公共卫生研究摘要 (2026-04-30)

共收录 49 篇研究文章

1. Complexities in evaluation and management of infectious myelopathies.

期刊: Current opinion in infectious diseases 发表日期: 2026-Jun-01 链接: PubMed

摘要

To review recent advances in infectious myelopathies and integrate them into a practical, syndrome-based approach that supports early recognition, guides testing, and avoids pitfalls. Advances in MRI pattern recognition and pathogen-specific diagnostics have refined the evaluation of infectious myelopathies, with strategies tailored to geographic epidemiology, host susceptibility, and distinction from immune-mediated causes. During the COVID-19 pandemic, SARS-CoV-2-associated myelopathy emerged as a rare para- or postinfectious cause of myelitis. The pandemic coincided with a decline in enterovirus outbreaks and acute flaccid myelitis, which are now re-emerging, underscoring the importance of epidemiologic surveillance. Metagenomic next-generation sequencing is useful in suspected infectious myelopathy because it can identify unexpected pathogens from cerebrospinal fluid, but its imperfect sensitivity and contamination risk mean it should complement rather than replace conventional testing. Growing recognition of compartmentalized central nervous system inflammation and cerebrospinal fluid viral escape in HIV myelopathy has shifted management toward antiretroviral resistance patterns and treatment optimization. Therapeutic advances remain limited and largely pathogen-specific, although targeted approaches such as mogamulizumab for HTLV-1-associated myelopathy are promising. Recent progress in infectious myelopathies has been driven by improved pathogen detection and more tailored diagnostic strategies, although treatment advances are beginning to emerge.

2. Intersectional HIV disparities among transgender Medicare beneficiaries of color.

期刊: AIDS (London, England) 发表日期: 2026-Jun-01 链接: PubMed

摘要

We compared the prevalence of HIV across race and ethnicity groups for transgender and gender-diverse (trans) and cisgender Medicare beneficiaries using quantitative intersectional analysis of Medicare claims data from 2011 to 2020. We found that approximately 61% of the excess HIV prevalence among trans Asian and Pacific Islander beneficiaries, 62% among Hispanic beneficiaries, and 78% among Black beneficiaries is associated with the intersection of racialized and gendered experience.

3. SGLT2 inhibitor dapagliflozin attenuates HIV-associated cardiac fibrosis, steatosis and diastolic dysfunction in a mouse model via inhibition of TGFβ signaling.

期刊: AIDS (London, England) 发表日期: 2026-Jun-01 链接: PubMed

摘要

Myocardial fibrosis, steatosis, and heart failure with preserved ejection fraction are increasing among people with HIV (PWH). The sodium-glucose cotransporter type 2 inhibitor (SGLT2i) dapagliflozin has efficacy for cardiovascular disease (CVD) prevention in type 2 diabetes and is a promising therapy for the inflammatory component of CVD risk in PWH. We show dapagliflozin preserved diastolic function and suppressed cardiac fibrosis and steatosis linked to HIV in mice, suggesting potential utility in PWH.

4. Ethical Considerations in Promoting Physical Activity for Nursing Home Residents With Cognitive Impairment: Implications for Policy and Practice.

期刊: Journal of gerontological nursing 发表日期: 2026-May 链接: PubMed

摘要

Promoting physical activity (PA) among nursing home (NH) residents, particularly those with cognitive impairment, often generates ethical tensions that may be rooted in paternalism, risk-averse cultures, and institutional routines. Therefore, it is necessary to address ethical considerations that can inform policy and practice aimed at promoting safe and effective PA intervention strategies. PA promotion was examined through the bioethical principles of autonomy, beneficence, nonmaleficence, and justice. The analysis was extended by introducing a relational autonomy framework suited to contexts of cognitive vulnerability. By situating agency within relational, cultural, and organizational structures, the relational autonomy framework clarifies how ethically grounded and cognitively responsive PA can be enabled or constrained in long-term care settings. The analysis further demonstrated that principlist approaches alone are insufficient to address the relational dependencies and fluctuating capacities that shape NH residents’ participation. Meaningful PA requires communication strategies attuned to cognitive fluctuation, identity-aligned activity design, and institutional flexibility that reduces structural barriers. Integrating relational autonomy into PA policy, staff training, and everyday care practices is ethically necessary to not only promote overall health, but to uphold agency, equity, and personhood for cognitively impaired NH residents.

5. Refractory, Resistant and Recurrent Cytomegalovirus Infections in Solid Organ Transplant Recipients: Risk Factors and Clinical Outcomes.

期刊: Clinical transplantation 发表日期: 2026-May 链接: PubMed

摘要

Cytomegalovirus (CMV) infection remains one of the most prevalent and consequential post solid organ transplant (SOT) infections. Treatment is often challenging, especially when dealing with refractory and resistant CMV infections. We performed a retrospective multicenter cohort study of SOT recipients with clinically significant CMV infection (csCMVi) during 2010-2016. The primary outcome was early refractory CMV infection and secondary outcomes were drug resistance, CMV recurrence, and mortality. Analysis was done with Kaplan-Meier, univariable logistic regression analysis, and multivariable Cox regression. We included 145 SOT recipients with csCMVi, majority were liver transplant (49%). Most common induction was an anti-IL-2 antibody (43.9%). The majority (n = 82; 56.5%) were CMV D+/R- mismatch and presented asymptomatic infection (50.3%). After the initial 3 weeks of antiviral therapy, 13 (8.9%) patients had probable refractory csCMVi; most of them (10 [76.9%]) were CMV D+/R- mismatch. Longer time after transplant had lower risk (OR 0.68; CI 0.48-0.95, p = 0.029) while lower absolute lymphocyte count (ALC) had a higher risk of early refractory csCMVi (OR 1.54; CI 1.01-2.44, p = 0.048). Drug-resistant csCMVi occurred in 7 patients (4.8%); a high initial CMV DNA level was associated with resistant csCMVi (OR 2.00; CI 1.08-3.93, p = 0.031). 25 patients (17.2%) experienced recurrent csCMVi within 6 months. 30 patients (20.7%) died; refractory, resistant or recurrent CMV infections were not associated with mortality. Refractory csCMVi is associated with a low ALC and an earlier onset after transplant. Resistant csCMVi is associated with high initial CMV DNA levels. Recurrence of csCMVi is common and potentially associated with low ALC at the end of antiviral treatment.

6. Barrett's Esophagus.

期刊: The New England journal of medicine 发表日期: 2026-Apr-30 链接: PubMed

摘要

Barrett’s esophagus develops as a result of chronic acid and bile reflux and carries an increased risk of esophageal adenocarcinoma. Because it has no specific symptoms, many patients do not receive a diagnosis or they present with symptoms of gastroesophageal reflux disease and other related risk factors or complications. Diagnosis relies on endoscopic and histopathological findings, including a visible columnar-cell-lined segment measuring at least 1 cm long that contains intestinal metaplasia with goblet cells. Ongoing surveillance focuses on early detection of malignant progression, particularly high-grade dysplasia and early-stage cancer, which allows curative endoscopic treatment and avoids the adverse effects associated with chemotherapy or esophagectomy. Participation in clinical trials is encouraged to improve detection, risk stratification, and management strategies.

7. Pulmonary Tuberculosis Detection with MiniDock MTB Using Swab Samples.

期刊: The New England journal of medicine 发表日期: 2026-Apr-30 链接: PubMed

摘要

Improved diagnostic tools for tuberculosis that are suitable for use in peripheral health centers are essential for reducing the persistent gap between estimated and notified cases. The diagnostic accuracy and usability of the MiniDock MTB test for detecting pulmonary tuberculosis is unknown. We conducted a prospective, cross-sectional study at outpatient centers in India, Nigeria, the Philippines, South Africa, Uganda, Vietnam, and Zambia. Patients 12 years of age or older with presumptive pulmonary tuberculosis were enrolled between September 12, 2024, and March 31, 2025. Assessment with MiniDock MTB was performed with sputum swabs and tongue swabs. Diagnostic accuracy was evaluated against a sputum-culture-based reference and as compared with sputum-smear microscopy and Xpert MTB/RIF Ultra assay. Usability was assessed with a system usability scale and direct observation. A total of 1380 participants were enrolled; 255 (18.5%) had human immunodeficiency virus infection and 226 (16.4%) had culture-confirmed tuberculosis. MiniDock MTB sensitivity was 85.7% (95% confidence interval [CI], 80.4 to 90.0) with sputum and 79.6% (95% CI, 73.8 to 84.7) with tongue swabs; specificity was greater than 97.5% for both. Results of sputum tests with MiniDock MTB closely matched those with Xpert MTB/RIF Ultra for sensitivity (difference, -2.8 percentage points; 95% CI, -6.0 to 0.5). MiniDock MTB had greater sensitivity than smear microscopy for tests of sputum (difference, 24.3 percentage points; 95% CI, 17.9 to 30.7) and tongue swabs (difference, 18.3 percentage points; 95% CI, 12.0 to 24.7). The test showed diagnostic accuracy that was consistent with World Health Organization (WHO) accuracy targets for near-point-of-care tuberculosis diagnostics (≥85% sensitivity for sputum and ≥75% for nonsputum and ≥98% specificity for both). The median score on the system usability scale (range, 0 to 100, with higher scores indicating better perceived usability) was 75 (interquartile range, 65 to 80), which indicated good usability. No adverse events related to the index test were reported. MiniDock MTB met WHO targets for diagnostic accuracy and usability for tuberculosis detection across diverse clinical settings. (Funded by the National Institutes of Health and others; Rapid Research in Diagnostics Development for TB Network and Assessing Diagnostics at Point-of-Care for Tuberculosis ClinicalTrials.gov numbers, NCT04923958 and NCT05941052.).

8. Mim8 Bispecific Antibody Prophylaxis in Hemophilia A with or without Inhibitors.

期刊: The New England journal of medicine 发表日期: 2026-Apr-30 链接: PubMed

摘要

Mim8 (denecimig), a bispecific antibody mimicking activated factor VIII, was developed for bleeding prophylaxis in patients with hemophilia A with or without factor VIII inhibitors. In this phase 3, randomized trial, we assigned patients 12 years of age or older with hemophilia A with or without inhibitors to receive subcutaneous Mim8 once weekly or once monthly at a dose tiered according to body weight and given in a fixed injection volume (0.8 ml). Patients who had been receiving on-demand treatment before the trial were assigned in a 1:1:1 ratio to continue on-demand treatment (group 1) or receive Mim8 once weekly (group 2a) or once monthly (group 2b). Patients who had been receiving clotting factor concentrates during a run-in phase were assigned in a 1:1 ratio to receive Mim8 once weekly (group 3) or once monthly (group 4). The first primary end point was the annualized rate of treated bleeding events (those treated with a coagulation factor product) in an evaluation of Mim8 in group 2a and Mim8 in group 2b as compared with on-demand treatment in group 1. The second was the annualized rate of treated bleeding events in an intrapatient evaluation of Mim8 in group 3 and Mim8 in group 4 as compared with clotting factor concentrate prophylaxis during the run-in phase. Of the 58 patients in the pretrial on-demand treatment cohort, 17 were assigned to group 1, 21 to group 2a, and 20 to group 2b. The estimated mean annualized rate of treated bleeding events was 0.57 (95% confidence interval [CI], 0.25 to 1.30) in group 2a and 0.20 (95% CI, 0.06 to 0.71) in group 2b, as compared with 15.76 (95% CI, 10.70 to 23.20) in group 1 (relative decrease, 96.4% and 98.7%, respectively; P<0.001 for both comparisons). Of the 196 patients in the pretrial prophylaxis cohort, 98 each were assigned to group 3 or group 4. The estimated mean annualized rate of treated bleeding events was 2.25 (95% CI, 1.37 to 3.71) in group 3, as compared with 4.90 (95% CI, 3.65 to 6.56) during the run-in phase (relative decrease, 54.0%; P = 0.006), and 1.78 (95% CI, 1.18 to 2.71) in group 4, as compared with 3.12 (95% CI, 2.25 to 4.32) (relative decrease, 42.8%; P = 0.006). Injection-site reactions were reported in 103 of 4005 injections (2.6%). No patient was reported to have a thromboembolic event or clinical evidence of neutralizing anti-Mim8 antibodies. Among patients with hemophilia A with or without inhibitors, Mim8 prophylaxis was superior to on-demand treatment and clotting factor concentrate prophylaxis regarding the annualized rate of treated bleeding events. (Funded by Novo Nordisk; FRONTIER2 ClinicalTrials.gov number, NCT05053139.).

9. The consequences of changes in exercise habits on work engagement and presenteeism: Evidence from an event-study analysis using Japanese longitudinal data.

期刊: Scandinavian journal of work, environment & health 发表日期: 2026-Apr-30 链接: PubMed

摘要

This study aimed to estimate the consequences of changes in employee exercise habits (starting and quitting) on work engagement and presenteeism. Since January 2023, the Japan Institute for Labour Policy and Training has conducted the semi-annual JILLS-i longitudinal, web-based survey to represent Japan’s middle-aged population structure (512 strata defined by gender, age, employment status, region, education). Of the 11 148 regular employees in the first wave, we analyzed the four-wave data of 6576 individuals (N=26 304 person-waves). We utilized work engagement and productivity (presenteeism) as our analytical outcomes. Binary indicators for relative time from changes in exercise habits were included as explanatory variables to estimate temporal associations with job-related outcomes using an event-study analysis, a quasi-experimental approach. Both starting and quitting exercise habits showed no significant association with presenteeism. However, starting exercise was positively associated with work engagement, whereas quitting was negatively associated with it. Starting exercise showed a significant association over longer follow-up waves than quitting exercise. Gender differences were observed in the association of quitting exercise with work engagement. The acquisition of exercise habits may lead to a sustained improvement in work engagement, a crucial psychological resource for employees. Our results potentially suggest a divergence in the dynamics of effect between organizational support for starting versus preventing quitting exercise. Although exercise promotion may not lead to substantial improvements in productivity as measured by presenteeism, it may still yield meaningful psychological benefits.

10. Home- and Community-Based Service Use and Preferences Among Post-9/11 Veterans With or at High Risk of Alzheimer Disease and Related Dementia and Their Caregivers: Protocol for a Mixed Methods Observational Study.

期刊: JMIR research protocols 发表日期: 2026-Apr-29 链接: PubMed

摘要

Veterans have an increased risk of developing Alzheimer disease and related dementia (ADRD) due to military exposures such as traumatic brain injury. There is a lack of information on home- and community-based services (HCBS) use among Veterans who served in the post-9/11 era and their caregivers. This study aims to (1) quantify HCBS use among post-9/11 Veterans with or at higher risk of ADRD, (2) identify facilitators, barriers, and preferences for HCBS among Veterans and family caregivers, and (3) prioritize HCBS interventions with input from Veterans and family caregivers. This study will include post-9/11 Veterans aged 65 years or younger with early-onset Alzheimer disease or frontotemporal dementia (current ADRD), and Veterans at elevated ADRD risk due to traumatic brain injury or cognitive dysfunction. Veterans’ family caregivers will also be recruited. Secondary data will come from the Department of Veterans Affairs (VA), the Department of Defense, and a previous neurotrauma study. Using VA data augmented with Centers for Medicare and Medicaid Services data, we will characterize HCBS utilization. To address aim 1, we will calculate the crude and adjusted cumulative frequency of HCBS use and the proportion of Veterans using a service among Veterans with ADRD, and those at higher and lower risk for ADRD. We will compare groups using t tests for continuous measures (number of services) and chi-square tests for categorical measures (any service use). To address aim 2, we will interview Veterans and caregivers to identify facilitators and barriers to HCBS use. We will use descriptive content analysis, including rich descriptions, coding, and theme identification. Finally, to address aim 3, we will use a modified Delphi approach to identify and rank HCBS modifications that would increase use. Using the ranking data, we will consider items to have consensus on high importance if 70% or more respond “important” or “very important.” Participants for primary data collection will be recruited from prior studies, VA health systems data, VA clinics, and Veteran- and caregiver-serving organizations. This study was reviewed by the institutional review boards of the University of Utah, Salt Lake City Veterans Affairs, and UT Health at San Antonio and classified as exempt. The 46,053 Veterans in the preliminary aim 1 cohort (903 with early-onset Alzheimer disease/frontotemporal dementia and 45,150 at-risk Veterans matched on age and index year) averaged 55 years old at the index date and were mostly male (38,842/46,053, 84%) and non-Hispanic White (28,016/46,053, 61%). This study will quantify current HCBS use and identify barriers and needs of Veterans with or at higher risk of ADRD and their caregivers. It will identify HCBS modifications that have consensus for needed changes, which will be shared with health system leaders.

11. Forging Hopeful Futures Community-Partnered Violence Prevention Intervention: Protocol for a Comparative Effectiveness Trial.

期刊: JMIR research protocols 发表日期: 2026-Apr-29 链接: PubMed

摘要

Homicide is the third leading cause of death for US adolescents and the leading cause among Black youth. Youth violence also contributes to significant mental health burden and educational disruption, with the highest impact in neighborhoods with limited resources. Programs that address intersecting determinants, including social factors and limited economic opportunities, may reduce violence experiences and perpetration. This protocol paper describes a community-partnered, 2-arm cluster-randomized trial across 16 neighborhoods (12 in Pittsburgh, Pennsylvania, and 4 in the Washington, DC, region) evaluating the Forging Hopeful Futures (FHF) intervention, enrolling approximately 720 youth aged 13 to 19 years. FHF comprises 12 sessions delivered over 6 to 12 weeks by trusted community facilitators and addresses conflict resolution, peer and intimate partner relationships, youth leadership, and job readiness with connections to employment and mentorship. Comparison clusters receive enhanced usual care (individual wellness check-ins). Assessments occur at baseline, the end of the program, 3 months, and 6 months post-program. Primary outcomes are violence involvement (experience and perpetration); secondary outcomes include experiences of multiple types of violence (eg, relationship abuse, sexual violence, bullying, and weapon carrying). Implementation data are collected using RE-AIM (reach, effectiveness, adoption, implementation, and maintenance)-informed tools and qualitative interviews. The study was funded in October 2022, and recruitment began in July 2023. As of December 1, 2025, the study had enrolled 542 participants, with follow-up expected to continue through July 30, 2026. Data analysis for primary end points is expected on January 1, 2027. Primary analyses will estimate intervention effects on recent violence perpetration using generalized linear mixed models with random effects for neighborhood and participant, adjusting for baseline values and city. Exploratory analyses will examine mediation (eg, shifts in attitudes) and moderation (eg, baseline risk profiles). This trial is designed to provide rigorous effectiveness and implementation evidence to inform policy and practice in youth violence prevention. If demonstrated to be effective, FHF could serve as an integrated, scalable model that addresses the social and economic drivers of youth violence and leverages community partnerships for sustainability.

12. Rethinking Trust in Synthetic Health Data: Lessons From 7 European Research Initiatives.

期刊: Journal of medical Internet research 发表日期: 2026-Apr-29 链接: PubMed

摘要

Synthetic data generation (SDG) structured health data is increasingly promoted as a solution to longstanding barriers in health data access. It is offering the promise of privacy-preserving data reuse for research, innovation, and policy. Despite rapid technical advances, the adoption of synthetic health data in real-world settings remains limited. Shaped by challenges around data quality, representativeness, infrastructure readiness, trust, and legal uncertainty, this viewpoint draws on experiences from 7 European research initiatives within the HealthData4EU cluster to reflect on how SDG is being operationalized in practice. It synthesizes cross-project insights to highlight recurring methodological and governance tensions and to examine their implications for trust and responsible use. The analysis argues that trustworthy SDG cannot be achieved through technical optimization alone but requires alignment between evaluation practices, upstream data stewardship, regulatory clarity, and sustained stakeholder engagement. Addressing these conditions is essential for moving synthetic data from experimental pilots toward a credible and sustainable component of European health research ecosystems.

13. A Eulogy for Structural Competence?

期刊: The New England journal of medicine 发表日期: 2026-Apr-29 链接: PubMed

摘要

14. A New Model for Youth-Driven Community Change: Exploratory Testing of Artificial Intelligence-Supported Citizen Science.

期刊: JMIR AI 发表日期: 2026-Apr-29 链接: PubMed

摘要

Generative artificial intelligence (AI) systems are increasingly used in health and community settings, yet empirical evidence on how they function within participatory, youth-led action frameworks remains limited. Large language models can provide structured feedback to support planning and critical reflection, and AI-based image transformation can generate realistic visual prototypes to enhance shared understanding. However, risks include output variability, feasibility gaps when AI-generated recommendations or visualizations imply solutions that are not operationally workable, and the potential to displace adolescent voice and agency if AI outputs are treated as authoritative rather than as inputs for collective deliberation. This study examines how 2 generative AI tools-structured feedback using a GPT model and AI-based image transformation-functioned as deliberative and visualization supports within a youth-led citizen science intervention addressing environmental health concerns in El Pozón, Cartagena, Colombia. This exploratory action research study included a preparation phase and an implementation phase. During preparation, researchers iteratively tested SecureGPT (a privacy-enhanced version of ChatGPT 4.0) prompt configurations and compared DALL-E with Adobe Photoshop AI for place-based image modification, selecting a fixed prompt format requesting 3 strengths, 3 weaknesses, and 5 reflective questions (3-3-5). During implementation, 12 adolescent citizen scientists completed the Our Voice process. AI use was facilitator-mediated: prompts were co-developed through youth consensus, a facilitator entered prompts and operated tools while youth observed, and outputs were reviewed with the group in real time before use. Data sources included structured field notes, analytic memos, archived prompts and outputs, and session recordings. Analysis was descriptive and process-oriented, examining how AI shaped deliberation, solution refinement, and stakeholder engagement. Structured GPT prompts supported deeper critical analysis and iterative refinement toward more feasible interventions. Model outputs varied in usefulness; role-based prompting often produced redundant responses, and early outputs were occasionally overly generic, requiring facilitator guidance and prompt refinement. The structured 3-3-5 format improved specificity and reduced wordiness. DALL-E did not generate sufficiently realistic place-based modifications, whereas Adobe Photoshop AI, used with iterative prompting and area-selection tools, produced visually plausible prototypes that supported group discussion and stakeholder communication. Highly realistic visualizations also introduced a feasibility gap when depicted infrastructure exceeded operational constraints, requiring explicit framing of images as aspirational prototypes rather than technical designs. In this facilitated participatory context, generative AI tools served as structured deliberative and visualization supports rather than autonomous decision makers. For participatory action and citizen science researchers, these findings suggest a practical workflow in which structured prompting, real-time group review, and domain-informed oversight can help participants refine feasible solutions, strengthen communication with stakeholders, and document iterative decision-making while managing variability, accuracy, privacy, and feasibility alignment.

15. Associations between extreme weather events, mobility, and resource insecurities with HIV vulnerabilities among older adults in Moshi, Tanzania: Cross-sectional findings.

期刊: International journal of STD & AIDS 发表日期: 2026-Apr-29 链接: PubMed

摘要

BackgroundEnvironmental and social hazards shape HIV vulnerabilities in Sub-Saharan Africa. Although older adults (>55) have an HIV prevalence higher than the national average in Tanzania, they are understudied in HIV research. To address this knowledge gap, we examined associations between extreme weather event exposure, mobility, resource insecurities, and HIV vulnerabilities among older adults in Moshi, Tanzania.MethodsWe conducted a cross-sectional survey in Moshi with adults aged ≥50 randomly sampled from the Prospective Urban Rural Epidemiology cohort. We conducted multivariable linear and logistic regression analyses to examine associations between environmental (past-year extreme weather events; recent [past 6- and 1-month] seasonal/weather-related mobility) and social (food, water, and/or sanitation insecurity) hazards, protective factors (social support, resilience), and HIV vulnerabilities (condom use self-efficacy; sexual relationship power; lifetime intimate partner violence). Models were adjusted for age, gender, education, and relationship status.ResultsAmong participants (n = 250; mean age: 60.6 years, SD = 11.1; 72.8% women), over half (56.0%) reported >1 past-year extreme weather. Past-year extreme weather exposure (adjusted beta [aβ] = -1.09, 95% Confidence Interval [CI]: -2.08 to -0.10), past-month mobility (aβ = -2.25, 95%CI: -3.45 to -1.06), past 6-month mobility (aβ = -1.83, 95% CI: -3.17 to -0.48), and low food security (vs high/marginal) (aβ = -0.94, 95% CI: -1.72 to -0.15) were associated with lower condom use self-efficacy. Social support (aβ = 0.11, 95% CI: 0.06- 0.16) and resilience (aβ = 0.28, 95% CI: 0.12-0.44) were associated with increased condom use self-efficacy. Past-month (aβ = -5.03, 95% CI: -7.04 to -3.02) and 6-month (β = -2.59, 95% CI: -4.72 to -0.48) mobility were associated with lower sexual relationship power. Past-month mobility (aOR = 12.31, 95% CI: 2.67-56.80) and sanitation insecurity (aOR = 1.20, 95% CI: 1.10-1.32) were associated with higher intimate partner violence odds.ConclusionsExtreme weather event exposure, seasonal/weather-related mobility, and resource insecurities were associated with HIV vulnerabilities among older adults in Moshi. HIV programs in climate-affected contexts can include older populations and integrate social and environmental hazards.

16. Agile Development and Testing of a Gamified Human Milk Feeding Education Mobile App for Participants of the Special Supplemental Nutrition Program for Women, Infants, and Children: Co-Design Approach.

期刊: Journal of medical Internet research 发表日期: 2026-Apr-29 链接: PubMed

摘要

Human milk feeding and breastfeeding are the recommended standards for infant feeding. Nevertheless, breastfeeding rates in the United States remain below target levels, with disparities across racial, ethnic, and income groups. The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) plays a substantial role in reducing these disparities by providing lactation support to individuals with low income. With ongoing WIC modernization efforts, there is an opportunity to create and optimize technology solutions responsive to WIC participants’ and staff’s needs to increase access to the program and its services. This study aimed to describe the development and pilot testing of Daily Drop, a gamified, low-bandwidth mobile app to provide human milk feeding education and support for WIC participants. Guided by the 5-stage model for comprehensive research on telehealth, Daily Drop underwent 3 stages: concept development, service design, and preimplementation. Using a mixed methods approach, the project team sought feedback from WIC leadership and staff at the state and local levels, state IT staff, and WIC participants at each stage. Suggestions from stages 1 and 2 were incorporated into the testable app before field testing (stage 3). During field testing, participants and staff completed surveys across multiple time points and qualitative interviews to evaluate the app’s feasibility, usability, and acceptability. Quantitative data were analyzed using descriptive statistics, and qualitative data were thematically analyzed. Key feedback from WIC participants and staff included providing flexibility for a variety of human milk feeding approaches (stage 1); and providing easily accessible educational information throughout gameplay, diversifying progress tracking to emphasize knowledge growth and expertise development, and including supportive or affirming messages for users (stage 2). During field testing (stage 3), >67% of WIC participants agreed with 7 out of 12 acceptability, satisfaction, and usability questions about the app, reiterated in interviews where they highlighted the simplicity of the app and how it increased their confidence to feed human milk. However, barriers to app use included a lack of reminders and repetitive information for parents with previous human milk feeding experience. Similarly, for WIC staff, mean scores for acceptability and feasibility were 3.8 (SD 1.0) and 4.4 (SD 0.6), respectively (max 5) at the early phase, but these scores declined over time. Staff recommendations included providing further, in-depth training to increase their familiarity with the app and reporting, and integrating the reports into WIC’s management information system. The development of Daily Drop followed an agile development, co-design approach with the involvement of relevant key partners at all stages of development. Overall, Daily Drop was deemed acceptable, usable, and engaging by WIC participants and staff. Future research could focus on testing its effectiveness in improving human milk feeding behaviors and cost-effectiveness.

17. Nontraditional Data in Pandemic Preparedness and Response: Identifying and Addressing First- and Last-Mile Challenges.

期刊: Journal of medical Internet research 发表日期: 2026-Apr-29 链接: PubMed

摘要

The COVID-19 pandemic served as an important test case of complementing traditional public health data with nontraditional data, such as mobility traces, social media activity, and wearable data, to inform real-time decision-making. Drawing on an expert workshop and a targeted survey of epidemic modelers in Europe, this study assesses the promise and the persistent limitations of such data in pandemic preparedness and response. We distinguish between “first-mile” challenges (obstacles to accessing and harmonizing data) and “last-mile” challenges (difficulties in translating insights into actionable policy interventions). The expert workshop, convened in March 2024 in Brussels, brought together 50 participants, including public health professionals, data scientists, policymakers, and industry leaders, to reflect on lessons learned and define strategies for better integration of nontraditional data into epidemic modeling and policymaking. The accompanying survey, gathering experiences from 29 modelers, offers empirical evidence of the barriers faced by modelers during the COVID-19 pandemic and highlights areas where key data were unavailable or underused. The experiences collected through the survey and workshop resulted in ten key actions and three overarching recommendations for public entities, data providers, and stakeholders. Our findings reveal ongoing issues with data access, quality, and interoperability, as well as institutional and cognitive barriers to evidence-based decision-making. Approximately 66% of all datasets had at least one access problem, with data sharing reluctance for nontraditional sources being double that of traditional data (30% vs 15%). Only 10% of respondents reported that they could use all the data they needed. These limitations included issues related to timeliness and granularity of data, as well as issues with linkage, comparability, and biases. To overcome these hurdles, we propose a set of enabling mechanisms, including data inventories, standardization protocols, simulation exercises, data stewardship roles, and data collaboratives. For first-mile challenges, solutions focus on technical and legal frameworks for data access. For last-mile challenges, we recommend fusion centers, decision accelerator laboratories, and networks of scientific ambassadors to bridge the gap between analysis and action. We argue that realizing the full value of nontraditional data requires a sustained investment in institutional readiness, cross-sectoral collaboration, and a shift toward a culture of data solidarity. Grounded in the lessons of the COVID-19 pandemic, the study can be used to design a roadmap for using nontraditional data to confront a broader array of public health emergencies, from climate shocks to humanitarian crises.

18. Touch-Based Partner Yoga for Gay, Bisexual, Transgender, and Queer Men in a Community Wellness Setting: Protocol for a Mixed Methods Program Evaluation of "The Studio".

期刊: JMIR research protocols 发表日期: 2026-Apr-29 链接: PubMed

摘要

Leisure-time physical activity (LTPA) is a well-established contributor to physical, psychological, and social well-being worldwide. Human touch also plays a vital role in life course health, yet opportunities for safe, consensual touch are often limited, particularly in LTPA settings. For gay, bisexual, transgender, and queer (GBTQ) men, barriers to affirming LTPA spaces can make it particularly difficult to access such benefits. In response, community-based approaches that integrate touch are needed, alongside systematic evaluations of such strategies. “The Studio” (pseudonym), a membership-based wellness community, addresses this gap by offering touch-centered partner yoga and bodywork programs designed to support the holistic health of GBTQ men. This protocol describes a mixed methods evaluation of the Studio’s touch-based yoga programming in New York City. The primary aim is to assess the feasibility and acceptability of implementing a touch-centered partner yoga program within a GBTQ community wellness setting. Secondary aims include exploring preliminary physical, emotional, and social outcomes associated with participation, including flexibility, stress, body awareness, social connection, trust, and belonging. The evaluation uses a pre- and posttest mixed methods design. A total of 40-50 participants will be recruited from new Studio members. Quantitative measures will include flexibility (sit-and-reach and goniometry), stress (Perceived Stress Scale), body awareness (Multidimensional Assessment of Interoceptive Awareness), and resilience (Brief Resilience Scale). Social network analysis will map participant connections before and after program participation. Qualitative data will be collected through semistructured interviews with 15-20 participants, or until saturation is reached, focusing on comfort with touch, emotional regulation, and experiences of community connectedness. Survey and interview guides will be codeveloped with a community advisory group to ensure cultural responsiveness and relevance. Findings will be integrated using triangulation methods to explore convergence across data sources. As of March 2026, this study has not yet begun. Institutional Review Board submission is planned for September 2026. Afterward, study instruments will be finalized and pilot-tested with Studio teachers. Participant recruitment is projected to begin in July 2027, and data collection will include 3 time points (baseline, postintervention, and 4-6 wk follow-up). Data analysis and dissemination of findings are expected in 2028. Preliminary pilot testing of the survey instruments with Studio employees and community advisory group members will indicate feasibility and cultural fit. This evaluation will be among the first to systematically examine touch-focused partner yoga for GBTQ men in a community wellness setting. Findings are expected to provide novel insights into the feasibility and the role of intentional touch in LTPA spaces, support trauma-informed and inclusive wellness practices, and contribute to broader discourse on GBTQ health promotion and intervention. Results will be disseminated to the Studio employees, members, and GBTQ-focused wellness organizations, as well as through peer-reviewed publications and conferences.

19. High-precision aortic banding with O-rings: A versatile model for studying heart failure mechanisms in rats.

期刊: Journal of applied physiology (Bethesda, Md. : 1985) 发表日期: 2026-Apr-29 链接: PubMed

摘要

Animal models play a critical role in cardiovascular research, and reliable and reproducible phenotypes are essential. Aortic banding is a well-established technique for inducing pressure overload/heart failure in rats; however, conventional methods often lead to variability in outcomes. This study aims to employ rubber O-rings to achieve reliable pressure overload in rats, and to investigate how varying ring sizes result in distinct cardiac phenotypes six weeks post-surgery. Male Sprague-Dawley rats (~100 grams, approx. 4 weeks old) underwent surgical aortic banding using nitrile O-rings of three different sizes (1.5 mm, 1.3 mm, and 1.07 mm) plus a sham-operated group. The rats were then monitored for six weeks, after which cardiac function and structure were evaluated using echocardiography and magnetic resonance imaging (MRI) (N=70 rats). Expression of molecular markers of cardiac remodeling were also quantified. We found that all banded rats developed significant left ventricular hypertrophy, with approximately 42%-58% higher ventricular weights than control. The 1.07 mm group showed a decline in stroke volume and ejection fraction, indicative of reduced systolic function, while also exhibiting signs of diastolic dysfunction. Congestion indices were also severely impacted in the 1.07 mm group, and tissue fibrosis gene expression were higher in the 1.5 mm and 1.07 mm groups. The O-ring method successfully creates distinct cardiac phenotypes that reflect various degrees of heart failure, from hypertrophy to congestion with reduced ejection fraction. The associated increase in cardiac fibrosis gene expression and impaired diastolic function with tighter constriction underscores the utility of this model for studying heart failure mechanisms.

20. Expiratory loading modulates the quadriceps muscle pump-induced venous return during rhythmic isometric exercise.

期刊: American journal of physiology. Regulatory, integrative and comparative physiology 发表日期: 2026-Apr-29 链接: PubMed

摘要

During exercise, venous return is enhanced by the skeletal muscle pump. Expiratory loading increases intra-abdominal pressure, which may impede venous return from the lower limbs. However, its effect on venous return mediated by the quadriceps muscle pump remains unclear. The purpose of this study was to elucidate the effect of expiratory loading on venous return facilitated by the quadriceps muscle pump. Healthy young participants performed rhythmic unilateral isometric knee-extension exercise of the right quadriceps (10% maximal isometric voluntary contraction; 2 s contraction/2 s relaxation), and data was successfully obtained from twelve participants. Controlled breathing (breathing frequency: 15 breaths/min; inspiratory-to-expiratory ratio: 1:1; tidal volume: twice the resting tidal volume) was performed with and without expiratory load. The expiratory phase was synchronized with the contraction phases. Expiratory load was adjusted to produce a mouth pressure of 20 cmH2O during expiration. Quantity of blood flow in the right femoral vein (Qfv) was continuously measured using Doppler ultrasound. No significant differences were observed in the increases in force and electromyography during expiration between the non-loading and loading conditions. Quadriceps muscle contraction increased Qfv; however, the contraction-induced increase was smaller (P = 0.005) with expiratory loading (497.6 ± 350.5 mL/min, mean ± standard deviation) than without expiratory loading (694.8 ± 358.9 mL/min). These findings suggest that increased expiratory loading may partly reduce the effectiveness of the quadriceps muscle pump in facilitating venous return during light-intensity exercise.

21. The Effectiveness of Digital Interventions to Increase Preventive Care Uptake in Older Adults: Systematic Review.

期刊: JMIR aging 发表日期: 2026-Apr-29 链接: PubMed

摘要

Older adults face increasing health risks associated with aging and chronic disease; yet, uptake of recommended clinical preventive services remains low. Digital health interventions have the potential to enhance access and engagement, but their effectiveness in older adult populations remains unclear. This systematic review aimed to examine the range and types of digital clinical preventive service interventions and assess their impact on preventive care uptake among older adults. We conducted a systematic review of peer-reviewed research literature published since 2014. Eligible studies included experimental and quasi-experimental designs evaluating digital interventions targeting community-dwelling adults aged 60 years and older. Interventions focused on high-priority preventive services, including cancer screening and adult immunizations. Data were extracted using a standardized form and synthesized narratively due to heterogeneity in study designs and outcomes. In total, 24 studies involving over 1.3 million participants from 11 countries were included. Interventions used a range of digital tools, including telephone calls, SMS text messages, patient portals, and video-based education. While some digital and automated interventions demonstrated modest improvements in preventive services uptake, results were mixed. Interventions incorporating personalized elements (eg, tailored telephone counseling or in-person education) were generally more effective than generic, automated communications. Few studies reported on digital literacy support or intervention reach, and engagement with digital platforms was often low. Digital interventions can support modest improvements in preventive services uptake among older adults, particularly when personalized or combined with human interaction. However, assumptions of digital fluency and limited reporting on engagement constrain generalizability. Future research should prioritize inclusive design, detailed reporting, and strategies that address digital equity to better support older adult populations.

22. The impact of lipoprotein(a) on coronary atherosclerotic plaque phenotype in primary prevention.

期刊: European journal of preventive cardiology 发表日期: 2026-Apr-29 链接: PubMed

摘要

Lipoprotein(a) (Lp[a]) is a causal risk factor for cardiovascular events. However, the effect of Lp(a) on coronary plaque composition and high-risk plaque (HRP) features has not been fully characterized. This study aimed to investigate the association between Lp(a) and coronary atherosclerotic plaque phenotype at the plaque level. This study included 710 patients who underwent coronary computed tomography angiography (CCTA) and had Lp(a) measured between 2008 and 2024. CCTA scans were analyzed with a previously validated artificial intelligence-based algorithm (AI-QCT, Cleerly Inc.). The association of Lp(a) with noncalcified and calcified plaque volumes and HRP features was evaluated at the plaque level using generalized estimating equation models adjusted for traditional cardiovascular risk factors. Among the 710 patients, the mean age was 56±10 years and 379 (53%) were male. In total, 3642 plaques were identified. In the adjusted plaque-level analysis, elevated Lp(a) (≥150 nmol/L) was associated with an increase in noncalcified plaque volume per plaque (P=0.009), but not with an increase in calcified plaque volume (P=0.81). Furthermore, elevated Lp(a) (≥150 nmol/L) was strongly associated with the presence of HRP at the plaque level (adjusted odds ratio: 1.78, 95% CI: 1.25-2.54, P=0.001), whereas low-density lipoprotein-cholesterol and high-sensitivity C-reactive protein were not (P>0.05). In this plaque-level CCTA study of 3642 individual plaques, elevated Lp(a) levels were independently associated with increased noncalcified plaque volume and with the presence of HRP, but not with calcified plaque volume. These findings elucidate the impact of Lp(a) on unstable plaque phenotypes, even in patients without prior cardiovascular events. This coronary computed tomography angiography (CCTA) study aimed to investigate the association between lipoprotein(a) (Lp[a]) and coronary plaque phenotype in an intermediate- to high-risk primary prevention population using artificial intelligence-based quantification of 3642 individual plaques.Elevated Lp(a) levels were independently associated with an increased noncalcified plaque volume and with the presence of high-risk plaque, but showed no significant association with calcified plaque volume.These findings elucidate the impact of Lp(a) on unstable plaque phenotypes even in individuals without prior cardiovascular events and highlight the importance of early recognition of elevated Lp(a) levels to optimize primary prevention strategies.

23. Local B cell immunity and durable memory after live-attenuated influenza intranasal vaccination of humans.

期刊: Science translational medicine 发表日期: 2026-Apr-29 链接: PubMed

摘要

Seasonal influenza vaccines are most frequently delivered as intramuscular inactivated vaccines, which elicit systemic responses against the immunodominant hemagglutinin (HA) head domain. An intranasally administered, live-attenuated influenza vaccine designed to stimulate mucosal immunity, FluMist, is the sole intranasal vaccine approved in the United States. However, FluMist has lower systemic immunogenicity and efficacy in adults compared with intramuscular formulations. In this study, human mucosal and systemic immunity were examined after seasonal intramuscular or intranasal vaccination. Nasopharyngeal swabs of adenoid tissue were used to longitudinally sample the upper airway. FluMist induced substantial increases in upper respiratory tract IgG+ and IgA+ HA-specific memory B cells, which displayed an activated CD27+CD21- phenotype. H1, H3, and influenza B virus HA-specific memory B cells were all detected in the upper airway after intranasal immunization, remained elevated at 6 months postvaccination, and were associated with the presence of circulating T follicular helper (cTFH) cells. Recently activated upper airway memory B cells were not readily detected in intramuscular vaccinees, despite the elevation of systemic antibodies and circulating HA-specific memory B cells. Thus, despite minimal immune responses detected in circulation, adults vaccinated with the live-attenuated influenza vaccine generate substantial local antigen-specific memory B cell responses. These findings have implications for improving influenza vaccines and for mucosal vaccination against other respiratory pathogens.

24. Clinical cure of chronic hepatitis B is associated with priming and perpetuation of hepatic CD4+ T cell responses.

期刊: Science translational medicine 发表日期: 2026-Apr-29 链接: PubMed

摘要

Chronic infection with hepatitis B virus (HBV) often leads to immune-mediated progressive liver injury and liver cancer. Seroclearance of the surface antigen (HBsAg) defines clinical cure and reduces disease-associated risks but rarely occurs. Here, we aimed to study the immune mechanisms of HBsAg clearance in chronic hepatitis B (CHB) using a mouse model of age-dependent HBsAg clearance and persistence and longitudinal peripheral blood samples from participants in the BeNEG-DO clinical trial who exhibited either HBsAg clearance or stable HBsAg level retention after stopping nucleos(t)ide analog therapy. Whereas HBsAg clearance in young mice failed and the ability to initiate and sustain HBV-specific CD4+ T cell responses in the liver was impaired, adult mice exhibited a robust HBV-specific CD4+ T cell response and HBsAg clearance. Depletion of CD4+ T cells in adult mice prevented HBsAg seroclearance and hepatocellular injury and disrupted hepatic leukocyte organization and HBV-specific CD8+ T cell cytotoxicity, whereas depletion of CD8+ T cells did not alter HBsAg seroclearance. Upstream of the CD4+ T cell response, hepatic myeloid cells, particularly type 2 conventional dendritic cells, directed CD4+ T cell priming and differentiation. Studies using samples from patients with CHB identified features of HBsAg clearance that overlapped with the mouse model, including T helper 1 and cytotoxic CD4+ T cell activation and augmented CD8+ T cell effector function. These findings identified a role for CD4+ T cell activation in the clinical cure of CHB and suggest that therapeutically enhancing CD4+ T cell responses could improve HBsAg clearance rates.

25. Lived Experiences of Older Adults Using Wearables With Real-Time Feedback: Phenomenological Study.

期刊: JMIR mHealth and uHealth 发表日期: 2026-Apr-29 链接: PubMed

摘要

Wearable devices with real-time feedback (WRFs) provide increasing opportunities to enhance physical activity and improve rehabilitation through collecting and processing health-related data. Real-time feedback (RTF) from the device is expected to result in a more dynamic, coordinated, and synchronous rhythmic activity, defined as step-by-step movements mediated by the real-time heart rate feedback. However, age-specific characteristics in the user engagement with WRFs integrating real-time audio feedback have largely remained unexplored. This study explores the lived experiences of older adults using wearables with RTF to uncover motivations, aspirations, and hindering factors in their engagement with WRFs in rhythmic activity. The study explores narratives that older adults articulate in their previous use of wearables for physical activity, their experiences with WRFs during rhythmic activity, and their meaning-making of the interactive features enhancing the synchronization of the movement during rhythmic activity. The study was conducted as a qualitative interview study with 18 older adults who used a WRF for rhythmic activity during a 3-week period in their home environment. The wearable used in the study is a chest-band sensor device that helps users to synchronize their steps with their heartbeat through the provision of real-time audio feedback. The material consists of semistructured interviews before and after using the device. Material from the semistructured interviews was analyzed with an interpretative phenomenological analysis method. The study identified four main themes characterizing older adults’ lived experiences with wearables, which are (1) use of wearable technologies without RTF in daily life, (2) embodied rhythmic negotiation with RTF, (3) interpretation of health data with RTF, and (4) temporal trajectories of device engagement with RTF. Older adults demonstrated intentional distancing from wearable technologies rather than simple disuse, prioritizing authentic bodily experiences over external validation. Their engagement was fundamentally relational, mediated through trusted social networks, and required dialogical support for data interpretation. Device-guided movement synchronization created contextually situated challenges that varied significantly based on environmental demands, individual bodily capacity, and exercise routines. Extended temporal engagement transformed participants’ relationships with the technology from initial disruption to potential integration, with RTF serving as a bridge toward enhanced embodied awareness when carefully designed. The study concludes that RTF from the device can enhance synchronization and bodily awareness, but meaningful engagement requires adaptive designs that respect older adults’ authentic movement practices, accommodate their relational approach to technology validation, and allow sufficient time for embodied competency development.

26. Clinical AI is Not (Yet) Trustworthy-But It Could Be.

期刊: Journal of medical Internet research 发表日期: 2026-Apr-29 链接: PubMed

摘要

The growing emphasis on trustworthy artificial intelligence (AI) in health care reflects a shift away from models optimized for predictive performance toward governable and auditable systems that can be adopted and sustained in clinical practice. Nonetheless, many clinical AI applications continue to privilege technical performance while underaddressing ethical, regulatory, and societal considerations, leading to concerns around robustness, transparency, and clinical adoption. To address this, governance frameworks such as the Assessment List for Trustworthy Artificial Intelligence (ALTAI) have been proposed to operationalize trust-related requirements across the AI lifecycle. However, evidence on the practical use of these frameworks remains limited. In this Viewpoint, we describe the application of ALTAI as a procedural governance framework within the Horizon Europe AI-PROGNOSIS project, which aims to support Parkinson disease diagnosis and care through predictive models and digital biomarkers derived from everyday devices. The seven ALTAI requirements (ie, human agency and oversight; technical robustness and safety; privacy and data governance; transparency; diversity, nondiscrimination, and fairness; societal and environmental well-being; and accountability) were mapped to key stages of the AI lifecycle within the project, including design and specification, data preparation, model development and validation, user interface and user experience deployment, external prospective validation, and overarching management and workflow. To examine how these requirements were perceived in practice, we conducted a structured internal survey among AI developers and data scientists involved in the AI-PROGNOSIS project (n=10). Participants rated the relevance of the 17 ALTAI subdomains using a three-point prioritization scale. Technical accuracy, data governance, and privacy were consistently rated as highly relevant, whereas societal impact received the lowest prioritization. This pattern reflects a documented tension in AI development, where technical teams tend to deprioritize broader societal concerns under delivery and performance constraints. Nonetheless, this work should be interpreted as a context-specific case study rather than a validation of ALTAI. The small sample size and project-specific setting limit generalizability, and these findings should not be considered as representative of broader clinical AI development. Overall, by making prioritization gaps explicit and embedding multidisciplinary review across lifecycle checkpoints, this case study illustrates how structured governance frameworks can surface implementation tensions and support accountable AI development. While these approaches do not resolve all of the aforementioned challenges, they provide practical guidance for integrating trust-related considerations into clinical AI projects.

27. Building Enhanced Public Health Data Systems With a Situational Awareness and Learning Tool: Focus Group Study.

期刊: Online journal of public health informatics 发表日期: 2026-Apr-29 链接: PubMed

摘要

Situational awareness is the accurate and timely perception of factors in the environment, comprehension of their meanings, and projection of their future states. We aimed to develop a cloud-based Situational Awareness and Learning Tool (SALT) that generates near-real-time analytic content from multimodal health care, government, community, and environmental data, enabling public health and hospital professionals to make informed decisions during complex population health challenges. Several focus groups were conducted with representatives from local health departments, hospitals, and emergency agencies. The first round identified data needs and requirements to inform SALT’s design. SALT was developed as a secure, cloud-based platform featuring automated deployment, role-based access, and version-controlled content publishing. The second round of focus groups evaluated the SALT prototype’s utility and gathered feedback for improvements. Participants highlighted the need for integrated data from multiple sources, tailored dashboards for specific audiences, and legal frameworks to guide timely data sharing. SALT met these requirements by providing interactive visuals, secure access levels, and a collaborative content management system. The second focus groups affirmed SALT’s effectiveness in enhancing decision-making and strategic planning, suggesting enhancements such as clearer data labeling, expanded data coverage, and forecasting capabilities. SALT addresses limitations exposed by the COVID-19 pandemic in public health data systems by offering a scalable platform for data sharing, rapid analysis, and situational awareness. It fulfills user needs for integrated, timely data, and customized analytic products. SALT represents a viable solution for enhancing public health data systems in preparation for future pandemics and other complex, multisector population health challenges.

28. Predicting Individual Water Intake in Beef Cattle Using Longitudinal Data and Long Short-Term Memory Models.

期刊: Journal of animal science 发表日期: 2026-Apr-29 链接: PubMed

摘要

Water intake (WI) remains an under-characterized yet essential trait in beef cattle systems, with implications for animal health, climate resilience, and resource efficiency. Existing predictive models, including those from the National Academies of Sciences, Engineering, and Medicine (NASEM), rely on static equations derived from outdated data and lack resolution at the individual animal level. In this study, we developed and evaluated a Long Short-Term Memory (LSTM) model to predict daily WI using longitudinal data on animal characteristics, dry matter intake (DMI), and engineered environmental features. Data were collected from 2,268 animals across drylot and grazing systems between 2019 and 2024, with environmental variables sourced from NOAA and NASA. Feature engineering captured biologically relevant dynamics via rolling deltas, interaction terms, and temporal encodings. The LSTM model trained with these engineered features achieved strong predictive performance (root mean square error [RMSE] = 3.85 L/day; R2 = 0.74; P < 0.001) and generalized well to unseen regional (RMSE = 4.20 L/day; R2 = 0.61; P < 0.001) and non-regional (RMSE = 4.19 L/day; R2 = 0.63; P < 0.001) drylot datasets. In contrast, models trained without engineered features failed to generalize (RMSE = 22.7 L/day; R2 = -0.96), and NASEM predictions systematically underestimated high intake values. Permutation-based feature importance analysis highlighted the value of short-term environmental stress indicators, particularly temperature-humidity index (THI) and temperature deltas. These results demonstrate that sequence-based models incorporating dynamic environmental covariates can significantly improve WI prediction in beef cattle and provide a scalable decision-support framework for water-efficient genetic selection and adaptive management. Water is a vital nutrient for beef cattle, but we still lack accurate tools to predict how much water an individual animal needs each day. This matters because cattle are raised in a wide range of climates, and water availability is becoming less predictable with climate change. In this study, we used a machine learning model to predict daily water intake for individual beef cattle using information available in intake-monitored herds and structured performance-test environments, such as animal weight, dry matter intake, and local weather. We trained the model using data from over 2,200 animals raised in different production systems, including both pasture and feedlot settings. The model learned to detect patterns over time, such as how animals respond to changes in heat and humidity. When tested on new animals and environments, the model made highly accurate predictions and outperformed the standard equation currently used by the beef industry. These results show that artificial intelligence can be used to predict water needs in real time, which could help producers manage cattle more effectively during hot weather and identify animals that use water more efficiently.

29. Learning From the Adoption of a Readmission Clinical Decision Support Tool: Group Model Building Approach.

期刊: JMIR human factors 发表日期: 2026-Apr-29 链接: PubMed

摘要

Computerized clinical decision support (CDS) has the potential to improve patient outcomes by offering evidence-based guidance at the point of care-enhancing guideline adherence and diagnostic accuracy-and supporting system-level outcomes by enabling predictive analytics for more efficient resource planning. Prior work has identified factors that affect adoption, such as clinicians’ expectations of usefulness, ease of use, alignment with workflows, and resources to support utilization. However, CDS adoption is not static and changes according to dynamic systems of behaviors and workflows, requiring a deeper understanding of how evolving conditions affect implementation and outcomes. To explore the dynamic factors influencing CDS adoption, we examined the implementation of the “Unplanned readmission model version 1,” developed by Epic Medical Records System, at Duke University Health System, using group model building and system dynamics modeling. We first conducted group model-building workshops with staff (case managers, physical and occupational therapists, hospitalist faculty physicians, and resident physicians) who participate in decisions about discharging patients. Study team members guided participants to identify and connect variables in causal loop diagrams. We coded workshop transcripts in software designed for system dynamics analysis to identify themes, aggregated them into a causal loop diagram, and reviewed them with participants to converge on a common model. A team member applied equations to the pathways and tested data to simulate conditions leading to full, limited, or no adoption of a tool. We identified key balancing loops driven by external pressure (eg, Centers for Medicare & Medicaid Services penalties) that motivated initial adoption and reinforcing loops based on perceived internal benefits to sustain use. While institutional incentives led to early training and tool use, efforts declined due to staff turnover, competing priorities (eg, COVID-19), and workflow changes. Reinforcing loops emerged when staff described clinical utility, such as improved discharge planning and team communication. However, staff also suggested that these loops were often weak due to difficulty linking the use of the tool to outcomes in real time. Simulation modeling showed that while strong external pressure and rapid training led to initial success, interest in using the tool waned as workflows improved and readmission rates approached Centers for Medicare & Medicaid Services goals. When conflicting priorities were introduced, adoption stalled earlier, and fewer staff were trained. In contrast, when internal motivation was strengthened by reducing the amount of evidence needed to perceive success, individual interest remained high even as institutional attention declined, sustaining tool use and further reducing readmissions. External pressure to improve can be a strong motivator for initial adoption, but in the face of conflicting demands for attention, it may fall short of sustained long-term tool use. Tools are more likely to have extensive and sustained use when those using the tools can perceive internal benefits.

30. Evaluation of Combined Educational Methods on Motivational Interviewing for Final-Year Medical Students: Mixed Methods Study.

期刊: JMIR human factors 发表日期: 2026-Apr-29 链接: PubMed

摘要

Motivational interviewing (MI) is a patient-centered communication approach that supports health behavior change; yet, its integration into undergraduate medical curricula remains inconsistent. Combined learning models that comprise face-to-face instruction with structured web-based components may strengthen MI training, but evidence supporting their effectiveness among medical students, particularly in Asian contexts, is limited. This study evaluated the impact of a combined MI educational model on final-year medical students’ MI knowledge, confidence, and application in real patient encounters during clinical rotations. This study used a sequential explanatory mixed methods design. The quantitative component used a before-and-after study to evaluate changes in MI knowledge and confidence among final-year medical students enrolled in an Ambulatory Care course in 2024. All 130 students participated in a 2-hour interactive MI workshop, and 120 completed pre- and postintervention questionnaires assessing MI knowledge and self-reported confidence. Students were also provided access to a 3-hour web-based MI learning module, and learning-management system analytics were used to track engagement. The qualitative component consisted of semistructured interviews with 12 purposively selected students, conducted to explore their experiences applying MI during clinical encounters. Quantitative data were analyzed using paired-samples t tests, and qualitative data were analyzed using inductive conventional content analysis. Findings from both components were integrated during interpretation to provide a comprehensive understanding of the educational intervention. Students demonstrated a significant improvement in MI knowledge following the educational intervention (pretest mean 8.87, SD 2.69; posttest mean 15.04, SD 2.99; t₁₁₉=-18.45; P<.001; η²=0.74). After the workshop, 96.9% (126/130) of students reported applying MI with patients, and 92.3% (n=120) agreed that the combined learning approach was adequate for supporting clinical use. Learning analytics data showed that 76.9% (n=100) of students enrolled in the web-based MI module, and 51% (n=51) completed all lessons. Students most frequently applied MI when counseling patients with diabetes, hypertension, and dyslipidemia, especially related to diet, physical activity, and medication adherence. Interview findings indicated that students mainly used brief MI, were most comfortable with engaging and focusing, and developed greater empathy, confidence, and patient-centered communication skills. Challenges included limited time during consultations, clinical workload, and difficulty applying all MI processes to complex cases. A combined MI learning approach integrating a short workshop with a web-based course was associated with higher MI knowledge scores and greater self-reported confidence among students, as well as reported use of MI-informed communication strategies during clinical encounters. Students perceived MI as a practical and ethically grounded communication approach that can enhance patient engagement, particularly in the management of chronic diseases. Introducing MI training longitudinally through a spiral curriculum, with opportunities for repeated practice and reinforcement, may help strengthen behavior-change communication competencies in undergraduate medical education.

31. Low overlap of plasma and CSF protein quantitative trait loci affects protein discovery for neurological disease.

期刊: Science translational medicine 发表日期: 2026-Apr-29 链接: PubMed

摘要

Plasma protein quantitative trait loci (pQTLs) have been integrated with genetic studies to prioritize proteins implicated in numerous human diseases. However, limited interaction between plasma and the central nervous system decreases the fluid’s relevance for neurological disease. We compared the pQTL landscapes between plasma and cerebrospinal fluid (CSF), detecting widespread differences across fluids that translate to the identification and prioritization of proteins and pathways implicated in neurological disorders. Of almost 5000 CSF and plasma pQTLs, fewer than 30% were present in both fluids, demonstrating the importance of cross-context analyses to understand genetic regulation of protein abundance. We identified 427 associations between proteins and risk of 14 neurological traits, including 249 associations that were not found in previous studies. Only 69 of the associations were consistently detected in both fluids, demonstrating the information gained through the analysis of multiple bodily contexts. We further demonstrated that CSF proteogenomics captures more substantial disease overlap (for example, between Alzheimer’s disease and dementia with Lewy bodies) and captures trait-relevant biology missed in plasma, including cell death and immune response signatures in Alzheimer’s and multiple sclerosis. Through this work, we demonstrated the importance of analyzing less accessible but more trait-relevant contexts to fully understand human disease.

32. Indoor HEPA Filtration Mitigates Adverse Cardiorespiratory Effects of Ozone Reaction Products.

期刊: Environmental science & technology 发表日期: 2026-Apr-29 链接: PubMed

摘要

When ozone (O3) enters indoor environments, a substantial portion reacts with indoor chemicals, producing ozone reaction products (ORPs) that have shown adverse cardiorespiratory effects. Some ORPs partition to PM2.5 that can carry these species to the deep lung and may even enter the circulatory system. High-efficiency particulate air (HEPA) filtration has been shown to reduce indoor PM2.5 levels and may decrease the amount of ORPs reaching the deep lung. We, hence, hypothesized that HEPA filtration could mitigate ORPs’ cardiorespiratory health effects. We analyzed data from an intervention study with 84 participants, 50 receiving indoor HEPA filtration and 34 serving as controls. Each participant underwent two assessments of cardiorespiratory biomarkers. We measured personal exposures to PM2.5, O3, and O3 loss (a proxy for ORPs exposure). Among participants without HEPA filtration, O3 loss was significantly associated with adverse changes in biomarkers of systemic oxidative stress, vasoconstriction, thrombosis, airway inflammation, and pulmonary oxidative stress. In stark contrast, no significant adverse associations between O3 loss and these biomarkers were observed in participants receiving HEPA filtration. These findings suggest that HEPA filtration, in addition to being effective in reducing PM2.5 exposure, may be useful in mitigating the harmful health effects of ORPs exposure.

33. Vaccination strategies for responding to public health emergencies of infectious diseases.

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

摘要

The outbreak of infectious diseases remains a serious public health problem in today’s society,and emergency vaccination stands as a pivotal public health intervention for responding to the tricky situation and reducing the impact of public health emergencies. This review systematically examines vaccine emergency vaccination policies and expert recommendations from both domestic and international sources, revealing a current lack of standardized reference criteria and evidence-based implementation guidelines regarding optimal timing and specific intervention measures. It is imperative to develop a scientific evaluation system for emergency vaccination initiation and establish global standardization frameworks. In order to successfully curb the spread of infectious diseases, a high coverage rate of emergency vaccination is a guarantee. Increasing vaccine accessibility through cross-departmental collaboration and flexible allocation of existing resources, while scientifically and reasonably allocating the sequence, are both important steps in smoothly implementing emergency vaccination. Reasonable evaluation of the efficacy of established vaccines can provide a reference for their subsequent application. This review also focuses on the numerous challenges faced by vaccines against emerging infectious diseases since their development. The rapid mutation of pathogens makes the task, which already lacks sufficient research and development time, even more urgent. Emergency Use Authorization and rapid review procedures have emerged as a result. Many countries have established regulations governing relevant procedures and post-implementation management of emergency vaccination, which specify conditions, processes, timelines, and oversight requirements. Vaccine hesitancy poses particular challenges for the rollout of newly developed vaccines. Community participation, enhancing public confidence, and solution to “infodemic” provide new solutions to the previous problem. The continuous innovation of vaccine technology and increasingly sophisticated monitoring methods are expected to further improve vaccine safety. This review aims to provide both theoretical foundations and inspired experience for optimizing global emergency vaccination, thereby enabling more efficient and effective public health responses to future epidemics.

34. Multigroup analysis of determinants influencing infant mortality rates in six Gulf Cooperation Council countries.

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

摘要

This study examines the interplay of social determinants of health (SDOH), healthcare status resources (HSR), and environmental (ENV) factors in shaping infant mortality rate (IMR) disparities across Gulf Cooperation Council (GCC) nations. A retrospective time-series design (1990-2022) used secondary datasets from international organizations, including the World Bank and Global Economy. The study analyzed IMR in relation to SDOH, HSR, and ENV factors using Partial Least Squares Structural Equation Modeling (PLS-SEM), Measurement Invariance of Composites Models (MICOM), and PLS Multigroup Analysis (PLS-MGA) used to dissect temporal and cross-national variabilities. The GCC-wide model delineates a cascading effect: SDOH → ENV → HSR → IMR. SDOH, driven by GDP, fertility rate, and life expectancy, emerged as the primary determinant. HSR-IMR effects were pronounced in Bahrain and Oman, while Kuwait exhibited dominant ENV-IMR influence. Qatar led in SDOH-to-IMR impact, whereas the UAE’s ENV effects varied. SDOH exerted the strongest negative IMR influence, peaking in the UAE (-0.938, p < 0.001) and lowest in Oman (-0.834, p < 0.001). Kuwait’s HSR impact was non-significant (-0.034, p = 0.639), while pairwise PLS-MGA underscored stark cross-national heterogeneity. Findings highlight the primacy of SDOH and call for longitudinal inquiries into disparities in healthcare access and environmental stressors across the GCC. To achieve significant reductions in IMR, GCC nations must implement targeted socio-economic policies to improve maternal health outcomes.

35. The legacy of slavery and Black-White disparities in homicide by county-United States, 2000-2020.

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

摘要

To investigate the relationship between the legacy of slavery and contemporary racial disparities in homicide rates at the county level in the United States. Cross-sectional, multilevel, spatial dependence regression analysis. County-level crude homicide rates and racial homicide disparities during the period 2000-2020 were obtained for the overall, non-Hispanic Black, and non-Hispanic White populations. We explored the relationship between the percentage of enslaved persons in each county in 1860 and contemporary racial disparities in homicide using a multilevel, spatial dependence model. Controlling for a range of county- and state-level factors, counties in the South had a White homicide rate that was 16.3% higher than in the non-South, a Black homicide rate that was 21.3% lower, and a Black-White homicide rate ratio that was 32.4% lower. Higher White homicide rates and lower Black homicide rates in the South were only observed for firearm-related homicide. Within the South, the percentage of enslaved persons in 1860 was not associated with homicide rates in adjusted analyses. Even after controlling for a range of homicide-related factors, counties in the South had higher White firearm homicide rates, lower Black firearm homicide rates, and lower Black-White racial disparities in homicide. These results suggest that while the White population in the South gained socioeconomic advantage due to slavery, this came at the expense of increased levels of violence resulting in higher White homicide rates.

36. Association of walking and osteoporosis risk among 432,493 UK participants: A prospective cohort study.

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

摘要

This study aimed to investigate the optimal dosage of walking duration for osteoporosis prevention. This study represents a prospective cohort analysis based on data derived from the UK Biobank. Utilizing prospective data from the UK Biobank (n = 432,493), we analyzed osteoporosis incidence in adults aged 38-73 years. Walking duration was assessed via validated questionnaires. Cox proportional hazards models adjusted for demographics, comorbidities, and lifestyle factors. Restricted cubic splines characterized nonlinear associations. Participants in all walking groups exhibited significantly lower osteoporosis risk versus the non-walking group. In fully adjusted models, the hazard ratios (HR) (95% confidence intervals) for osteoporosis were: 0.72 (0.65-0.79; P < 0.001) for the <180 min/week of walking group, 0.73 (0.65-0.81; P < 0.001) for the 180-360 of walking group, and 0.74 (0.67-0.83; P < 0.001) for the >360 min/week of walking group, respectively. A U-shaped dose-response relationship was demonstrated (P for nonlinearity <0.001). Regular walking demonstrates significant osteoporosis protection, with optimal benefits at 180-360 min/week. This aligns with global physical activity guidelines while revealing an upper threshold beyond which additional walking yields no further risk reduction. Our findings support tailored exercise prescriptions for osteoporosis prevention.

37. Environmental sound perception in individuals with hearing loss: A systematic review.

期刊: Auris, nasus, larynx 发表日期: 2026-Apr-28 链接: PubMed

摘要

This systematic review aimed to clarify the current status of environmental sound perception in individuals with hearing loss using hearing aids and/or cochlear implants, and to identify effective support methods. We systematically reviewed articles on environmental sound perception in individuals with hearing loss published between 1995 and June 22, 2025. Four databases (PubMed, Scopus, Google Scholar, and the Cochrane Library) were searched, and these searches were supplemented by a manual review of a prior systematic review on environmental sound perception in cochlear implant users and its reference list. Using PICOS criteria, we organized the evidence regarding the current status of environmental sound perception, associated factors, and the effects of interventions aimed at improvement. Risk of bias and levels of evidence were also assessed. Of 2609 records, 15 peer-reviewed original articles were included. In environmental sound identification tasks, individuals with hearing loss generally showed poorer performance than normal-hearing listeners; however, performance among individuals with hearing loss varied widely across studies depending on task format, the presence of contextual scenes, scoring methods, and device-related performance differences. Associations with background factors showed consistent correlations with speech perception performance and cognitive function, whereas findings for age and hearing thresholds were inconsistent. Acoustic characteristics, particularly frequency and temporal information, as well as categorical characteristics such as human sounds and non-verbal human vocalizations also influenced performance. Improvements in environmental sound identification associated with hearing aids and cochlear implant use alone were modest, whereas a training-based intervention study reported improved performance in environmental sound identification. This systematic review indicates that environmental sound perception in individuals with hearing loss is generally poorer than that in normal-hearing listeners, although these difficulties may be restricted to specific stages of perception. Environmental sound perception is also influenced by individual background factors, device-related differences, and the acoustic and categorical characteristics of environmental sounds. Preliminary evidence from a single study suggests that training may improve environmental sound identification; however, further controlled studies are needed to confirm its efficacy and generalizability. These findings provide foundational knowledge to guide auditory rehabilitation.

38. Advanced maternal age and infertility: The role of biological aging, lifestyle, and biomarkers.

期刊: Journal of reproductive immunology 发表日期: 2026-Apr-25 链接: PubMed

摘要

Infertility in women of advanced maternal age is often attributed to chronological aging, yet the contribution of biological aging and immunometabolic dysregulation remains unclear. This cross-sectional study analyzed nationally representative data from the 2021-2023 National Health and Nutrition Examination Survey, including 895 women aged 35-49 years with complete reproductive, lifestyle, and biomarker data. Self-reported infertility was defined as a history of attempting pregnancy for at least one year without success. Biological age was estimated using standardized metabolic and inflammatory biomarkers, including C-reactive protein and glycemic indices. Multivariable logistic regression, unsupervised clustering, and machine learning-based partial dependence analyses were applied to characterize age-dependent immunometabolic associations with infertility. Biological age closely paralleled chronological age and did not differ significantly between women reporting infertility and those not reporting infertility (p = 0.38). However, women reporting infertility exhibited a broader upper-tail distribution of biological age, suggesting a subgroup with elevated immunometabolic burden. Clustering identified four distinct immunometabolic phenotypes, with infertility prevalence ranging from 7.4% to 21.4%, highest in the phenotype characterized by elevated systemic inflammation. Machine learning analyses revealed nonlinear and age-specific associations between body mass index, inflammatory markers, and infertility risk, particularly among women aged 40-44 years, patterns not detected using conventional regression models. These findings suggest that infertility in advanced maternal age is not uniformly associated with accelerated biological aging but reflects heterogeneous immunometabolic pathways, particularly those related to systemic inflammation. Integration of inflammatory biomarkers with advanced analytic modeling may improve individualized risk stratification and understanding of age-related infertility.

39. Telework perceptions in hospital workers throughout the COVID-19 pandemic-the ADAPTAWORK2 study.

期刊: European journal of public health 发表日期: 2026-Apr-11 链接: PubMed

摘要

The COVID-19 pandemic has changed work organization in hospitals, notably with the expansion of telework. This study aimed to assess perceptions of telework among hospital workers throughout the pandemic and to identify factors associated with telework perceptions in the post-pandemic period. An observational cross-sectional study was conducted from October to December 2023. All hospital workers, regardless of their occupation or status, were invited to participate in an online survey. Perceptions of telework were assessed using visual analog scales, ranging from 0 (very negative) to 100 (very positive), across three periods: before the COVID-19 pandemic, during the first French lockdown, and after the pandemic. A total of 882 hospital workers were included in the analysis. Throughout the pandemic, 41.4% reported adopting telework. Overall, perceptions of telework became significantly more positive over time, rising from a mean score of 54.3 ± 25.3 before the pandemic, to 62.7 ± 27.4 during the first lockdown, and to 66.0 ± 27.5 after the pandemic (P < .001). Experiencing telework for the first time was associated with more favorable perceptions, with high levels sustained among those who continued teleworking post-pandemic. Perceptions of telework improved significantly among hospital workers throughout the pandemic with notable shifts in work practices, with nearly one third of participants teleworking in the post-pandemic period. Experiencing telework was associated with more positive perceptions.

40. Projected trends in frailty prevalence and associated health service use and costs in the over-50s in England, 2025 to 2040: a simulation modelling study.

期刊: Age and ageing 发表日期: 2026-Apr-04 链接: PubMed

摘要

To model projected trends in frailty prevalence, associated service use and costs in people aged 50 and over in England to 2040. System dynamics simulation modelling. Adult population (aged 50 and over) of England. Routine data from primary care patients aged 50 and over (2.2 million individuals) from participating practices from the Royal College of General Practitioners Research Surveillance Centre (RCGP RSC) database between 2006 and 2017. Projected frailty prevalence, primary, secondary and urgent care service use and costs in those aged 50 and over between 2025 and 2040. The population of England aged 50 and over is projected to increase from 23.1 million in 2025 to 24 million in 2040. Frailty prevalence in this group will rise from 70.2% to 76.1%, with associated service use costs increasing by £10 billion. Measures to reduce frailty incidence or progression could reduce costs by £310 million/annum and £644 million/annum, respectively. Frailty prevalence and associated service use and costs will increase substantially in the ageing population. A shift in focus to prevention and slowing progression in middle age and the younger old would substantially reduce service use and costs by older people living with frailty.

41. Determinants and Socioeconomic Inequalities in Breast and Cervical Cancer Screening in Tajikistan: Evidence From the 2023 Demographic and Health Survey.

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

摘要

This study examined the determinants of breast and cervical cancer screening and quantified socioeconomic inequalities in service use. We analyzed data from women age 15-49 years from the 2023 Tajikistan Demographic and Health Survey. The outcomes were self-reported ever having received a clinical breast examination for breast cancer and ever having been tested for cervical cancer. The prevalence was estimated using weighted descriptive statistics and Rao-Scott chi-square tests. Determinants were examined with multivariable logistic regression, reporting adjusted odds ratios (AORs), and 95% confidence intervals. Socioeconomic inequality was assessed using concentration curves and concentration indices, accounting for the complex survey design. The final sample size was 9,824. Breast and cervical cancer screening prevalence was 6.2% and 9.3%, respectively. Uptake increased with age (25-34 years: breast AOR = 2.68; cervical AOR = 2.41; 35-49 years: breast AOR = 3.54; cervical AOR = 3.27, v 15-24 years) and with household wealth (richest v poorest, cervical AOR = 1.95). Higher screening odds were associated with parity, recent health care visits, contraceptive use, and media exposure, whereas lower odds were associated with nonmotorized transport use. The prevalence was greater in urban areas. Concentration indices showed significant pro-rich inequality for both screening services (breast = 0.05; cervical = 0.05; P < .001). Strategies prioritizing integrating screening into reproductive and primary care, expanding outreach to poorer households, ensuring financial protection, and delivering community-based services in rural areas, alongside monitoring equity indicators, are critical to advancing universal access to breast and cervical cancer screening in Tajikistan.

42. From Diagnosis to Execution: A National Plan Proposal to Redesign Clinical Research in Brazil to Improve Cancer Care and Innovation Access.

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

摘要

Brazil has substantial capacity to contribute to global clinical research, supported by its population size, epidemiological diversity, and the Unified Health System (SUS). Despite this potential, the country has been described in policy documents and stakeholder discussions as being underrepresented in international clinical trials, reflecting persistent regulatory, operational, and structural barriers. Law No. 14.874/2024 was discussed as representing a major regulatory milestone, although its impact depends on effective implementation and system-level coordination. This article is based on a structured, multistakeholder deliberative process conducted during the First Annual Clinical Research Meeting (Encontro Anual de pesquisa Clinica-in Brazilian Portuguese), held in Brazil in May 2025. The meeting convened 20 speakers from industry, research organizations, clinical investigators, public and private research centers, patient advocacy groups, civil society, and health policy. Discussions were organized through plenary sessions and thematic working groups. A qualitative synthesis was conducted after the meeting to identify convergent policy directions and areas of divergence. Key challenges identified during the deliberative process included regulatory predictability, taxation and importation of research supplies, mandatory post-trial access, underutilization of SUS, workforce constraints, logistical bottlenecks, regional inequities, and limited public trust. Convergent policy directions discussed by participants emphasized effective secondary regulation of Law No. 14.874/2024, digital transformation, stronger integration of clinical research within SUS, workforce professionalization, patient-centered trial designs, and differentiated approaches for rare diseases and priority populations. Strengthening Brazil’s clinical research ecosystem was described by participants as requiring coordinated policy action, transparent governance, and sustained investment. The policy directions synthesized here, derived from multistakeholder deliberation, are intended to inform regulatory development and institutional strategies rather than to serve as a formal consensus statement or implementation plan.

43. Treatment Patterns and Outcomes in Localized Urothelial Carcinoma in Middle-Income Countries: A Multicenter Real-World Study.

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

摘要

Disparities in health care access and resource availability in middle-income countries often lead to suboptimal management of localized bladder urothelial carcinoma (UC). However, real-world data describing treatment patterns and outcomes in these settings remain limited. This multicenter, retrospective, real-world study included patients with high-risk non-muscle-invasive (HR-NMIBC) and localized muscle-invasive bladder cancer (MIBC) diagnosed between 2017 and 2022 across nine cancer centers in a middle-income setting. Treatment data and clinical outcomes were collected from medical records and analyzed using descriptive statistics and Kaplan-Meier survival estimates. Among 343 patients analyzed, 217 (63.3%) had HR-NMIBC, of whom only 29.5% received adjuvant Bacillus Calmette-Guérin (BCG), often substituted with intravesical gemcitabine because of supply shortages. BCG exposure was associated with superior overall and cancer-specific survival compared with non-BCG patients. In the muscle-invasive cohort (n = 126; 36.7%), cystectomy was performed in 48.4% and significantly improved survival. Perioperative chemotherapy remained limited, with only 39.3% receiving neoadjuvant therapy, and just one third receiving cisplatin-based regimens that conferred the greatest survival benefit. This multicenter real-world study exposes major gaps in the management of localized UC in a middle-income setting. Limited access to BCG, perioperative chemotherapy, and cystectomy remain key barriers to guideline-concordant care, underscoring the urgent need for policy actions to improve treatment delivery and outcomes in comparable health care systems.

44. A systematic review of noise pollution in hospitals.

期刊: The Journal of the Acoustical Society of America 发表日期: 2026-Apr-01 链接: PubMed

摘要

The issue of noise pollution in hospitals has been discussed since 1851. Numerous studies have examined sound levels and sources of noise in hospitals, revealing that noise levels in hospitals often exceed the recommended standards from the World Health Organization (WHO). Noise pollution in hospitals has psychological and physical consequences for patients and staff. Identifying and implementing noise-reduction strategies in hospitals significantly improves acoustic conditions in these settings. This systematic review aims to identify and assess noise-generating sources across various hospital departments and the components that reduce noise in hospitals. Utilizing PRISMA guidelines (the Prisma checklist consists of 27 items related to the content of a systematic review and meta-analysis), data were gathered from five databases: Scopus database, Web of Science database, ScienceDirect database, Sage database, and Willey database. A total of 72 articles, dated between 2012 and 2024, were reviewed. Noise levels were recorded at 61-66 dB in intensive care units and 63 dB in inpatient wards. Most interventions for noise reduction have been managerial, with fewer engineering-based solutions. While interventions generally led to noise reduction, levels still did not meet WHO standards. Analysis of the articles identified patient-staff conversations and medical equipment alarms as the most frequently reported noise sources. Based on an extensive classification framework, noise-reducing components were grouped into six categories: noise management, equipment, materials, functional space, furniture, and cultural patterns, under three strategies: managerial, physical, and cultural.

45. Sustaining health interventions in urban schools to construct educational possibilities.

期刊: Health education research 发表日期: 2026-Mar-31 链接: PubMed

摘要

School-based health and wellness initiatives have evolved from isolated efforts into comprehensive, multi-level programs designed to improve and sustain children’s overall health and well-being. When focused on building knowledge and changing behavior, these interventions can positively influence the development of lifelong healthy habits in youth. While facilitators and barriers to initial implementation are well documented, less is known about the long-term sustainability of such programs after external support and funding end. This qualitative study examined how inputs, activities, and resources provided during implementation affect the ongoing sustainability of comprehensive health interventions in schools. Semi-structured interviews were conducted with teachers and administrators from low-income, urban elementary schools to explore their experiences and perspectives. Data were analyzed using theory-driven methods guided by the Social Ecological Model and Whole School, Whole Community, Whole Child frameworks. Open coding identified critical themes and variables related to sustaining programming post-intervention. Findings revealed that alignment and continuity across levels of implementation, strong teacher and administrator buy-in, and the availability of ongoing resources, especially time, funding, and professional development, were essential to sustaining program benefits. These results offer practical insights for supporting the long-term success of school-based health and wellness programs.

46. Smart Devices and Better Health: Positive Associations Between Smart Devices and Health Among Older Adults.

期刊: Inquiry : a journal of medical care organization, provision and financing 发表日期: 2026 链接: PubMed

摘要

IntroductionSmart devices hold significant value for enhancing the health of older adults by promoting healthcare utilization and supporting chronic disease prevention.MethodsThis study investigates the relationship between smart device usage and health status among older adults, along with the underlying mechanisms, using panel data from the 2018 and 2020 waves of the China Longitudinal Aging Social Survey (CLASS). The baseline analysis employs a Two-Way Fixed Effects model to estimate the relationship between smart device usage and multiple health indicators. To ensure robustness, we further conduct instrumental variable estimation and exclude specific interfering samples. Additionally, heterogeneity across demographic subgroups is examined using interaction-term-based split-sample regression.ResultsUse of smart wristbands is associated with better self-rated health (SRH), lower depression scores, and higher social adaptation. Smart assistants and audiobooks are also associated with better social adaptation. Overall, smart devices enhance health by increasing healthcare utilization, encouraging social participation, strengthening social support, and facilitating early diagnosis of chronic diseases. These effects vary notably across gender, marital status, residence, age, and education level. Moreover, smart device use is linked to a pronounced reduction in medical expenditures.ConclusionThe findings reveal a positive association between smart device use and health outcomes among older adults, indicating the important role of smart devices in supporting health management and alleviating medical burdens among older adults. This study provides empirical evidence for promoting digital health interventions and suggests that policy efforts should consider demographic differences to enhance the equitable adoption of smart technologies.

47. Healthcare professionals' perspectives on medicine prescribing, vaccination, and alternative therapies in pregnancy and breastfeeding: A qualitative study from Catalonia, Spain.

期刊: PloS one 发表日期: 2026 链接: PubMed

摘要

Healthcare professionals (HCP) encounter a multitude of challenges regarding the utilisation of medicines, vaccines, and alternative therapies in pregnant and breastfeeding women (PBW). The objective of this study was to explore the experiences, beliefs, and attitudes of HCP toward prescribing medicines, vaccines, and alternative therapies during pregnancy and breastfeeding in Catalonia, Spain. This study employed a qualitative methodology, guided by a gender-based perspective. Three discussion groups were conducted, with the participation of 21 HCP during February 2024. Sampling was intentional, purposive designed to ensure discourse diversity. Recruitment was conducted through key contacts in public primary healthcare centres, sexual and reproductive health care centres, hospital settings in Catalonia, using snowball techniques. The data were analysed using thematic analysis. The challenges encountered by HCP who provide care to PBW are numerous and vary depending on the healthcare speciality area. Family physicians and nurses identified a lack of training in obstetrics as a factor contributing to difficulties in prescribing medicines. Midwives emphasised the importance of monitoring and follow-up during pregnancy, especially in cases where an adaptation of medication is required, while gynaecologists drew attention to the challenges posed by an increase in medication avoidance. HCP expressed concerns about the safety of the COVID-19 vaccine, as opposed to the greater safety of evidence of pertussis and influenza vaccines. The use of alternative therapies may lead to potential complications during consultations, as some users do not disclose their use. This study underscores the challenges encountered by HCP in drug prescriptions, complementary medicine, and vaccination during pregnancy and breastfeeding, considering HCP differences between specialities. Additionally, the study emphasises the difficulties associated with dual follow-up cases and the significance of establishing trusting relationships with users and shared decision-making processes or a good medication adherence. HCP have participated sharing their experience in prescribing medication and recommendations on vaccines and alternative medicine. The results of this study can be used to effect change in the practice of HCP.

48. National HTA system in Canada: From system analysis and understanding to system strengthening.

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

摘要

Health Technology Assessment (HTA) has played a critical role in guiding evidence-based decision-making in Canada’s healthcare system; however, its current structure and processes face several limitations that reduce its effectiveness and responsiveness. To effectively address these challenges, there is a clear need for a comprehensive framework that outlines the key components of Canada’s HTA system-including its conceptual foundations, policy environment, structural organization, governance models, institutional capacities, implementation pathways, and integration into decision-making processes. Such a framework would support more coordinated, transparent, and responsive HTA practices across jurisdictions. Using a systems thinking and analytical approach, the study aims to comprehensively analyze the components of the national HTA system in Canada. The study was conducted between 3rd May 2021 and 22nd April 2022, selectively recruiting experts and organizations involved in HTA. Seven national HTA experts participated in virtual In-Depth Interviews (IDIs) to understand HTA from a policy perspective, and ten HTA-associated organizations from the Canadian governmental and non-governmental sectors completed one electronic institutional survey to understand HTA from a technical perspective. Findings indicate a high level of literacy/understanding and perceived applicability of HTA, though challenges exist in governance, legislation, and decentralized coordination. While there’s general support for HTA, concerns arise regarding the extent of HTA report utilization and the need for a more cohesive national HTA approach. Capacity-wise, sustainable funding exists, but challenges include varying assessment coverage and the lack of harmonized guidelines resulting from a decentralized structure revealed within provinces. Qualitative findings revealed a decentralized structure with provincial-level HTA bodies, limited national coordination, and inconsistent integration into decision-making. Experts emphasized the need for standardized guidelines, improved capacity, and stronger national oversight to enhance the utilization of HTA. This study proposes advancing national coordination and developing standardized HTA guidelines to address fragmentation. It also recommends investing in capacity-building, training, and sustainable funding to strengthen HTA implementation. In conclusion, this study generates evidence of the strengths of the Canadian HTA system, as well as the presence of significant legislative, structural, policy, and capacity-related challenges. Despite the available funding, human resources, and capacity, and the active role of the Canadian Agency for Drugs and Technologies in Health (CADTH), establishing national HTA frameworks and strategies is a priority. This strategy, along with reinforcing provincial and federal stakeholder engagement, improving adoption pathways of HTA recommendations, and adapting HTA methodologies for more flexible and timely evaluations, can strengthen the Canadian HTA system.

49. The emerging role of the microbiome in bladder cancer: prognostic implications and treatment response.

期刊: Brazilian journal of medical and biological research = Revista brasileira de pesquisas medicas e biologicas 发表日期: 2026 链接: PubMed

摘要

Bladder cancer (BCa) is a histologically and molecularly heterogeneous disease and is one of the leading causes of cancer death globally. The main risk factors are sex (with incidence 3 to 4 times higher in men), tobacco usage, occupational exposure to carcinogens, and persistent infections, such as those caused by Schistosoma haematobium. Urine and the bladder were recently confirmed to be non-sterile, prompting investigations into the urinary and intratumoral microbiomes and their roles in tumor stage, prognosis, and therapy response. In this context, the role of the urinary and intratumoral microbiome in bladder carcinoma is among the most promising areas in translational uro-oncology. Recent evidence demonstrates the presence and diversity of microbial communities in both urine and bladder cancer tissue, with patterns associated with tumor stage and prognosis. Chronic inflammation, genotoxin production, altered carcinogen metabolism, and modulation of the immune microenvironment are biological processes that provide a rationale for the functional role of these microorganisms in the bladder. Furthermore, microbial profiles have been correlated with responses to intravesical therapies (such as BCG - Bacillus Calmette-Guérin) and, potentially, with systemic immunotherapies. The microbiome can help identify predictors of treatment response and potential adjuvant interventions, and offers a non-invasive, translational pathway for diagnosis and surveillance. This review summarizes current evidence on the microbiome in bladder cancer patients and its prognostic and therapeutic potential.