公共卫生研究摘要 (2026-04-28)
共收录 57 篇研究文章
1. Important Role of Ultrasound in Assessing Tubulocystic Renal Cell Carcinoma.
期刊: Ultrasound quarterly 发表日期: 2026-Jun-01 链接: PubMed
摘要
Tubulocystic renal cell carcinoma is a rare renal neoplasm with imaging characteristics that may make it challenging to differentiate from benign cystic lesions. This retrospective single-institution study characterized the multimodality imaging features of pathologically confirmed tubulocystic renal cell carcinoma with emphasis on ultrasound (US) findings. Cases identified between 2016 and 2023 were reviewed for demographic, clinical, and imaging features on computed tomography (CT), magnetic resonance imaging (MRI), and US. Seven patients (6 male, 1 female; mean age 61 ± 8 y) were included, with presentations of abdominal pain (n=2), hematuria (n=1), and incidental detection (n=4). The mean maximal tumor diameter was 2.4 cm (range: 1.4-4.8 cm); 6 lesions were round and 1 was bilobed. On CT, masses demonstrated low attenuation (mean 15 HU) with variable enhancement (mean 23 HU). MRI in 5 cases demonstrated predominantly T1 hypointense and T2 hyperintense lesions, with 1 lesion showing mixed T2 signal intensity; 3 cases showed enhancement, including septa or a mural nodule. Two hyperechoic lesions demonstrated enhancement on MRI, with enhancement corresponding to the hyperechoic portions of the mixed echogenic mass. US in 5 cases showed 3 uniformly hyperechoic, 1 mixed echogenic, and 1 septated hypoechoic mass, all demonstrating posterior acoustic enhancement. CEUS in 1 case revealed septal enhancement. Although CT and MRI features may mimic cysts, US most commonly demonstrates a hyperechoic lesion with posterior acoustic enhancement and may provide important additional diagnostic information when other imaging findings are equivocal.
2. Automated Detection of Pediatric Pneumonia via Clinically Driven AI Analysis of Lung Ultrasound.
期刊: Ultrasound quarterly 发表日期: 2026-Jun-01 链接: PubMed
摘要
Lung ultrasound (LUS) is increasingly utilized for diagnosing pediatric pneumonia due to its bedside accessibility, radiation-free nature, and high diagnostic sensitivity. However, broader clinical adoption remains hindered by operator dependency, inconsistent interpretation, and training challenges, particularly among trainees and less-experienced health care providers. Currently, there is an unmet need for practical tools that help trainees reliably detect pneumonia-related ultrasound findings. In this technical innovation study, we evaluated a semi-automated, artificial intelligence (AI)-assisted system designed to identify clinically relevant lung abnormalities, including pleural line thickening, consolidation morphology, and B-line patterns. Our computerized analysis demonstrated the system’s technical capability to accurately detect these structural changes with minimal user interaction. Although our primary aim was to assess diagnostic feasibility, the intuitive nature and real-time visual annotations provided by this AI tool highlight its strong potential for future integration into educational contexts. By visually assisting trainees in recognizing key sonographic features, this technology can facilitate learning, improve detection skills, and effectively support the training of health care providers performing pediatric LUS.
3. Historic logbooks reveal spatial footprints of commercial whaling.
期刊: Proceedings of the National Academy of Sciences of the United States of America 发表日期: 2026-May-12 链接: PubMed
摘要
Commercial harvesting of bowhead whales (Balaena mysticetus), primarily by British and American whalers during the late-1700s to early-1900s, nearly caused their extinction. While whaling-offtake rates during this period are known, their spatiotemporal footprints are not, creating an important gap in understanding of the species recovery patterns. Using archival logbooks and Bayesian modeling, we reconstructed daily positions for >700 whaling voyages (totaling >90,000 d) across the Arctic, revealing spatiotemporal patterns and causal drivers of these seafaring routes and their hunting successes. We find that whaling operations by British and American whalers expanded rapidly throughout the Arctic, moving in predictable ways through hazardous sea ice conditions, reaching all but the most remote bowhead whale habitats within a century. Extensive sea ice cover formed barriers, delaying access to some profitable whaling grounds and suppressing harvest intensity. These fine-scale processes created important population refugia across the Arctic, forming a network of naturally “protected areas” where cumulative harvest impacts were minimized. Our analyses show that these refugia were larger and persisted longer in bowhead whale populations that are recovering faster today, indicating that modern recovery patterns are likely tied to the spatial patterns of past exploitation.
4. Serologic Surveillance of Highly Pathogenic Avian Influenza Virus Subtype H5 in Wildlife, Northeast Germany, 2023-2025.
期刊: Emerging infectious diseases 发表日期: 2026-May 链接: PubMed
摘要
We tested wild ruminants, boar, and carnivores in northeast Germany for highly pathogenic avian influenza subtype H5 antibodies. Wild ruminants were seronegative, but 3.5% of boar and 12.5%-21.9% of carnivores were seropositive, indicating frequent spillover. Because such events might accelerate mammalian (and ultimately human) adaptation, sustained monitoring remains essential.
5. Psychometric Properties of the Adult Executive Functioning Inventory: Application of Rasch Analyses.
期刊: Brain and behavior 发表日期: 2026-May 链接: PubMed
摘要
Executive function is important ability for individuals to deal with daily living activities, and the Adult Executive Functioning Inventory (ADEXI) with promising psychometric properties was developed to assess executive function in nonclinical adult populations. However, psychometric properties evidence for ADEXI was primarily based on classical test theory; therefore, the current study used Rasch analysis to examine ADEXI to provide additional psychometric properties evidence. Participants aged 18-25 years (n = 1764; 55.9% women) were recruited using a social media platform (Dcard). They completed self-report Mandarin version of the ADEXI (of which includes three subscales of working memory, inhibition, and flexibility) and demographic characteristics (age, gender, and educational level) via online survey. Rasch analyses with differential item functioning (DIF) were used as analytic methods. All ADEXI items aligned with their intended subscales, with fit statistics of mean square ranging between 0.5 and 1.5. Moreover, the 5-point Likert scale of the ADEXI followed its order to indicate the difficulty (i.e., a higher score in the Likert scale indicates a poorer level of executive function). Moreover, no DIF items were displayed for the ADEXI across gender subgroup (men vs. women) or educational subgroup (college or above vs. high school or below). The psychometric properties of ADEXI were satisfactory, as indicated by the Rasch analysis findings. Unidimensionality of each ADEXI subscale was supported, categorical function was in order for the response, and no items displayed DIF. Therefore, the ADEXI can be used to evaluate executive function for general population and to enhance health promotion.
6. Integrated Metabolomic and Biochemical Profiling of Benzodioxane-Derived Hydrazones Targeting Nrf2 to Mitigate Cadmium-Induced Metabolic Dysregulation.
期刊: Journal of biochemical and molecular toxicology 发表日期: 2026-May 链接: PubMed
摘要
Benzodioxane-derived hydrazones (BDHs) have emerged as promising antioxidant agents due to their redox-modulatory properties, structural versatility, and ability to activate cellular defense pathways. This study evaluated the protective potential of two BDH derivatives-MBDH (methoxy-substituted) and TBDH (thiophene-substituted)-against Cd-induced toxicity, a major environmental health concern associated with multi-organ dysfunction via oxidative stress and mitochondrial impairment. Using LC-MS/MS-based metabolomic profiling together with biochemical assays in a mouse model, we compared the efficacy of BDHs with that of ascorbic acid. Cd exposure resulted in significant metabolic disruption, including reduced levels of amino acids (serine, methionine), elevated lipid peroxidation products (ceramides, phospholipid fragments), and mitochondrial dysfunction. Ascorbic acid (AA) provided partial metabolic and histological protection. MBDH exhibited moderate effects by reducing lipid peroxidation markers and partially restoring some amino acid levels, with a hydroxylated metabolite detected at m/z 328. TBDH, however, demonstrated superior protection, with near-complete normalization of metabolic profiles, formation of a stable metabolite (m/z 304), and marked attenuation in lipid peroxidation. Additionally, TBDH activated the Nrf2 signaling pathway, increased intracellular glutathione levels, and significantly improved histopathology in the liver, brain, and pancreas. It also reduced the levels of systemic inflammatory markers such as CRP, ESR, and procalcitonin. The enhanced performance of TBDH is attributed to its thiophene moiety, which facilitates improved electron delocalization and redox potential. This study highlights TBDH as a potent Nrf2 activator and antioxidant agent capable of mitigating Cd-induced metabolic and oxidative damage, providing a strong basis for the development of BDH-based therapeutics targeting heavy metal toxicity and related oxidative stress disorders.
7. Mycobacteria Amplicon Sequencing Tool: automated resistance prediction and lineage classification for Mycobacterium tuberculosis.
期刊: Microbiology resource announcements 发表日期: 2026-Apr-27 链接: PubMed
摘要
The Mycobacteria Amplicon Sequencing Tool (https://github.com/guthrielab/MAST) is a modular Nextflow pipeline for antimicrobial resistance prediction and lineage classification of Mycobacterium tuberculosis from amplicon or whole-genome sequencing data sets. The workflow automates read processing, variant calling, and annotation to produce standardized, human-readable reports in DOCX and TSV format.
8. Stigma and discrimination toward people living with HIV among healthcare workers in a public hospital in Mexico: A cross-sectional study.
期刊: Medwave 发表日期: 2026-Apr-27 链接: PubMed
摘要
In the global context of the HIV pandemic, the biopsychosocial environment of key populations remains marked by a culture that fosters stigma and discrimination. These attitudes, based on misconceptions of what it means to live with HIV, transcend the healthcare sphere and negatively impact people’s quality of life. In Mexico, systematic documentation of this issue within hospital settings remains limited. The objective of this study was to estimate the frequency of HIV-related stigma and discrimination among healthcare personnel of a secondary-level public hospital, as well as to identify differences by job category. We conducted an observational, descriptive, cross-sectional study from February to March 2025 at a secondary-level public hospital in Cancún, Quintana Roo, Mexico. We applied the short version of the HIV stigma questionnaire proposed by Nyblade et al. A total of 316 healthcare workers from different areas participated. To identify differences in stigmatizing attitudes across professional groups and to explore potential associations between sociodemographic variables and HIV-related beliefs, descriptive statistical analyses were performed, along with non-parametric tests (Kruskal-Wallis, Mann-Whitney U, and Spearman correlations) and post hoc comparisons using Dunn’s test with Bonferroni correction. A total of 22.5% of participants reported having witnessed refusal to work with people living with HIV, and 30.1% observed lower-quality care toward them. Additionally, 32.9% agreed that people living with HIV are irresponsible, and 30.4% believed they “do not care about spreading the infection.” Significant differences in stigma levels were found across occupational categories (p < 0.001). Medical assistants and interns showed higher levels of stigmatizing attitudes, while family physicians, nursing supervisors, and laboratory staff demonstrated greater empathy. Personally knowing someone living with HIV was significantly associated with greater acceptance of the right to become pregnant (p = 0.047). Stigma toward people living with HIV remains present in hospital environments. There is an urgent need to implement institutional training and awareness programs to reduce discriminatory attitudes and promote respect, accurate information, and empathy among all healthcare staff. En el contexto global del VIH, el entorno biopsicosocial de las poblaciones clave sigue marcado por una cultura que promueve el estigma y la discriminación. Estas actitudes, basadas en concepciones erróneas sobre lo que implica vivir con VIH, trascienden el ámbito sanitario y afectan la calidad de vida de las personas. En México, su documentación dentro de unidades hospitalarias es aún limitada. El objetivo de este estudio fue estimar la frecuencia de estigma y discriminación hacia el VIH en el personal de salud de un hospital público de segundo nivel, así como identificar diferencias según la categoría laboral. Se realizó un estudio observacional, descriptivo y transversal entre febrero y mayo de 2025 en un hospital público de segundo nivel, ubicado en Cancún, Quintana Roo, México. Se aplicó el cuestionario breve de estigma hacia personas con VIH propuesto por Nyblade . Participaron 316 trabajadores de distintas categorías laborales. Con el fin de identificar diferencias en las actitudes estigmatizantes según la categoría profesional y explorar posibles asociaciones entre variables sociodemográficas y las creencias relacionadas con el VIH, se realizaron análisis estadísticos descriptivos, pruebas no paramétricas (Kruskal-Wallis, U de Mann-Whitney, correlaciones de Spearman) y comparaciones con prueba de Dunn y corrección de Bonferroni. El 22,5% del personal reportó haber presenciado rechazo a trabajar con personas que viven con VIH y el 30,1% observó atención de menor calidad hacia ellas. El 32,9% estuvo de acuerdo con que las personas seropositivas son irresponsables y el 30,4% con que “no les importa el contagio”. Se identificaron diferencias significativas en el nivel de estigma entre categorías laborales (p < 0,001). Asistentes médicos y becarios mostraron actitudes más estigmatizantes, mientras que médicos familiares, jefaturas de enfermería y laboratoristas destacaron por su empatía. Conocer personalmente a una persona que vive con VIH se asoció significativamente con una mayor aceptación del derecho a embarazarse (p = 0,047). El estigma hacia las personas que viven con VIH continúa presente dentro del entorno hospitalario. Es apremiante establecer programas de sensibilización y formación continua orientados a reducir actitudes discriminatorias, promoviendo el respeto, la información y la comprensión entre todo el personal de salud.
9. In Response.
期刊: Anesthesia and analgesia 发表日期: 2026-Apr-27 链接: PubMed
摘要
10. Machine Learning-Derived Cardiovascular Aging Phenotypes From Cardiac Function and Stroke Risk in the UK Biobank: Cohort Study.
期刊: JMIR aging 发表日期: 2026-Apr-27 链接: PubMed
摘要
Cardiovascular magnetic resonance (CMR) is widely used across various cardiac conditions and systematically assesses cardiac anatomical structures and functional dynamics. Machine learning (ML) can accurately predict outcomes and understand the inherent features of clinical data. This study aimed to derive CMR phenotypes related to cardiovascular aging, investigate the relationship between these phenotypes and stroke risk, and relearn these phenotypes using supervised ML. We enrolled 36,467 participants without stroke and extracted CMR parameters from the UK Biobank, with follow-up data extending until September 30, 2023. Using the generative topographic mapping technique, we identified latent grid nodes among participants and then derived phenotypes through agglomerative hierarchical clustering. We used supervised ML models to predict cardiac function phenotypes and used Cox proportional hazards models to assess the association between these phenotypes and long-term stroke risk. We enrolled 36,467 participants in the study. The mean age was 54.9 (SD 7.5) years, with 17,442 (47.8%) male participants. During a mean follow-up time of 14.7 (SD 1.1) years, 500 (1.4%) participants developed stroke and 664 (1.8%) participants died, respectively. After generative topographic mapping modeling, we identified 2 distinct phenotypes: phenotype 1, characterized by adverse cardiac function and an accumulation of cardiovascular risk factors, reflecting cardiovascular aging; and phenotype 2, associated with a lower risk of stroke (hazard ratio 0.695, 95% CI 0.559-0.864; P=.001), which remained significant after accounting for competing mortality (hazard ratio 0.578, 95% CI 0.484-0.691; P<.001). We selected the random forest model as the optimal model for the phenotypes, demonstrating high accuracy (area under the curve 0.914, 95% CI 0.911-0.918 for training and 0.867, 95% CI 0.858-0.876 for validation) and calibration ability (Brier score 0.111, 95% CI 0.109-0.113 for training and 0.132, 95% CI 0.127-0.137 for validation). By integrating unsupervised and supervised ML methods, we identified cardiovascular aging-related phenotypes that demonstrate robust predictive ability for incident stroke, which may have the potential to improve preventive and therapeutic strategies for high-risk populations.
11. Stigma, Food Insecurity, and Limited Social Support as Psychosocial Correlates of Antiretroviral Therapy Adherence Among Pregnant Women Living With HIV: Cross-Sectional Study.
期刊: JMIR public health and surveillance 发表日期: 2026-Apr-27 链接: PubMed
摘要
Adherence to antiretroviral therapy (ART) during pregnancy is critical for maternal health and the prevention of vertical HIV transmission. In Uganda, where HIV prevalence remains high, pregnant women living with HIV face intersecting structural and psychosocial challenges, including stigma, food insecurity, and limited social support. Although each factor has been linked to ART nonadherence, less is known about how these factors co-occur within individuals and jointly shape vulnerability to nonadherence during pregnancy. This study used latent profile analysis to identify empirically derived psychosocial vulnerability profiles reflecting the co-occurrence of stigma, food insecurity, and limited social support among pregnant women living with HIV in Uganda and examine whether profile membership is associated with ART adherence. We conducted a cross-sectional analysis of 167 pregnant women living with HIV recruited from 6 health facilities in Uganda between June and December 2020. Measures included experienced HIV stigma, internalized HIV stigma, household food insecurity, and interpersonal social support. Latent profile analysis identified psychosocial profiles, and linear regression models assessed associations between profile membership and ART adherence, adjusting for sociodemographic covariates. A 2-class solution provided the best model fit (entropy=0.93). The higher-risk profile (75/167, 45.1%) was characterized by increased experienced stigma (mean score 1.97, SE 0.05), higher internalized stigma (mean score 2.66, SE 0.07), severe food insecurity (mean score 7.53, SE 0.20), and lower social support (mean score 2.06, SE 0.04). The lower-risk profile (92/167, 54.9%) showed significantly lower internalized stigma (mean score 2.32, SE 0.04; P<.001), lower experienced stigma (mean score 1.72, SE 0.05; P<.001), minimal food insecurity (mean score 0.82, SE 0.15; P<.001), and slightly higher social support (mean score 2.14, SE 0.04; P<.001). Membership in the higher-risk profile was associated with significantly lower ART adherence compared with membership in the lower-risk profile (B=0.88; β=0.40, 95% CI 0.02-0.78; P=.04). Distinct psychosocial profiles are meaningfully associated with ART adherence among pregnant women living with HIV in Uganda. By moving beyond single-risk models, these findings demonstrate the added value of person-centered analytic approaches for identifying subgroups of pregnant women living with HIV exposed to clustered psychosocial and structural vulnerabilities. The findings underscore the need for multicomponent, person-centered interventions that simultaneously address stigma, food insecurity, and limited social support rather than treating these challenges in isolation. Identifying empirically derived vulnerability profiles provides a targeted framework for prioritizing high-risk subgroups and informing contextually appropriate intervention design. Addressing these intersecting vulnerabilities is essential for improving maternal ART adherence and supporting efforts to prevent vertical HIV transmission in high-burden settings.
12. Interpersonal Relationship, Academic Performance, & Life Skills: A Comparative Study of Children With and Without Emotional and Behavioral Problems.
期刊: Clinical child psychology and psychiatry 发表日期: 2026-Apr-27 链接: PubMed
摘要
BackgroundEmotional and behavioral problems (EBPs) in children significantly influence developmental domains, including interpersonal relationships, academic performance, and life skills.MethodsA cross-sectional study was adopted with purposive sampling. The study includes 120 children aged 6-14 years from West Bengal, equally divided into groups with and without EBPs. Standardized tools such as the Pediatric Symptom Checklist (PSC), Child Interpersonal Relationships and Attitudes Assessment (CIRAA), Academic Performance Scale (APS), and Life Skills Assessment Scale (LSAS) were used.ResultsChildren with EBPs significantly scored lower in interpersonal relationships (p = .015) and life skills (p < .001) compared to peers without EBPs. However, they seem to scored slightly better in academic performance (p = .026). Correlation analyses showed a weak but significant relationship between EBPs and interpersonal relationships (r = 0.198, p = .030), a negative correlation with academic performance (r = -0.217, p = .017), and a moderately strong positive correlation with life skills (r = 0.457, p < .001).ConclusionThese EBPs obstruct the development of interpersonal and life skills, while their impact on academics varies with contextual factors. Thus, the study stresses that interventions should provide academic support, social-emotional learning and life skills training in schools and communities. Our recent study examined how emotional and behavioral problems in children affect their daily lives and development. We have collected the data from 120 children between 6 and 14 years old in India. We wanted to understand how these challenges impact three important areas of children’s lives: their relationships with others, their performance in school, and their ability to handle everyday tasks and situations. Using several assessment tools designed for children, we measured how well the kids were doing in each of these areas. We found that children dealing with emotional and behavioral problems had noticeably more difficulty forming and maintaining relationships with friends, family, and teachers compared to children without these issues. They also struggled significantly more with everyday life skills things like managing their time, solving problems, making decisions, and coping with stress. We found that emotional and behavioral problems had a moderate to strong relationship with life skills difficulties, meaning children with more emotional challenges typically struggled more with handling daily situations. The connection with relationships and academic performance was weaker but still noticeable. Our study’s key message is clear: emotional and behavioral problems in children create real obstacles in developing social connections and practical life skills, even though their effect on schoolwork may vary. This means that schools and communities need to provide comprehensive support not just helping children keep up academically, but also teaching them how to manage emotions, build healthy relationships, and develop the skills they need to navigate life successfully.
13. Outcome Differences Between General and Neuraxial Anesthesia for Hip Fracture by Frailty and Age in the Elderly: A Retrospective Cohort Study.
期刊: Anesthesia and analgesia 发表日期: 2026-Apr-27 链接: PubMed
摘要
Frailty and age are major outcome drivers in hip fracture surgery, but their interaction has not been considered in neuraxial versus general anesthesia comparisons. Using the Hospital Frailty Risk Score (HFRS), we examined this interaction. In this retrospective cohort study (2016-2023, Premier Healthcare Database), adults undergoing hip fracture surgery with neuraxial or general anesthesia were included and stratified by age quantiles (≤71, 72-86, ≥87 years) and HFRS (low, intermediate/high). The primary outcome was an in-hospital composite of mortality and major system complications. Intensive care unit (ICU) admission and high opioid use or prolonged length of stay (LOS) ≥75th percentile were also assessed. We used mixed-effects models and reported odds ratios (OR) and 95% confidence intervals (CIs). Among 623,122 patients, neuraxial (versus general) anesthesia was associated with lower odds of the composite outcome in patients ≥87 years with intermediate/high frailty (OR, 0.88 and 95% CI, 0.83-0.94; P < .001). Overall, neuraxial anesthesia was linked to higher odds of respiratory complications (OR, 1.06 and 95% CI, 1.01-1.10; P = .03), driven by patients ≤71 years with intermediate/high frailty, and lower odds of renal failure (OR, 0.87 and 95% CI, 0.83-0.92; P < .001), primarily among those ≥72 years with intermediate/high frailty. Neuraxial anesthesia was also associated with higher cardiac complication odds (OR, 1.07 and 95% CI, 1.02-1.12; P = .008), particularly in patients aged 72 to 86 years with intermediate/high frailty. Mortality odds were lower overall (OR, 0.83 and 95% CI, 0.74-0.93; P = .003), driven by patients ≥87 years with intermediate/high frailty. Neuraxial anesthesia was associated with higher odds of prolonged LOS in patients aged 72 to 86 years with low frailty (OR, 1.16 and 95% CI, 1.04-1.31; P = .035), but lower odds in those ≥87 years with intermediate/high frailty (OR, 0.92 and 95% CI, 0.87-0.97; P = .012). It was associated with lower odds of high opioid use overall and within each subgroup. ICU admission odds were higher in patients ≤71 years with intermediate/high frailty (OR, 1.16 and 95% CI, 1.05-1.29; P = .019) but lower in those ≥87 years with intermediate/high frailty (OR, 0.82 and 95% CI, 0.75-0.90; P < .001). Neuraxial anesthesia was linked to higher odds of discharge home (OR, 1.08 and 95% CI, 1.04-1.12; P < .001), except among ≥87-year-old intermediate/high frailty patients, where odds were lower (OR, 0.90 and 95% CI, 0.81-0.99; P = .041). Neuraxial versus general anesthesia showed modest overall benefits after hip fracture, varying by age-frailty subgroup, supporting frailty-guided anesthetic decisions clinically.Level of evidence: III. Retrospective cohort study.
14. Integrating AI Into Governmental Public Health Decision Making: Challenges, Considerations, and a Path Forward.
期刊: JMIR public health and surveillance 发表日期: 2026-Apr-27 链接: PubMed
摘要
Public health emergencies such as pandemics, natural disasters, and epidemics may require rapid, high-stakes decisions often made by elected officials with limited public health training. Artificial intelligence (AI) holds significant promise to enhance the quality, transparency, and timeliness of governmental decision-making during such crises. This paper examines the potential of AI as a decision-support tool for elected officials while identifying key technical, logistical, ethical, and policy challenges. Technical considerations include model accuracy, data representativeness, and privacy protection, while ethical imperatives center on fairness, transparency, and accountability to prevent amplification of existing health disparities. The paper further explores workforce development needs, emphasizing AI literacy and cross-sector collaboration to enable informed use of AI insights. This viewpoint presents a novel AI Decision Support Lifecycle framework specifically designed for governmental public health emergency response, mapping six phases from problem definition through post-emergency evaluation. We provide stakeholder-specific recommendations for model developers, health agencies, and elected officials, and illustrate practical application through a detailed case example and use cases. Drawing on empirical evidence regarding digital health technologies and AI governance, we emphasize that technology deployment alone is insufficient. Successful implementation requires complementary investments in organizational capacity, data infrastructure, workforce training, community engagement, and continuous evaluation. AI integration also requires robust governance frameworks, continuous model evaluation, and alignment with existing crisis management structures. Policy recommendations highlight the importance of ethical AI frameworks, risk assessments, and public engagement to foster trust. Ultimately, AI can strengthen public health decision-making if developed and implemented responsibly within transparent and equitable systems.
15. Strategies to Address Communication Vulnerability in Adult Intensive Care Units Through Practice, Environment, and Policy Modifications.
期刊: Journal of nursing care quality 发表日期: 2026-Apr-27 链接: PubMed
摘要
16. Mixed-Methods Development and Validation of PRO/PREM Items for Patients Undergoing Colon Polyp Surveillance.
期刊: Journal of clinical gastroenterology 发表日期: 2026-Apr-27 链接: PubMed
摘要
Patient-reported outcomes (PROs) and experience measures (PREMs) are essential in assessing patient outcomes and experiences in comparative effectiveness research and clinical practice. While validated measures exist for colorectal cancer (CRC) screening, none address colon polyp surveillance. We aimed to develop and validate PRO/PREM items for this purpose. Using a mixed-methods instrument development design, we conducted semistructured interviews with 14 older adults with a history of colon polyps and 9 primary care physicians and then tested a 16-item PRO/PREM questionnaire. We conducted exploratory factor analyses (EFAs; N=449), confirmatory factor analyses (CFAs; N=466), and test-retest reliability (N=155) to assess validity and reliability. Interviews revealed 6 PRO/PREM domains: Test Satisfaction, Test Convenience, Testing Complications, Assistance Needed, Confidence in Test, and Cancer Worry. Whereas the EFA results supported a 3-factor solution, the CFA results supported a 1-factor, 4-item model of Test Experience/Satisfaction. Test-retest reliability for this composite Test Experience/Satisfaction score was good. Test-retest reliability was moderate for 12 of the individual PRO/PREM items and poor for 3 items. To our knowledge, this is the first study to develop and validate PRO/PREM items for adults undergoing colon polyp surveillance. Although subsequent research is required to assess the predictive validity of these items, our findings provide strong initial support for their psychometric properties, and this study represents an essential first step toward implementing PRO/PREM items for colon polyp surveillance in research and clinical settings.
17. Short-Term Effects of an mHealth Intervention on Healthy Behaviors and Cardiometabolic Health in Sedentary Employees: Quasi-Experimental Study.
期刊: JMIR mHealth and uHealth 发表日期: 2026-Apr-27 链接: PubMed
摘要
Sedentary employees face increased chronic health risks due to physical inactivity, immobility, and unhealthy eating behavior. Although mobile health (mHealth) interventions show promise in improving lifestyle behaviors, their effectiveness in occupational settings remains underexplored. Building on previous workplace interventions, this study developed and evaluated a mobile-enabled web app, SIMPLE HEALTH, developed with Din-J Design Co, Ltd, integrating activity tracking, healthy eating, and behavioral support for sedentary employees. This study evaluated the short-term effects of a 12-week mHealth intervention on physical activity, sedentary behavior, dietary habits, and cardiometabolic health indicators among sedentary employees in Taiwan. A 2-arm quasi-experimental study was conducted at 2 aerospace industrial workplaces. A total of 101 sedentary employees (mean age 46.9, SD 12.2 years; 52/101, 51.5% female) were enrolled from 2 worksites that were assigned by coin toss to either the intervention condition (n=50) or the control condition (n=51). The intervention group participated in the SIMPLE HEALTH program, an mHealth intervention grounded in Social Cognitive Theory and the Ecological Model, consisting of 8 components: activity tracking, goal setting, behavior logging, reminders, personalized advice, educational and motivational electronic booklets, and individual and team challenges. The control group received 6 print educational booklets. Cardiometabolic biomarkers, objectively measured physical activity (Fitbit Charge 3; Fitbit Inc), occupational sitting (occupational sitting and physical activity questionnaire), and dietary behavior (3-day photographic food records and the healthy eating behavior inventory) were assessed at baseline and 12 weeks. Data were analyzed using generalized estimating equations following the intention-to-treat principle. At 12 weeks, the intervention group showed a significant increase in step counts (adjusted mean difference, MD 1227.13, 95% CI 2.90-2451.36; P=.049), a more favorable between-group change in moderate physical activity (adjusted MD 0.17, 95% CI 0.01-0.33; P=.04), and favorable dietary behaviors, including reduced intake of calories (adjusted MD -144.59, 95% CI -276.57 to -12.60; P=.03), carbohydrates (adjusted MD -19.88, 95% CI -37.99 to -1.78; P=.03), fats (adjusted MD -6.99, 95% CI -13.69 to -0.29; P=.04), and grains (adjusted MD -1.46, 95% CI -2.43 to -0.50; P=.003), and increased vegetable intake (adjusted MD 0.47, 95% CI 0.06-0.88; P=.02), compared to the control group. Favorable trends were noted in diastolic blood pressure (adjusted MD -2.38, 95% CI -4.99 to 0.22; P=.07) and soft lean mass (adjusted MD 0.34, 95% CI -0.06 to 0.75; P=.10). Both groups showed significant within-group improvements in low-density lipoprotein cholesterol (intervention: P=.01; control: P=.03), body fat percentage (intervention: P<.001; control: P=.01), waist circumference (intervention: P=.001; control: P=.002), and occupational sitting (intervention: P<.001; control: P=.03), and occupational walking (intervention: P=.01; control: P=.046), but between-group differences were nonsignificant. The 12-week mHealth intervention improved physical activity and dietary behaviors and showed favorable trends in cardiometabolic indicators among sedentary employees. These findings support integrating mHealth programs into employee wellness initiatives to promote healthy behaviors, mitigate productivity loss, and reduce chronic disease burden. Further research should assess long-term sustainability, scalability, and cost-effectiveness in diverse occupational settings.
18. Effectiveness and Feasibility of Self-Monitoring for Weight Management in Individuals With Mental Disorders Using Digital Intervention: Protocol for a Stepped-Wedge Cluster Randomized Trial ("SWIM" Study).
期刊: JMIR research protocols 发表日期: 2026-Apr-27 链接: PubMed
摘要
Individuals with schizophrenia or bipolar disorder face a significantly elevated risk of obesity, primarily due to weight gain associated with psychiatric medications and lifestyle factors. While digital self-monitoring tools offer scalable solutions, their application remains underexplored in psychiatric populations. To address these gaps, this type 1 hybrid effectiveness-implementation study investigates the preliminary effectiveness and implementation feasibility of a mobile health-assisted weight management intervention for patients with severe mental illness. This study aims to evaluate the preliminary effectiveness and implementation feasibility of a mobile health-assisted weight management intervention for patients with severe mental illness transitioning from inpatient care to community-based recovery. This single-center, open-cohort stepped-wedge cluster randomized trial with a 2-month step duration will recruit 204 patients from 6 clinical units. Clusters are randomized into 2 waves, with staggered transitions to a digital intervention, including smart scales, health apps, and biweekly educational modules, over a 6-month observation period. The design evaluates the intervention across the transition from inpatient care to community-based recovery. The primary outcome is the proportion of participants achieving ≥5% weight loss at month 6. Implementation feasibility is assessed through device technical success and intervention adherence (defined as ≥50% completion of weekly weigh-ins and daily dietary logs). Participant data collection began in May 2023 and was completed by June 2025 with a total of 204 participants. The publication of key findings and results is anticipated in late 2026. This protocol describes a pragmatic, technology-supported intervention designed to address metabolic side effects in a tertiary psychiatric setting. By bridging the gap between acute hospitalization and community recovery, this hybrid stepped-wedge cluster randomized trial provides a crucial framework for integrating digital metabolic monitoring into routine clinical workflows for vulnerable populations.
19. Frugal-Oriented Information and Communication Technology for Development Framework Toward Low-Cost Digital Maternal Health in Low- and Middle-Income Countries: Quantitative Descriptive Study.
期刊: JMIR formative research 发表日期: 2026-Apr-27 链接: PubMed
摘要
The Sustainable Development Goals (SDGs) aim to eradicate poverty and inequality while ensuring that all individuals enjoy good health. Among these, target 3.1 seeks to reduce the global maternal mortality ratio to less than 70 per 100,000 live births. However, progress toward this target has been limited, particularly in low- and middle-income countries (LMICs), where health care delivery remains constrained by limited resources. While digital innovations have increasingly been adopted to improve health care access and service delivery, a significant proportion of populations in LMICs continues to experience inadequate access to essential maternal health services. This gap underscores the need for affordable, sustainable, and contextually appropriate strategies that are cost-effective in improving maternal health outcomes in underserved communities. This study leverages the principles of frugal innovation and information and communication technologies for development (ICT4D) to propose a frugal-oriented ICT4D framework to deliver low-cost digital maternal health solutions in LMIC settings. The framework seeks to optimize the use of available resources, foster equitable access to maternal health care, and contribute toward achieving SDG 3, particularly target 3.1. The study was conducted in both rural and urban-poor settings in Kenya using a 2-phased quantitative approach. In phase 1, eight theoretical themes relevant to maternal health uptake were explored. These themes were represented on color-coded sorting cards, which participants ranked according to perceived importance. Phase 2 involved administering structured survey questionnaires to collect empirical data. The study included a total of 32 participants, whose insights provided a foundation for analyzing the significance of contextual factors influencing maternal health service utilization. The weighted scores for 3 of the 8 predetermined theoretical themes-such as resources, information services, and social support programs-emerged as the most influential factors shaping maternal health promotion (N=32). Resources ranked highest (n=6, 18.81%), followed by information services (n=6, 17.99%), while social support programs accounted for 9.64% (n=3) of the overall influence. These findings highlight critical enablers and barriers within the maternal health care landscape and provide a nuanced understanding of contextual dynamics that affect the uptake of maternal health services. The results informed the design of a frugal-oriented ICT4D framework that prioritizes low-cost digital interventions tailored to resource-limited settings. Despite increasing recognition of digital innovations as tools for health care transformation in LMICs, adoption of existing capital-intensive solutions remains low due to financial and infrastructural constraints. This study emphasizes the importance of adopting frugal innovation and ICT4D principles in designing low-cost, scalable digital health interventions to improve access to maternal health care. Implementing such approaches can address resource limitations, enhance maternal health outcomes, and support progress toward SDG 3, particularly target 3.1. The proposed framework provides a foundation for future research and practical interventions aimed at sustainable, equitable maternal health service delivery in LMIC contexts.
20. Eight weeks of high-intensity interval training is insufficient to prevent sitting-induced endothelial dysfunction and microvascular impairment.
期刊: Experimental physiology 发表日期: 2026-Apr-27 链接: PubMed
摘要
Prolonged sitting disrupts lower-limb endothelial and microvascular function, likely via reduced shear stress and blunted microvascular reactivity. We examined whether Tabata-style high-intensity interval training (HIIT) mitigates this sitting-induced vascular dysfunction. Twenty-two healthy young adults (age 20.3 ± 0.8 years) were randomly assigned to a control group (n = 11) or a training group (n = 11); each group comprised seven men and four women. Participants completed 8 weeks of HIIT (4 sessions/week) using a cycle ergometer and bodyweight exercises. Before and after the intervention, participants underwent a 3 h period of sitting during which popliteal artery flow-mediated dilation (FMD) and reactive hyperaemic blood flow were assessed; plasma nitrate/nitrite and endothelin-1 were also measured at rest. Sitting reduced popliteal artery blood flow and shear rate in both groups before and after training (P < 0.05). Popliteal artery FMD decreased after sitting at baseline in both groups and remained lower after sitting in the training group post-intervention. However, post-sitting FMD at week 8 was higher in the HIIT group than in controls after adjustment for pre-sitting FMD. Post-sitting blood-flow area under the curve was decreased by sitting in both groups before and after the intervention (P < 0.05), and resting nitrate/nitrite and endothelin-1 did not change with training. These results indicate that 8 weeks of HIIT does not prevent sitting-induced impairments in endothelial function or microvascular function. Although the HIIT maintained higher post-sitting FMD, HIIT alone was insufficient to counteract the acute endothelial and microvascular dysfunction imposed by sitting.
21. Phenolic Acid Metabolites Generated via Lactic Acid Bacteria Fermentation of Wild Blueberries: Comparison to Circulating Gut-Derived Metabolites from Endogenous Fermentation.
期刊: Journal of agricultural and food chemistry 发表日期: 2026-Apr-27 链接: PubMed
摘要
In vitro fermentation models with strains of Lactiplantibacillus plantarum and Bacillus subtilis were used to track the structural changes in polyphenolic composition in wild blueberry treatments after 72 h fermentation, and to compare metabolites from exogenous fermentation to those reported to be produced by human gut-derived catabolism. Shifts in the profiles of flavonoids, anthocyanins, proanthocyanidins, phenolic acids, and phenolic acid conjugates (some putatively identified for the first time in wild blueberries) were quantified. While glucuronide and sulfate conjugates of phenolic acids (which rely on human enzymes) are not produced in vitro, exogenous fermentation can, depending on the conditions, replicate a broad range of the bioactive phenolic acids generated by endogenous fermentation of wild blueberries in the human gut. Exogenous fermentation may therefore yield more standardized and physiologically relevant phenolic profiles than an unfermented blueberry extract for use in translational preclinical research on berry health benefits.
22. Bacteremia and Bacterial Meningitis Among Low-Risk Febrile Infants Aged 29 to 60 Days.
期刊: JAMA pediatrics 发表日期: 2026-Apr-27 链接: PubMed
摘要
This diagnostic study examines the performance of the updated Pediatric Emergency Care Applied Research Network rule in determining the risk for invasive bacterial infections in an international sample of infants.
23. The Epidemiology of the Global Syndemic in Africa: New Evidence and Key Insights.
期刊: Current obesity reports 发表日期: 2026-Apr-27 链接: PubMed
摘要
24. A Mixed-Methods Study of Patient Identification Barriers and Facilitators in a Pediatric Surgery RCT.
期刊: The Journal of surgical research 发表日期: 2026-Apr-26 链接: PubMed
摘要
Successful clinical trials require robust patient enrollment, yet study sites often struggle to identify potentially eligible patients, particularly in pediatric populations. During a stepped-wedge, cluster randomized clinical trial, ENhanced Recovery in CHildren Undergoing Surgery (ENRICH-US), concerns about adequate recruitment led us to assess the relationship between site characteristics and enrollment rates. We conducted a mixed-methods, explanatory, sequential design study using (a) secondary quantitative data from the Pediatric Health Information System (PHIS) database to identify potentially eligible patients (ages 10-18 undergoing elective gastrointestinal surgery) at 10 ENRICH-US study sites and (b) qualitative data from semi-structured focus groups to assess site-specific enrollment barriers and facilitators. The number of potentially eligible patients identified through PHIS (07/01/20-04/30/23) was compared to the actual ENRICH-US enrollment to calculate site enrollment rates. Semi-structured interviews (10/01/19-04/01/23) were then analyzed to identify themes of barriers and facilitators. Of 485 potentially eligible patients, 312 (64.3%) were enrolled. Enrollment rates varied (27.6%-88.5%). High-enrollment rate sites (>60%) had dedicated staff, engaged study leaders, clinical trial experience, and expanded the intervention beyond the study population. Automated tools facilitated patient identification, mitigating personnel turnover challenges. Using secondary quantitative databases to assess clinical trial enrollment is a novel approach. When combined with qualitative insights, these data can inform strategies to enhance recruitment and enrollment.
25. From cells to niches: Rewiring cardiovascular disease through spatial immunity.
期刊: International immunopharmacology 发表日期: 2026-Apr-26 链接: PubMed
摘要
Cardiovascular diseases (CVDs) remain the leading cause of mortality worldwide, yet their underlying immune mechanisms are still incompletely understood. A central limitation of current frameworks is that they largely conceptualize immune responses at the level of individual cell types, without fully accounting for how spatial context shapes cellular behavior. Over the past decade, bulk and single-cell transcriptomic approaches have substantially expanded our understanding of immune heterogeneity in cardiovascular tissues, revealing diverse macrophage, lymphocyte, and stromal populations implicated in disease progression. However, these approaches inherently disrupt tissue architecture and therefore fail to capture how immune cells operate within structured microenvironments. Recent advances in spatial transcriptomics, multiplexed imaging, and single-cell multi-omics now enable the interrogation of gene expression within intact tissues, providing direct insight into the spatial organization of immune responses. These technologies reveal that cardiovascular inflammation and repair are not diffusely distributed processes but are instead organized into discrete, spatially constrained niches. Within these niches, cellular identity, anatomical positioning, and local signaling gradients converge to regulate key processes including inflammation, fibrosis, and vascular remodeling. Evidence from myocardial infarction, atherosclerosis, and vascular injury demonstrates that microenvironments such as inflammatory foci, fibrotic border zones, and lipid-rich plaque regions orchestrate dynamic interactions among macrophages, T cells, fibroblasts, and endothelial cells. Here, we synthesize recent advances in spatial immunomics to propose a conceptual shift from cell-centric to niche-centric models of cardiovascular disease, framing tissues as structured immune ecosystems. We discuss computational strategies that integrate single-cell sequencing, spatial transcriptomics, and imaging data to reconstruct cellular neighborhoods and infer intercellular communication networks, while highlighting current limitations in resolving causality from spatial correlations. Finally, we explore the translational potential of spatial immunomics, including the identification of spatially defined biomarkers, the development of niche-targeted therapeutic strategies, and the construction of predictive models linking tissue architecture to clinical outcomes.
26. Fatal norovirus infection in a patient with congenital adrenal hyperplasia: forensic use of BioFire FilmArray GI panel.
期刊: Legal medicine (Tokyo, Japan) 发表日期: 2026-Apr-25 链接: PubMed
摘要
Identifying infections during autopsy is challenging in forensic pathology. Although microbiological testing can assist in diagnosis, distinguishing true pathogens from contaminants is often difficult. Molecular methods, such as PCR, may support diagnostic conclusions. On August 22, 2024, a 30-year-old woman was admitted to the Department of Emergency Medicine, Clinical Centre, University of Debrecen, Hungary, with severe vomiting and diarrhea. Her medical history included treated congenital adrenal hyperplasia. Within 30 min of admission, she developed sudden cyanosis and respiratory insufficiency. Despite resuscitation efforts, the patient died shortly after arrival. Two days before hospitalization, she had collected sewage samples from the Kraszna River (Hungary) as part of her job. According to her colleagues, she did not wear any protective equipment (mask, gloves, or coveralls). The samples were later analyzed at the National Center for Public Health and Pharmacy and tested positive for Norovirus. Postmortem examination, including microbiological and molecular investigations (BioFire FilmArray GI multiplex PCR), confirmed Norovirus infection. These findings supported the hypothesis that viral infection significantly contributed to rapid clinical deterioration. This case highlights the utility of molecular microbiology in forensic investigations. Multiplex PCR panels, routinely used in clinical diagnostics, can provide valuable evidence in postmortem settings, particularly in acute gastrointestinal deaths where autopsy findings are non-specific. Early patient education in congenital adrenal hyperplasia may prevent fatal outcomes in similar cases.
27. Co-Exposure to Food-Grade and Nano-TiO2 with High-Fat Diet Induces Multi-Organ Injury in Liver, Intestine, Brain, and Testicles.
期刊: Toxics 发表日期: 2026-Apr-21 链接: PubMed
摘要
Titanium dioxide nanoparticles (TiO2 NPs), widely used as food additives, frequently coexist with high-fat diets (HD) in modern dietary patterns, yet their combined in vivo toxicity remains poorly understood. This study investigated the multi-organ effects of co-exposure to TiO2 NPs or food-grade E171 and HD in male C57BL/6J mice. Mice were randomly assigned to six groups and fed regular or high-fat diets containing 1 wt% TiO2 NPs or E171 for 13 weeks. Histopathology, serum biochemistry, organ coefficients, and open-field behavioral tests were used to assess tissue injury and functional alterations. Co-exposure to TiO2 NPs and HD markedly exacerbated tissue damage across multiple organs. In the liver, more severe ballooning degeneration, necrosis, and inflammatory infiltration were observed, accompanied by altered liver enzymes and reduced organ coefficients. Intestinal injury was characterized by crypt distortion and increased inflammation, particularly in the HD + TiO2 group. Testicular tissues showed disorganized seminiferous tubules, loss of spermatogenic cells, and interstitial hyperplasia. In the brain, hippocampal neurons exhibited pyknosis and disarray, with decreased brain coefficients and impaired exploratory behavior. E171 induced similar but milder effects. These findings indicate that HD enhances TiO2 NPs induced multi-organ toxicity, highlighting the health risks of realistic co-exposure to dietary nanoparticles and high-fat foods.
28. Generation of a human induced pluripotent stem cell line SDQLCHi087-A from a healthy Chinese child donor.
期刊: Stem cell research 发表日期: 2026-Apr-20 链接: PubMed
摘要
In this study, a healthy iPSC line SDQLCHi087-A was successfully generated by reprogramming from peripheral blood mononuclear cells using integration-free episomal plasmids. The iPSC line presented a normal karyotype, expressed high levels of pluripotent markers, and exhibited the ability to differentiate to three germ layers in vitro. The cell line serves as a valuable control for studies of molecular pathogenesis and the development of disease models.
29. From 'dismissal' to 'medical gaslighting': A literature review of women's experiences of reproductive health services in the UK.
期刊: Midwifery 发表日期: 2026-Apr-18 链接: PubMed
摘要
Women in the United Kingdom face noticeable challenges in accessing and receiving reproductive health care. The emotional impact of these challenges is seldom evaluated. Recent research and wider societal discourse suggest that many women experience ‘gaslighting’, a form of psychological manipulation where their health concerns are not taken seriously, leading to feelings of dismissal and resulting in withdrawal from mainstream healthcare services. This can culminate in delayed diagnoses and poorer health outcomes. A qualitative systematic review of the literature investigating gaslighting and dismissal in women’s reproductive health in the UK, with a focus on how these experiences differ across intersecting identities such as ethnicity, sexuality, and socioeconomic status. Search of qualitative literature across key databases including PubMed, PsycInfo, CINAHL plus, Web of Science, Medline, Scopus, Embase, Science Direct, and HMIC retrieving 25,258 papers. The review identified no papers explicitly addressing gaslighting in women’s reproductive health in the UK. However, seven related studies were found containing relevant themes (e.g. dismissal), providing a basis for the review. A thematic summary based on the extracted data resulted in the development of four themes 1) dismissal of symptoms and needs (patients experiences, systemic issues), 2) marginalised experiences (ethnic minority women, LGBTQ+ people), 3) stigma and fear of judgement, and 4) poor communication and limited autonomy. The review highlights the need for more targeted research in this area as the scarcity of literature underscores the importance of exploring the emotional impact and framing of dismissal as gaslighting by women in reproductive healthcare. Better conceptualisation and understanding could inform practice and policy changes aimed at validating women’s experiences and improving equity in reproductive healthcare access and outcomes.
30. Oxidative Stress, DNA Damage, DNA Repair Inhibition, and Apoptosis Induced by Lead and Cadmium Combined Exposure in TK6 Cells.
期刊: Toxics 发表日期: 2026-Apr-18 链接: PubMed
摘要
Lead (Pb) and cadmium (Cd) are common environmental pollutants. Our previous population study revealed a significant positive association between Pb and Cd exposure and the micronuclei frequency among lead smelting workers. However, the underlying mechanisms remain unclear. In this study, human lymphoblastoid TK6 cells were used to investigate the genotoxicity and its mechanisms induced by individual or combined exposure to Pb and Cd. Our results showed that Pb and Cd exposure, alone or in combination, triggered oxidative stress, as evidenced by reduced antioxidant enzyme activity (GSH, SOD and CAT) and increased content of ROS and GSSG. Both metals induced pronounced DNA damage, as shown by elevated Tail DNA% in the Comet assay and γ-H2AX fluorescence intensity. Furthermore, Pb and/or Cd exposure caused inhibition of the DNA repair proteins, including BRCA1, CtIP, RAD52, and XRCC2, indicating impaired DNA repair capacity; and upregulated Bax expression and the Bax/Bcl-2 ratio and Caspase-3 with downregulation of Bcl-2. Notably, Pb and Cd co-exposure produced an antagonistic effect, modulating oxidative stress indicators, cell-cycle arrest, DNA damage markers, DNA repair and apoptosis-related proteins. These findings demonstrate that Pb and Cd induce oxidative stress, DNA damage, inhibition of DNA repair, and apoptosis in TK6 cells. Our study provides new insights into the mechanisms of heavy metal combined exposure-induced genotoxicity and identifies potential molecular targets for intervention.
31. Wastewater surveillance of dengue and chikungunya during the worst arbovirus epidemic in Brazil.
期刊: Water research 发表日期: 2026-Apr-17 链接: PubMed
摘要
This study evaluated wastewater-based epidemiology (WBE) for monitoring dengue virus (DENGV) and chikungunya virus (CKV) during Brazil’s most severe arbovirus epidemic, focusing on the city of Belo Horizonte, Minas Gerais. From March 2022 to August 2024, 24-hour composite raw sewage samples were collected weekly from two major wastewater treatment plants, encompassing over 80% of the city’s population. Viral RNA was quantified via RT-qPCR and positive samples underwent genome sequencing for genotype characterization. DENGV and CKV RNA were detected in over 90% of samples across both wastewater treatment plants (WWTPs), demonstrating sustained and widespread viral circulation throughout epidemic and inter-epidemic periods. Although CHIKV concentrations varied significantly across years, DENGV concentrations remained statistically stable, and no significant correlations were observed between wastewater viral loads and reported clinical cases. A considerable proportion of samples presented concentrations below the limit of quantification, indicating that while WBE is highly sensitive for qualitative detection of arboviruses, quantitative interpretation remains methodologically constrained. Sequencing confirmed the presence of DENGV-1 sorotype I and CKV genotype V, clustering with contemporaneous Brazilian strains and reflecting regional transmission dynamics. Wastewater-based modelling further suggested that reported clinical cases may substantially underestimate true infection burden, although quantitative estimates were highly sensitive to assumptions regarding viral shedding variability. These findings demonstrate that WBE provides a sensitive, non- invasive, population level approach for tracking arboviral circulation and viral diversity during large-scale outbreaks and could complement public health surveillance frameworks, especially in regions with limited diagnostic capacity or high levels of underreporting, to enhance epidemic response and control strategies.
32. Evaluation of Salmonella Paratyphi specific antibody quantity and function after vaccination and controlled human infection.
期刊: Journal of immunology (Baltimore, Md. : 1950) 发表日期: 2026-Apr-15 链接: PubMed
摘要
Salmonella Paratyphi A is a major cause of paratyphoid fever. Despite growing global concern, knowledge of S. Paratyphi A immunity remains limited, and no licensed vaccine exists. In a controlled human infection model (CHIM) homologous S. Paratyphi A rechallenge showed a non-significant reduction in risk of acute disease. This study evaluates humoral immunity following experimental S. Paratyphi A exposure and vaccination with a bivalent S. Typhi-S. Paratyphi A conjugate vaccine (Sii-PTCV). Serum samples from 2 UK CHIM studies and a Phase I trial in India of Sii-PTCV were analyzed. S. Paratyphi A-specific IgG, serum bactericidal activity (SBA), antibody-dependent monocyte phagocytosis (ADMP), and neutrophil phagocytosis (ADNP) were measured pre and post-exposure or vaccination. Statistical differences were assessed using Wilcoxon matched-pairs signed rank test or the Mann-Whitney test. Experimental challenge significantly increased IgG, SBA, ADMP, and ADNP (all P < 0.0001), with strongest responses in participants who developed systemic infection. No immune marker correlated with protection in rechallenged individuals. Baseline antibody levels were higher in the Indian cohort than in the United Kingdom (P = 0.0041), suggesting prior natural exposure enhances humoral immunity. Vaccination with Sii-PTCV induced significantly greater responses than challenge, particularly for IgG (P < 0.0001), SBA (P < 0.001), and ADMP (P < 0.001). This study highlights differences in S. Paratyphi A immunity between naive and exposed populations. Both challenge and vaccination with S. Paratyphi A elicited strong humoral responses, with vaccination producing higher magnitude responses. The bivalent vaccine shows promise for paratyphoid prevention, though a clear correlate of protection remains to be defined.
33. Early dynamics of multimorbidity in 17.4 million people in Spain: onset patterns and prognostic value.
期刊: European journal of public health 发表日期: 2026-Apr-11 链接: PubMed
摘要
Multimorbidity, the coexistence of two or more chronic diseases, has become a defining challenge for ageing societies. Yet evidence on when and how chronic diseases begin to cluster, and on the prognostic importance of this timing, remains limited. We used nationwide primary care electronic health records covering 17.4 million people in Spain to reconstruct the onset and progression of chronic disease over the life course. The first recorded diagnosis was used to trace temporal trajectories of multimorbidity by age and sex. We examined how the first condition, age at diagnosis, and time since that diagnosis were associated with advanced (≥3 diseases), multisystem (≥2 organ systems), and complex multimorbidity (≥3 organ systems), as well as premature mortality (<50 and <65 years) and outcomes related to polypharmacy and high-risk prescribing, using multivariable regression and gradient boosting models. By 2021, more than one in three Spaniards lived with a chronic condition, and over half of adults aged 45 years or older had multimorbidity. Among them, nearly 60% had complex multimorbidity. The time elapsed since the first diagnosis showed the closest link to further accumulation, followed by age at first diagnosis and current age. Later onset, particularly after the mid-50s, was associated with faster decline once disease emerged. The timing of the first chronic condition is a powerful but often overlooked prognostic marker. Public health strategies delaying onset and integrating early management could substantially reduce the long-term burden of multimorbidity in European populations.
34. Clinicogenomic Real-World Data Enable Prediction of Hospital Readmissions at a Comprehensive Cancer Center.
期刊: JCO clinical cancer informatics 发表日期: 2026-Apr 链接: PubMed
摘要
Curating high-quality clinical and genomic data sets from patients with cancer to predict hospital readmission using machine learning (ML) models. We extracted data from electronic health records for patients with cancer in the University of California, San Diego Health System, to curate clinicogenomic data sets for lung, breast, and colon cancers. We constructed ML models to predict the risk of hospital readmission 30, 60, and 90 days postdischarge. Standard ML models (logistic regression, random forest [RF], gradient boosting [GB], neural network) and multitask neural network models were developed to simultaneously predict all three readmission outcomes. Our results revealed that rehospitalization is most frequent in colon cancer within 30 days. For the 30-day hospitalization prediction, GB achieved the highest area under the precision recall curve (PR-AUC) for lung (0.415) and breast (0.470) cancers and RF achieved the overall highest PR-AUC for colon cancer (0.621). Explainability analysis revealed that health care metrics (such as the number of previous admissions and average length of stay), risk scores composed of diagnosis codes, and treatments are significant features in predicting readmission within cancer types. It also identified EGFR mutations as a potential predictor of readmission in colon cancer. The study highlights the potential of integrating clinical and genomic data for predicting adverse outcomes in patients with cancer. The standard ML approaches were able to successfully capture patterns in readmission and outperformed the more complex models. Limitations include the relatively small data set from a single institution. Ultimately, this study highlights the value of curating and maintaining clinicogenomic information at an institution level to streamline data set curation and model development.
35. Medication use for patients with obesity: trends and characteristics for US employees.
期刊: The American journal of managed care 发表日期: 2026-Apr 链接: PubMed
摘要
Obesity has a US prevalence of more than 40% and is associated with many comorbid conditions, posing a significant burden on employers. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are recently available and effective weight loss agents. We examined characteristics and outcomes of employees with obesity and those using vs not using GLP-1 RAs. Retrospective analysis of employee patients in Workpartners Research Reference Database from 2016 to 2023. Employees with obesity claims were identified and assigned to annual cohorts based on first year of obesity diagnosis (index). Study employees had at least 1 year of continuous data following their index diagnosis. Annual employee characteristics, comorbidities, absences, disability claims, and direct cost trends were explored for the year following diagnosis. Employees with obesity using and not using GLP-1 RAs were compared on the same metrics. Costs were inflation adjusted to December 2023 US$. We identified 127,408 employees with obesity. Obesity prevalence increased during the study. Employees with obesity and type 2 diabetes decreased slightly, and other comorbidities were relatively stable during the time frame. Overall, 5.8% of employees with obesity (n = 7359) used a GLP-1 RA. GLP-1 RA use increased annually (3.6% in 2016 to 18.3% in 2023) and accounted for approximately 30% of the cohort’s 2023 pharmacy costs. During the 12-month study period, compared with non-GLP-1 RA users, those using GLP-1 RAs had higher Charlson Comorbidity Index scores (difference = 0.71), higher proportions with all study comorbidities, $11,360 higher direct all-category costs (total medical costs were $12,092 [19.4%] higher), and 0.86 more absence days. Prevalence of obesity is increasing, and use of GLP-1 RAs as the preferred antiobesity medication has increased as well. The long-term impact of this increased use warrants monitoring and management.
36. Growth of dual-eligible special needs plans following permanent authorization.
期刊: The American journal of managed care 发表日期: 2026-Apr-01 链接: PubMed
摘要
To examine trends in Dual-Eligible Special Needs Plan (D-SNP) offerings and enrollment before and after permanent authorization in 2018. Retrospective descriptive analysis. We analyzed publicly available monthly SNP Comprehensive Reports, comparing preauthorization (2010-2018) and postauthorization (2019-2025) periods. We calculated annual totals of D-SNPs and enrollees along with mean annual growth rates for both periods. The mean annual growth rate of unique D-SNP offerings increased from 10.0% preauthorization to 16.2% post authorization. Enrollment of dually eligible beneficiaries increased from a mean annual growth rate of 0.3% preauthorization to 12.8% post authorization. D-SNP enrollment has steadily increased, more than doubling over the past 5 years. By January 2025, there were 986 D-SNPs with 6,030,665 dual enrollees, representing approximately 44% of total dual enrollees. The significant acceleration in both D-SNP offerings and enrollment reflects notable changes in the D-SNP market following permanent authorization. As states transitioned plans into D-SNPs through 2025, these specialized Medicare Advantage plans are positioned to play an increasingly vital role in addressing the complex needs of Medicare-Medicaid dual enrollees.
37. Refining a diagnostic code list to investigate low-acuity utilization by veterans.
期刊: The American journal of managed care 发表日期: 2026-Apr-01 链接: PubMed
摘要
Recent Veterans Affairs (VA) legislation expanding access to community (non-VA) emergency care use has important implications for budget and policy. Understanding drivers of community emergency department (ED) and urgent care (UC) utilization for low-acuity conditions is crucial for budgeting and improving care continuity, but current tools for identifying low-acuity ED visits have significant limitations. This study aimed to update and make publicly available a dichotomous diagnosis code list to identify low-acuity ED visits. We describe low-acuity community ED/UC visits and their users and assess patient-level characteristics associated with the use of community facilities. Retrospective cross-sectional study. We evaluated all International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) diagnoses with at least 100 ED visits across fiscal years 2018-2023. Severity probabilities were calculated and reviewed by 3 study personnel. Summary statistics were used to describe low-acuity community ED/UC visits. A logistic regression model was fitted to determine patient-level factors associated with using community settings for low-acuity care. For code list refinement, 4694 ICD-10 codes were reviewed, with 2439 (52.0%) rated as low acuity. Visits to community EDs and UCs for low-acuity conditions rose over the study period. Low-acuity diagnoses constituted 35.1% of community ED visits and 83.8% of community UC visits. Being younger, being female, and living farther from a VA ED were associated with greater odds of using community settings for low-acuity care. Community ED and UC utilization for low-acuity conditions remains below rates in VA settings but is rising, resulting in increased non-VA spending. Targeted interventions may be useful in redirecting low-acuity community ED use to lower-cost settings.
38. The cost of implementing and sustaining the Massachusetts model.
期刊: The American journal of managed care 发表日期: 2026-Apr-01 链接: PubMed
摘要
To identify and value resources required to implement and sustain the Massachusetts model of office-based addiction treatment (MA Model) in the Primary Care Opioid Use Disorders Treatment trial (NCT03407638) using a nurse care manager (NCM) to support medication for opioid use disorder in primary care settings. A site-specific microcosting analysis was conducted via activity-based costing. Guided by a structured costing instrument, we conducted semistructured interviews with relevant personnel and assigned nationally representative costs. Data came from 6 health care systems. Costs were categorized as fixed start-up, time dependent, or variable and estimated as annual per-clinic and per-patient costs for implementation and sustainment phases. Mean implementation cost (ie, year 1 fixed start-up, time-dependent, and variable) was $238,888 per clinic ($3185 per patient); each subsequent year cost $229,676 ($3062 per patient), assuming 75 patients per month and 29% new patient case mix. Mean onetime fixed start-up costs were $9212 per clinic and included supplies and training. Time-dependent costs were $70,446 per clinic and included rent and meetings. Variable costs were $159,229 per clinic and included NCMs’ and prescribers’ clinical duties. On average, NCMs spent 1967.6 hours on MA Model-related work per year (26.2 hours per patient). In sensitivity analyses, costs varied drastically with patient caseload, provider mix, and new patient case mix. Fixed start-up and time-dependent costs were minimal. Variable costs were 66.7% of implementation costs and 69.3% of costs annually afterward. The primary cost driver was NCM time conducting MA Model-related work. The additional value of the model will depend on associated downstream outcomes. These results may be helpful to health care systems considering implementing the MA Model.
39. Community response teams: extending the rapid response model to outpatient care.
期刊: The American journal of managed care 发表日期: 2026-Apr-01 链接: PubMed
摘要
To propose community response teams (CRTs) as a systematic managed care approach that applies rapid response principles to prevent clinical deterioration and reduce costs in outpatient settings. Conceptual framework analysis with evidence review. We analyzed structural parallels between hospital rapid response teams and community-based systems, reviewed evidence on early intervention for rising-risk patients, and examined implementation models for managed care organizations. CRTs can leverage existing care management infrastructure while focusing on rising-risk patients identified through predictive analytics rather than traditional high-cost populations. Multisite implementation demonstrates significant improvements in patient outcomes, chronic disease control, and reduced emergency department visits and hospitalizations, enabling shared savings models that fully fund proactive interventions. CRTs represent a paradigm shift in managed care population health management, providing a scalable, cost-effective approach to preventing avoidable clinical deterioration while generating measurable return on investment through reduced medical expenditures.
40. Large language models for psychosocial risk assessment: A multi-method evaluation across suicide, intimate partner violence, and substance misuse.
期刊: PLOS digital health 发表日期: 2026-Apr 链接: PubMed
摘要
Psychosocial risk assessment is a cornerstone of mental health care, yet remains resource-intensive and inconsistently delivered across domains such as suicide, intimate partner violence (IPV), and substance misuse. Recent advances in large language models (LLMs) raise the possibility of scalable, conversational agents capable of detecting and evaluating psychosocial risk. Across three interlinked studies, we evaluated the performance of LLMs in this context. Study 1 benchmarked GPT-4 and Claude 3 Sonnet against vignettes constructed from participants’ lived-experience, finding high accuracy in detecting risk domains and substantial agreement with participant-rated severity, though suicidality proved more challenging than IPV or substance misuse. Study 2 examined participants’ perceptions of LLM-generated responses, revealing that most judged them accurate, empathic, and clinically useful, with no differences across models or domains. Study 3 implemented a supervised, three-agent GPT-4o-based chatbot system integrating one chatbot as a therapeutic agent, a supervisor for risk detection, and a JSON-based assessor for structured evaluation. The therapeutic agent chatbot was successfully completed full risk assessments most of the time while maintaining therapeutic quality. Together, these studies suggest that LLMs can contribute to psychosocial risk detection and structured assessment under controlled conditions, while underscoring the need for careful supervision, rigorous validation, and clearly defined boundaries before consideration of real-world clinical deployment.
41. PICDGI: A framework for predicting cancer driver genes through dynamic gene-gene interaction modeling of single-cell data.
期刊: PLoS computational biology 发表日期: 2026-Apr 链接: PubMed
摘要
Identifying cancer driver genes (CDGs) remains a central challenge in cancer genomics, as frequency-based mutation approaches often miss rare but functionally important regulators. We present PICDGI, a computational framework that predicts driver-like regulatory genes by integrating dynamic gene-gene interaction modeling with single-cell RNA sequencing (scRNA-seq) data. Rather than relying on DNA mutation calls, PICDGI infers functional driver activity from time-resolved expression patterns and latent regulatory influence among genes during tumor progression. Methodologically, PICDGI employs a time-varying state-space model with variational Bayesian inference and Markov Chain Monte Carlo (MCMC) sampling to estimate evolving gene interaction effects. The posterior distributions capture both the magnitude and uncertainty of each gene’s inferred regulatory influence. From these, PICDGI derives a driver coefficient that quantifies the strength and reliability of each gene’s contribution to progression-associated expression dynamics, enabling the prioritization of impactful regulators over neutral passengers. Applied to lung adenocarcinoma (LUAD) scRNA-seq data, PICDGI recovered known oncogenes and tumor suppressors and nominated novel candidate drivers, including JPH1 and CHEK1, which are implicated in calcium signaling, mitochondrial regulation, and DNA repair. These genes exhibit trajectory-aligned activity consistent with tumor evolution and immune-modulatory processes. Comparative analysis using Moran’s I statistics in Monocle 3 showed that PICDGI-prioritized genes display stronger progression-associated dynamics than genes selected by spatial autocorrelation alone. We further validated PICDGI on an independent pediatric acute myeloid leukemia (AML) scRNA-seq cohort, where it consistently recovered known drivers and relapse-associated regulatory programs under fixed model parameters. By integrating interaction-informed dynamic modeling with single-cell resolution data, PICDGI provides a generalizable and biologically grounded framework for identifying rare and context-specific regulatory drivers of cancer progression, with broad applicability across tumor types.
42. Addressing Frailty in the Emergency Department: Early Outcomes of a Geriatric Rapid Access Clinic.
期刊: Academic emergency medicine : official journal of the Society for Academic Emergency Medicine 发表日期: 2026-Apr 链接: PubMed
摘要
Older adults represent a growing proportion of emergency department (ED) visits, with an increased risk of adverse outcomes following discharge, particularly when frailty is present. Access to post-ED geriatric follow-up is often delayed, leaving patients without timely support and increasing their risk of ED revisits and subsequent hospital admissions. This study evaluates a novel Geriatric Rapid Access Clinic (Geri-RAC) designed to provide expedited, specialized follow-up for high-risk older adults discharged from the ED. A retrospective chart review was conducted of all patients who attended the Geri-RAC at a large academic hospital in Toronto from January 2023 to July 2024. Older adults identified as high-risk in the ED were referred to the clinic. Patient outcomes included ED revisit rates and anticipated hospital admission avoidance; data on clinic performance indicators, patient characteristics, and accessed supports were also measured. Thirty-three patients attended the Geri-RAC during the 19-month pilot. Mean age was 82.6 years, with 81.8% having a Clinical Frailty Scale score ≥ 4. Functional limitations were present in 69.7% of patients. Median wait time from ED referral to appointment was 7 days. Cognitive testing was conducted in 78.7% of attendees and medication de-prescribing was initiated in 48.5%. Most patients (87.9%) were newly connected to support services, averaging 2.6 ± 2.1 service linkages per patient. 45.5% of patients received new specialist referrals. The 7-, 30-, and 90-day ED revisit rates were 0%, 12.1%, and 24.2%, respectively. Admission avoidance was anticipated in 42.4% of cases. The Geri-RAC provided timely access to post-ED follow-up and multidisciplinary care for frail older adults. Early findings highlight the potential for this model to enhance ED discharge planning, facilitate structured care transitions, and decrease reliance on emergency services in this high-risk population.
43. Investigation of the Association of the Attitudes and Beliefs of Adolescents and Their Parents with the Aggression Behaviours of Adolescents.
期刊: Turkish archives of pediatrics 发表日期: 2026-Mar-30 链接: PubMed
摘要
Violent behavior is prevalent among adolescents and represents a leading cause of morbidity and mortality. Understanding the factors contributing to adolescent aggression is essential for developing effective prevention strategies and promoting public health. This study aims to examine the association of the beliefs and attitudes of adolescents and their parents with the aggression of adolescents. This cross-sectional study includes 413 adolescents aged 13-19 and their parents (408 mothers and 383 fathers). The Buss-Perry Aggression (BPA) scale was employed to assess aggression levels in adolescents, while the Attitude Toward Violence (ATV) and Belief in Violence (BIV) scales were used to evaluate the attitudes and beliefs of adolescents and their parents. The mean BPA score of 409 adolescents (aged 13-19 years) was 2.56 ± 0.58, with 41 (10%) classified as low, 321 (78.5%) as medium, and 47 (11.5%) as high. Given that the overall aggression score was at a moderate level, subscale scores were not examined. The BPA scores were significantly associated with adolescents’ ATV and BIV scores, as well as mothers’ ATV scores. Correlation analysis revealed significant positive relationships among all scales, except between BPA and the BIV scores of both mothers and fathers. The findings suggest that the attitudes and beliefs regarding violence held by adolescents and their parents significantly influence the development of aggressive behaviors in adolescents within their immediate social environment.
44. Is It Possible to Foresee the Risk Factors for Carbapenem-Resistant Gram-Negative Bacterial Colonization in Newborns?
期刊: Turkish archives of pediatrics 发表日期: 2026-Mar-20 链接: PubMed
摘要
Carbapenem-resistant gram-negative bacteria (CR-GNB) have become a critical concern in neonatal intensive care units (NICUs) due to limited therapeutic options, high morbidity, and mortality. Early identification of modifiable risk factors for rectal colonization is essential to guide infection control and preventive strategies. This study aimed to determine the risk factors associated with CR-GNB rectal colonization in hospitalized infants and to define the prevalence, clinical impact, and temporal trends of colonization in a tertiary NICU. A total of 112 infants with rectal CR-GNB colonization and 113 non-colonized infants were retrospectively evaluated between January 2017 and 2020. Colonized patients were identified through routine weekly rectal swab surveillance initiated within the first 24 hours of NICU admission. Controls were matched for gestational age and approximate date of birth and received similar NICU care, although unmeasured factors related to caregivers and environment may exist. Demographic, perinatal, clinical, microbiological, and treatment data were retrospectively collected. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors. Colonization was significantly associated with male sex, prolonged hospitalization, mechanical ventilation, perinatal hypoxia, colostomy, intraventricular hemorrhage, bronchopulmonary dysplasia, indwelling catheters, total parenteral nutrition, Orogastric (OG) tube, colostomy, antibiotic exposure, and formula feeding. Healthcare-associated infections were more common in the colonized group. Multivariate analysis identified OG tube, male sex, and antibiotic use as independent risk factors. Identifying and addressing modifiable factors such as orogastric tube use, broad spectrum antibiotic exposure, and formula feeding should be prioritized in preventive NICU protocols to reduce CR-GNB colonization. Recognition of these risk factors and careful monitoring of infection indicators may improve neonatal outcomes.
45. About "Addressing Pediatric Antimicrobial Resistance in Türkiye: Closing Policy Gaps to Protect Child Health": Being AWaRe of Surveillance Opportunities in Türkiye.
期刊: Turkish archives of pediatrics 发表日期: 2026-Mar-04 链接: PubMed
摘要
46. Efficacy of Mediterranean diet for the primary prevention of oncological diseases: A systematic review and meta-analysis featured in the Italian National Guidelines "La Dieta Mediterranea".
期刊: Nutrition (Burbank, Los Angeles County, Calif.) 发表日期: 2026-Jan-31 链接: PubMed
摘要
The Mediterranean diet (MD), characterized by high consumption of plant-based foods, olive oil, moderate intake of fish and poultry, and limited red and processed meats, has been associated with various health benefits, but its role in cancer prevention remains under debate. This review was conducted in accordance with PRISMA 2020 and MOOSE guidelines. A comprehensive search of PubMed/MEDLINE, Scopus, Embase, and Cochrane Library was performed up to February 28, 2024. Study quality was assessed using the Newcastle-Ottawa Scale, and the certainty of evidence was evaluated with the NUTRIGRADE approach. Pooled effect sizes were computed using a random-effects model and expressed as risk ratios (RR), hazard ratios, or odds ratios, as appropriate. A total of 126 studies, including more than 8 million participants, across all included studies, were included. High adherence to the MD, as one point increase in the adherence, was significantly associated with a modest reduced risk of several site-specific cancers, including head and neck (RR = 0.88, 95% CI 0.78-0.98), oral cavity (RR = 0.83, 95% CI 0.73-0.95), stomach (RR = 0.93, 95% CI 0.88-0.97), liver/gallbladder (RR = 0.94, 95% CI 0.93-0.96), colorectal (RR = 0.95, 95% CI 0.92-0.98), bladder (RR = 0.96, 95% CI 0.92-0.995), and breast cancer (RR = 0.95, 95% CI 0.92-0.98). Higher adherence was also associated with lower cancer-related mortality (RR = 0.97, 95% CI 0.96-0.99). Certainty of evidence was rated as moderate for the main outcomes. Greater adherence to the MD is associated with a lower risk of several site-specific cancers and reduced cancer mortality. These findings support the promotion of the MD as a preventive dietary strategy within public health policies.
47. Asian Burden of Liver Cancer 1990-2021 and Predictions to 2040: An Analysis of the Global Burden of Disease Study 2021.
期刊: Cancer control : journal of the Moffitt Cancer Center 发表日期: 2026 链接: PubMed
摘要
BackgroundLiver cancer (LivCa) is one of the most prevalent malignancies globally, and can result from viral hepatitis, non-alcoholic steatohepatitis (NASH), and alcohol use. LivCa is of increasing concern in Asia, but the burden of etiology-specific LivCa and future projections remain to be elucidated.MethodsWe extracted the incidence, mortality, and disability-adjusted life years (DALYs) of LivCa across Asia and in 34 Asian countries in 1990-2021 from the Global Burden of Disease Study 2021 (GBD 2021). We then calculated their estimated annual percentage change (EAPC) and percentage variation to quantify the changes in the burden of LivCa. The association of the level of social development with LivCa burden was explored using the sociodemographic index (SDI). Moreover, the trend of the epidemiology of LivCa burden in Asia from 2022 to 2040 was predicted using the Bayesian age-period-cohort (BAPC) model.ResultsOverall, the age-standardized incidence, mortality, and DALYs rates of LivCa in Asia showed a general declining trend, with EAPCs of -0.47, -0.73, and -1.14, respectively. Notably, hepatitis B virus remained the predominant cause. However, the burdens attributed to non-alcoholic steatohepatitis and alcohol use increased significantly, while that of hepatoblastoma decreased. Regarding demographic distribution, the highest disease burden was observed among males and the elderly population aged 85-94 years. Geographically, Nepal, Taiwan (Province of China), India, and Malaysia contributed most substantially to the increasing burden. In terms of risk factors, high BMI and alcohol use were prominent in Central Asia, whereas smoking was a key factor in East and Southeast Asia. Additionally, a positive correlation was observed between the SDI and the burden of LivCa. Finally, projections from the BAPC model indicated a persistent decline in the burden of LivCa from 2022 to 2040.ConclusionsDespite the overall decreasing trend, targeted strategies addressing etiology-specific risks and regional disparities are urgently needed to further reduce the future burden of LivCa in Asia.
48. Scoping review of mental health-related policies issued in the context of the COVID-19 pandemic in Peru.
期刊: PLOS mental health 发表日期: 2026 链接: PubMed
摘要
This study aims to identify, describe and analyze the policies enacted by the Peruvian health authorities to address the population mental health needs and adequate health services in the context of the COVID-19 pandemic. We conducted an scoping review of mental health-related policies published between 6 March 2020 (first case of COVID-19 in Peru) and 31 May 2023. The official websites of the Peruvian Government, the Social Security Health System (EsSalud), and the LILACS scientific database were used. Data was analyzed using content and thematic analysis. Eighty-two documents were included. Policies contents were divided into three main categories. First, the governance of mental health care, which portrays the principles guiding policies and those seeking to strengthen mental health services by increasing the allocation of budget, use technology to provide remote care, enhance infrastructure, equipment and materials, hiring and training staff, and assure biosafety measures. Second, service delivery of mental health care, including policies aimed to detect and provide specialized mental health care to different groups of the population. Third, some policies focused on community engagement, promotion, and prevention in mental health, such as reducing misinformation, promoting self-care, community participation, and working with local organizations. We found that Peru included most of the international recommendations, but some important weaknesses were found, such as the lack of indicators to assess their completion or procedures on how to adapt these policies to routine practices. Peru designed several policies to attend to the mental health of its population during the COVID-19 pandemic, specifically on the principles for the provision of mental health care, the strengthening of these services, detection of mental disorders, provision of mental health care, and care at the community level. This study will inform other countries on their design of mental health policies, especially those with a community model-of-care.
49. Pre-analytical errors during HIV viral load (HIV-VL) and early infant diagnosis (EID) testing in Cameroon.
期刊: PloS one 发表日期: 2026 链接: PubMed
摘要
HIV Viral Load (HIV-VL) and Early Infant Diagnosis (EID) play a pivotal role in the laboratory surveillance, monitoring of HIV/AIDS, and its elimination as a public concern. However, sample rejection due to sample nonconformity (SNC) resulting from inadequate collection, transportation, and management, especially during the pre-analytical phase, negatively affects laboratory performance. This study aimed to characterize errors observed during the pre-analytical phase of HIV-VL and EID testing across national reference laboratories in Cameroon and to identify factors associated with rejection. A descriptive and quantitative study of the nonconformities (NC) identified was collected from 11/01/2024 to 08/12/2024 in seventeen HIV reference laboratories, which constitute the national network of HIV-VL and EID testing coverage. For this study, the number of rejected samples, the reason for rejection, and the type of test ordered were recorded monthly. During the study period, 326,885 and 38,354 specimens received for HIV viral load and EID. Of those 12,748 (3.9%) and 2.7% (1,039) were rejected. The SNC analysis indicates the presence of multiple errors or NC in some samples. For HIV viral load, our results indicate that specimen identification errors for viral load were the most common NC (63.14%; n = 8049; P = 0.031), followed by insufficient specimen volume (43.7%; n = 5571; P = 0.049) and quality errors, including hemolyzed specimens (27.8%; n = 3543; P = 0.054), and specimen transport packaging errors (9.1%; n = 1160; P = 0.069). For HIV EID, specimen rejections were primarily attributed to missing or mismatched identification on the request forms (37.12%, n = 386; P = 0.042), sample unavailability (13.4%; n = 139; P = 0.056), and information discrepancies (44.2%; n = 459; P = 0.033). The observed significant rejection rates for both HIV viral load and EID exceeded the established national rejection rate of <2% of errors. Our results suggest that corrective action is critical, along with the establishment of policies to detect and resolve preanalytical errors in Cameroon. Our findings highlight the high magnitude of preanalytical errors for HIV-VL and EID tests used in the testing and management of people living with HIV/AIDS in Cameroon. Therefore, the laboratory system should be strengthened to ensure high-quality patient services and support optimization. Suggestions for improvement include distributing a validated specimen-collection manual, creating electronic test-request forms, providing staff training, and regularly on-site supervising the use of available resources, all of which are necessary in this country.
50. Strengthening access to and confidence in COVID-19 vaccines among equity-deserving populations across Canada: An exploratory qualitative study.
期刊: PloS one 发表日期: 2026 链接: PubMed
摘要
There is a need to reflect on the COVID-19 vaccine distribution plans across Canada and the extent to which they considered equity-deserving populations, as lessons from the rollout can inform future emergency responses and foster trust in public health. This paper examined and compared strategies implemented by six Canadian provinces to increase access and promote the uptake of COVID-19 vaccines among selected priority populations. We also explored the factors that impacted the implementation of these strategies. In six provinces (Alberta, British Columbia, Manitoba, Nova Scotia, Ontario, and Quebec), we conducted an environmental scan of provincial rollout documents and media sources reporting vaccine distribution among selected priority populations: First Nations, Inuit, and Métis; Black communities; essential workers; people experiencing homelessness; and people with disabilities. We subsequently interviewed 39 key informants to validate the environmental scan results, identify additional strategies to increase COVID-19 vaccine uptake, and uncover perceptions of the facilitators and challenges that influenced the strategies implementation. We identified that provincial health authorities employed several strategies to overcome structural, geographical, and attitudinal barriers to COVID-19 vaccines experienced by the priority populations. Most provinces implemented walk-in, mobile, and pop-up vaccination clinics, mobilized their public and private health workforce, and designed multilingual communication materials. Facilitators in implementing COVID-19 vaccination strategies included harmonizing communication efforts, leveraging existing relationships and networks, and ensuring representation and leadership of community partners. Challenges to implementing COVID-19 vaccination strategies included uncoordinated communication efforts, inadequate distribution of vaccines to areas with the greatest need, mistrust in the government and healthcare system, vaccine hesitancy, and lack of cultural competence by vaccine providers. This study highlights the divide between well-intentioned strategies and interventions and the reality of on-the-ground implementation. The findings offer valuable insights and can inform the implementation of strategies to distribute vaccines equitably in future large-scale vaccination efforts in Canada and globally.
51. Designing a children's health exposomics study protocol: The CHILDREN_FIRST multi-country prospective cohort using multi-omics and personalized prevention approaches.
期刊: PloS one 发表日期: 2026 链接: PubMed
摘要
Non-communicable diseases (NCDs) account for ~71% of all deaths globally, including 15 million premature deaths each year (deaths between 30-69 years of age). Instead of waiting until disease manifestation, focusing on the origins of NCDs during childhood offers a critical window of disease prevention and control. The CHILDREN_FIRST international cohort observatory study aims to investigate how the spatio-temporal evolution of the children’s exposome profiles in the Mediterranean region influences early-life programming of chronic disease risk during the critical window of susceptibility in primary school years (6-11 years of age). The study protocol adopts the human exposome framework integrated with a personalized prevention approach, using multi-omics platforms and advanced machine learning algorithms implemented across Mediterranean countries, namely Cyprus, Greece, and Albania. The cohort will consist of children enrolled in the first grade of primary school, who will undergo annual follow-up assessments until completion of primary education. During the annual assessments, children’s exposome parameters from the three main exposome domains will be evaluated using different assessment types, i.e., molecular biomarkers of exposure/effect, sensors, and questionnaires. Standardized biospecimen and data collection methods will be employed following harmonized standardized operating procedures. The reference model of Observational Medical Outcomes Partnership - Common Data Model (OMOP-CDM) developed and maintained as part of the Observational Health Data Sciences and Informatics (OHDSI) initiative will be used to conduct federated data analysis. This CHILDREN_FIRST study protocol is a human exposome-based initiative to establish a long-term prospective cohort infrastructure for biomedical research on children’s health in the Mediterranean region. The cohort’s exposome-based findings will systematically feed into the evaluation and design of chronic disease prevention programs. Expected results would inform evidence-based policy making and the development of health interventions for reducing the risk of NCDs in childhood and later in adult life.
52. Environmental DNA screening of Phocoenobacter atlanticus subsp. atlanticus in Atlantic salmon aquaculture.
期刊: PloS one 发表日期: 2026 链接: PubMed
摘要
There has been a drastic increase of pasteurellosis cases in Atlantic salmon aquaculture in Norway since 2018, caused by the bacterium Phocoenobacter atlanticus subsp. atlanticus, resulting in reduced animal welfare and increased mortalities. Early detection and identification of pathogens are crucial in intensive aquaculture to enable implementation of effective management and mitigation strategies. The increased application of environmental DNA (eDNA) monitoring in aquatic environments demonstrates the potential use for early detection of pathogens in aquaculture. In this study we investigated the usage of eDNA monitoring of Ph. atlanticus in Atlantic salmon aquaculture. We conducted a trial to investigate the effect of storage conditions and transport time on eDNA detection of Ph. atlanticus from water samples. We then conducted three field trials: a) to investigate the optimal sampling location for eDNA samples from farms with known Ph. atlanticus infection status, b) to screen farms presumed non-infected with Ph. atlanticus and c) to evaluate the eDNA detection in samples collected from anaesthetic tanks during lice counting. The storage trial revealed a reduction in Ph. atlanticus detection after one week at 4 °C or after two days at 22 °C. At farms with known Ph. atlanticus infection status we experienced poor detection of Ph. atlanticus from water samples collected in the net pen. However, samples collected from treatment water during thermal delousing revealed concentration of Ph. atlanticus during treatment, even in farms with negative net pen samples. Subsequent eDNA screening (sampling treatment water) of farms with presumed non-infected status, identified the presence of Ph. atlanticus in ~55% of the farms tested. Ph. atlanticus was also detected in water samples collected from anaesthetic tanks following lice counting. Our results demonstrate early detection of Ph. atlanticus, even in lowly prevalent populations, demonstrating the potential use of eDNA monitoring of pathogens in Atlantic salmon aquaculture.
53. Community health worker intervention to reduce worker exposure to volatile organic compounds in small business auto and beauty shops in a marginalized community: A cluster randomized controlled trial.
期刊: PloS one 发表日期: 2026 链接: PubMed
摘要
Occupational diseases affect many workers in the United States, with Latinos disproportionately affected. Small businesses face barriers to implementing workplace health protections that community health workers (CHWs) may help overcome. The objective of this study was to determine whether a CHW-led industrial hygiene intervention could reduce volatile organic compound (VOC) exposure in small auto repair and beauty shops that primarily employ marginalized workers. In this two-arm, parallel, cluster randomized trial, small business (≤25 employees) auto repair and beauty shops in Tucson, AZ were randomized to immediate or delayed intervention, stratified by sector. CHWs assessed shops and provided knowledge of controls and $300 for new ones. Total VOCs (TVOCs) were measured using photoionization detectors placed on or near participants. The primary outcome was the change in TVOCs at the shop level after the intervention, assessed across three timepoints with four workshift measurements per assessment. Mixed-effects models accounted for clustering by shop. We enrolled 38 auto repair shops and 46 beauty shops (73% Latino workers) and analyzed 846 workshift measurements at 236 shop assessments. Adjusted models showed a non-statistically significant intervention effect: auto shops experienced on average an estimated 28% TVOC increase (95% CI: -46% to 203%); beauty shops experienced on average an estimated 27% reduction (95% CI: -55% to 19%). Beauty shops had TVOC concentrations about 10 times higher than auto shops, and 87% of their assessments had ventilation rates below the recommended minimum. Although not statistically significant, the CHW-led intervention may meaningfully reduce VOC exposure in beauty shops. High TVOC concentrations and inadequate ventilation in beauty shops highlight the need for targeted interventions and policy changes to improve the air quality in these underserved small businesses. This trial was registered with clinicaltrials.gov (NCT03455530) on March 6, 2018.
54. Uptake and determinants of Hepatitis B vaccination among health laboratory practitioners in tertiary hospitals in Dar es Salaam, Tanzania: A cross-sectional study.
期刊: PLOS global public health 发表日期: 2026 链接: PubMed
摘要
Hepatitis B virus (HBV) infection is a significant occupational risk for laboratory practitioners. Despite proven vaccine effectiveness and global recommendations, HBV vaccine uptake among healthcare workers in Tanzania remains low. This study assessed HBV vaccination uptake and its determinants among laboratory practitioners in tertiary hospitals in Dar es Salaam. An analytical cross-sectional study was conducted from March to June 2025 across four tertiary hospitals, enrolling 130 participants using the Kish-Leslie formula. Data were collected using a structured, pre-tested, interviewer-administered questionnaire and verified vaccination records, and analyzed with IBM SPSS v27. Descriptive statistics summarized participant characteristics, and associations were assessed using chi-square, Fisher’s exact tests, and log-binomial regression with robust variance. Of 130 participants (median age 30 years, IQR: 25-36), 54.6% (71/130) completed the three-dose hepatitis B vaccination schedule, 23.8% (31/130) received partial doses, and 21.5% (28/130) were unvaccinated. Among the partially vaccinated, missed appointments (48.4%, 15/31) and lack of vaccine availability (41.9%, 13/31) were the main reasons. Half of the unvaccinated (50.0%, 14/28) cited lack of opportunity. Most participants knew the vaccine is essential (99.2%, 129/130), and 94.1% (96/102) acknowledged three doses are required for full protection. Although females, those with longer work experience, and those perceiving high exposure risk had higher vaccination prevalence, none of these associations reached statistical significance in univariate or multivariable analyses. HBV vaccine uptake among laboratory practitioners in Dar es Salaam is suboptimal, mainly due to structural barriers. Strengthening workplace vaccination programs, ensuring consistent vaccine supply, and implementing reminder systems could improve healthcare worker protection.
55. Clinical Features and Outcomes of Severe Pneumonia in Pediatric Human Metapneumovirus Infections.
期刊: Turkish archives of pediatrics 发表日期: 2025-Dec-29 链接: PubMed
摘要
Human metapneumovirus (hMPV) is a significant agent of respiratory infections in pediatric populations. Despite its global prevalence, the epidemiological characteristics and clinical burden of hMPV infections remain insufficiently recognized. This study aimed to evaluate the clinical features and outcomes of severe pneumonia among children hospitalized with hMPV infection. This retrospective study analyzed pediatric patients diagnosed with hMPV infection at Hacettepe University İhsan Doğramacı Children’s Hospital between January 2018 and December 2024. Demographic, clinical, and laboratory data were systematically reviewed to identify factors associated with severe pneumonia. A total of 116 children with hMPV infection were included, of whom 17.2% (n = 20) developed severe pneumonia requiring respiratory support. Notably, 85% (n = 17) of these severe cases occurred in children under 5 years of age, and 90% (n = 18) had underlying chronic medical conditions. In cases of non-severe pneumonia, hMPV monoinfection was identified in 74.8% (n = 56) of patients, while 25.2% (n = 19) had coinfections, most commonly involving rhinovirus (14.7%, n = 17). Conversely, among severe pneumonia cases, hMPV monoinfection was predominant (90%, n = 18), with coinfections detected in only 10% (n = 2). A substantial increase in hospitalization rates was observed in 2024 (36%), potentially indicating an evolving disease severity. Additionally, 1 infection-related mortality (3.1%) was recorded in an older pediatric patient. Severe pneumonia in this single-center series was mainly linked to hMPV monoinfection, with hospitalizations rising in 2024. These findings underscore the clinical impact of hMPV and the need for strengthened surveillance and timely diagnostics, while informing preventive strategies, including future vaccines/therapeutics.
56. An Extremely Rare Case of Sequential Onset of Streptococcal Toxic Shock Syndrome and Kawasaki Disease Following Varicella Infection in a 2.5-Year-Old Girl.
期刊: Turkish archives of pediatrics 发表日期: 2025-Dec-29 链接: PubMed
摘要
Varicella is a common viral disease of childhood that is usually benign and self-limiting, but it can lead to rare complications, including streptococcal toxic shock syndrome (STSS) and Kawasaki disease (KD). The simultaneous or sequential occurrence of these 2 complications after varicella has been reported very rarely. A 2.5-year-old girl presented with fever, swelling, and neck erythema 5 days after varicella infection and a history of ibuprofen use. She was admitted with a diagnosis of cellulitis. Despite initial antibiotic therapy, the patient’s clinical condition rapidly deteriorated, and she developed shock, thrombocytopenia, organ failure, and pleural effusion. The patient was transferred to the pediatric intensive care unit, intubated, and received Intravenous Immunoglobulin (IVIG). Blood culture revealed beta-hemolytic Streptococcus group A, confirming the diagnosis of STSS. After recovery and discharge from the hospital, the child presented again with fever and peeling fingertips and was admitted with suspicion of KD. Echocardiography revealed coronary artery ectasia, and she received IVIG again. The ectasia resolved on subsequent follow-up. This is one of the rarest cases of sequential occurrence of STSS and KD after varicella infection. Clinical attention to unusual complications of varicella, timely diagnosis, and appropriate treatment are essential in preventing severe and long-term outcomes in pediatric patients.
57. Long-Term Cardiovascular Risks Associated with Childhood Obesity: A Systematic Literature Review.
期刊: Turkish archives of pediatrics 发表日期: 2025-Nov-26 链接: PubMed
摘要
Pediatric obesity is an emerging health issue worldwide resulting in an increased risk of cardiovascular diseases upon reaching adulthood. These risks are further exacerbated by socioeconomic and demographic factors. The systematic literature review seeks to comprehensively evaluate future cardiovascular complications arising from pediatric obesity, particularly focusing on hypertension, dyslipidemia, and metabolic disorders. A systematic literature review was conducted following PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines of studies published between 2000 and 2024. Databases such as PubMed, Scopus, Web of Science, and Embase were accessed to retrieve relevant literature on childhood obesity and cardiovascular risk factors. A rigorous inclusion and exclusion protocol was employed with selected studies including children under 18 years with obesity and evaluating long-term cardiovascular risk in adulthood. Cross-sectional studies lacking follow-up, non-English studies, conference proceedings, and reviews were excluded. Twenty-five longitudinal cohort studies were selected essentially revealing childhood obesity to be a highly influential factor of cardiovascular disease in adulthood. Pediatric obesity was highlighted to exert early-life cardiovascular changes such as arterial stiffness, endothelial dysfunction, and diabetes. These early life alterations underscore the necessity of early life interventions. Furthermore, socioeconomic status and demographics, especially lower-income populations where minorities and poor people are exposed to poor eating habits, lack of physical activity, and poor healthcare. Pediatric obesity is strongly associated with future cardiovascular complications. Mitigating this risk requires early interventions and comprehensive prevention strategies. Future studies should focus on longitudinal studies to find sustainable solutions to lower childhood obesity-led cardiovascular complications.