公共卫生研究摘要 (2026-04-29)

共收录 57 篇研究文章

1. Stakeholders' experiences of physical activity programmes development, implementation, and evaluation in universities in the United Kingdom and Indonesia.

期刊: International journal of qualitative studies on health and well-being 发表日期: 2026-Dec-31 链接: PubMed

摘要

To explore stakeholders’ experiences and perspectives regarding the development, implementation, and evaluation of physical activity (PA) programmes in universities which are critical to be understood to address the implementation challenges. This qualitative study gathered experiences and perspectives from 34 participants recruited using purposive and snowball sampling. Participants represented five stakeholder levels, four types of United Kingdom institutions and three types of Indonesian institutions. Data were analysed using the six-stage framework method analysis by three coders, informed by critical realism and drawing on the Consolidated Framework for Implementation Research and the United Kingdom Medical Research Council framework for developing and evaluating complex interventions. Seven themes influenced PA programme implementation in university across both countries. Three themes cut across development, implementation and evaluation: institutional mobilisation and alignment, leadership and champions, external PA communities. Practical guidance and stakeholder capability shaped programme development. Delivery capacity and staffing, as well as physical and digital infrastructures shaped implementation. Institutional recognition facilitated evaluation. Our findings may help identify and address challenges faced by stakeholders in developing, implementing, and evaluating PA programmes in universities. They also suggest a need for context-sensitive support to help stakeholders address these challenges within their institutional settings.

2. Post-licensure safety of nirsevimab from the Canadian National Vaccine Safety (CANVAS) network.

期刊: Human vaccines & immunotherapeutics 发表日期: 2026-Dec 链接: PubMed

摘要

Although clinical trials have shown that nirsevimab is safe, post-licensure safety data from routine clinical settings are lacking. This study describes parent-reported health events occurring within seven days of nirsevimab administration. Post-licensure, active, safety surveillance was conducted during the 2024-25 viral season in Canada, using parent-completed questionnaires distributed 8 days after immunization. Parents or caregivers of 1,559 children completed the survey. A third (454/1,559) of children had received nirsevimab co-administered with routine vaccines. Local injection-site reactions were reported in 140 children (9.0%), 79/454 (17.4%, [95%CI: 14.2-21.3]) when nirsevimab was co-administered and 61/1,105 (5.5% [95%CI: 4.3-7.1]) when nirsevimab was given alone. Injection-site reactions extending beyond the closest joint were uncommon (6/1,559, 0.4%). Health events that prevented daily activities or required healthcare consultation were reported in 38/1,105 (3.4%) cases with nirsevimab administered alone and 19/454 (4.2%) with nirsevimab co-administered. The most reported symptoms were rhinorrhea: 1.8%, cough: 1.7%, feeding/eating changes: 1.6%, fever: 1.6% and diarrhea or change in bowel habits: 1.5%. Rash occurred in 10 children (0.6%). No cases of anaphylaxis were reported. Overall, in this study nirsevimab was well tolerated, with low incidence of health events within seven days of immunization. Results after co-administration support the incorporation of nirsevimab into the routine vaccination schedule. Documenting parent-reported outcomes in post-licensure settings expands the safety data obtained from clinical trials and offers transparent, timely additional reassuring data to enhance parental confidence in RSV antibody interventions.

3. NOS1 hypermethylation may participate in the colorectal cancer development and be associated with its prognosis.

期刊: Epigenetics 发表日期: 2026-Dec 链接: PubMed

摘要

Colorectal cancer (CRC) is a leading cause of cancer-related deaths worldwide. Although epigenetic alterations are common in CRC, the epigenetic changes that occur during colorectal carcinogenesis remain unclear. Thus, we sought to elucidate the role of NOS1 methylation in colorectal carcinogenesis, which is essential for understanding disease pathology. We used the UCSC Xena database to comparatively analyze NOS1 expression and methylation status between tumour and adjacent normal tissues across 33 cancer types. Low expression and hypermethylation of NOS1 have been identified in 12 cancer types, with CRC demonstrating this characteristic epigenetic regulation. NOS1 promoter methylation status was examined using genomic DNA extraction and MassARRAY EpiTYPER methylation analysis. NOS1 hypermethylation was confirmed among CRCs in in-house dataset 1 (p < 0.001), and among CRCs and advanced adenomas in in-house dataset 2 (p < 0.001). An upward trend in methylation changes was identified from non-advanced adenoma to advanced adenoma to CRC (p for trend < 0.001). Quantitative real-time PCR was used to analyze NOS1 expression in in-house Dataset 3, and significantly low NOS1 expression was also identified in CRCs (p < 0.001). Kaplan-Meier estimator and Cox proportional hazard models were used to assess the prognostic and predictive roles of NOS1. NOS1 hypermethylation was significantly associated with better disease-specific survival (DSS) in CRC patients. NOS1 hypermethylation is an epigenetic driver of colorectal tumorigenesis and is associated with better survival.

4. Coadministration of mRNA-1345 RSV vaccine with high-dose quadrivalent influenza vaccine in adults aged 65 and older: An observer-blinded, placebo-controlled, randomized, phase 3 trial.

期刊: Human vaccines & immunotherapeutics 发表日期: 2026-Dec 链接: PubMed

摘要

Coadministration of respiratory syncytial virus (RSV) and seasonal influenza vaccines can increase vaccination uptake. mRNA-1345 (mRESVIA, Moderna, Inc.) is indicated in multiple countries for prevention of RSV-lower respiratory tract disease in adults. This randomized, observer-blind, phase 3 study evaluated safety, tolerability, immunogenicity, and inferred efficacy of mRNA-1345 when coadministered with quadrivalent influenza vaccine-high dose (QIV-HD). Adults ≥65 y (n = 1900) were randomly assigned 1:1 to receive both vaccines coadministered at day 1 or sequentially, 21 d apart. Noninferiority of six co-primary immunogenicity endpoints was assessed up to 21 d post vaccination, comparing coadministered versus sequential vaccination. Immunogenicity was measured by serum-neutralizing antibody responses and seroresponse rates for RSV or seroconversion rate for influenza. Reactogenicity was mild/moderate and there were no safety concerns, related serious adverse events, or deaths. Noninferiority of immune responses against influenza A (H1N1, H3N2) and B (Austria, Phuket) was demonstrated, with geometric mean ratios (GMRs; coadministration vs sequential vaccination) of anti-hemagglutinin titers ranging from 0.868-0.948. All lower bounds of the corresponding 95% CI were >0.667, consistent with the commonly accepted noninferiority margin of 1.5 (i.e. 0.667 = 1/1.5). Noninferiority against RSV-A and RSV-B based on GMR was not demonstrated; GMRs (95% CI) of neutralizing antibody were 0.625 (0.570-0.686) and 0.638 (0.584-0.697) for RSV-A and RSV-B, respectively, with the lower bound of 95% CI < 0.667 for RSV-A and B. Coadminstration is estimated to maintain the efficacy of mRNA-1345 against RSV-lower respiratory tract disease based on a correlate of protection model. These results support coadministration of mRNA-1345 with QIV-HD.Clinical trials registration: ClinicalTrials.gov: NCT06060457.

5. Importance of and Strategies for Implementing DPYD Testing to Prevent Severe Fluoropyrimidine Chemotherapy Toxicity in Health Care Systems.

期刊: American Society of Clinical Oncology educational book. American Society of Clinical Oncology. Annual Meeting 发表日期: 2026-Jun 链接: PubMed

摘要

Recent regulatory and guideline changes have established pretreatment DPYD genotyping as a critical strategy to prevent severe fluoropyrimidine toxicity. Following earlier European leadership by the European Medicines Agency, the US Food and Drug Administration added boxed warnings to capecitabine and 5-fluorouracil labels recommending genetic testing before therapy. Concurrent updates from the National Comprehensive Cancer Network and ASCO align US with European practice supporting universal testing. Fluoropyrimidines remain foundational treatments across multiple cancers but can cause life-threatening toxicity in patients with dihydropyrimidine dehydrogenase (DPD) deficiency, most commonly because of inherited DPYD variants. DPYD variant carriers receiving standard doses experience markedly increased risk of severe toxicity and treatment-related mortality, emphasizing the clinical importance of DPYD testing and genotype-guided dosing. Evidence demonstrates that dose individualization based on guidance from the Clinical Pharmacogenetics Implementation Consortium reduces toxicity risk while maintaining treatment effectiveness and potentially reducing overall costs. Patient advocacy, particularly efforts led by Advocates for Universal DPD/DPYD Testing, has accelerated policy change, increased clinician awareness, and highlighted ethical implications of preventable harm. Despite growing adoption, implementation challenges persist, including workflow integration, clinician education, and equitable access. Integrated health systems such as the Veterans Health Administration demonstrate how centralized infrastructure and clinical decision support can facilitate uptake. Barriers are more pronounced in resource-constrained settings, where limited infrastructure, reimbursement uncertainty, and insufficient pharmacogenomic education hinder implementation. Regional initiatives illustrate education-focused, context-adapted strategies to expand testing and address population-specific variant knowledge gaps. Collectively, emerging evidence, regulatory alignment, and advocacy efforts position DPYD genotyping as a patient-safety imperative necessary to achieve safer, more equitable fluoropyrimidine therapy worldwide.

6. A Trojan horse pathogen breaking through partner-choice barriers in the insect gut.

期刊: Proceedings of the National Academy of Sciences of the United States of America 发表日期: 2026-May-05 链接: PubMed

摘要

Mutualistic symbioses are potentially vulnerable to exploitation, particularly in hosts that acquire symbionts from the environment, where harmful exploiters inhabit. The independent evolution and persistence of intricate partner-choice mechanisms in many symbioses testify the threat by specialized exploiters of mutualisms, although only few have been documented in nature. We report here a lethal “Trojan horse” pathogen, Burkholderia sp. SJ1, exploiting the stinkbug-Caballeronia gut symbiosis. This bacterium resembles symbionts by using wrapping motility to traverse the host’s sorting organ, inducing symbiotic organ morphogenesis and colonizing it. Unlike mutualists, however, it resists host digestion for nutrient acquisition, breaches the gut epithelium, and causes sepsis, rapidly killing the host. Colonization of the symbiotic organ is essential for its lethality. This case shows how pathogens can exploit mutualisms, highlighting the evolutionary pressures shaping partner-choice mechanisms and the fragility of even highly specialized mutualisms.

7. LRBA organizes distinct vesicular trafficking systems in distal nephron segments for water and sodium conservation.

期刊: Proceedings of the National Academy of Sciences of the United States of America 发表日期: 2026-May-05 链接: PubMed

摘要

Lipopolysaccharide-responsive and beige-like anchor protein (LRBA) deficiency is a rare genetic disorder characterized by immune dysregulation. The immune checkpoint molecule cytotoxic T lymphocyte-associated antigen 4 (CTLA-4) fails to perform proper membrane trafficking in the absence of LRBA. In addition to immune cells, LRBA localizes to intracellular vesicles in various epithelial cells; however, its physiological roles have not been accurately deciphered. It was observed in this study that LRBA facilitates water and sodium transport by promoting vesicular trafficking of aquaporin-2 (AQP2) and AQP4 in renal collecting duct cells and that of sterile 20/SPS1-related proline/alanine-rich kinase (SPAK) in distal convoluted tubule cells. Consequently, Lrba knockout mice exhibited vasopressin-resistant polyuria and hypotension under sodium-restricted conditions. This registry study revealed a polyuric phenotype in a subset of patients with LRBA deficiency, characterized by inappropriately low urine specific gravity despite the presence of chronic diarrhea. Notably, desmopressin treatment ameliorated impaired urinary concentration in a mouse model of human LRBA deficiency. LRBA functions as a central coordinator of fluid and sodium homeostasis by organizing segment-specific vesicular trafficking systems in renal epithelial cells.

8. Parallel algorithms for phylogenetic inference under a structured coalescent approximation.

期刊: Proceedings of the National Academy of Sciences of the United States of America 发表日期: 2026-May-05 链接: PubMed

摘要

Advances in molecular epidemiology and computational modeling have improved our ability to track pathogen evolution, but accurate reconstruction of spatiotemporal transmission remains essential for epidemic preparedness and response. Structured coalescent models offer a phylogeographic framework by restricting coalescence to lineages within the same deme. Although the Bayesian structured coalescent approximation (BASTA) provides a tractable approach, contemporary phylogeographic analyses involving dozens of localities and hundreds to thousands of genomes exceed the computational capacity of existing implementations. The BASTA likelihood scales cubically with deme count and quadratically with sequence count due to matrix exponentiation and partial likelihood vectors update. Here, we introduce an algorithmic restructuring of the structured coalescent likelihood that eliminates redundancies, optimizes memory access, and exposes parallelization opportunities. Our approach reorganizes computations along three dimensions: i) independent calculation of deme-transition probability matrices across time intervals; ii) simultaneous evaluation of partial likelihood vectors within temporal slices; and iii) concurrent aggregation of coalescent probabilities. Algorithmic restructuring cuts average coalescent likelihood computation by 7 to 8 fold, and parallelization further boosts performance to 10 to 26 fold, enabling joint phylogeographic analyses of dengue virus across 10 South American countries and H5N1 avian influenza across 20 Eurasian regions to finish in a fraction of prior time. This computational efficiency also enables comparison between backward-in-time structured coalescent approximations and forward-in-time phylogeographic methods, revealing that the former provides appropriately conservative posterior estimates, particularly at intermediate phylogenetic depths. We integrate our implementation into the BEAST X and BEAGLE software packages, providing researchers with an accessible and scalable tool for real-time phylogeographic surveillance of rapidly evolving pathogens.

9. Mitochondrial fusion heterogeneity drives bidirectional tumor phenotypic transition in combined hepatocellular-cholangiocarcinoma.

期刊: Proceedings of the National Academy of Sciences of the United States of America 发表日期: 2026-May-05 链接: PubMed

摘要

Dysregulation of mitochondrial dynamics modulates malignant cell fate; however, the substantial heterogeneity in mitochondrial dynamics among tumor cells within individual tumor nodules and the resultant functional consequences remain inadequately characterized. In this study, we induced mosaic impairment of mitochondrial fusion in mouse liver under tumorigenic conditions and unexpectedly identified the formation of combined hepatocellular-cholangiocarcinoma (cHC), a monoclonal tumor displaying features of both hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC). Restoration of the mitochondrial fusion protein MFN1 effectively suppressed cHC development. Analysis of human cHC samples revealed that ICC-like cells exhibit more pronounced mitochondrial fusion impairment compared to HCC-like cells. Mechanistically, increasing impairment of mitochondrial fusion resulted in a dose-dependent elevation of reactive oxygen species (ROS). Low levels of ROS upregulated HNF4α, promoting HCC-like differentiation, whereas high ROS levels activated HES1, facilitating ICC-like differentiation. Collectively, these results demonstrate that heterogeneity in mitochondrial dynamics is a critical determinant of cHC path-ogenesis.

10. Supportive Care Needs and Associated Factors Among Family Caregivers of Elderly Patients With Dementia and Diabetes Mellitus: A Cross-Sectional Study.

期刊: Nursing open 发表日期: 2026-May 链接: PubMed

摘要

This study aimed to examine the supportive care needs of family caregivers of elderly patients with dementia and diabetes mellitus, and identify the associated factors to provide a scientific basis for the development of effective supportive care interventions. Cross-sectional study. Using convenience sampling, we recruited 108 family caregivers of elderly patients with dementia and diabetes mellitus from five neighbourhood committees and 10 natural villages in a community in Xiamen, China. Data on caregivers’ demographics and supportive care needs were collected via questionnaires. Caregivers reported high levels of need, with physiological, emotional and safety needs rated most highly. The Caregiver Burden Inventory score was a significant positive predictor of physiological, informational, safety, emotional and spiritual needs, but not of social needs. Physiological needs were associated with the caregiver’s occupation and economic status; informational needs with sex and education level; safety needs with sex and occupation; spiritual needs with age and economy; and emotional and social needs with cohabitation status, marital status and relationship to the patient. Caregiver burden is a key factor associated with the supportive care needs of family caregivers of older adults with dementia and diabetes mellitus. Future interventions should consider both caregiver burden and individual characteristics to provide targeted, multi-level support. No patient or public contribution. Assessment of caregiver burden should be integrated into community health practice to guide support strategies for caregivers of patients with chronic conditions. The findings will guide community health professionals and policymakers in designing support programmes for caregivers managing complex chronic conditions.

11. Solutions and Challenges in Focusing Trap and Spectral Deconvolution for Characterization of Odor Active VOCs in Hot Mix-Asphalt.

期刊: Journal of mass spectrometry : JMS 发表日期: 2026-May 链接: PubMed

摘要

This work shows the measurement of trace of odor-active compounds in air sampler collect from channeled emissions of Asphalt Mixture Plants by Nalophan bags, including formaldehyde, hydrocarbons, and volatile sulfur compounds by thermal desorption-gas chromatography-mass spectrometry (MS) equipped with an automated, three-stage preconcentration and water-management mechanism without liquid cryogen thanks to a dedicated focusing traps. The success of this application has benefited from computational workflow in Non-Targeted Analysis, applied to the complex raw MS data to obtain qualitative and quantitative matrix information through deconvolution by MassHunter Unknowns Analysis software. Deconvolution is one of the most challenging steps in GC-MS data processing reconstructing a pure mass spectrum for each component, permitting the identification of co-eluted volatile organic compounds (VOCs) by both matching the electronic ionization (EI) mass spectra and the Linear Temperature-Programmed Retention Index with reference values provided by spectral library. The described approach permitted a semi-untargeted screening of VOCs in complex matrix by single quadrupole-MS. Several oxygenated VOCs were found with relatively low abundances under the unresolved complex mixtures produced by co-elution in the range between heptane and dodecane. Samples collected in typical asphalt production conditions produced between 2000 and 4500 deconvolution results, with 300 to 500 library hits considering a minimum match factor of 70/100. Very VOCs resulted chromatographically resolved, while early eluting peaks were qualified by standard injection and single-ion monitoring acquisition, since EI spectra of such light molecules are characterized by an insufficient number of peaks to achieve a deconvolution under the predominant early elution of carbon dioxide.

12. Towards a tool to discriminate between pain mechanistic descriptors: expert ranking of clinical features and allocation of weights using a forced choice paradigm.

期刊: Pain 发表日期: 2026-Apr-29 链接: PubMed

摘要

Pain treatments have modest effects. Health outcomes might be improved if treatments are matched to mechanisms underlying the persistence and biopsychosocial impact of an individual’s pain. The International Association for the Study of Pain (IASP) defines 3 mechanistic pain descriptors presumed to involve different mechanisms-nociceptive, neuropathic, and nociplastic. Although treatments to address each descriptor have been proposed, there is no consensus on how to assign descriptors to clinical presentations. A recent consensus identified candidate clinical features to discriminate between descriptors in clinical practice and research. These need refinement to progress towards a tool. This study aimed to determine the rank and relative weight of identified clinical features to aid discrimination between mechanistic pain descriptors. Candidate clinical features (n = 196) were refined by the IASP Terminology Task Force to converge similar and remove redundant features. The Task Force (n = 24) and an expert panel (n = 39) ranked features using 1000minds conjoint analysis software and assigned weights based on discrete pairwise choices. Participants nominated from pairs of scenarios, which most likely indicated that pain aligned predominantly to a descriptor. Highest ranked features for neuropathic and nociplastic pain were aligned with IASP Clinical Criteria. Criteria for nociceptive pain have not been established. A ranked list of features shared by 2 mechanisms (indicating mixed mechanisms) was also identified. This study identified expert consensus on the highest ranked clinical features with potential to discriminate between pain descriptors, reflective of different underlying mechanisms. This study extends current frameworks by identifying and refining key discriminators for future operationalisation and validation.

13. Prevalence of Cognitive Distortion Markers in a Suicide Prevention Chat Service: Mixed Methods Study.

期刊: JMIR mental health 发表日期: 2026-Apr-28 链接: PubMed

摘要

Suicide helplines increasingly employ chat services to aid those in urgent need, but the wording and structure of text-driven exchanges may affect their effectiveness. Given the association of cognitive distortions with depression and anxiety, this study investigated their prevalence in the language of individuals seeking help from the Dutch 113 suicide helpline. We observed the prevalence of cognitive distortions for both help seekers and counselors in a large volume of chat sessions (N=71,148) of the Dutch 113 suicide chat helpline using natural language processing. The results were compared to 2 large collections of online text data from Dutch social media and web content. We found that nearly all types of cognitive distortions are more prevalent in the language of help seekers compared to the control group of helpline counselors. Distortions of the personalizing, emotional reasoning, and mental filtering types were, respectively, 20.22, 7.87, and 4.53 times more prevalent among help seekers, revealing a distinct pattern of thought and language among individuals affected by suicidality. Our results raise the prospect of improving the effectiveness of online therapeutic interventions that target cognitive distortions through lexical analysis that detects the cognitive and lexical markers of suicidality.

14. Trends in Antimicrobial Consumption in Pakistan (2016-2028): Retrospective Observational Study With Forecasting.

期刊: JMIR public health and surveillance 发表日期: 2026-Apr-28 链接: PubMed

摘要

Antimicrobial resistance is a public health crisis exacerbated by the irrational use of antibiotics, particularly in low- and middle-income countries. Pakistan, one of the highest consumers of antibiotics globally, faces unique challenges, including unregulated sales, overuse of broad-spectrum antibiotics, and inadequate stewardship programs. This study aimed to analyze antibiotic consumption trends in Pakistan from 2016 to 2023, project future use through 2028, and evaluate the subsequent implications for antimicrobial resistance and antimicrobial stewardship programs. Antibiotic sales data were retrieved for Pakistan from the IQVIA MIDAS database spanning 2016 to 2023. Data were converted to defined daily doses (DDDs) and DDD per 1000 inhabitants per day (DID) using the World Health Organization Anatomical Therapeutic Chemical classification system. Data cleaning, statistical analyses, and data visualization were performed using R software (version 4.3.2) and Microsoft Excel. Trends were analyzed using linear regression, while future projections (2024-2028) were developed using trend-based models. Descriptive analysis was performed, and visualizations were used to illustrate findings. The total antibiotic consumption in Pakistan from 2016 to 2023 was 12.88 billion DDDs. Broad-spectrum penicillins and fluoroquinolones, each accounting for 37.7 DID, were the most consumed classes. The analysis revealed significant increases in the consumption of macrolides (+76%; rising from 2.26 to 3.99 DID) and cephalosporins (+36%; from 2.87 to 3.89 DID) from 2016 to 2023, with macrolides projected to reach 5.79 DID by 2028. Reserve antibiotics, including oxazolidinones (+354%; from 0.03-to 0.014 DID) and glycylcycline (+236%; from 0.001 to 0.0003 DID), also showed appreciable increases, reflecting greater reliance on last-line therapies. In contrast, aminoglycosides (-36%; from 0.013 to 0.14 DID) and narrow-spectrum penicillins (-30%; from 0.008 to 0.005 DID) experienced notable declines. The study highlights a concerning overreliance on broad-spectrum and reserve antibiotics in Pakistan, thus underscoring the urgent need for robust antimicrobial stewardship programs and stricter regulation of over-the-counter antibiotic sales to rationalize antibiotic use. Future efforts should focus on addressing gaps in prescribing practices, improving diagnostic capacity, and monitoring stewardship program outcomes to mitigate resistance development and preserve antibiotic efficacy.

15. Benefit of the N-of-1 Approach Versus Aggregate Analysis in Tracking Individual Trajectories During Pregnancy: Comparison of Longitudinal Wearable Observational Studies.

期刊: JMIR formative research 发表日期: 2026-Apr-28 链接: PubMed

摘要

Personal digital health technologies (DHTs) enable real-time monitoring of physiological metrics and behavioral data, including heart rate variability (HRV), supporting analysis of pregnancy-related conditions and personalized care throughout the perinatal period. While recent studies demonstrate the utility of personal DHTs in tracking pregnancy-related symptoms, they often rely on aggregate statistical methods that overlook individual variability. This study aims to compare aggregate and individual-level analyses of DHT data for pregnancy-related conditions, using the comprehensive BUMP (Better Understanding the Metamorphosis of Pregnancy) dataset to highlight the importance of individual variability and data heterogeneity. We analyzed wearable and self-reported data from 256 participants enrolled in the BUMP study (January 2021 to May 2022), including HRV, sleep, and fatigue measured via Oura Rings and smartphone surveys. Individual-level (N-of-1) trajectories were evaluated and compared with aggregate results to uncover personal and collective trends. A statistical method was developed to assess the influence of adverse events and severe symptoms, while case studies explored confounding and modifying factors underlying heterogeneity. Comprehensive statistical analysis included the coefficient of determination, Kolmogorov-Smirnov tests, likelihood ratio tests, and Welch t tests, with interindividual variability flagged based on high-variability thresholds. Substantial interindividual variability was observed across all features. Only 4.76% (12/256) of participants exhibited an HRV inflection at the aggregate week-33 inflection point, with a coefficient of variation of 14.24%. The median value of the gestational week in individual fatigue troughs was 23 (IQR 8; range 8-38) weeks, differing from aggregate estimates. Distributional comparisons showed no statistically significant differences in individual-level model fit (R²) by pregnancy complications or age (P values ranging from .06 to .99 across all model fit comparisons). Case studies further highlighted both intraindividual and interindividual differences, emphasizing the importance of considering external factors, such as adverse events and severe symptoms. Our findings show that aggregate wearable data often fail to generalize across populations, oversimplifying pregnancy-related physiological and subjective changes. This simplification can obscure individual trajectories, leading to generalized insights that may not reflect many pregnant women’s experiences. Our results highlight the impact of heterogeneity on pregnancy outcomes, emphasizing the need to move beyond one-size-fits-all models and leverage DHT for personalized care.

16. Bridging the Implementation Gap in Medical AI Education: 3-Lever Framework for Concurrent Reform.

期刊: JMIR medical education 发表日期: 2026-Apr-28 链接: PubMed

摘要

The rapid integration of artificial intelligence (AI) into clinical practice necessitates urgent restructuring of medical education and physician assessment to ensure that future physicians are proficient and responsible users of AI tools. Despite the existence of core AI competencies, the current state of AI education in Canadian undergraduate medical education is highly inconsistent and disjointed, and available data indicate that most medical students receive minimal to no formal AI training even as they anticipate that AI will profoundly shape their future careers. National policy, specifically the Pan-Canadian AI for Health Guiding Principles, has advanced the agenda by calling for AI literacy among health professionals and emphasizing core values such as equity, robust data practices, and Indigenous-led data governance. However, these principles offer limited practical guidance on the educational and regulatory mechanisms required for effective implementation. We contend that this critical implementation deficit arises from a traditional, sequential reform model in which faculty development, curriculum change, and regulatory updates occur in isolation. This slow, siloed approach is fundamentally inadequate for addressing AI’s inherent speed, opacity, and significant equity risks. To overcome this challenge, we propose a 3-lever concurrent implementation framework that provides a conceptual lens to address the interdependencies among faculty development, curriculum, and regulation. This model posits that AI competencies transition from abstract requirements to practical application only when 3 levers-clinician-educator capacity, digitally enabled learning environments, and regulatory and assessment reform-are activated simultaneously and in alignment. This Viewpoint extends existing AI competency frameworks by theorizing AI curriculum implementation as a problem of concurrent lever activation and by outlining minimum concurrent actions for deans and regulators that can be adapted to competency-based medical education systems. Although illustrated with Canadian examples, the framework is designed to be transferable beyond Canada and offers a testable, licensure-level blueprint for embedding AI competence in medical education.

17. Multi-dose metronidazole treatment for Trichomonas vaginalis more effective than single-dose treatment in clinical practice: A retrospective cohort study.

期刊: Sexually transmitted diseases 发表日期: 2026-Apr-28 链接: PubMed

摘要

Trichomonas vaginalis (TV) is the most prevalent non-viral sexually transmitted infection (STI) globally. The objective of this study was to estimate the effectiveness of multi-dose metronidazole treatment on repeat TV test positivity in pregnant and non-pregnant women. This retrospective cohort study used electronic medical record data and included patients testing positive for TV by nucleic acid amplification test between July 2020 and June 2022 at a large safety-net hospital in the Southeast United States. The primary exposure was treatment type (no treatment, single-dose metronidazole, multi-dose metronidazole), and the outcome was a repeat positive TV test between 4 and 20 weeks after the initial test. Covariates included demographic characteristics, substance use, pregnancy, and concurrent STI. Log-binomial regression modeling estimated the association between treatment type and repeat positive TV test. Of 1,583 women with a positive TV test during the study period, 66% were under the age of 35, 96% self-identified as Black, and 39% were pregnant. Only 487 women (31%) had a repeat test performed, and 26% of these (n=125) had TV on repeat testing. Compared with multi-dose treatment, both no treatment and single-dose treatment were associated with higher risk of repeat positive TV test (RR 2.43; 95% CI 1.48, 4.01 and RR 1.44; 95% CI 1.05, 1.99, respectively). Repeat test rates were low and repeat TV positivity was high. Multi-dose metronidazole was superior to single-dose treatment. Strategies to increase repeat testing and address high repeat positivity should be undertaken in routine clinical settings.

18. Initiation of Eplerenone vs Spironolactone and All-cause Mortality in HFrEF: Linked Database Study.

期刊: European heart journal. Cardiovascular pharmacotherapy 发表日期: 2026-Apr-28 链接: PubMed

摘要

Mineralocorticoid receptor antagonists (MRAs) are recommended as part of guideline-directed medical therapy for heart failure with reduced ejection fraction (HFrEF). The comparative effectiveness of spironolactone and eplerenone, however, remains uncertain. This was a non-interventional database study using nationwide Danish health registries, January 1, 2020-June 30, 2025. Patients aged ≥45 years with HFrEF (ejection fraction ≤40%) initiating eplerenone or spironolactone were included. An active-comparator, new-user design and inverse-probability-of-treatment weighting based on propensity scores was used. The primary outcome was all-cause mortality. Secondary outcomes included cardiovascular mortality, heart failure hospitalization, and their composite. Weighted hazard ratios (wHRs) were estimated using Cox proportional hazards models.A total of 4550 patients initiating eplerenone and 6651 initiating spironolactone were included. Median follow-up was 2.3 years. There were 571 deaths in the eplerenone group (5.0 per 100 person-years) and 1168 in the spironolactone group (7.0 per 100 person-years). A lower risk of death was observed with eplerenone (wHR, 0.83; 95% CI, 0.75-0.93), corresponding to an absolute rate difference of -1.10 per 100 person-years (95% CI, -0.50 to -1.70). For secondary outcomes, wHRs were 0.89 (95% CI, 0.81-0.98) for cardiovascular death or heart failure hospitalization, 0.79 (95% CI, 0.67-0.92) for cardiovascular death, and 0.97 (95% CI, 0.87-1.09) for heart failure hospitalization.Effect estimates were attenuated in per-protocol analyses. In this large nationwide study, initiation of eplerenone was associated with lower risks of all-cause and cardiovascular mortality compared with spironolactone, with findings suggesting a contribution of better treatment persistence.

19. Applications of Natural Language Processing and Large Language Models for Social Determinants of Health: Systematic Review.

期刊: Journal of medical Internet research 发表日期: 2026-Apr-28 链接: PubMed

摘要

Social determinants of health (SDOH) are the social, economic, and environmental conditions that influence health outcomes. SDOH information is often embedded in unstructured text, such as notes in electronic health records and social media posts. Advances in natural language processing (NLP), including emergent large language models (LLMs), offer opportunities to extract, analyze, and interpret SDOH expressions from free text for inclusion in downstream analyses. Existing literature on NLP applications for SDOH is dispersed across disciplines and characterized by methodological heterogeneity and variability in study quality and scope, complicating synthesis and cross-study comparison. This study aimed to examine the use of NLP, including LLMs, in SDOH research, and highlight gaps and future research directions. We conducted a systematic review following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, searching 7 major databases for publications between 2014 and November 2025. We included journal and conference proceedings papers that applied NLP methods to identify, classify, extract, or predict SDOH from text. Three reviewers independently screened studies and extracted data; conflicts were resolved by two senior reviewers. We abstracted study metadata, dataset characteristics, NLP approaches, SDOH domains addressed, and NLP performance metrics. We also conducted risk-of-bias analyses and identified influential studies based on relative citation counts. 142 studies met the inclusion criteria. Nearly two-thirds (89/142, 62.7%) were published between 2023 and 2025, reflecting rapid recent growth. Most studies relied on electronic health records (93/142, 65.5%) and private datasets (81/142, 57.0%), while only 20.4% (29/142) used publicly available data. Commonly studied SDOH domains were housing instability (72/142, 50.7%), employment (65/142, 45.8%), and financial conditions (63/142, 44.4%); structural factors, such as immigration status (5/142, 3.5%), were rarely examined. Of studies that reported evaluation metrics, most focused on classification (26/83, 31.32%) or extraction (38/83, 45.7%), and used cross-sectional designs. Reported model performances were typically strong, with median F1-scores ranging roughly from 0.75 to 0.85 across model categories. Only 49 studies shared code, and fewer than half clearly described model interpretability or reproducibility practices. LLMs (including encoder-decoder models) appeared in 19.7% (28/142) of studies, highlighting emerging interest but also raising new concerns around transparency and governance. This review provides a timely synthesis of NLP and LLM applications across the SDOH research spectrum, addressing an important gap in a topic receiving increasing research attention. By comparing task formulations, data sources, and performance patterns, the review clarifies the research readiness of current approaches and reveals critical gaps. Our findings advance the field by highlighting the absence of a unified SDOH framework, uneven availability of public benchmarks, and limited evaluation of real-world deployment. Addressing these gaps through transparent, inclusive dataset development and implementation-focused evaluation is essential for translating NLP advances into equitable, real-world health impact.

20. A Doorway Into Power: Debriefing and Reflection in Virtual Reality Health Policy Education.

期刊: Simulation in healthcare : journal of the Society for Simulation in Healthcare 发表日期: 2026-Apr-28 链接: PubMed

摘要

21. Associations Between Ultra-Processed Food (UPF) Consumption and Weight Change and Obesity Risk Among Consumers of Plant-Based Diets: A Systematic Review.

期刊: Journal of the American Nutrition Association 发表日期: 2026-Apr-28 链接: PubMed

摘要

Interest in plant-based diets for health promotion continues to grow, emphasizing whole and minimally processed foods. Consistent with broader U.S. trends, plant-based consumers derive many calories from UPFs, whose impact on weight change, overweight, and obesity remains unclear. This review aimed to evaluate the association between UPF consumption and weight change, overweight, and obesity among consumers of plant-based diets. A systematic literature search was performed in Web of Science, PubMed, and Scopus databases, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. This review analyzed twelve studies published between 2020 and 2025 involving 206,727 participants aged 18 and older across six countries. There was a mixed association between UPF consumption and weight change, overweight, and obesity among plant-based consumers, with some suggestion that higher diet quality UPFs were inversely or not associated with body weight. Among the 12 studies included, 4 specifically examined the research question, while the rest separately reported baseline UPF intake and weight-related outcomes. The quality of evidence was weak. While the four studies addressing the research question were rated fair to good quality individually, it was not possible to draw definitive conclusions, as the studies were observational and had a high risk of bias. Across the studies, there was also variability in consumption patterns and potential misclassification of plant-based consumers. Further research evaluating the quality of plant-based UPFs and UPF subcategories is warranted, as diet quality appears to be an influencing factor of the association. Few studies evaluated the association between UPF consumption and weight-related outcomes among plant-based consumers, and the quality of evidence was weak.The studies that evaluated the research question found a mixed association between ultra-processed food (UPF) consumption and overweight and obesity among plant-based consumers.Diet quality may partly mediate the association between UPF consumption and weight-related outcomes in the population.

22. Evaluation and management of recent onset cardiomyopathy in the current era of heart failure therapeutics. A clinical consensus statement of the Heart Failure Association of the ESC.

期刊: ESC heart failure 发表日期: 2026-Apr-28 链接: PubMed

摘要

Recent-onset cardiomyopathy represents a clinically dynamic and potentially reversible clinical framework of non-ischemic cardiomyopathy, characterized by high variability in left ventricular (LV) function and arrhythmic risk. This clinical consensus statement provides a structured diagnostic and therapeutic approach based on two prognostic axes: the potential for left ventricular reverse remodeling (LVRR) and the risk of sudden cardiac death (SCD). We operationalize four trajectories in the LV evolution, ranging from recovered LV ejection fraction (LVEF) to persistently reduced LVEF. Multimodal stratification including echocardiography, cardiac magnetic resonance (CMR), genetic profiling, biomarkers, and early treatment response allows tailored decision-making on pharmacological and device-based therapies. We propose a unified management algorithm emphasizing early initiation of guideline-directed medical therapy, structured reassessment at 3 and 6 months, and individualized consideration of defibrillators, resynchronization therapy, arrhythmia ablation, transcatheter valve leaflet edge to edge repair, and advanced HF assessment. This document aims to support clinicians in risk stratification and timely management or referrals.

23. Perceptions and Perspectives of Mission-Involved Members on Lifestyle, Non-communicable Diseases, and Health Promotion in Seventh-Day Adventist Churches in Argentina.

期刊: Journal of religion and health 发表日期: 2026-Apr-28 链接: PubMed

摘要

Faith-based organizations provide effective platforms for implementing basic health programs because of their social engagement and influence on personal health decisions. This study aimed to evaluate the perceptions and perspectives of Seventh-day Adventist (SDA) church members in Argentina about risk factors for non-communicable diseases (NCDs) and health promotion within their churches and the surrounding community. This is a qualitative exploratory study with 30 focus groups, each comprising 4-7 local church members, representing 119 churches across 13 provinces in Argentina. Semi-structured audio-recorded interviews were conducted, designed to gather insights into participants’ perceptions and perspectives. Subsequent meetings focused on training in lifestyle and NCDs, and the collaborative development of health promotion strategies. Information from the interviews was transcribed, coded, and manually analyzed using inductive thematic analysis. Church leaders identified hypertension, diabetes, and obesity as the most prevalent NCDs affecting church members and the broader community. Major risk factors include sedentarism, poor nutrition, and mental stress. While church members’ lifestyles were perceived to be better than those of the general community, they were still considered suboptimal. Health promotion programs were deemed necessary, with members suggesting that tailored approaches to their churches and communities may significantly improve lifestyles. By the end of the training, leaders proposed adapted health programs to meet the perceived needs of each community. Perceptions of NCDs risk factors were identified, and perspectives on health programs were viewed positively to foster beneficial changes that support healthier lifestyle habits in SDA church members and their surrounding communities in Argentina.

24. Arginine-vasopressin systems in autistic phenotype schizophrenia: effect of a genetic variant of AVPR1a and AVPR1b.

期刊: Journal of neural transmission (Vienna, Austria : 1996) 发表日期: 2026-Apr-28 链接: PubMed

摘要

Much attention has been devoted to exploring the similarities between schizophrenia and autism spectrum disorder (ASD). Autistic traits in schizophrenia have recently been assessed using the Positive and Negative Syndrome Scale for Schizophrenia Autism Severity Scale (PAUSS). Although studies on arginine-vasopressin (AVP) systems have focused on the etiology of ASD, there are no reports regarding AVP systems and autistic traits in schizophrenia. This study aimed to assess autistic traits in schizophrenia using the PAUSS and examine their associations with the PAUSS and AVP-related biological measures. This is a cross-sectional study. We recruited patients with schizophrenia (n = 80) and healthy controls (HCs; n = 27). Patients with schizophrenia were classified as having either an autistic phenotype schizophrenia (AU) or a non-autistic phenotype (NAU). All patients with schizophrenia underwent clinical assessments focusing on symptom severity, autistic traits, neurocognition, and social cognition. HCs were examined for neurocognition and social cognition. We also evaluated AVP-related biomarkers, including serum AVP levels, single-nucleotide polymorphisms, and promoter-region microsatellites. The AU group showed worse symptom severity and social cognition than the NAU group. The T allele of rs28632197 in the AVP receptor (AVPR)1b was associated with more severe autistic traits in patients with schizophrenia, while the short allele of RS1 in AVPR1a was associated with less severe autistic traits. Our results suggest that autistic traits in schizophrenia are linked to more severe symptoms and poorer social cognition and that AVP system dysfunction may contribute to their etiology. Clinicians should carefully evaluate autistic traits.

25. Monoclonal antibodies in the management of hereditary angioedema.

期刊: Expert opinion on biological therapy 发表日期: 2026-Apr-28 链接: PubMed

摘要

Hereditary angioedema (HAE) is a rare, potentially life-threatening, unpredictable disease characterized by recurrent subcutaneous and/or submucosal edema (HAE attacks). HAE imposes a significant biopsychosocial burden on patients and their families, owing to the erratic nature and variable severity of HAE attacks. Current guidelines appoint sustained disease control as one of the main treatment goals, achievable through the initiation of long-term prophylaxis (LTP). This review focuses on the evaluation of three monoclonal antibodies developed for LTP of HAE, namely lanadelumab (Takhzyro®), garadacimab (Andembry®), and navenibart, in this order. Lanadelumab inhibits plasma kallikrein and has been an approved LTP option since 2018. Garadacimab inhibits activated factor XII (FXIIa) and has been approved for LTP in 2025. Navenibart, a drug currently under development, inhibits plasma kallikrein and has been modified to extend its circulating half-life. The transition from the older non-targeted LTP options to the use of monoclonal antibody-based therapies has fundamentally changed the treatment landscape by offering a safe, effective, and highly targeted solution. Although having different pharmacological characteristics, these LTP options share the same objective: to achieve complete disease control. Hereditary angioedema is a rare disease where the main symptoms are unpredictable swellings of the skin or the mucous membranes. These swellings may lead to disfigurement and can even be life-threatening when affecting the mucous membranes of the upper airways. The unpredictability of the swellings leads to a high psychological, economic, and social burden for the patients. To alleviate these burdens, physicians aim to prevent the occurrence of swellings and advise their patients to take preventive medications regularly. Monoclonal antibodies are a group of medications that are being used in more and more fields of medicine because they provide us with the opportunity to target specific molecules in the body. Three different monoclonal antibodies are used or being developed for the long-term prevention of swellings in hereditary angioedema, lanadelumab, garadacimab, and navenibart. In this article, the authors summarize the information available in the literature about these three drugs. However, these medications do not offer 100% protection against swelling attacks; therefore, it is important that patients always keep acute treatment with them, even if they receive preventive medications and/or are symptom-free.

26. Missed Opportunities for HIV and Syphilis Co-Testing in Emergency Departments.

期刊: Clinical infectious diseases : an official publication of the Infectious Diseases Society of America 发表日期: 2026-Apr-28 链接: PubMed

摘要

27. A Changing Climate Requires Changing Tools: Environmental Exposures and Cardiovascular Health through a CMR Imaging Lens.

期刊: European heart journal. Cardiovascular Imaging 发表日期: 2026-Apr-28 链接: PubMed

摘要

28. INS-17 acts as a nutrient deprivation signal to mediate adult IIS-regulated associative behaviors in C. elegans.

期刊: PLoS genetics 发表日期: 2026-Apr-28 链接: PubMed

摘要

Insulin/Insulin-like growth factor 1 (IGF-1) signaling (IIS) is a pleiotropic signaling pathway that functions across tissues to coordinate phenotypic changes in response to nutrient status. Thus, the ubiquity of the IIS pathway hinders efforts to elucidate the mechanisms driving specific IIS-related phenotypes. Previous research in the nematode worm C. elegans has demonstrated that loss of function of the IIS transmembrane receptor (IR) ortholog, DAF-2, results in a doubled lifespan and enhanced learning and memory behaviors in young and aged animals. However, these findings are the result of reducing DAF-2 receptor function rather than modulating ligand-receptor interactions. In the current study, we aimed to dissect ligand-receptor interactions that may regulate associative behaviors apart from canonical IIS lifespan phenotypes in C. elegans. To this end, we performed targeted genetic screening of Insulin-like Peptides (ILPs) previously identified as DAF-2 antagonists to test their role in learning and memory phenotypes. We discovered that only a single uncharacterized ILP, INS-17, is required for learning and memory. We also demonstrate that INS-17 is sufficient to confer extended memory ability and can promote the maintenance of learning and memory with age. Additionally, we observe that INS-17 regulates associative behaviors independent of lifespan, uncoupling some IIS-mutant phenotypes. We find that regulation of the ins-17 genetic locus explains its unique requirement among ILPs for learning and memory behaviors. Finally, we found that INS-17 acts to signal a state of nutrient deprivation. This activity is required to properly process stimulus valence to promote advantageous behaviors. Our findings deepen the understanding of how IIS can regulate specific phenotypic outputs in response to changes in internal metabolic states.

29. Seasonal Peaks and Climatic Predictors of Chronic Urticaria: A Global Google Trends Analysis.

期刊: Journal of cutaneous medicine and surgery 发表日期: 2026-Apr-28 链接: PubMed

摘要

30. Characterization of Neisseria meningitidis Carriage in Military at Joint Base San Antonio, Texas, June-August 2024.

期刊: Military medicine 发表日期: 2026-Apr-28 链接: PubMed

摘要

The bacteria, Neisseria meningitidis, is a frequent colonizer of the oropharynx, but can also lead to invasive disease with encapsulated strains. All military services currently use a quadrivalent polysaccharide vaccine against serogroups A, C, W, and Y to prevent outbreaks among trainees. With the introduction of novel vaccines against serogroup B, this study evaluated the current carriage of N. meningitidis among military trainees. Between June and August 2024, a sample of 909 military trainees received oropharyngeal sampling at the time of beginning basic military training before universal vaccination and penicillin administration. All isolates were serogrouped by polymerase chain reaction (PCR) and whole genome sequencing. This study was reviewed by the Lackland Institutional Review Board and determined to be occupational surveillance and not human research. Thirty-five (3.9%) trainees had carriage of N. meningitidis. While the PCR suggested, 11 (31%) isolates were encapsulated with Serogroup B, to be the most common colonizing isolate (n = 8, 22%). However, when characterized by whole genome sequencing, only one isolate, expressing serogroup C, was predicted to have a functional capsule. These data demonstrate the continued threat of N. meningitidis in military training populations and the need for whole genome sequencing in characterizing colonizing isolates and the determination of vaccination policies. Furthermore, these data support the current policy of quadrivalent vaccination in the military training population.

31. Epilepsy in emerging adulthood: Clinical, psychosocial, and surgical challenges.

期刊: Epilepsia 发表日期: 2026-Apr-28 链接: PubMed

摘要

Emerging adulthood (EAs; ages 19-29 years) is a unique developmental stage marked by major psychological, social, and occupational transitions. We sought to characterize the clinical, psychosocial, and surgical features of epilepsy in emerging adulthood, considering both current age and age at epilepsy onset. We conducted cross-sectional analyses in two cohorts, an adult epilepsy registry in Calgary, Canada (single tertiary center; first visits 2007-2024), and a multi-center epilepsy surgery satisfaction cohort recruited from three Canadian centers and Gothenburg, Sweden. Age categories were <19, 19-29, and >29 years. Outcomes included seizure freedom, anti-seizure medications, substance use, patient-reported outcomes measures, and surgical characteristics (procedure type, wait times, seizure and psychosocial outcomes, and satisfaction). Of 7439 registry patients, 1724 (23%) were EAs and 1252 had EA-onset epilepsy. Compared with other ages, EAs had lower 1-year seizure freedom and higher depression, anxiety, disability, and substance use (all p’s < .001). EA-onset epilepsy showed similar psychosocial burden, especially for anxiety and substance use. In 240 epilepsy surgery patients (69 EAs), EAs were less likely to undergo selective amygdalohippocampectomy (odds ratio [OR] .17, 95% confidence interval [CI] .03-.94) and had higher rates of permanent complications (OR 6.01, 95% CI 1.45-24.94). EA also spent a greater proportion of life waiting for epilepsy surgery and reported lower post-operative psychosocial satisfaction despite a seizure-freedom rate similar to that for other ages. Epilepsy during emerging adulthood is associated with elevated psychosocial morbidity and less seizure freedom, whereas EAs undergoing epilepsy surgery have a distinct case profile with comparable seizure freedom, more complications, and lower post-operative psychosocial satisfaction. These findings highlight the distinctive impact of epilepsy during this developmental stage and underscore the need for targeted transitional care, mental-health support, and timely surgical evaluation. Longitudinal studies are warranted to elucidate causal mechanisms and inform targeted interventions.

32. Functional food literacy competencies of people with Parkinson's disease and multiple sclerosis: a qualitative study.

期刊: Disability and rehabilitation 发表日期: 2026-Apr-28 链接: PubMed

摘要

Neurodegenerative diseases can impair food literacy skills such as meal planning, cooking, and management of food resources. This study aimed to identify the specific needs of individuals with Parkinson’s disease and multiple sclerosis regarding functional food literacy, to inform the development of targeted interventions that promote nutritional autonomy. Four focus groups were conducted with 10 participants, including individuals living with a neurodegenerative disease and caregivers. Data were collected through semi-structured verbal questions and analyzed thematically using the International Classification of Functioning, Disability and Health (ICF), complemented by a functional food literacy model. Participants reported significant challenges related to grocery shopping and cooking, mainly due to cognitive and physical fatigue. Difficulties using kitchen tools were also described, linked to reduced strength and mobility. All participants emphasized the essential role of caregiver support. Interest was expressed in assistive devices and learning strategies to facilitate food-related tasks. Some participants used compensatory strategies, such as task anticipation, sequencing, and selecting simple recipes. This study led to eight recommendations and highlighted the need for a tailored functional food literacy intervention for individuals with neurodegenerative diseases. Such an intervention could enhance nutritional autonomy, improve quality of life, and reduce caregiver burden. Neurodegenerative diseases impair cognitive, motor, and executive functions essential to daily activities, requiring occupational therapy interventions to integrate cognitive and physical compensation strategies for meal preparation and grocery shopping.Rehabilitation programs should include the provision and training in the use of assistive devices (e.g., adapted utensils, planning applications) to support functional autonomy.Home-based interventions should support the adaptation of the kitchen and meal-related routines (e.g., layout, meal planning, grocery management).The interventions should aim to enhance functional efficiency and promote autonomy.

33. Predicting abdominal obesity in children and adolescents via machine learning: a longitudinal cohort study.

期刊: Journal of pediatric endocrinology & metabolism : JPEM 发表日期: 2026-Apr-27 链接: PubMed

摘要

This study aimed to construct and verify machine learning (ML) models to predict long-term abdominal obesity (AO) risk in children and adolescents. We trained and externally validated ML models to predict pediatric AO 4-5 years later using a publicly available longitudinal cohort. The body roundness index (BRI) was used as the diagnostic criterion for AO. The training/internal-validation cohort comprised 635 youths (2011→2015); an independent 2006→2011 cohort (n=456) provided external validation. After screening 25 routine variables and multiple imputation, four ML algorithms were evaluated by area under the receiver operating characteristic curve (AUC), sensitivity, specificity and F1-score across all three datasets. Among 635 children and adolescents in the raw-training set followed for four years, 164 (25.83 %) developed AO. Univariable analysis identified 12 significant baseline predictors (p<0.1); multivariable logistic regression (LR) retained five independent factors: body mass index (BMI), height, carbohydrate intake, reading/writing activity and urban residence. Four machine-learning algorithms were trained and validated; LR demonstrated the most stable performance across training (AUC=0.705), internal validation (AUC=0.742) and external validation (AUC=0.667) datasets. The LR model stands out as a potential tool in predicting long-term AO risk in children and adolescents.

34. Patterns of diagnostic errors using hierarchical cluster analysis: a single-center, cross-sectional study in general internal medicine.

期刊: Diagnosis (Berlin, Germany) 发表日期: 2026-Apr-27 链接: PubMed

摘要

Diagnostic errors are caused by disease complexity, variable settings in which care is provided, and multiple cognitive and system-level factors. However, whether outpatient diagnostic errors aggregate into specific failure modes that align with the clinical context remains unclear. Therefore, we aimed to explore these modes by examining the salient causes of unexpected readmission. We conducted a cross-sectional study to analyze unexpected readmissions among outpatients in general internal medicine who visited a clinic within 14 days of their initial visit. Two physicians independently assessed the diagnostic errors using the Revised Safer Dx Instrument and Diagnostic Error Evaluation and Research (DEER) taxonomy. We applied hierarchical clustering to the DEER taxonomy and conducted Fisher’s exact tests to examine the associations with patient, physician, and system factors (presence of a referral letter, personal protective equipment [PPE] use, and late session). Among the 146 patients, 50 (34.2 %) experienced diagnostic errors. Cluster analysis revealed two main categories of failure modes: (1) diagnostic prioritization and urgency appraisal failure, and (2) information acquisition and synthesis failure. The latter category was further divided into three clinically relevant subtypes: data-gathering failure, where PPE use was more common; information synthesis and interpretation failure, in which referral letters were more common; and undertesting and safety-netting failure. We identified that diagnostic errors were divided into four diagnostic failure modes that mapped to distinct DEER failure patterns and other factors. Linking these failure modes to measurable contextual variables may provide targets for diagnostic safety programs.

35. Antimicrobial Resistance (AMR) Consequences of the use of Doxycycline for Prevention of Bacterial Sexually Transmitted Infections (STIs): A Systematic Review.

期刊: Sexually transmitted diseases 发表日期: 2026-Apr-27 链接: PubMed

摘要

Canada has experienced rising rates of bacterial sexually transmitted infections (STIs)-notably syphilis, chlamydia, and gonorrhoea-over the past two decades, especially among gay, bisexual, and other men who have sex with men. Doxycycline pre- and post-exposure prophylaxis (Doxy-PrEP/PEP) has emerged as a potential prevention strategy. However, concerns about antimicrobial resistance (AMR) have prompted further investigation. We conducted a systematic review of English-language studies (2013-2023) using PubMed, Embase, Cochrane, and MedRxiv. We included randomized controlled trials (RCTs), cohort, case-control, ecological studies, and systematic reviews that reported on prolonged or recurrent doxycycline use for any indication across all populations. Data were summarized descriptively due to heterogeneity, and risk of bias and GRADE assessments were conducted to rate level of evidence. Sixteen studies across 17 publications met inclusion criteria. Included studies comprised two systematic reviews, eight RCTs, three cohort studies, two cross-sectional studies, and one modeling study. Seven studies assessed tetracycline/doxycycline resistance in STI pathogens and 12 focused on non-STI organisms. Findings were mixed with some studies reporting increased resistance, others minimal or no change. N. gonorrhoeae showed high baseline doxycycline resistance. Evidence on resistance in skin and gut flora was limited and inconsistent, and no clear pattern of co-resistance to other antimicrobials was found. Overall, the quality of evidence was low to very low. Evidence on AMR risks from Doxy-PrEP/PEP published up to 2023 was limited and uncertain. Findings are inconsistent and underpowered and emerging evidence could change these conclusions.

36. Transformation of sediment from mercury reservoir to potential mercury source in drought-stricken wetlands influenced by climate change.

期刊: Marine pollution bulletin 发表日期: 2026-Apr-27 链接: PubMed

摘要

The primary objective of this study was to investigate the effects of climate change on mercury (Hg) mobilization in areas of the Büyük Menderes River (BMR) basin, where sediment is transitioning to soil or has the potential to do so. Fractionation studies using the European Community Bureau of Reference (BCR) sequential extraction procedure yielded the following ranges: for sediment F1 nd-3.93%, F2 nd-9.81%, and F3 + F4 88.40-99.84%; for soil F1 nd-11.75%, F2 nd-25.86%, and F3 + F4 62.40-99.86%. The combined F1 + F2% fraction, which is easily released into the ecosystem and bioavailable to organisms, was found to be higher in soil areas (5.3%) than in sediment (3.1%). Although the fractional analysis indicates that a greater proportion of Hg is present in the less mobile F3 + F4 phases compared to F1 and F2, the sum of all fractions (∑F) and the total Hg concentration reveal that soil generally attains higher values than sediment. The mean Hg concentration (6.43 μgL-1) in water samples was higher than the WHO standard value, and high values were detected in plant samples and physicochemical parameters (except pH) in the soil (p < 0.05). The mean contamination and ecological risk indices were also higher in the soil than in the sediment. In the human health risk assessment, the Hazard Index (HI) for both sediment and soil was determined to be <1. Based on the integration of different chemical and analytical approaches, it was concluded that Hg is more mobile and has higher bioavailability for living organisms in the soils of the BMR basin.

37. Mercury migration during leaf litter decomposition in a coastal artificial mangrove wetland.

期刊: Marine pollution bulletin 发表日期: 2026-Apr-27 链接: PubMed

摘要

We implemented a 10-month in-situ decomposition experiment on Laguncularia racemosa litter within an urban coastal mangrove in China. By integrating total mercury (THg) measurements with stable isotope tracing, we examined mercury migration and transformation patterns in the intertidal zone. Mercury dynamics showed a distinct two-stage evolution. During the early decomposition phase (March-June), the THg concentrations significantly decreased from 84.0 ± 5.1 to 58.6 ± 2.4 ng·g-1, indicating a net release, with a loss rate of 8.5 ± 3.1 ng·g-1·month-1. The significant negative correlation between THg and δ202Hg (r = -0.980, p < 0.05) suggests the preferential migration of light mercury isotopes. Conversely, during the late decomposition stage (July-December), we observed mercury net enrichment at an average rate of 5.8 ± 3.2 ng·g-1·month-1. Calculations using a Δ199Hg-based isotope mixing model indicated that this transition from a “source” to a “sink” was driven by exogenous inputs. Specifically, external mercury contributions from surrounding sediments and tidal waters increased from 36.6 ± 7.3% initially to 64.5 ± 12.9% in the later phase. Furthermore, the litter exhibited a distinct Δ199Hg/Δ201Hg ratio (1.21 ± 0.14), differing from that of the surrounding environmental media, implying specific photochemical or microbially mediated mercury transformation processes within the decomposition microenvironment. With an estimated annual mangrove litterfall mercury flux of ≥73.5 μg·m-2·yr-1, litter serves not only as a downward vector for atmospheric mercury but also acts as an active late-stage sink, playing a pivotal role in mercury retention and regional biogeochemical cycling in coastal wetlands.

38. The Paradoxical Association of Disaggregated Data Collection With Diabetes Control Among Latino Patients.

期刊: Medical care 发表日期: 2026-Apr-27 链接: PubMed

摘要

Data disaggregation in Latino patients has been called for by national organizations. However, analyses of the association between the collection of this data point, especially the place of birth, and common disease-specific factors, including disease severity, are lacking. To examine the relationship between the collection of place of birth data and diabetes control in a national network of community health centers (CHCs). Hispanic/Latino adult patients, aged 18 to 79 years, with diabetes. We described the following groups by demographic, clinical, and neighborhood factors, and compared odds of hemoglobin a1c (HbA1c) always <7% or ever >9%, stratified by preferred language: (1) patients whose clinics never collected place of birth; (2) those whose clinics did collect this information, but they personally did not have a country of birth in their record; and (3) those with country of birth documented. In our study population (n=81,107), Spanish-preferring Latinos with their place of birth recorded (HbA1c always <7: OR=0.75, 95% CI: 0.65-0.87; HbA1c ever >9: OR=1.68, 95% CI: 1.44-1.95) had worse HbA1c measures than Spanish-preferring Latino patients in clinics that did not collect country of birth. In a national CHC network, Spanish-preferring Latino patients with country of birth information in their records had less well-controlled HbA1cs than those who were served by clinics that did not collect these data. These surprising findings underscore the need to assess disaggregated data collection in Latino patients to better understand the data necessary for high-quality primary care in Latino communities.

39. Implementing Evidence-based Opioid Prescribing in Pediatric Orthopaedics.

期刊: The Journal of the American Academy of Orthopaedic Surgeons 发表日期: 2026-Apr-24 链接: PubMed

摘要

Effective pain management is essential in pediatric orthopaedic procedures to ensure optimal patient outcomes and recovery. Although opioids are an important component of pain control, their misuse remains a notable public health concern. Pediatric patients often encounter opioids for the first time after orthopaedic procedures, underscoring the need for stringent prescribing protocols. The Pediatric Orthopaedic Society of North America guidelines provide a comprehensive framework for tailoring pain management to procedure intensity. Despite their potential, implementation challenges and variability persist. This review examines the Pediatric Orthopaedic Society of North America guidelines, barriers to adoption, and opportunities to optimize postoperative pain management while mitigating risks. Future research and guideline evolution are necessary to uphold patient safety and combat the opioid crisis.

40. Borderline ovarian tumors and low-grade serous carcinoma: A retrospective analysis from argentine and Uruguayan oncology centers.

期刊: Surgical oncology 发表日期: 2026-Apr-22 链接: PubMed

摘要

Borderline ovarian tumors (BOT) and low-grade serous carcinoma (LGSC) are rare epithelial ovarian neoplasms with distinct clinicopathologic features and generally more favorable outcomes than high-grade epithelial tumors. This study aimed to describe the clinical, pathologic, and treatment characteristics of BOT and LGSC treated in Argentine and Uruguayan oncology centers, and to report oncologic outcomes. A multicenter retrospective study was conducted including 369 adult patients diagnosed between 2009 and 2020 in 19 hospitals in Argentina and 1 in Uruguay. Clinical, pathologic, surgical, treatment, and survival data were collected from medical records. Of the 369 patients, 336 (91.1%) had BOT and 33 (8.9%) had LGSC. Most tumors were diagnosed at an early stage. BOT was more frequently associated with stage I disease, conservative surgery, and very limited use of systemic treatment, whereas LGSC showed more bilateral disease, ascites, neovascularization, invasive pathologic features, greater use of staging-related procedures, and more frequent systemic treatment. In BOT, 5-year overall survival (OS) and recurrence-free survival (RFS) were 98.9% and 90.2%, respectively. In LGSC, the corresponding rates were 91.4% and 75.5%. BOT and LGSC showed clearly different clinical, pathologic, treatment, and survival profiles in this South American multicenter cohort. BOT was usually diagnosed at an early stage and had excellent oncologic outcomes, whereas LGSC was associated with more aggressive clinicopathologic features, more frequent systemic treatment, and poorer survival.

41. Antimicrobial susceptibility and virulence gene analysis of Clostridioides difficile from healthcare-associated infections in Southern Brazil.

期刊: Diagnostic microbiology and infectious disease 发表日期: 2026-Apr-21 链接: PubMed

摘要

Clostridioides difficile (CD) is the leading cause of antimicrobial-associated diarrhea (AAD) and causes a spectrum of disease with high recurrence, morbidity, and mortality. CD pathogenicity is primarily driven by toxins A and B, and, in some strains, by the binary toxin. This study evaluated antimicrobial susceptibility profiles and resistance and virulence genes profiles of isolates from patients with antimicrobial‑associated diarrhea in hospitals across southern Brazil. Stool samples from 371 patients were analyzed by toxigenic cultures. Antimicrobial susceptibility to vancomycin, metronidazole, and ciprofloxacin was determined by gradient strip testing. Toxin production was confirmed by enzyme immunoassay and Polymerase Chain Reaction targeting toxin genes. Genomic DNA from selected isolates was sequenced on an Illumina MiSeq and analyzed using bioinformatics tools. Seventy-two CD isolates were recovered, of which 54 were toxigenic. All isolates were susceptible to metronidazole and vancomycin; all were resistant to ciprofloxacin. Multilocus sequence typing (MLST) identified 13 different sequence types (STs), with ST42 (23.5%), ST5 (20.6%), and ST2 (17.6%) most prevalent. Toxin genes and virulence factors related to adhesion and sporulation were detected. Although genes associated with vancomycin resistance were identified genotypically, no phenotypic resistance was observed. Clinical CD isolates from southern Brazil display substantial genomic diversity, with variable STs and distinct resistance and virulence gene profiles. An understanding of CD genomic diversity and toxin profiles is essential for guiding the development of new diagnostic tools, therapeutic strategies, and public-health interventions.

42. Enhancing detection efficiency of RD-proteins in Mycobacterium tuberculosis culture filtrate by biomimetic affinity chromatography coupled with LC-MS/MS.

期刊: Journal of chromatography. B, Analytical technologies in the biomedical and life sciences 发表日期: 2026-Apr-19 链接: PubMed

摘要

Mycobacterium tuberculosis culture filtrate proteins (MTB-CFPs) are critical for tuberculosis diagnosis and vaccine development. To explore their diagnostic potential, MTB was statically cultured in Sauton’s medium for 15 days; MTB-CFPs were collected, fractionated using six biomimetic affinity chromatography (BiAC) resins, and analyzed by Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS). Four MTB-specific regions of difference (RDs) and the PstS1 protein were recombinantly expressed and purified, with their serological efficacy assessed by ELISA using sera from 157 pulmonary tuberculosis (pTB) patients and 71 healthy controls (HCs). LC-MS/MS identified 622 MTB proteins, 307 of which were validated with ≥2 peptides and P < 0.05. BiAC fractionation significantly increased the average peptide number (2.09-fold), peptide coverage (1.43-fold), and the exponentially modified Protein Abundance Index (emPAI) (1.70-fold) in 281 common identifications. Receiver Operating Characteristic (ROC) analysis revealed rEC (a fusion expression product of the Rv3875 and Rv3874 genes in the RD1 region, linked by a 15-nucleotide connector) as the optimal diagnostic marker Area Under the Curve (AUC = 0.8030), with sharply distinct IgG levels between pTB patients and HCs (P < 0.0001). Notably, rEC combined with GmdA (encoded by the Rv1511 gene located in RD11) enhanced sensitivity while preserving high specificity, especially for Acid-Fast Bacilli (AFB) negative pTB cases demonstrating substantial clinical translation potential. Additionally, extended culture promoted MTB autolysis and cytoplasmic protein release, providing valuable insights into TB pathogenesis and biomarker discovery. This integrated approach of BiAC fractionation, proteomics, and serological validation advances TB precision diagnostics.

43. 177Lu-PSMA-617 SPECT/CT for Early Prediction of Overall Survival in Participants with Metastatic Castration-Resistant Prostate Cancer.

期刊: Radiology 发表日期: 2026-Apr 链接: PubMed

摘要

Background Lutetium 177 (177Lu) prostate-specific membrane antigen (PSMA)-617 SPECT/CT has demonstrated promise as a response biomarker for 177Lu-PSMA-617 therapy. Purpose To predict overall survival (OS) after enzalutamide plus 177Lu-PSMA-617 using quantitative parameters at 177Lu-PSMA-617 SPECT/CT at 6 weeks, as well as prostate-specific antigen (PSA) response, in participants with metastatic castration-resistant prostate cancer. Materials and Methods This secondary analysis of the multisite prospective ENZA-p trial (August 2020-July 2022) included participants who received enzalutamide plus 177Lu-PSMA-617 (7.5 GBq). SPECT/CT was performed 24 hours after each treatment, and total tumor volume (TTV) and mean standardized uptake value were compared between the first (baseline) and second (6-week) doses. TTV complete response (CR) at SPECT/CT was defined as TTV less than 1 mL at dose 2, and deep PSA response was defined as 90% or greater PSA reduction at dose 2. Relationships between TTV CR and deep PSA response at dose 2 and OS were examined. Results This analysis included 74 men (median age, 71 years [IQR, 66-78 years]). Median follow-up was 33 months (95% CI: 28, 37). Median OS was 31 months (95% CI: 25, 33), and the 2-year survival rate was 70% (95% CI: 58, 79). Median TTV was 236 mL (IQR, 81-688 mL) at baseline and 65 mL (IQR, 12-215 mL) at 6 weeks. Median change in TTV was -57% (IQR, -89% to -38%); 4.1% (three of 74) of participants had an increase in TTV, and 16% (12 of 74) had TTV CR. Deep PSA response was seen in 63% (45 of 71) of participants. The 2-year survival rate with TTV CR was 83% (95% CI: 48, 96), versus 67% (95% CI: 54, 77) without TTV CR (hazard ratio, 0.26 [95% CI: 0.08, 0.85]; log-rank P = .02). The 2-year survival rate was 76% (95% CI: 58, 87) with deep PSA response without TTV CR (log-rank P = .05 vs TTV CR) and 54% (95% CI: 33, 71) with neither deep PSA response nor TTV CR (log-rank P = .003 vs TTV CR). Conclusion TTV CR at 177Lu-PSMA-617 SPECT/CT at 6 weeks was associated with improved OS and may be a valuable tool for treatment personalization with 177Lu-PSMA-617. ClinicalTrials.gov Identifier: NCT04419402 © RSNA, 2026 Supplemental material is available for this article. See also the editorial by Galgano and Turner in this issue.

44. The principles of Population-Level Approaches to Dementia Risk Reduction (PLADRR).

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

摘要

Dementia is a leading health policy challenge, with cases expected to triple by 2050, particularly in low- and middle-income countries. Epidemiological evidence demonstrates falling age-specific incidence rates in high-income countries, suggesting risk can be lowered at the population level.The Population-Level Approaches to Dementia Risk Reduction (PLADRR) Research Group is a diverse, international network of researchers committed to investigating how structural, social, and environmental conditions can promote life course brain health and reduce dementia risk across the population.This Policy Forum article sets out the guiding principles of our approach, the building blocks required, our research priorities, and how PLADRR research can inform and translate into policy changes.

45. Exploring Participant Perspectives on Implementation and Sustainment of Taking It to the Pews: A Faith-Based HIV Intervention With African American Churches.

期刊: AIDS education and prevention : official publication of the International Society for AIDS Education 发表日期: 2026-Apr 链接: PubMed

摘要

African American faith institutions can play a key role in increasing HIV education and testing in communities disproportionately burdened by HIV. This focus group study explored church participant perspectives of a religiously tailored HIV education and testing intervention implemented through a clustered, randomized controlled trial with 14 African American churches in Kansas City. Focus group participants from intervention churches emphasized the importance of churches providing access to HIV screening/education and support for people with HIV. They noted that pastors’ involvement (e.g., integrating messages into sermons, publicly getting tested) encouraged others to get tested. TIPS materials were seen as easy to understand, and the intervention fostered more HIV discussions and partnerships with public health organizations. Challenges included time demands and limited church staff. Participants recommended stronger connections among intervention churches for support and idea sharing. Overall, religiously tailored HIV education and testing interventions are highly acceptable when supported by trusted faith and public health partnerships.

46. CT-based Opportunistic Screening for Adding Clinical Value: How I Do It.

期刊: Radiology 发表日期: 2026-Apr 链接: PubMed

摘要

There is a growing awareness that body CT scans contain rich cardiometabolic information that can be leveraged for additional patient benefits. However, the clinical implementation of opportunistic CT screening in routine practice has been hindered by valuable yet onerous manual measurements and subjective assessments. Explainable artificial intelligence (AI) algorithms are now poised to change this. The potential impact of opportunistic screening is further enhanced by the large volume of CT scans being obtained. In this “How I Do It” installment, the authors briefly outline some current approaches that can be obtained “on the fly,” while focusing more on emerging automated solutions. Detecting unsuspected or presymptomatic conditions, such as osteoporosis, cardiovascular disease, sarcopenia, and hepatic steatosis, could lead to preventive interventions, regardless of the original indication for imaging. Composite models that combine multiple cardiometabolic CT biomarkers can be applied to survival prediction and assessment of biologic aging, frailty, cancer cachexia, metabolic syndrome, and fracture risk, among other factors. For clinical reporting, a range of logistical, actuarial, and ethical issues must be carefully considered. However, if executed properly, we believe that opportunistic CT screening can add substantial value, be cost saving, and provide a new level of personalized precision medicine befitting the dawning AI information era.

47. Using EPIS and facilitation to support delivery of classroom-based physical activity interventions: a case study.

期刊: Translational behavioral medicine 发表日期: 2026-Jan-07 链接: PubMed

摘要

Youth physical inactivity is a major public health concern, particularly in schools serving socioeconomically disadvantaged children. Classroom-based physical activity (PA) interventions offer structured, equitable opportunities for movement, but adoption-fidelity gaps persist. Implementation science frameworks can support schools in aligning interventions with local context and sustaining delivery. This study examined the feasibility of using the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework, paired with facilitation by trained regional school health coordinators, to guide classroom PA implementation in a Michigan elementary school. An EPIS-aligned implementation guide was developed and refined through a two-phase process to ensure theoretical grounding and practical applicability. Six coordinators were trained and evaluated the training using validated measures of acceptability, appropriateness, and feasibility. One coordinator facilitated InPACT implementation at a single school over 18 months, supporting pre-implementation, rollout, and early sustainment. Implementation was documented using the Hexagon Tool, RE-AIM, Plan-Do-Study-Act cycles, and routine administrative data. Coordinators rated the training highly on all measures. In the pilot school, teachers delivered an average of three PA breaks per day, with lower-elementary classrooms averaging four and upper-elementary classrooms averaging two. Fidelity was supported through structured ramp-up, teacher training, technical assistance, and classroom tracking. Integration into school systems helped to fill gaps in the school district wellness policy. Behavioral referral data indicated a 34% reduction in minor classroom incidents over the first year of implementation. EPIS-guided implementation with facilitation is feasible for supporting adoption, fidelity, and early sustainment of classroom PA. Structured pre-implementation planning, phase-specific support, and alignment with school priorities are critical. Multi-site studies are needed to examine grade-specific strategies, fidelity variability, and long-term sustainment. Many children do not get enough physical activity (PA) during school, especially in under-resourced settings. This inactivity can negatively affect physical, emotional, and cognitive development. We tested whether the EPIS framework—Exploration, Preparation, Implementation, and Sustainment—combined with facilitation provided by trained regional school health coordinators, could help schools adopt and maintain InPACT (Interrupting Prolonged Sitting with Activity), a classroom-based PA intervention. Facilitation means hands-on support for teachers and leaders, including strategic thinking and problem-solving, and guidance on using EPIS-aligned tools. InPACT encourages teachers to provide short activity breaks throughout the school day. Six coordinators were trained to use the guide combining EPIS with facilitation. One elementary school piloted the approach for over 18 months. Teachers delivered an average of three activity breaks daily, with younger grades averaging more than older ones. Teachers and administrators also reported improved student behavior, and the school embedded activity breaks into staff onboarding to ensure long-term use. Our findings show that EPIS with facilitation can help schools plan, deliver, monitor, and sustain classroom activity breaks. Larger studies are needed to strengthen evidence and support wider adoption.

48. Pain sensitivity following a standardized two-hour cycling session: a randomized controlled crossover Study.

期刊: Scandinavian journal of pain 发表日期: 2026-Jan-01 链接: PubMed

摘要

Exercise induced hypoalgesia (EIH) is characterized by an acute reduction in pain perception following exercise. However, lack of knowledge exists regarding the effects of long duration exercise on EIH. This study aims to explore (1) the effect of a 120 min exercise on EIH in trained male cyclists, and (2) whether the potentially observed EIH results differ between local loaded and unloaded central landmarks. In a randomized controlled crossover design, 20 trained male cyclists conducted a bicycle ergometer session of 120 min at 70 % of the individual anaerobic threshold (IAT) and a control session in addition to a pre-experimental session (including medical anamnesis, incremental exercise test, IAT determination) with pauses of ≥2 days in between the respective visits. Heart rate (bpm), lactate concentrations (mmol/l), and rate of perceived exertion (RPE; 6-20) were documented. Pre and post, pain sensitivity was measured employing pressure pain thresholds (PPT [N/cm2]) at local muscular (rectus femoris, tibialis anterior), local articular (knee, ankle), and central landmarks (sternum, forehead). Exercise resulted in an average heart rate of 141.2 ± 9.4 bpm, an average lactate concentration of 1.6 ± 0.4 mmol/l, and RPE scores of 14.9 ± 2.9. Regarding PPT, no ‘time’ × ’session’ interaction effects were observed for local muscular (p=0.588), local articular (p=0.588), or central landmarks (p=0.910), with these PPT (N/cm2) values observed: local muscular (exercise: pre=81.0 ± 19.5, post=83.0 ± 18.4, relative change: 4.5 ± 16.6 %; control: pre=85.1 ± 22.9, post=85.3 ± 22.5, relative change: 0.7 ± 10.8 %), local articular (exercise: pre=81.9 ± 21.0, post=80.8 ± 21.5, relative change: -0.7 ± 12.2 %; control: pre=81.7 ± 20.9, post=79.2 ± 23.3, relative change: -3.2 ± 12.8 %), and central (exercise: pre=47.9 ± 13.7, post=45.9 ± 11.7, relative change: -1.1 ± 19.8 %; control: pre=48.8 ± 13.0, post=47.1 ± 13.5, relative change: -3.3 ± 16.1 %). Findings suggest that long duration exercise of a standardized moderate intensity may not be effective to induce EIH in trained male cyclists, while also no hyperalgesia is observed. These results are not different between loaded and unloaded body parts. SK/AE 221026 (University of Wuppertal, Germany).

49. Climate change and the future of psychiatry: challenges and opportunities for the next three decades.

期刊: International review of psychiatry (Abingdon, England) 发表日期: 2026 链接: PubMed

摘要

Climate change is an escalating global health threat with significant implications for the field of psychiatry. This narrative review explores the anticipated psychiatric consequences of climate change over the next three decades, highlighting emerging challenges and potential opportunities for mental health care. Evidence links extreme weather events, heatwaves, and environmental degradation to increased rates of anxiety, depression, post-traumatic stress disorder, and suicide. Vulnerable groups include rural women, youth, and individuals with pre-existing mental disorders. The rise of eco-anxiety and climate-related depression points to the emergence of new clinical presentations that may warrant future inclusion in diagnostic frameworks such as the DSM and ICD. The review emphasizes the urgent need to adapt psychiatric training, strengthen healthcare systems, and implement climate-informed policies. Digital solutions, especially telepsychiatry, are vital for maintaining care delivery amid climate disruptions. Concurrently, advances in stress-related biomarkers offer promising avenues for early detection and prevention. Psychiatry must engage proactively in climate change mitigation and adaptation, promoting climate justice and equitable access to care. Addressing the mental health dimensions of climate change is crucial to building resilient psychiatric services capable of responding to the evolving environmental and societal landscape.

50. Psychiatry at crossroads yet again: social policies must lead the way.

期刊: International review of psychiatry (Abingdon, England) 发表日期: 2026 链接: PubMed

摘要

The global burden of mental and substance use disorders is rising at an unprecedented rate worldwide, driven by a complex and evolving network of social determinants. Mental health policies are predominantly rooted in biomedical frameworks and interventions, partially considering the crucial social, economic, and political factors that fundamentally shape mental health outcomes. Thus, policy responses often emphasize individualized, symptom-focused treatments, primarily psychopharmacological, while overlooking structural inequities. A paradigm shift is imperative: mental health policies must integrate social justice, equity, and community empowerment as foundational, evidence-based components of psychiatric care. And if psychiatry is to survive, then psychiatrists must be at the forefront of this revolution, as advocates and campaigners, alongside patients and their care partners. Embedding social determinants into psychiatric training, service design, and policymaking is not merely contextual enhancement, it is a moral and scientific necessity. Participation of people with lived experience, transparent governance, ring-fenced funding, and regular rights compliance audits are all crucial for a socially- oriented mental health plan.

51. The past, present and future of Social Psychiatry.

期刊: International review of psychiatry (Abingdon, England) 发表日期: 2026 链接: PubMed

摘要

In psychiatry, tensions have often arisen between biological and social approaches, despite their interconnection. Social psychiatry has evolved alongside changing understandings of mental health and its ties to broader social and geopolitical determinants. Global factors such as economic inequality, migration, and social exclusion are increasingly recognized as key influences on mental health outcomes. Nonetheless, challenges like stigma, lack of access, and resource limitations persist. The Biopsychosocial Model remains central to social psychiatry, offering an integrated framework that considers biological, psychological, and social dimensions. This comprehensive perspective ensures that interventions target not only symptoms but also contextual factors contributing to mental illness. The future of social psychiatry will be shaped by heightened awareness of social determinants, particularly amid global crises like war or COVID-19. Consistent application of the biopsychosocial model in clinical settings is essential. Policy advocacy focused on housing, employment, and inclusive care-alongside cultural sensitivity and the use of digital tools-will be vital. Moreover, enhancing psychiatric education and fostering interdisciplinary collaboration will be key to addressing social determinants across all levels of mental health care.

52. Companionship utilization and its associated factors during childbirth among mothers who delivered at public hospitals in Shashemene town, Southern Ethiopia: A mixed-method study.

期刊: PloS one 发表日期: 2026 链接: PubMed

摘要

Childbirth companionship has multiple benefits and is associated with improved maternal and neonatal outcomes. However, childbirth companionship is an important component of respectful maternity care that is still underutilized in the clinical setting. Therefore, this study assessed factors associated with childbirth companionship utilization among mothers who delivered at a public hospital in Shashemene town, southern Ethiopia. A facility-based mixed methods study was performed among 411 mothers who delivered at Public Hospitals in Shashemene town from August 20 to September 20, 2021. We entered the collected data into Epidata version 3.1 and exported it to SPSS software version 23 for analysis. A binary logistic regression model was employed to assess the relationship between independent variables and childbirth companionship utilization. A p < 0.05, with an Adjusted Odds Ratio (AOR) and 95% confidence interval (CI) were employed to declare the association. For an in-depth interview, the interview guide was utilized to collect data. We used Open Code software 4.03 for verbatim transcription, translation, and thematic analysis of the data. The magnitude of childbirth companionship utilization was 14.4% (95% CI: 11.2-17.6). Having complications during pregnancy and labor [AOR = 3.25, (95% CI: 1.74, 6.05)], having a future desire to have companions [AOR = 4.02, (95% CI: 1.72: 1.66, 9.41)], primiparous [AOR = 2.54, (95% CI: 1.25, 5.28)], and good knowledge of companionship [AOR = 3.00, (95% CI: 1.53, 5.91)] were significantly associated with childbirth companionship utilization. Qualitative findings also revealed that healthcare providers’ denial, overcrowding of the delivery room, and mothers’ fear of exposing partner/family members to stress were barriers to utilizing childbirth companionship. In this study, the magnitude of childbirth companionship utilization was low and below the WHO recommendation. Therefore, the study highlights the significance of acting on the health system, client, and provider-side factors, which are important to improve the implementation of respectful maternity care components at the facility level. In addition, the integration of respectful maternity care counseling into routine prenatal care, regardless of mothers’ pregnancy risk status, could enhance utilization. Moreover, addressing barriers to companionship utilization through healthcare provider training, developing clear facility-based guidelines, and improving health facilities’ infrastructure is crucial to enhance childbirth companionship and improve maternal health outcomes.

53. Mapping programmes for mental health promotion in Singapore: A scoping review.

期刊: PloS one 发表日期: 2026 链接: PubMed

摘要

Mental health disorders are on the rise globally, with policies promoting programmes that aim to enhance mental wellbeing across various population domains. This scoping review aims to examine the literature to identify and map the mental health programmes in Singapore, while identifying critical knowledge gaps and scope for future systematic reviews. A systematic search was conducted across multiple databases including Medline, PsycINFO, CINAHL, OpenGrey and ProQuest, complemented by hand and bibliography searches. Articles published from 2000 onwards in English language were included. Independent parallel reviews were conducted by multiple reviewer pairs. Data was extracted into standardised, pre-piloted templates that incorporated the Template for Intervention Description and Replication (TIDieR) checklist. One hundred and six studies were included in the review, demonstrating diverse programmes targeting different age groups, with particular focus on older adults in hospital and community settings. The programmes addressed mental health outcomes in individuals with mental disorders, physical conditions, neurodevelopmental and learning disabilities, and among healthy individuals. Implemented by trained care teams or multidisciplinary professionals, these programmes generally showed positive outcomes. However, significant gaps were identified in the literature regarding user experiences, with minimal focus on implementation barriers and enablers. Notably, there was limited evidence of successful community-level implementation beyond the experimental phase, raising questions about programme sustainability and real-world effectiveness. Critical gaps were also identified in youth-specific suicide prevention programmes, despite suicide being a leading cause of death among youths, and programmes targeting the impact of built environment on mental health outcomes and workplace wellbeing. These areas represent important opportunities for future research and intervention development in Singapore’s mental health landscape. Singapore has developed an active research network over the past decade to design and implement programmes aimed at improving mental health across different populations and settings. However, stronger collaborative approaches between academics and policymakers are needed to better utilise research findings and understand which programmes add value to the public health domain. Future research should focus on implementation science, long-term sustainability, and cost-effectiveness of these programmes in real-world settings.

54. University students' awareness of the social dimension of sustainable transportation: The case of Amasya/Turkey.

期刊: PloS one 发表日期: 2026 链接: PubMed

摘要

Promoting walking and cycling is crucial for enhancing quality of life and supporting sustainable mobility. Although the literature includes numerous studies addressing the physical and environmental dimensions of sustainable transportation, the social dimension-particularly in relation to bicycle use-has not been sufficiently explored. This gap limits the wider adoption of cycling as a mode of transport. The present study examines university students’ awareness of the social dimension of sustainability, which represents a critical factor in advancing sustainable transportation. Amasya University in Turkey was selected as the case study area due to its diverse academic faculties, the existence of bicycle paths, and the suitability of its urban structure for cycling accessibility. The study aims to reveal how the awareness levels of students from different academic disciplines shape the development of social sustainability in transportation. A mixed-methods approach was adopted, combining attitude analysis, survey applications, and field observations. Attitude analysis was employed to evaluate individuals’ perceptions and behaviors and to explore the extent to which these tendencies can be influenced. The surveys and field observations enabled an integrated evaluation of both quantitative and qualitative data. The findings reveal significant differences in sustainable mobility awareness according to faculty affiliation and socio-demographic characteristics. Female students reported higher bicycle use (60%), while most cyclists belonged to middle- and low-income groups (73.2%). Approximately 47.3% of participants used bicycles for short distances, and 77.4% stated that they cycled primarily for health benefits. In addition, socio-cultural pressures influenced cycling behavior, as 80% of Theology students reported avoiding cycling due to social norms. Overall, the results indicate that indicators such as equity, accessibility, health and safety, individual responsibility, integrated planning, and cultural values and habits play significant roles in shaping students’ awareness and influencing their bicycle use. The study highlights the importance of integrating social dimensions into sustainable transportation policies and university education programs. By doing so, it provides both academic and practical insights for promoting bicycle use and supporting more inclusive and sustainable urban mobility systems.

55. Stress, resilience and job satisfaction among emergency department healthcare workers in Greece.

期刊: Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego 发表日期: 2026 链接: PubMed

摘要

Aim: This study aimed to assess levels of perceived stress, psychological resilience and job satisfaction among Emergency Department (ED) healthcare professionals in Attica, Greece, and examine the correlations among them. Materials and Methods: A cross-sectional study was conducted in 12 public hospitals in Attica, Greece, using self-administered questionnaires: Perceived Stress Scale (PSS-10), Connor-Davidson Resilience Scale (CD-RISC-10), and Job Satisfaction Survey (JSS). Descriptive statistics, Pearson correlations, and multiple linear regression analyses were performed using SPSS v30. Results: Participants reported moderate levels of perceived stress (M=17.72, SD=6.30) and psychological resilience (M=27.18, SD=6.01), while job satisfaction appeared variable, with an overall mean score indicating low to moderate satisfaction (M=113.10, SD=23.41). A significant negative correlation was found between perceived stress and job satisfaction (r=-0.36, p < .001), as well as between stress and resilience (r=-0.53, p < .001). A positive but weaker correlation was observed between resilience and job satisfaction (r=0.14, p < .001). Conclusions: Psychological resilience plays a critical protective role against stress and positively influences job satisfaction among ED healthcare professionals. Resilience-enhancing interventions may reduce stress and improve satisfaction among ED staff.

56. Variability of enteric pathogen infections by season and meteorological conditions in a low-income, urban setting in Mozambique.

期刊: PLOS global public health 发表日期: 2026 链接: PubMed

摘要

Enteric pathogen transmission is influenced by seasonality and meteorological conditions, yet pathogen-specific dynamics are not well understood. We investigated the relationships between (1) season, (2) heavy rainfall events, and (3) temperature and enteric pathogen infections among 12-month-old children in a low-income, urban setting. We analyzed household data and stool samples from 630 participants enrolled in the PAASIM Study in Beira, Mozambique (February 2022-November 2023) and applied generalized estimating equations with robust standard errors (modified Poisson for binary outcomes and linear regression for continuous outcomes). During the rainy season, compared to the dry season, we found a 34% lower prevalence of protozoan infections [aPR: 0.66; 95% CI: (0.51,0.86)], an 11% lower prevalence of co-infections [aPR: 0.89; 95% CI: (0.78,1.00)], and lower total number of concurrent infections per individual [ab: -0.17; 95% CI: (-0.38,0.04)], as well as relationships with some individual pathogens. Following heavy rainfall events (1-week lag), there was a 30% higher prevalence of protozoan infections [aPR: 1.30; 95% CI: (1.06,1.59)], a 22% higher prevalence of viral infections [aPR: 1.22; 95% CI: (0.95,1.57)], and a 10% higher prevalence of co-infections [aPR: 1.09; 95% CI: (0.99,1.21)]. Temperatures above the median (1-week lag), compared to below the median, were associated with a 35% lower prevalence of protozoan infections [aPR: 0.65; 95% CI: (0.49,0.86)] and a 14% lower prevalence of co-infections [aPR: 0.86; 95% CI: (0.76,0.97)]. Our results contrast many previous studies that have predominately shown a higher risk of bacterial infections and a lower risk of viral infection during periods with higher temperatures and precipitation but align with previous research suggesting a higher prevalence of some enteric infections following heavy rainfall events. Both long-term seasonal trends in enteric infections as well as the more immediate effects of extreme weather events, including heavy rainfall events, are important considerations for designing interventions.

57. Time-Threshold Dose-Response Relationship Between Duration of Premature Rupture of Membranes and Maternal, Neonatal, and Laboratory Evidence of Infection: A Systematic Review and Meta-Analysis.

期刊: La Clinica terapeutica 发表日期: 2026 链接: PubMed

摘要

To identify the continuous dose-response relationship between the duration of premature rupture of membranes (PROM) and the probability of neonatal and maternal infectious morbidity. This meta-analysis and systematic review synthesise data from 15 studies worldwide involving more than 70,000 mother-neonate pairs. A two-step random-effects model of PROM duration as a continuous dose, using restricted cubic splines, was used to estimate specific risk thresholds. The analysis established a progressive, non-linear escalation of risk. The onset of statistical risks at 16 hours is the early-onset pneumonia (Adjusted OR 1.86, 95% CI: 1.152.99). At the age of 18 hours, the incidence of culture-proven sepsis in neonates was 4.0%, and the odds ratio for maternal fever was significantly higher (AOR 36.6). The analysis of the ROC curves revealed a critical mathematical pivot point at 37 hours, after which complications escalate exponentially. Latency greater than 48 hours was the most significant independent predictor of culture-proven sepsis, with an increased risk of 8.2 (p < 0.001). Histologic chorioamnionitis was detected in 39% of mothers, and in many cases, they are clinically silent. Considerable heterogeneity (I2 > 60%) was mainly caused by gestational age disparities in cohorts of extremely preterm and term babies. PROM latency risk is not a threat but accelerates with time. Although 18 hours will be an acceptable early warning level, the range of 37 to 48 hours is a high-risk period that needs aggressive treatment. International guidelines need to be reviewed to reflect this non-linear trend, especially regarding pregnancy, where the risks of delivery are low compared to the rising risk of latency.