratories also performed GC-MS analyses on high-resolution QTOF or Orbitrap instruments. A strong consensus emerged on critical QA/QC practices: >90% of laboratories use internal standards for quality control, perform regular leak checks, and maintain injector systems through routine component replacement, spanning column (exchange/cuts), liners, syringes, and septa. Routine monitoring (>50%) involves method blanks, peak shape assessments, and systematic evaluation of intensity drifts, carryovers, and contamination. Retention indices coupled with mass spectral library matching served as the primary annotation approach (60%). Overall, a consensus of best practices in QA/QC and reporting emerged, providing evidence-based recommendations for high-quality GC-MS metabolomics.
25. Partially Replacing Animal-Based Protein Foods With Plant-Based Protein Foods: A Systematic Review of Randomized Controlled Trials in Healthy Adults.
期刊: Nutrition reviews 发表日期: 2026-Apr-24 链接: PubMed
摘要
Increasing our intake of plant-based protein may help improve both population and planetary health. A systematic synthesis of randomized controlled trials is needed to clarify evidence on the effects of increased plant-based protein intake. To evaluate the effects of partially replacing animal-based protein with plant-based protein in healthy adult cohorts for any outcome. On December 5, 2024, 3 databases were searched (PubMed, Cochrane, Embase). Articles were included for evaluation if the partial replacement of animal-based protein with plant-based sources was assessed for any outcome in a healthy adult cohort (mean or median age between 18 and 65 years) in a randomized controlled trial. Articles were screened at title, abstract, and full-text levels independently by 2 researchers. Results were extracted and synthesized. Risk of bias was assessed using the Cochrane Risk-of-Bias tool, version 2.0. Four dietary interventions reported in 7 articles were included in the final analysis. Three articles obtained a low risk-of-bias result, and the remaining 4 were identified to have “some concerns.” Vitamin B12 status was reduced significantly in those consuming diets with the highest proportion of plant-based protein, whereas the status of other micronutrients (specifically, folate, iron, and vitamin D) was not affected. Mixed evidence was reported on the impact on bone and mineral metabolism. Improvements in cardiovascular risk biomarkers (low-density lipoprotein cholesterol, total cholesterol, and body weight) were observed in those consuming higher proportions of plant-based protein. One study reported that the diet with reduced meat also was associated with reduced estimated greenhouse gas emissions. Replacing animal protein with some plant-based sources may improve certain biomarkers of cardiovascular disease risk and reduce the environmental impact of dietary intake. Mixed findings for nutrient status and bone and mineral metabolism highlight the need for further research to support integration of sustainable diets into food-based dietary guidelines. PROSPERO registration No. CRD42024584913.
26. Fetal and postnatal metal metabolism-related changes in brain function are associated with childhood behavioral deficits.
期刊: Science advances 发表日期: 2026-Apr-24 链接: PubMed
摘要
Exposure to neurotoxic metals early in life can disrupt brain development and increase risk of later mental health problems, but vulnerable periods and underlying mechanisms remain unclear. We examined how early life exposures to mixtures of metals affect children’s brain and behavior using naturally shed “baby” teeth as a biomarker of direct exposure. We studied 489 children aged 8 to 14 years and reconstructed weekly concentrations of nine metals from 20 weeks before birth to 40 weeks after birth. We assessed behavior using standardized questionnaires and measured brain structure and function with magnetic resonance imaging. Using lagged weighted quantile sum regression, we identified sensitive developmental windows during which higher exposure to metal mixtures was linked to more behavioral problems, smaller brain volume, reduced brain global efficiency, and weaker white matter integrity. Findings suggest that the developing brain is especially vulnerable to metals in early life, with lasting effects into adolescence.
27. Emergent spatial structure in the gut microbiota is driven by bacterial growth and gut contractions.
期刊: PLoS biology 发表日期: 2026-Apr-24 链接: PubMed
摘要
Spatial structure can functionally determine ecological interactions and evolution of microbial communities. The gut microbiota is known to be spatially structured longitudinally along the gastrointestinal tract, but micro-scale structure in the gut lumen has not been extensively explored. Here, we show that bacteria cluster within species in the cecum of gnotobiotic mice. We find that clustering is not driven by active swimming, antibody-mediated aggregation, or factors exclusive to the host, but likely due to bacterial growth in the matrix of gut content. In samples from mice and humans, we show that upper large-intestinal content behaves as a nonNewtonian fluid that changes its viscoelastic properties under the force of gut contractions. We argue that microbial growth in the gel-like structure of cecum content can lead to micro-scale bacterial clustering, which is periodically disrupted by peristalsis-driven shear thinning and clearance. Our study shows mechanistically how spatial structure in the gut emerges through the interplay between microbial and host physiology and highlights the possibility of host control over gut microbiota distribution through gut contractions.
28. The association between heat exposure, inflammation and hyperuricaemia among steelworkers.
期刊: Occupational medicine (Oxford, England) 发表日期: 2026-Apr-24 链接: PubMed
摘要
Occupational heat exposure is associated with the occurrence of hyperuricaemia. However, it is not clear how heat exposure affects hyperuricaemia. To explore the mediating role of inflammatory indices in the relationship between heat exposure and hyperuricaemia among steelworkers. A prospective cohort study comprising 3947 steelworkers was conducted. The Cox proportional hazards regression model was used to analyse the associations of heat exposure and inflammation with the incidence of hyperuricaemia. Generalized linear models were employed to examine the relationship between heat exposure and inflammation. Mediation analysis was performed to investigate the mediating role of inflammation in the association between heat exposure and hyperuricaemia among steelworkers. The incidence of hyperuricaemia among steelworkers was 19.53%. Exposure to heat (HR = 1.76, 95% CI 1.50-2.06) was associated with an increased risk of hyperuricaemia. Compared with the group with the lowest inflammation level, the highest levels of Systemic Immune-Inflammation Index (SII) (HR = 2.01, 95% CI 1.71-2.61), Systemic Inflammatory Response Index (SIRI) (HR = 2.07, 95% CI 1.66-2.58) and Aggregate Index of Systemic Inflammation (AISI) (HR = 2.22, 95% CI 1.78-2.77) were associated with the highest incidence of hyperuricaemia. The SII, SIRI and AISI levels in the heat exposure group were 50.218, 0.148 and 47.237 units higher than those in the non-exposure group, respectively (P < 0.001). SII, SIRI and AISI exhibited mediating effects in the relationship between heat exposure and the incidence of hyperuricaemia, with mediation proportions of 12.93, 6.33 and 8.98%, respectively. Inflammation is a partial mediator of the relationship between heat exposure and hyperuricaemia.
29. Continuing Education Needs of Occupational Health Nurses in the Mining Industry: Implications for Public Health Nursing Workforce Development.
期刊: Public health nursing (Boston, Mass.) 发表日期: 2026-Apr-24 链接: PubMed
摘要
This study aims to (1) explore the job duties of nurses working in the mining sector, (2) identify the competencies they require to perform their roles effectively, and (3) examine organizational factors that influence their ability to provide occupational and public health services in the Indonesian mining industry. An exploratory descriptive qualitative study was conducted using semi-structured focus group interviews to investigate the participants’ experiences and expectations regarding their roles and educational needs within the mining industry. Occupational health nurses (OHNs) (n = 20) working in Indonesian mining sector representing different professional categories participated in semi‑structured focus group discussions (FGDs). The analysis produced three overarching categories: (1) diverse public health roles and responsibilities in mining by OHNs, (2) obstacles and challenges experienced in delivering occupational health services, and (3) emerging competencies required to support workplace health and organizational productivity. Twelve themes were identified across these categories, highlighting substantial gaps between current practice demands and available educational opportunities. This study demonstrates that OHNs in the mining sector have expanded public health roles that often exceed their current training and routine duties. Strengthening continuing nursing education supported by the development of a formal occupational health nursing (OHN) curriculum is urgently needed to build workforce capacity. Structured education and training models, delivered through both formal and nonformal formats, should focus on communication, health data management and reporting, counseling, managerial negotiation, and interprofessional collaboration. Enhancing these competencies is vital for advancing public health nursing practice in occupational settings and improving health outcomes and productivity among mining workers.
30. Examining the Benefits of Trauma Focused Cognitive Behavioral Therapy and Trauma Informed Yoga for Survivors of Human Trafficking by Occupational Therapists: A Systematic Review.
期刊: Occupational therapy in health care 发表日期: 2026-Apr-24 链接: PubMed
摘要
Human trafficking (HT) is a violation of human rights causing injuries that often result in deep mental and physical scars on survivors with a lifelong deleterious impact on engagement in all occupations and overall health. A lack of attention to these needs results in chronic disorders that cause occupational injustice and imbalance, lifelong dependence on healthcare, and early mortality. In occupational therapy, adjunctive evidence-based interventions are needed to provide holistic care to support recovery for these individuals. Trauma-focused cognitive behavioral therapy (TF-CBT) and the mindfulness approach of trauma-informed yoga (TIY) are two interventions used with this population to alleviate post-trauma symptoms; however, their underlying mechanism to aid with recovery and their overall outcomes vary. The objective is to examine the effectiveness of trauma-focused interventions, TF-CBT and TIY, to holistically address the needs of HT survivors specifically for occupational therapy practice. Data sources are Ovid(Medline), CINAHL, and PsycINFO databases. The inclusion criteria were: (i) human participants, (ii) populations with trafficking trauma, (iii) interventions TF-CBT and/or TIY, (iv) published between 2009 and 2024, and (v) published in English. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used. The outcomes of these studies indicate that TF-CBT has moderate strength quantitative evidence and TIY evidence is considered weak. However, quality assessment of the Level 6 TIY studies indicates high qualitative value, with findings that were transparent, transferable, and generalizable to larger populations. TF-CBT and/or TIY are evidence-based interventions that can be used as adjunctive therapies, either administered by the occupational therapists or referred to specialists trained in these modalities, to mitigate trauma-related symptoms. When used together, they can be complementary and have a more holistic effect. However, higher level quantitative and mixed-methods studies using more rigorous methodologies are needed to strengthen the evidence.
31. [Delayed Cutaneous Reaction to a Jellyfish Sting].
期刊: Acta medica portuguesa 发表日期: 2026-Apr-24 链接: PubMed
摘要
32. National recommendations for the safe handling of hazardous drugs by pharmacy technicians in Portugal: A modified delphi study.
期刊: Journal of oncology pharmacy practice : official publication of the International Society of Oncology Pharmacy Practitioners 发表日期: 2026-Apr-24 链接: PubMed
摘要
BackgroundOccupational exposure to hazardous drugs is a recognised occupational risk in hospital pharmacy practice. Although international guidelines are available, the implementation is heterogeneous, and there are currently no formally endorsed national recommendations regarding the safety of pharmacy technicians in Portugal.ObjectiveTo develop consensus-based national recommendations for the safe handling of hazardous drugs by pharmacy technicians in Portugal.MethodsA modified Delphi study was conducted involving 43 invited experts from Portuguese hospital pharmacies. Fifty-eight statements were evaluated using a 0-10 agreement scale through one formal quantitative round, followed by a structured online consensus validation meeting and documentary confirmation. Consensus was predefined as a median score >7.ResultsThirty-six experts completed Round 1 (response rate 83.7%). All 58 statements voted on in Round 1 achieved consensus, with median scores of 10 for all recommendations and 98% of ratings ≥7. Following consolidation and merging procedures, the final set comprised 55 recommendations. The final recommendations were organised into five domains: occupational health surveillance, engineering controls and PPE, preparation technique and quality assurance, administrative safeguards, and environmental contamination and waste management.ConclusionsThis study establishes the first structured national consensus on hazardous drug handling safety for pharmacy technicians in Portugal. The resulting framework supports harmonisation of institutional practices, strengthens occupational risk governance, and provides a foundation for future implementation and evaluation studies.
33. Advanced midwifery practice: Considerations for an emerging global career structure.
期刊: Women and birth : journal of the Australian College of Midwives 发表日期: 2026-Apr-23 链接: PubMed
摘要
Advanced midwifery practice is gaining momentum as a means to improve maternal-infant outcomes, increase timely access to maternity care and improve workforce sustainability in diverse settings across the world. From an international perspective, there is no standardised way of practising at an advanced level in the midwifery profession, nor is there a universally recognised definition of advanced midwifery practice. To describe the approach to advanced midwifery practice by different nations across the globe and consider what requirements, if any, are needed to ensure that midwives who practice at an advanced level do so in a holistically safe and consistent way. This paper further demonstrates the worldwide inconsistencies seen in the way midwives practice at what might be considered an advanced level. Noticeably, in regard to how practice is regulated, preparatory education requirements, and how advanced practice roles are remunerated. This questions whether a more unified approach may be required to reduce dissonance and promote a coherent, universal approach to advanced midwifery practice. Internationally, an open conversation about advanced midwifery practice is needed. This paper invites discourse at a global level concerning the role that advanced midwifery practice will play, and how this should unfold - for now and into the future.
34. Overview of clinical pharmacy activities in geriatric oncology: A systematic review.
期刊: Journal of geriatric oncology 发表日期: 2026-Apr-23 链接: PubMed
摘要
Geriatric oncology is a multi-disciplinary field that aims to provide optimal care for older patients with cancer. The review’s objective was to comprehensively describe the clinical activities undertaken by pharmacists in geriatric oncology, in both inpatient and outpatient settings, and to assess their potential impacts. This systematic review was performed by two pharmacists according to PRISMA guidelines and SQUIRE checklist for the quality assessment. PubMed, EMBASE, and Web of Science databases were searched for studies written in English and French, published between 2010 and February 2024, that involved pharmacist-led interventions. Pharmaceutical care was analysed: description of activity and tools, pharmacist’s impact, patient satisfaction, pharmaceutical interventions (PIs), medication safety, quality of life (Qol), disease outcome, or economic impact. The studies with no original format or off topic were excluded. Six hundred fifty-eight articles were identified; 18 were included. Study designs were heterogeneous: pilot, prevalence, implementation studies, and randomized clinical trials. Two activities are described: medication review (100%) and medication therapy management (22%). Pharmacist’s impact has been analysed (61%) and a reduction in drug related problem was noticed (n = 8) ranging from 28 to 73%. Pharmacists’ interventions were described (n = 12) and their acceptance was quantified (n = 7) ranging from 22 to 91%. Two studies reported an economic impact, three assessed patient satisfaction, and one demonstrated a reduction in chemotherapy toxicity by 10.1%. Qol was not impacted. The pharmacist’s impact is measured by PIs’ acceptance, patient satisfaction, or economic impact. A measure of impact on mortality or treatment tolerability seems necessary.
35. Utility of the Shock Index at ICU admission as a prognostic tool in patients with COVID-19-related ARDS: Implications for nursing practice.
期刊: Enfermeria intensiva 发表日期: 2026-Apr-23 链接: PubMed
摘要
To evaluate the prognostic value of the Shock Index (SI) at intensive care unit (ICU) admission in predicting hospital mortality among patients with Acute Respiratory Distress Syndrome (ARDS), and to explore its potential application in nursing-led risk assessment. This retrospective cohort study was conducted in five public and private hospitals in Sergipe, Brazil, between April 2020 and January 2022. Adult patients diagnosed with ARDS and admitted to ICUs were included if data were available to calculate the SI (heart rate/systolic blood pressure), along with clinical and laboratory variables. All ARDS cases in this cohort were exclusively secondary to COVID-19 infection. Patients were categorized as survivors or non-survivors. Bivariate analyses, logistic regression, and Cox regression models were used to assess associations with hospital mortality. A total of 180 patients were included. The hospital mortality rate was 45%. Patients with SI ≥ 0.9 at ICU admission had a significantly higher risk of death (HR: 1.57; 95% CI: 1.01-2.45; p = 0.046). In the adjusted analysis, SI ≥ 0.9 remained independently associated with increased mortality risk (OR: 2.63; 95% CI: 1.21-6.09; p = 0.018), regardless of age, comorbidities, or severity scores. Additional predictors of mortality included advanced age, renal dysfunction, and elevated SAPS-3 and SOFA scores. The Shock Index at ICU admission demonstrated independent prognostic value for hospital mortality in COVID-19-related ARDS patients. As a simple, cost-effective, and nurse-accessible tool, SI may support early risk stratification, guide care prioritization, and assist in clinical decision-making in intensive care settings.
36. In vitro and in vivo anti-piroplasm activity of PBT2 against Theileria annulata and Babesia microti.
期刊: International journal for parasitology. Drugs and drug resistance 发表日期: 2026-Apr-22 链接: PubMed
摘要
Theileriosis and babesiosis remain major constraints to livestock production, and increasing drug resistance necessitates alternative therapeutic strategies. Here, we evaluated the metal ionophore PBT2 for anti-piroplasm activity. PBT2 inhibited proliferation of two Theileria annulata schizont infected cell lines with IC50 values of 450.9 nM and 407.8 nM and significantly reduced parasite burden. Colony formation was suppressed in both cell lines, consistent with parasite-associated growth inhibition. Cytotoxicity in BoMAC cells was limited, yielding a selectivity index exceeding 60-fold. ICP-MS analysis of purified schizonts showed dose-dependent Zn accumulation and concomitant Mn depletion following PBT2 treatment, whereas Cu and Fe levels were not significantly altered. In infected cells, PBT2 increased reactive oxygen species levels and reduced total superoxide dismutase activity. Partial restoration of viability by Mn supplementation supports a functional link between Mn depletion and growth inhibition. In a Babesia microti murine model, PBT2 reduced peak parasitemia in a dose-dependent manner and ameliorated infection-associated anemia. Our findings indicate PBT2 as a promising, safe, and broad-spectrum anti-piroplasm chemical compound that could be used to develop the drug formulation for controlling the infections of drug resistant piroplasm in future.
37. Differences in the Severity of Alcohol Craving Between Euthymic Unipolar and Bipolar Patients.
期刊: The primary care companion for CNS disorders 发表日期: 2026-Apr-21 链接: PubMed
摘要
Background: To compare the severity of alcohol craving between euthymic patients with unipolar and bipolar disorders and comorbid alcohol use disorder (AUD) and to explore associations between craving severity and clinical and biological markers, including carbohydrate-deficient transferrin (CDT) and homocysteine, to better characterize diagnostic-specific patterns of dual diagnosis. Methods: This cross-sectional study assessed 50 euthymic outpatients with comorbid AUD and either major depressive disorder (MDD) or bipolar disorder. Participants were evaluated using the Alcohol Use Disorder Identification Test (AUDIT), Visual Analog Scale (VAS) for craving, and blood biomarkers including homocysteine and CDT. Group differences and correlations between craving severity and clinical/biological variables were analyzed. Participants were consecutively recruited over a 12-month period, from June 2015 to May 2016. Results: Patients with AUD and MDD reported significantly higher alcohol craving (VAS), AUDIT scores, and CDT levels than those with AUD and bipolar disorder. In both groups, alcohol craving positively correlated with AUDIT scores, CDT levels, and plasma homocysteine concentrations. No significant associations were found with sociodemographic variables. Conclusions: Patients with AUD and MDD may represent a more severe clinical subtype of dual diagnosis. Elevated homocysteine may serve as a potential biomarker for craving intensity and mood instability. These findings support the need for integrated, personalized treatment approaches in dual-diagnosis populations. Prim Care Companion CNS Disord 2026;28(2):25m04123. Author affiliations are listed at the end of this article.
38. Post-vaccination serological status predicts protection against heterologous SAT1 foot-and-mouth disease virus challenge in goats.
期刊: Preventive veterinary medicine 发表日期: 2026-Apr-21 链接: PubMed
摘要
Foot-and-mouth disease (FMD) is a contagious transboundary animal disease of many cloven-hooved livestock and wildlife species readily transmitted by multiple routes of infection. Goats are susceptible to FMD and have been implicated in previous FMD outbreaks, but limited data are available for this species. The objective of the current study was to estimate the vaccinal antibody titer at the time of exposure that would protect goats from developing FMD lesions after experimental infection with a heterologous Southern African Territories 1 (SAT1) FMD virus (FMDV). Forty FMD-free goats were obtained for the evaluation of a pentavalent vaccine including an experimental challenge with a pool of heterologous FMDV SAT1. On the day of challenge, anti-FMDV structural protein antibodies were detected using virus neutralization tests (VNT) and multiple formats of a solid-phase competition ELISA (SPCE). Antibodies against non-structural proteins were measured using a commercial ELISA (NSPE). Goats were examined daily over two weeks to identify secondary FMD lesions that developed in the oral cavity and on the feet. Predictive modeling using logistic and probit regression as well as receiver-operating characteristic (ROC) analysis were performed to identify serological titers that were predictive of preventing FMD. Simulation modeling was also performed to describe the shape of the protection curve for VNT titers. Six vaccinated and challenged goats (6/29; 21%) developed secondary FMD lesions during the follow-up period with zero (0/5), one (1/9; 11%), one (1/7; 14%), and four (4/8; 50%) within a 2 ml (full dose), 0.67 ml, 0.33 ml, and 0.17 ml vaccine groups, respectively. The VNT and all evaluated SPCE formats could predict protection, with the VNT having better predictive ability based on Akaike information criterion (AIC) but an optimized format for the SPCE had slightly better area under the ROC curve (AUC; 0.862 versus 0.859). The NSPE results were not predictive of protection and 93% (27/29) of goats were positive on this assay at the time of experimental challenge. A log10 titer of 2.35 was required to protect 75% (95% CI, 50-90%) of experimentally challenged goats. Simulation modeling estimated a parabolic response curve rather a sigmoid shape as is generated from logistic and probit modeling. Post-vaccinal serological monitoring using VNT or SPCE is theoretically possible in goats to determine the proportion of the population at higher risk for clinical FMD. More research is necessary to determine the relationship between vaccine match and serological titer when modeling vaccinal protection from FMD in goats.
39. Disease-specific growth charts capture characteristic growth patterns in children with PMM2 - CDG.
期刊: Molecular genetics and metabolism 发表日期: 2026-Apr-20 链接: PubMed
摘要
Growth faltering is prevalent in 96% of children with Phosphomannomutase-2 congenital disorder of glycosylation (PMM2-CDG). Published long-term growth data is extremely limited. Growth and weight patterns of PMM2-CDG children differ from the general population limiting the utility of existing normative growth charts to track development trajectory in comparison to peers with PMM2-CDG. Create PMM2-CDG disease-specific height-, weight-, and BMI-for-age reference growth charts (0-20 years). De-identified growth data was provided by Frontiers in Congenital Disorders of Glycosylation Consortium, CDG Care, Minnesota Partnership for Biotechnology and Medical Genomics, and Glycomine, Inc. Semi-parametric modeling techniques were used to develop PMM2-CDG-specific charts along with nodal-point analyses for quantifying and examining PMM2-CDG growth differences relative to Centers for Disease Control (CDC) reference using one-sided quantile tests. Data of 156 children (females n = 75) with PMM2-CDG from 1614 visits were used to create height-, weight- and BMI-for-age growth curves. Median follow-up was 8.5 years (SD 4.5) for females and 6.8 years (SD 4.4) for males. CDG females were 13 cm shorter than their CDC reference peers at 20 years (150 vs 163 cm), and males were 16 cm shorter (160 vs 176 cm). All weight and height nodal points were significantly different (p < 0.05) at each age (4, 8, 12, 16, 20 years). PMM2-CDG specific reference charts can help enable the detection of deviations from peer growth patterns, aid in early detection of coexisting endocrinopathies, help guide treatment decisions and evaluate the effectiveness of new disease-modifying treatments in clinical trials.
40. Association between urban heat island and type 2 diabetes risk: genetic and proteomic insights.
期刊: Environment international 发表日期: 2026-Apr-19 链接: PubMed
摘要
The urban heat island (UHI) effect is increasingly recognized as an environmental risk factor for human health, yet its association with type 2 diabetes (T2D) and underlying mechanisms remain poorly understood. This study investigated the impact of summer UHI exposure on T2D incidence, while examining the modifying role of genetic susceptibility and the mediating effects of plasma proteins. This study analyzed 398,825 UK Biobank participants free of T2D at baseline, including a subset of 43,023 with proteomic data. Cox proportional hazards models were used to evaluate the association between summer UHI intensity and T2D risk. A polygenic risk score for T2D assessed potential gene-environment interactions. Mediation analyses further explored the roles of proteomic signatures and individual proteins in linking UHI exposure to T2D. High summer UHI exposure was associated with elevated T2D risk compared with low exposure. Subgroup analyses revealed heightened susceptibility among males and those with preexisting cardiovascular disease or cancer. Significant interactions were observed between UHI intensity and genetic risk. Participants with high genetic risk and high UHI exposure exhibited the greatest T2D incidence relative to those with low genetic risk and low exposure. Proteomic profiling identified 339 UHI-associated proteins, and mediation analyses demonstrated that proteomic signatures (mediation proportion: 13.0%) partially mediated the UHI-T2D association. Summer UHI exposure is linked to increased T2D risk, with genetic factors modifying this relationship and plasma proteins serving as potential mediators. These findings offer novel mechanistic insights and underscore the need for urban planning strategies to mitigate heat-related diabetes burdens.
41. Violence against healthcare workers as a signal of health system strain: Implications for health policy and governance.
期刊: Health policy (Amsterdam, Netherlands) 发表日期: 2026-Apr-18 链接: PubMed
摘要
Violence against healthcare workers has prompted policy responses across health systems that often emphasise security measures, legal sanctions, and behavioural interventions. While these approaches are essential to protect healthcare workers, their effectiveness remains limited. This Policy Comment argues that such framing may underemphasise determinants of violence arising at multiple levels of health systems, including broader policy choices (e.g., workforce planning, financing, and service configuration), governance arrangements (e.g., performance monitoring, administrative control, and regulatory standards), and organisational conditions (e.g., staffing shortages, workload, and care pathway bottlenecks), within a context influenced by international policy frameworks and societal factors. Drawing on a multi-level conceptual framework and examples from different countries, we suggest that violence can also be understood as an indicator of systemic strain arising from the persistent gap between healthcare needs and available capacity, reflecting how healthcare systems are organised, governed, and resourced. Rebalancing prevention efforts to address these policy and governance drivers may offer more sustainable solutions.
42. The impact of incorporating patient educational videos for secondary prevention in adults with coronary artery disease; A systematic review of randomized and quasi-experimental, controlled trials.
期刊: Patient education and counseling 发表日期: 2026-Apr-18 链接: PubMed
摘要
The study’s primary aim was to evaluate the effectiveness of educational interventions that incorporated video on outcomes in adults with CAD. The secondary aim was to compare the effectiveness of interventions that used videos as primary medium versus supplementary to deliver the educational content. A systematic search was conducted in PubMed, Scopus and Cochrane Central data bases (up to June 2024) for Randomized, controlled trials and Quasi-Experimental studies. Methodological quality was assessed using JBI checklists. Due to high heterogeneity, data were synthesized qualitatively following the Synthesis Without Meta-analysis (SWiM) guidelines based on the direction of effect. The certainty of evidence was evaluated using GRADE approach RESULTS: Twenty-two studies, comprised of 3421 participants, were included. Synthesis revealed that Video-Based Studies (V-BS) are highly effective in enhancing self-efficacy (Moderate certainty) and reducing depressive symptoms (High certainty), while also improving HRQoL (Moderate certainty). Conversely, multi-component studies (M-CS) demonstrated superior effectiveness in sustaining complex behavioral changes, specifically smoking cessation (High certainty) and physical activity (Moderate certainty). Both types showed predominantly neutral effects on physiological markers (BP, BMI, Glucose) with certainty ranging from Moderate to Very Low. Preliminary evidence suggests cost-effectiveness for V-BS, although certainty remains Low due to sparse data. V-BS is a potent tool for psychosocial empowerment and knowledge gain in CAD care. While V-BS are sufficient for improving emotional well-being and self-efficacy, complex lifestyle modifications require more systematic multi-component programs. Both interventions are indicated as beneficial and should be integrated as a complementary strategy to medical management, tailored to specific patient needs and phase of recovery utilizing videos for rapid empowerment and multi-component support for long-term behavioral change.
43. Dietary supplementation of Radix Isatidis polysaccharides improves meat quality in broilers by regulating lipid metabolism, antioxidant defense, and the gut-muscle axis.
期刊: Research in veterinary science 发表日期: 2026-Apr-17 链接: PubMed
摘要
This research assessed the impact of Radix Isatidis polysaccharides (RIPS) supplementation on the growth, meat quality, lipid metabolism, and gut microbiota of broiler chickens. A total of 320 AA broilers were separated into four groups and given either a basic diet or diets with 250, 500, or 1000 mg/kg RIPS for 42 days. We employed various multi-omics approaches, including serum biochemistry, lipidomics, transcriptomics, and 16S rRNA sequencing, to investigate the underlying mechanisms. The results indicated that 1000 mg/kg RIPS markedly enhanced meat color, elevated ω-3 and ω-6 polyunsaturated fatty acids, and augmented antioxidant activity in breast muscle. In the 500 mg/kg and 1000 mg/kg groups, alanine aminotransferase (ALT) activity was significantly decreased, and triglyceride (TG) levels were significantly reduced in the 1000 mg/kg group. Lipidomic analysis revealed that in the 1000 mg/kg group, the accumulation of triglycerides and ceramides in the chicken breast was lower, indicating an optimization of lipid metabolism. Transcriptomic analysis showed that in the ileum, the expression of FABP1 and APOA1 genes was significantly upregulated in the 1000 mg/kg group, suggesting improved fatty acid transport and cholesterol metabolism. RIPS also significantly improved the gut microbiota, particularly increasing the abundance of g__Actinomarinales and p__DTB120 in the 1000 mg/kg group, which were positively correlated with antioxidant capacity and meat quality. In summary, RIPS regulates lipid metabolism and antioxidant defense through the “gut-muscle axis,” leading to significant improvements in both meat quality and health in broiler chickens. This study emphasizes the potential of plant polysaccharides in animal nutrition and suggests 1000 mg/kg RIPS as an appropriate supplementation amount.
44. A protocol for external biosecurity assessment against wildlife in intensive pig farms: Are we ready for African Swine Fever?
期刊: Preventive veterinary medicine 发表日期: 2026-Apr-17 链接: PubMed
摘要
External biosecurity comprises the set of physical and management measures taken to prevent pathogens from entering a farm. Its implementation requires the creation of a protocol for developing Farm-specific Action Plans (FsAPs). This study describes an On-Farm Wildlife Risk Mitigation Protocol that can be applied to a wide range of intensive pig farming conditions and evaluates the risk posed by wildlife-livestock interactions on intensive pig farms in Spain. Our findings suggest that, in intensive pig production, the risk of ASF transmission between wild boar and domestic pig is primarily driven by the presence of wild boar near the farm and via fomites potentially introduced by vehicles or farm personnel. This emphasises the importance of good biosecurity practices as part of staff routines, especially a strict separation between dirty and clean areas at the entrances to farm facilities. Awareness-raising campaigns and training programmes are needed to equip farmers with the knowledge required to make informed decisions about their farms. This study is of significant interest as its results provide a protocol for developing FsAP, an easily transferable tool for disease prevention where intensively produced pigs and wildlife interact. This is particularly relevant in the context of African Swine Fever at the interface between wild boars and pig production.
45. Acupuncture for insomnia management: An international evidence-based guideline that integrates multidisciplinary consensus and regional adaptability.
期刊: Sleep medicine reviews 发表日期: 2026-Apr-16 链接: PubMed
摘要
Insomnia poses significant challenges to public health systems. Acupuncture, a widely used traditional therapy around the world, has shown promise in improving sleep outcomes, but clinical practice remains inconsistent. This guideline aims to provide evidence-based recommendations for acupuncture practice in insomnia management while addressing implementation across diverse healthcare settings. A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted, encompassing studies published before January 2025. Evidence certainty was assessed using the GRADE approach, and recommendations were formulated through a modified Delphi process involving a multidisciplinary panel of 26 experts from 11 countries that comprehensively considered patient preferences, cost-effectiveness, and regional accessibility. Based on moderate-to low-certainty evidence, it is conditionally suggested that electroacupuncture or manual acupuncture may be considered for patients with chronic insomnia particularly in institutions where it is available. Notably, electroacupuncture is conditionally suggested for patients with comorbid insomnia or for patients with poor sleep quality. To standardize clinical application, expert consensus established a core set of acupoints, including Baihui (DU20), Sanyinjiao (SP6), Sishencong (EX-HN1), and Anmian (EX-HN-54), and a treatment protocol involving needle retention for 30 min after obtaining “de qi”, administered three times per week for at least four weeks.
46. Mapping Evidence on Child-Focused Interventions for Promoting Healthy Sleep Habits: A Scoping Review.
期刊: Clocks & sleep 发表日期: 2026-Apr-07 链接: PubMed
摘要
Sleep is critical for physical growth and healthy child development. Traditionally, interventions targeting sleep improvement in children have focused on the parents. This scoping review aimed to identify and summarize the available evidence on child-focused interventions designed to promote healthy sleep habits among children aged 3-12 in healthcare settings. The review was conducted in accordance with JBI guidelines. A comprehensive search strategy was employed, encompassing databases such as PubMed, CINAHL, Psychology & Behavioral Sciences Collection, Education Source, Scopus, Web of Science, the Public Health Database, and Portugal’s Open Access Scientific Repository. Following identification and screening, 15 articles were included. Three types of interventions were identified: isolated, combined, and structured programs. Overall, the studies suggest that, while sleep-related knowledge tends to improve, achieving sustained, long-term behavioral change remains challenging in this age group. Active child participation appears essential for promoting lasting results and developing more tailored, child-friendly interventions.
47. The Severity of COVID-19 Is Associated with Greater Impairment of Cardiac Autonomic Modulation-Physical Training as a Countermeasure.
期刊: Journal of functional morphology and kinesiology 发表日期: 2026-Apr-02 链接: PubMed
摘要
Background: COVID-19 has been associated with persistent impairments in autonomic modulation of heart rate variability (HRV). However, whether disease severity during the acute phase influences the magnitude of these impairments remains insufficiently explored. In turn, aerobic physical training (APT) has been proposed as a countermeasure to autonomic dysfunction of HRV in different conditions, although its effects in individuals with COVID-19 are not yet well established. To address these gaps, this study investigated the consequences of COVID-19 on autonomic modulation of HRV according to disease severity and evaluated the effects of APT on this parameter. Methods: One hundred and sixteen individuals (58 men and 58 women) aged between 30 and 55 years were included, allocated into three groups according to the severity of the disease in the acute phase: Mild group (n = 38, mean age: 48 ± 7 years); Moderate group (n = 52, mean age: 43 ± 5 years); and Severe group (n = 26, mean age: 45 ± 6 years). All groups had anthropometric and hemodynamic parameters evaluated before and after the 16-week APT period, as well as parameters of autonomic modulation of HRV analyzed using linear (time and frequency domain) and non-linear (symbolic analysis) methods obtained from R-R interval (RRi) recordings in the supine position for 30 min. Results: Initially, all groups presented similar anthropometric and hemodynamic values. In contrast, the Moderate and Severe groups presented lower values for standard deviation of normal RRi (SDNN; Moderate: 38 ± 14 ms; Severe: 33 ± 12 ms vs. Mild: 55 ± 28 ms; p < 0.001), root mean square difference between adjacent normal RRi (RMSSD; Moderate: 28 ± 13 ms; Severe: 22 ± 7 ms vs. Mild: 47 ± 38 ms; p < 0.001), total variance (Moderate: 203 ± 127 ms2; Severe: 303 ± 157 ms2 vs. Mild: 526 ± 347 ms2; p < 0.001), and high-frequency (HF) oscillations in absolute units (Moderate: 259 ± 270 ms2; Severe: 153 ± 74 ms2 vs. Mild: 438 ± 421 ms2; p < 0.001), both compared to the Mild group. In turn, the Severe group, when compared to the other groups, also presented lower HF oscillations (Severe: 29 ± 12 nu vs. Mild: 44 ± 17 nu and Moderate: 42 ± 17 nu; p < 0.001) and higher low-frequency (LF) oscillations (Severe: 71 ± 12 nu vs. Mild: 60 ± 17 nu and Moderate: 58 ± 17 nu; p < 0.001), but in normalized units. After the 16-week APT, all groups showed increases in HF oscillations (Mild: -206 ms2 and -19.12 nu; Moderate: -236 ms2 and -26.7 nu; Severe: -211 ms2 and -31.0 nu; p < 0.001) and reductions in LF oscillations (Mild: 198 ms2 and 19.01 nu; Moderate: 98 ms2 and 26.7 nu; Severe: 218 ms2 and 31.1 nu; p < 0.001), both in absolute and normalized units. In this case, there were no further differences in LF and HF oscillations between the groups. Conclusions: Individuals who had COVID-19 and developed moderate to severe cases showed greater impairments in the autonomic modulation of HRV, characterized by increased sympathetic autonomic modulation and reduced vagal modulation. In turn, APT as a countermeasure appears to increase vagal autonomic modulation and reduce sympathetic autonomic modulation of HRV, regardless of the previous severity of COVID-19.
48. Predicting multiple sclerosis from radiologically isolated syndrome using generative artificial intelligence.
期刊: PLOS digital health 发表日期: 2026-Apr 链接: PubMed
摘要
Radiologically Isolated Syndrome (RIS) is characterized by incidental MRI findings indicative of multiple sclerosis (MS) in asymptomatic individuals. Factors such as younger age, positive cerebrospinal fluid biomarkers, and specific lesion locations have been previously linked to a higher risk of conversion from RIS to clinical MS. Predicting which individuals will develop clinical MS remains challenging. Based on widely available cross-sectional patient studies, unsupervised machine learning has been proposed to uncover MRI-driven MS phenotypes with distinct temporal progression patterns. We evaluated whether an unsupervised artificial intelligence framework based on generative manifold learning could stratify RIS patients by conversion risk. BrainGML-MS analyzed imaging biomarkers and generated individualized digital twins from MRI data. We studied 152 RIS individuals (32 converters, RIS-C), 152 MS patients, and 152 healthy controls. The model identified four RIS clusters with distinct five-year conversion risks ranging from 10% to 39%. The brain age gap increased progressively from healthy controls to RIS non-converters, RIS-C, and MS. RIS converters showed greater structural atrophy and greater similarity to MS profiles. These findings indicate that MRI-derived brain aging biomarkers and structural deviations measured at the first RIS scan may improve early risk stratification and support clinical decision-making in preclinical MS.
49. In-Vehicle Feedback With or Without Parent Communication Training and Teenage Driving Behaviors: A Randomized Clinical Trial.
期刊: JAMA network open 发表日期: 2026-Apr-01 链接: PubMed
摘要
Motor vehicle collisions are a leading cause of death among teenagers. Effective strategies to reduce risky driving, especially for teenage drivers cited for traffic violations, are critical yet underdeveloped. To evaluate the effectiveness of ProjectDRIVE, an in-vehicle and smartphone-based driving feedback intervention combined with parent communication training, in reducing risky driving events and unsafe driving behaviors among teenagers with traffic violations. This 3-arm, parallel randomized clinical trial enrolled 240 parent-teenager dyads, randomized evenly (80 per arm) to the control arm (device installed without feedback), the driving feedback only arm, or the driving feedback plus parent training arm. Enrollment occurred from September 28, 2020, to June 30, 2024, with 6 months of follow-up. Participants included teenagers aged 16 to 17 years with an intermediate license and a moving violation, and their parent or guardian, enrolled from 6 juvenile traffic courts across Ohio. Intervention teenagers received real-time, in-vehicle and smartphone-based feedback, as well as biweekly emailed reports. Parents in the driving feedback plus parent training arm accessed their teenager’s driving reports, completed virtual communication training, and received an online guide for discussing safe driving. Intent-to-treat analyses assessed intervention effects on the incidence rate of risky driving events per 1000 miles and the proportion of miles driven involving unsafe driving behaviors, measured using telematics. Among 240 parent-teenager dyads (teenager mean [SD] age, 16.7 [0.5] years; 123 female teenagers [51.3%]), teenagers completed 160 095 trips. Compared with control, driving feedback plus parent training significantly reduced risky driving event incidence (adjusted incidence rate ratio [AIRR], 0.68; 97.5% CI, 0.51-0.90) and the proportion of miles driven while speeding (adjusted exponentiated β coefficient, 0.54; 97.5% CI, 0.47-0.68). Driving feedback alone did not significantly reduce risky driving but did reduce miles driven while speeding (adjusted exponentiated β coefficient, 0.64; 97.5% CI, 0.54-0.79). Male teenagers exhibited higher rates of risky driving compared with female teenagers, including hard braking (AIRR, 1.39; 95% CI, 1.11-1.73) and sudden acceleration (AIRR, 2.13; 95% CI, 1.42-3.19), as well as greater proportions of miles driven while speeding. Combining driving feedback with parent communication training reduced risky driving among teenagers with traffic violations. Continued parental engagement after licensure, especially after traffic violations, might be key to reinforcing driving safety among teenagers. ClinicalTrials.gov Identifier: NCT04317664.
50. Trunk and upper arm postures and movements among older workers in physically demanding occupations.
期刊: Annals of work exposures and health 发表日期: 2026-Mar-12 链接: PubMed
摘要
Associations between work-related musculoskeletal disorders (WMSDs) and awkward postures and repetitive movements have been established. Action levels for elevated arms, trunk flexion, and fast movements have been suggested. With today’s prolonged working life, older workers in manual jobs may be at increased risk for WMSDs. The aim of this study was therefore to assess postural workload in older workers in four physically demanding occupational groups using technical measurements and compare the exposure of the groups with each other’s and with the action level. Postures and movements were measured for the right upper arm and the trunk using inertial measurement units (IMUs) during 3 workdays in construction workers (n = 35), kitchen workers (n = 37), cleaners (n = 27), and assistant nurses (n = 25), all over 50 years. Angle and angular velocity were computed, and time exceeding suggested angular cut-offs was assessed. Group mean and variance components within and between subjects were estimated in one-way random effect models. One-way ANOVA tests were conducted to compare exposure variables between the occupational groups. Construction workers spent more time with arms >60° than other occupational groups (7.9% vs. 4.4-5.6%) and >90° (2.8% vs. 1.0-1.3%). Across groups, a substantial share of days exceeded suggested action level for arm elevation >30° (8.0-24.6%) and >60° (6.3-22.7%). Cleaners had the highest 50th percentile trunk flexion (15.3°), while construction workers spent the most time with trunk flexion >45° (12.6%) and >60° (7.4%); exceedances of recommended levels occurred in up to 39% of days. Kitchen workers and cleaners exhibited more time with fast arm movements (31.8-35.6% vs. 23.9-24.0%). Considerable variability was observed both within and between individuals. In the included occupational groups, in workers over 50 years, arm elevation and trunk flexion may often exceed recommended levels. Since the physical capacity is decreasing with age, this indicates elevated musculoskeletal risks, and there is a clear need for targeted ergonomic measures to support sustainable working lives.
51. Economic evaluations of the Mediterranean diet: a systematic review.
期刊: Nutrition (Burbank, Los Angeles County, Calif.) 发表日期: 2026-Mar-08 链接: PubMed
摘要
The Mediterranean diet (MD) is widely recognized for its health benefits and increasing relevance in health system planning and dietary policy. Understanding the costs and cost-effectiveness of MD adherence is critical for informing public health policy and dietary interventions. This systematic review summarizes the evidence on the economic implications of the MD, distinguishing between studies assessing health outcome-based cost-effectiveness and those examining the monetary costs of adhering to the MD for households. This review was conducted in accordance with PRISMA 2020. We searched PubMed/MEDLINE, Embase, Scopus, and the Cochrane Library to February 2024. Data extraction and quality assessment followed standardized protocols using CHEC-Extended and Newcastle-Ottawa tools. Of 6,733 screened records, 24 studies met inclusion criteria and were included. Studies were grouped into: (A) economic evaluations (cost-effectiveness, cost-utility, cost-benefit, cost-of-illness - 13 studies) and (B) cost analyses of MD adherence (11 studies). Group A studies, conducted primarily from health system perspectives, found MD interventions generally cost-effective, particularly in cardiovascular prevention, despite higher initial dietary costs. Several reported favorable incremental cost-effectiveness ratio. Group B studies, adopting a societal perspective, consistently showed that greater MD adherence is associated with higher food costs, with a disproportionate impact on low-income populations. MD is a cost-effective intervention from a health system perspective, with potential for substantial long-term savings. However, economic barriers at the household level may limit uptake. Future evaluations should integrate environmental co-benefits and equity considerations to fully capture the MD’s public health value.
52. Role of social capital in improving diet of pregnant women in Southern Ethiopia: A non-randomized cluster controlled study.
期刊: Nutrition (Burbank, Los Angeles County, Calif.) 发表日期: 2026-Mar-04 链接: PubMed
摘要
Inadequate dietary intake among pregnant women is a major public health challenge in Ethiopia. Although nutrition interventions exist, they often overlook dietary diversity and face sustainability issues. This study evaluated a community-based intervention designed to improve dietary diversity for pregnant women in Southern Ethiopia by leveraging the women’s development army (WDA) platform. A non-randomized, cluster-controlled study with two parallel arms was conducted across North and South kebeles (clusters), which were assigned to either an intervention or control group. The intervention group received a program delivered through the existing WDA network, which provided modest monthly financial support (400 ETB) and targeted nutrition education. The control group received standard care. The primary outcome was the proportion of women meeting the minimum dietary diversity for women. A total of 372 pregnant women were enrolled (intervention: 179; control: 193). Cluster-level analysis showed that women in the intervention group had a 60% higher odds of achieving minimum adequate dietary diversity (odds ratio: 1.60; 95% confidence interval: 1.32, 1.93). This improvement was primarily driven by increased consumption of pulses, dairy, and other vegetables. The findings demonstrate that a community-centered intervention using the WDA as a delivery platform to combine financial support and nutrition education improved dietary diversity among pregnant women. This model effectively addresses key barriers to affordability and knowledge, offering a sustainable, community-owned approach to enhancing maternal nutrition.
53. Evaluation of an algorithm to tailor implementation strategies for community nutrition interventions to local readiness and capacity.
期刊: Translational behavioral medicine 发表日期: 2026-Jan-07 链接: PubMed
摘要
Policy, systems, and environmental (PSE) interventions are recommended to address diet-related chronic diseases, yet guidance for selecting PSE implementation strategies for unique community contexts remains limited. Previous research identified the importance of specific readiness and capacity factors for implementing PSEs at farmers markets and translated them into a weighted assessment for practitioners. We examined the robustness of a weighted scoring algorithm and algorithm derived recommendations to guide implementation of PSE interventions. The scoring algorithm, a hierarchical weighted-sum model, quantifies PSE readiness and generates recommendations to guide implementation strategies. Two tests evaluated the algorithm’s performance. Test 1 analyzed assessment data from practitioners in OH (N = 5) to explore readiness score variation and algorithm derived recommendations. Test 2 used a 30-indicator survey on farmers’ market PSEs to simulate 1000 baseline assessments (T0) and reassessments at three follow up time points (T1-T3). During reassessments, the simulation assigned probabilistic improvements in prioritized indicators to reflect varying success in accomplishing recommendations. In Test 1, overall readiness scores ranged from 37.31 to 70.31 (maximum = 100); 66.6% of all algorithm derived recommendations were unique to one responder. In Test 2, by the third reassessment (T = 3), 89.5% of the simulated respondents experienced changes in one (40.5%), two (36.7%), or three (12.3%) prioritized indicators from the preceding reassessment. The algorithm effectively characterized distinct readiness and capacity profiles and refined recommendations for PSE implementation strategies in response to changes in community readiness. Findings highlight one approach to efficiently prioritize PSE implementation strategies across different communities. Policy, systems, and environmental (PSE) interventions, such as farmers markets, are recommended to reduce diet-related chronic diseases within communities. Guidance for selecting PSE implementation strategies for unique community settings is limited. In this article, we describe the development of a web-based algorithm that provides a readiness score and generates actionable recommendations for community nutrition practitioners based on user responses to an assessment focused on farmers markets. We then describe two tests for evaluating the algorithm’s performance. The first assessed how well the algorithm generated unique recommendations for farmers market PSE implementation based on responses provided by five community practitioners. The second used simulated data to evaluate changes in recommendations based on reassessments over time. Findings revealed the algorithm effectively generated unique recommendations to guide implementation strategies for community nutrition PSEs that were responsive to different community profiles. In summary, the algorithm may support community health planning by tailoring PSE implementation strategies for optimal impact.
54. Resilient road safety modeling through spatially disaggregated explainable AI.
期刊: PloS one 发表日期: 2026 链接: PubMed
摘要
Understanding spatial disparities in traffic accident severity is essential not only for improving transport safety but also for advancing sustainable and inclusive transportation systems. Road crashes represent a persistent public health and equity challenge, directly linked to the United Nations Sustainable Development Goals (SDG 3: Good Health and Well-Being and SDG 11: Sustainable Cities and Communities). This study proposes an explainable, spatially segmented machine learning framework to examine urban-rural heterogeneity in crash outcomes, using disaggregated accident data from Kent, UK (2022-2024). By treating urban and rural systems as separate analytical units, the study captures risk heterogeneity that conventional pooled approaches often obscure. Among five tested models, Random Forest achieved the best performance and was further interpreted using SHapley Additive exPlanations (SHAP) to uncover how key factors differ in influence across spatial contexts. The results reveal a behavioral risk profile dominating in urban areas and infrastructure-driven risks in rural environments. These findings highlight the need for context-sensitive, evidence-based interventions that ensure transport equity across regions. Additionally, the study contributes to sustainable governance frameworks, enabling spatially adaptive risk mitigation, inclusive policy design and the long-term resilience of transport infrastructures.
55. Effects of a spore-forming probiotic blend on bowel habits and physical well-being in adults with functional constipation: A randomized, double-blind, placebo-controlled trial.
期刊: PloS one 发表日期: 2026 链接: PubMed
摘要
We aimed to evaluate the efficacy and safety of a spore-forming probiotic blend containing Clostridium butyricum IDCC 1301, Weizmannia coagulans IDCC 1201, and Bacillus subtilis IDCC 1101 for improving bowel function and well-being in adults with functional constipation (FC). In a randomized, double-blind, placebo-controlled trial, 78 adults with FC (Rome IV criteria) received either probiotic blend (n = 40) or placebo (n = 38) daily for 4 weeks. Primary outcomes were changes in weekly spontaneous bowel movements (WSBM) and stool form. Secondary outcomes included physical functioning scores from the 36-Item Short Form Health Survey. The probiotic blend group showed significant improvements in irritant bowel movements (p = 0.0458), incomplete evacuation (p = 0.0374), and abdominal pain before defecation (p = 0.0090). Stool consistency shifted toward normal types (Bristol types 3-4, p = 0.0176). Physical functioning improved only in the probiotic blend group (p = 0.0300). Probiotic blend effectively alleviated symptoms of FC and improved physical well-being. Trial registration: Clinical Research Information Service (CRIS), KCT0010085.
56. Social determinants of pain, distress, and quality of life in injured workers: A cross-sectional and longitudinal analysis of patient-reported outcomes.
期刊: PloS one 发表日期: 2026 链接: PubMed
摘要
Prognostic tools are widely used to guide early management of musculoskeletal (MSK) injuries. However, social identity factors such as age, gender, race, and socioeconomic status may influence symptom experience and reporting, potentially affecting the accuracy of risk classification. The purpose of this study is to identify those social identity variables associated with scores on common prognostic tools or their prognostic accuracy. We analyzed data from a cohort of workers (n = 203) with acute musculoskeletal injuries. Participants completed the Numeric Pain Rating Scale (NPRS), Traumatic Injuries Distress Scale (TIDS), EuroQoL (EQ5D-5L), and a demographic survey including age, sex, race, income, education, and perceived discrimination. Differences in baseline scores were assessed between identity groups. Recovery was dichotomized (fully recovered/not fully recovered) using 3 different recovery indicators. Predictive accuracy for recovery was evaluated using area under the receiver operating characteristic curve, sample-wide and when stratified by social identity variables. Older participants reported significantly higher pain (5.5 vs. 4.3/10, p < 0.01) and those indicating more experiences of discrimination rated higher post-trauma distress (11.1 vs. 9.2/24, p < 0.05). 8-week recovery rates were 21.7% to 54.7%. Lower education predicted <full recovery in administrative data only. The TIDS and EQ5D-5L were significantly better at predicting recovery compared to the NPRS. When disaggregated by social identity, the TIDS functioned significantly better in females than males, while the EQ5D-5L functioned similarly across all social categories. The results indicate that different risk/prognosis cut-scores, and even different tools, may be required for people with different intersectional identities. The results should be interpreted in light of some identities being reduced to broad categories. Most risk/prognosis tools in MSK recovery research use a single universal cut-score to distinguish low from high risk, but this study only partially supports that approach.
57. Prevalence of cancer related fatigue and its associated factors among adult cancer patients in eastern Ethiopia: A cross-sectional study.
期刊: PloS one 发表日期: 2026 链接: PubMed
摘要
Fatigue is a frequent and distressing symptom experienced by patients with cancer. It may result from the disease process and/or its aggressive treatment, which substantially impact the quality of life of cancer patients. Furthermore, there is a paucity of evidence in the Eastern part of Ethiopia. Hence this study aimed to assess the prevalence of cancer related fatigue and its associated factors among adult cancer patients, Eastern Ethiopia. Hospital based cross-sectional study was conducted from 1st May to 30th August, 2023 among 422 systematically selected cancer patients. Data were collected using structured, interviewer administered questionnaire. The outcome variable was evaluated using the Brief Fatigue Inventory (BFI). Binary logistic regression analyses were performed to examine the association between the explanatory variables and the outcome variable. Adjusted Odds Ratio (AOR) with 95% Confidence Interval (CI) at a P value less 0.05 was used to declare statistically significant association. Out of 422, 382 individuals with various cancer types participated in the study with a response rate of 90.5%. The prevalence of cancer related fatigue was found to be 71.2% (95%CI: 65.7-75.5). Rural residence (AOR = 2.84, 95%CI: 1.25-6.43), female sex (AOR = 3.25, 95%CI: 1.49-7.0), private occupational status (AOR = 6.44, 95%CI: 2.42-17.12), never used coffee (AOR = 7.02, 95%CI: 2.37-20.75), inpatient admission (AOR = 4.68,95%CI: 2.21-9.88) and advanced (AOR = 6.21, 95%CI: 2.61-14.78) & unclassified cancer stages (AOR = 4.84, 95%CI: 1.42-16.57) were significantly associated with cancer related fatigue. Nearly three out of four cancer patients in Eastern Ethiopia experienced cancer related fatigue. The findings highlight the need for a supportive care service including psychosocial counseling and targeted intervention for high risk groups such as female, rural residents, inpatients, private workers and advanced cancer patients. Further research is warranted to explore the protective role of coffee consumption.
58. [Impact of inflammatory bowel disease on quality of life, anxiety, and depression: a multicenter study in Lima, Peru].
期刊: Revista de gastroenterologia del Peru : organo oficial de la Sociedad de Gastroenterologia del Peru 发表日期: 2026 链接: PubMed
摘要
Inflammatory bowel disease (IBD) is a chronic condition characterized by periods of activity and remission, with an uncertain and unpredictable course. It mainly affects the economically active population and may compromise physical, psychological, social, and occupational well-being. The aim of this study was to describe health-related quality of life and the presence of anxiety and depression in patients with IBD. An observational, descriptive, cross-sectional study was conducted between April and December 2023. Patients older than 16 years with a confirmed diagnosis of IBD, at least six months of disease duration, and regular pharmacological treatment were included. The Inflammatory Bowel Disease Questionnaire-32 (IBDQ-32), the Patient Health Questionnaire-9 (PHQ-9), and the Generalized Anxiety Disorder-7 (GAD-7) were administered. Most patients (70%) reported a high quality of life, with no significant differences between ulcerative colitis and Crohn’s disease. However, a significant reduction in health-related quality of life was observed in patients with active disease. Symptoms of depression were identified in 62.2% of patients, and anxiety in 58.1%, with both conditions being more frequent in patients younger than 30 years. Although most patients with IBD maintain a good quality of life, more than half experience symptoms of anxiety or depression, even during clinical remission. These findings highlight the importance of integrating mental health assessment and management as an essential component of comprehensive IBD care, in accordance with STRIDE II recommendations.