公共卫生研究摘要 (2026-05-01)

共收录 62 篇研究文章

1. The process of overcoming challenges faced by midwives providing perinatal mental health care in obstetric facilities in Okinawa, Japan: A qualitative study.

期刊: Japan journal of nursing science : JJNS 发表日期: 2026-Jul 链接: PubMed

摘要

This study aimed to clarify how midwives overcome challenges in providing perinatal mental health (PMH) care in clinical settings and to inform feasible, context-sensitive educational support. We used an interpretivist-constructivist qualitative design with a sequential two-stage approach. Thirteen midwives working at five obstetric facilities in Okinawa, Japan, each with more than 2 years of PMH care experience, participated in one focus group discussion (FGD) and one in-depth interview (IDI). FGD transcripts were analyzed descriptively to clarify key challenges and concerns and to inform the development of IDI questions. IDI transcripts were analyzed using reflexive thematic analysis to explore how midwives navigated and overcame these challenges, thereby generating an interpretive account aligned with the study aim. Five themes were generated, from which we constructed a dynamic thematic map illustrating how challenges were overcome: contextual challenges triggered action; team-based support, reflective practice, and feedback from clinical cases interacted recursively; and motivational substrates underpinned these processes and were reinforced through ongoing practice, sustaining midwives’ involvement in PMH care under conditions of uncertainty. Reported barriers included limited opportunities for reflective dialogue within shift-based workflows and limited visibility of post-discharge outcomes. This study clarified the contextual challenges in PMH care and the key elements for overcoming them. These findings inform educational and organizational support combining flexible access to knowledge resources with interprofessional collaborative reflection grounded in psychological safety in emotionally and time-constrained obstetric settings, enabling midwives to sustain engagement in PMH care under conditions of uncertainty.

2. Temporal Trends and Regional Variations in Mortality of Adults With Status Epilepticus in the United States: A Retrospective Study From 1999 to 2020.

期刊: Neurology 发表日期: 2026-May-26 链接: PubMed

摘要

With an incidence of 18.3-41 per 1,000 people in the United States, status epilepticus (SE) can frequently result in death. We aimed to investigate the mortality trends in SE in the United States stratified by age groups, sex, race/ethnicity, and geographic region. We retrieved data from the CDC-WONDER database for adults aged ≥25 years. Crude rates (CRs) and age-adjusted mortality rates (AAMRs) per 100,000 persons were calculated. We estimated the annual percent change (APC) in mortality rates to identify trends using ioinpoint regression. From 1999 to 2020, a total of 32,174 SE-related deaths were recorded in adults, 83.7% of which occurred in medical facilities. The AAMR displayed a period of stability from 1999 to 2007, followed by an increase until 2020. We observed the highest CRs among adults ≥65 years. Men showed higher AAMRs than women. Non-Hispanic (NH) Black people had the highest AAMR and the greatest rise in mortality, followed by NH Whites and Hispanics or Latinos. The South displayed the highest AAMR of all regions. SE-related mortality in adults has been rising with notable disparities. Addressing racial disparities and tailoring management strategies for high-risk groups are critical to curb SE.

3. Glucagon-like Peptide-1 Receptor Agonists and Risk of Nonarteritic Anterior Ischemic Optic Neuropathy: Systematic Review and Meta-Analysis.

期刊: Neurology 发表日期: 2026-May-26 链接: PubMed

摘要

Recent observational studies have reported conflicting evidence regarding an association between glucagon-like peptide-1 receptor agonists (GLP-1RAs), particularly semaglutide, and nonarteritic anterior ischemic optic neuropathy (NAION). We aimed to synthesize the pooled evidence assessing the association between GLP-1RA use and NAION risk. Embase, Medline, and Cochrane CENTRAL databases were searched from inception to April 5, 2025. Observational studies and randomized controlled trials comparing NAION risk in GLP-1RA users with non-GLP-1RA users were included. Title/abstract and full-text screening were conducted in duplicate by 2 independent reviewers. Discrepancies were resolved through discussion or adjudication by a third reviewer. Risk of bias was assessed using the Risk of Bias In Nonrandomized Studies of Interventions (ROBINS-I) tool, and the certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation framework. Pooled relative risks (RRs) were estimated using Bayesian random-effects models, incorporating half-normal, between-study, and weakly informative priors. The RR with 95% credible interval (CrI) was computed to analyze the development of NAION associated with GLP-1RA exposure. Five studies were included in the primary analysis, encompassing 1,593,554 patients (682,456 semaglutide users and 911,098 non-GLP-1RA users). Semaglutide use was associated with a high probability of increased risk of NAION compared with non-GLP-1RA use (RR: 2.52, 95% CrI [1.56, 4.72], I2: 57.8%, P(RR > 1): 99.9%). This association was particularly pronounced among patients with diabetes (RR: 2.41, 95% CrI [1.57, 4.10], I2: 47.2%, P(RR > 1): 99.9%). The overall incidence of NAION across 5 studies and 7 comparisons, encompassing 1,460,760 patients (semaglutide: 1,108,542; dulaglutide: 326,282; and exenatide: 25,936) and 272 NAION events (semaglutide: 198; dulaglutide: 54; and exenatide: 20) was 85 cases per 100,000 GLP-1RA users (95% CrI [29, 263], I2: 98.8%, P(incidence >0.00001): 100%). The incidence of NAION across 1,108,542 semaglutide users was 118 cases per 100,000 (95% CrI [32, 451], I2: 98.8%, P(incidence >0.00001): 100%). Leave-one-out sensitivity analyses consistently supported these findings. Low-to-moderate certainty evidence indicates that semaglutide significantly increases risk of NAION relative to non-GLP-1RAs, particularly among patients with diabetes. These findings warrant further investigation and should inform clinical risk-benefit discussions.

4. Homologous specialization of arcuate fasciculus ventrolateral frontal connectivity in marmosets and humans.

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

摘要

The arcuate fasciculus (af) is a crucial dorsal pathway underpinning human language, yet its weak frontal connectivity in macaques-the standard primate model-creates an evolutionary puzzle. Here, we investigate the common marmoset, a distantly related platyrrhine with high vocal complexity, to test for convergent neural adaptations. By integrating retrograde and anterograde tracing with ultra-high-resolution diffusion MRI, we identified a robust af homolog in marmosets that is anatomically distinct from the superior longitudinal fasciculus. Comparative mapping across marmosets, macaques, chimpanzees, and humans reveals a notable similarity in connectivity patterns: The marmoset af terminates extensively in the ventrolateral frontal cortex, exhibiting a connectivity profile significantly more similar to humans than to that of the phylogenetically closer macaque. Functionally, this pathway targets cortical regions activated during vocal exchanges, partially overlapping with the human speech network. These findings suggest that the frontal connectivity of the dorsal audio-motor pathway is not strictly determined by phylogenetic proximity but represents an evolutionarily labile scaffold that undergoes lineage-specific elaboration under pressure associated with complex vocal communication.

5. Financial and occupational burden of leg ulcers in an active Portuguese tertiary hospital population: absenteeism, unemployment and retirement.

期刊: Journal of wound care 发表日期: 2026-May-02 链接: PubMed

摘要

The prevalence of leg ulcers (LUs) increases with age. Nevertheless, a significant number of working-age individuals are affected by hard-to-heal (chronic) wounds that last throughout their adult lives, impacting work capacity and leading to absenteeism, unemployment and subsequent financial burden. A retrospective observational study was carried out between January 2022 and June 2024 at a Portuguese tertiary hospital, which included working-age patients living with LUs. Patients who were unemployed and retired for reasons other than LUs were excluded from the study. Clinical data on wound care and work activity were registered, and the Work Productivity and Activity Impairment questionnaire General Health version 2 (WPAI-GH) was applied. Results: A total of 24 patients were included, with a mean age of 53.6±11.0 years. LUs had a median evolution of six years (interquartile range: 3-20) and 19 (79%) patients had recurrent ulcers. A total of 11 (46%) patients were unemployed or had retired early due to their LUs. A reduction of monthly income after developing the ulcer was noted in 43.5% of patients. The median number of work days missed by employed patients in the previous year was 39 (interquartile range: 2.5-317.5); three patients were on leave for ≥1 year. LU was related to incapacity for work and loss of income in almost half of the study cohort. Longer duration of the ulcers, recurrence rates and work that required prolonged standing were positively associated with unemployment and retirement. By establishing earlier and more efficient treatment plans, clinicians can reduce duration of treatment and work incapacity in people with LUs.

6. CANCER-ASSOCIATED RETINOPATHY AFTER CHIMERIC ANTIGEN RECEPTOR T-CELL THERAPY.

期刊: Retinal cases & brief reports 发表日期: 2026-May-01 链接: PubMed

摘要

To describe a case of cancer-associated retinopathy (CAR) after chimeric antigen receptor T (CART)-cell therapy. Retrospective case report. A 71-year-old man with follicular lymphoma refractory to multiple chemotherapies underwent CART-cell therapy. Two weeks after CART initiation, he presented with rapid-onset decreased peripheral vision in both eyes. Fluorescein angiography showed attenuation of peripheral vessel filling, and optical coherence tomography showed loss of ellipsoid zone with foveal sparing. Electroretinography revealed nondetectable rod responses and severely prolonged and diminished cone responses. Antiretinal antibody testing showed positive antienolase and antiheat shock protein 60 antibodies on Western blot with strong staining of the outer segments on immunohistochemistry. The patient was diagnosed with CAR and is currently on monthly IV immunoglobulin (IVIg) with stable central visual acuity. This patient developed CAR immediately after receiving CART-cell therapy, which depletes B cells. This suggests that CAR pathophysiology may not be purely autoantibody mediated as typically believed.

7. Torsemide and warfarin: A cautionary case of altered international normalized ratio and bleeding risk.

期刊: Indian journal of pharmacology 发表日期: 2026-May-01 链接: PubMed

摘要

Warfarin is a widely used oral anticoagulant with a narrow therapeutic index and multiple drug-drug interactions that may significantly alter its anticoagulant effect. Torsemide, a loop diuretic commonly prescribed for heart failure and fluid overload, shares metabolic pathways with warfarin, raising the possibility of clinically significant interactions. However, the evidence regarding this interaction remains limited and inconsistent. A 66-year-old male with a history of type 2 diabetes mellitus, hypertension, chronic kidney disease, and prior aortic valve replacement on chronic warfarin therapy presented with extensive soft tissue necrosis of the left leg following minor trauma. During hospitalization, warfarin (3 mg once daily) and Torsemide (20 mg once daily) were initiated concurrently. Subsequently, the patient developed a progressive elevation in international normalized ratio (INR), necessitating repeated fresh frozen plasma transfusions due to increased bleeding risk. Despite supportive management, INR remained elevated. Torsemide was discontinued and replaced with furosemide, after which a gradual stabilization of INR levels was observed. The patient later required left above-knee amputation due to worsening necrosis but recovered following multidisciplinary management. Assessment using the Naranjo Adverse Drug Reaction Probability Scale suggested a possible interaction between warfarin and Torsemide. This case highlights a potential interaction between warfarin and Torsemide resulting in elevated INR and increased bleeding risk. Clinicians should exercise caution and ensure close INR monitoring when initiating Torsemide in patients receiving warfarin therapy.

8. Determinants of Household-Level Double Burden of Malnutrition in South and Southeast Asia: A Systematic Review and Meta-analysis.

期刊: Current developments in nutrition 发表日期: 2026-May 链接: PubMed

摘要

The double burden of malnutrition (DBM), defined as the coexistence of undernutrition and overnutrition within the same household, is an increasing public health concern in South and Southeast Asia, yet evidence on its household-level determinants remains fragmented. This systematic review and meta-analysis aimed to synthesize evidence on factors associated with household-level DBM in South and Southeast Asia. PubMed, Scopus, and Web of Science were searched for observational studies published between January 2000 and September 2025. Two reviewers (AT & MAS) independently screened studies, extracted data, and assessed quality using the Newcastle-Ottawa Scale adapted for cross-sectional studies. Random-effects meta-analyses were conducted for factors reported in ≥5 studies, and pooled odds ratios (ORs) with 95% confidence intervals (CIs) were estimated. Thirty studies were included, of which 26 were eligible for meta-analysis. Urban residence (OR = 1.38, 95% CI: 1.20, 1.59), higher household wealth (OR = 1.55, 95% CI: 1.31, 1.83), older maternal age (OR = 2.22, 95% CI: 1.97, 2.50), maternal short stature (OR = 1.90, 95% CI: 1.69, 2.13), older child age (OR = 1.79, 95% CI: 1.44, 2.23), and cesarean delivery (OR = 1.76, 95% CI: 1.20, 2.57) were associated with higher likelihood of DBM. Higher maternal education and breastfeeding were found to be protective factors. Effective interventions should adopt integrated, life-course approaches that simultaneously address undernutrition and overnutrition across critical stages, particularly during adolescence, pregnancy, and early childhood. Policies should prioritize maternal education, breastfeeding promotion, and adolescent nutrition to break intergenerational cycles of malnutrition.This study was registered at PROSPERO as CRD420251155844.

9. Tapentadol-induced urticarial rash in a patient with acute pancreatitis.

期刊: Indian journal of pharmacology 发表日期: 2026-May-01 链接: PubMed

摘要

Tapentadol, a dual-action opioid, is increasingly used for pain management in acute pancreatitis (AP). Although its common side effects are well-documented, cutaneous reactions are rare. We report a 30-year-old gentleman with AP who developed generalized urticaria following oral tapentadol use. The patient had no prior history of atopy or drug allergies. The rash resolved after discontinuation of tapentadol and administration of a short course of corticosteroids and antihistamines. Cutaneous reactions to tapentadol are extremely rare but should be recognized promptly to ensure timely management and prevent unnecessary investigations.

10. Discovery of the protective effect of glutamine on acute alcoholic liver injury.

期刊: Indian journal of pharmacology 发表日期: 2026-May-01 链接: PubMed

摘要

Our research aims to evaluate the important role of glutamine (Gln) in alcohol (ethanol)-induced liver damage. In our study, the mice were simultaneously divided into normal group, alcohol group, and Gln+alcohol group. After different treatments, we detected alanine aminotransferase (ALT), aspartate aminotransferase (AST), and liver index. Then, some histopathological examination was used to observe the damage of liver tissue, glycogen, and liver cell apoptosis in mice. In addition, the expression of apoptosis-related proteins Bcl-2, Bax, Caspase3, heat stress protein 70 (HSP70), cytochrome cytochrome P450-2E1, NFκB pathway-related proteins IkB-a, NFκB-p65, and tumor necrosis factor-α were detected in different groups by western blotting. The experiment in vitro, we used normal hepatocytes L02, after treatment with alcohol and Gln for 24 h, carried out CCK-8 cell proliferation detection and western blotting to detect the expression of related proteins. Our results showed that, in serological testing, Gln can significantly reduce the levels of ALT, AST, and liver index in Gln+alcohol group; and in the histopathological examination, Gln can increase the glycogen content and decrease the apoptosis rate in Gln+alcohol group. In addition, the differential expression of IκBα, NFκB-p65, and other factors in Western blotting shows that the NFκB signaling pathway plays important role in acute alcoholic liver injury. Our results showed that Gln played an important protective role in alcohol-induced liver injury in mice by regulating glycogen stores, apoptosis, anti-oxidative stress and inhibiting NF-κB signaling pathways in liver cells.

11. Gestational age determination in pregnancies conceived via assisted reproductive technology.

期刊: Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology 发表日期: 2026-Apr-30 链接: PubMed

摘要

To compare gestational age (GA) dating models for pregnancies conceived via assisted reproductive technology (ART), assess whether 14 or 15 days more accurately reflects the median follicular-phase duration in ART pregnancies and evaluate whether the gestational timelines of ART pregnancies are comparable with that of spontaneously conceived pregnancies. We employed population data from the Medical Birth Registry of Norway (2015-2021), including 163 544 children conceived spontaneously, 2067 conceived via fresh embryo transfer (ET) and 2080 conceived via frozen ET. Among ART pregnancies, we compared two GA dating methods: a population-based ultrasound model (GAUS) and an ART-based formula based on the known oocyte fertilization date. Statistical agreement was evaluated by calculating individual pairwise differences in GA estimates. Bias and precision in the estimated date of delivery (EDD) were assessed by constructing cumulative birth distribution (Kaplan-Meier) curves for fresh and frozen ET pregnancies separately, employing time-to-event analysis to account for nonspontaneous births. The absolute individual GA differences between ultrasound and ART-based dating, considering a 14-day median follicular-phase duration, were ≤ 1 day for 969/2067 (46.9%) fresh ET pregnancies and for 874/2080 (42.0%) frozen ET pregnancies. An approximate systematic difference of 1 day was observed, which we corrected by employing a 15-day median follicular-phase duration in the ART-based formula (GAART,15). There was a median pairwise difference between GAUS and GAART,15 of -0.4 (95% CI, -0.5 to -0.3) days in fresh ET pregnancies and -0.2 (95% CI, -0.4 to -0.1) days in frozen ET pregnancies. Both models demonstrated equivalent precision in the EDD. Measured using the ultrasound model, frozen ET pregnancies had a median pregnancy duration of 286.1 (95% CI, 285.5-286.7) days, which was 3.2 (95% CI, 2.4-3.9) days longer than that in fresh ET pregnancies, and 2.6 (95% CI, 2.0-3.2) days longer than that in spontaneously conceived pregnancies. We found close statistical agreement between ultrasound and ART-based dating models for both GA and EDD. However, 15 (not 14) days of follicular-phase duration should be utilized in the ART-based formula to avoid systematic bias in ART-based GA estimates. Fresh and frozen ET pregnancies had different birth distributions and median pregnancy durations, underscoring that they are not comparable with spontaneously conceived pregnancies and they should be evaluated separately. © 2026 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

12. Relationship Between Online Health Information Acquisition and Shared Decision-Making Among Patients With Diabetes: Cross-Sectional Survey Study.

期刊: Journal of medical Internet research 发表日期: 2026-Apr-30 链接: PubMed

摘要

Shared decision-making allows patients and clinicians to make decisions together to help determine the most appropriate option. Patients need comprehensive health information to participate and evaluate different options during the shared decision-making process. Patients with diabetes need to constantly monitor their health status. They experience an array of health information needs during their ongoing health management. Online health information acquisition is a common behavior among patients with diabetes, and online information can impact the interaction between patients with diabetes and health care providers. This study explored the relationship between 2 types of online health information acquisition behavior (active online health information seeking and incidental online health information acquisition) and shared decision-making. It also investigated the mediating role of eHealth literacy during the information acquisition process among US patients with diabetes aged 18 to 44 years. Participants were patients with diabetes aged 18 to 44 years in the United States and were recruited by a survey company, Centiment. The sampling process matched the national distribution of gender and age in the United States. An online survey questionnaire was distributed through Qualtrics. A total of 558 valid responses were collected. The average age of the sample was 35.91 (SD 6.04) years. Among the sample, 260 participants were men, 291 participants were women, and 7 participants identified their gender as other. Bivariate analyses and partial least squares structural equation modeling were used for data analysis. All data analyses were performed in R. The prevalences of active online health information seeking (mean 3.97, SD 0.78) and incidental online health information acquisition (mean 4.27, SD 0.78) were high among participants. Education was a key factor related to eHealth literacy (P<.001) and shared decision-making (P<.001). Model testing indicated that active online health information seeking was related to eHealth literacy (β=.192, 95% CI .067-.320) and shared decision-making (β=.234, 95% CI .123-.346). Incidental online health information acquisition was related to eHealth literacy (β=.335, 95% CI .205-.461). eHealth literacy was related to shared decision-making (β=.441, 95% CI .334-.536). Therefore, eHealth literacy partially mediated the relationship between active online health information seeking and shared decision-making, while it fully mediated the relationship between incidental online health information acquisition and shared decision-making. This study contributes to the ongoing development of health communication strategies and the modification of health information training programs for patients with diabetes. The need for the information industry to deliver accurate and easy-to-understand health information to the public to support their decision-making process and encourage positive health behaviors is urgent.

13. Association Between Gestational Blood Pressure Trajectories and Postpartum Normotension Recovery in Hypertensive Disorders: Retrospective Cohort Study.

期刊: JMIR public health and surveillance 发表日期: 2026-Apr-30 链接: PubMed

摘要

Hypertensive disorders of pregnancy (HDP) may cause lasting vascular, cardiac, and renal damage, potentially increasing the risk of postpartum cardiovascular disease. This study aimed to examine the association between gestational blood pressure (BP) trajectories in HDP and the risk of unrecovered BP at 6 weeks post partum. A total of 3162 women with HDP were obtained from the antenatal care and the postpartum follow-up information system, between January 1, 2018, and December 31, 2024. Of the 3162 women included, 1674 had gestational hypertension, 607 had preeclampsia, 246 had chronic hypertension with superimposed preeclampsia, and 635 had chronic hypertension. Group-based trajectory modeling was used to fit systolic BP (SBP), diastolic BP (DBP), and mean arterial pressure (MAP) trajectories during pregnancy. Modified Poisson regression was used to assess the association between gestational BP trajectories and the risk of unrecovered BP at 6 weeks post partum. Trajectories of SBP, DBP, and MAP during pregnancy were significantly associated with unrecovered BP at 6 weeks post partum. For gestational hypertension, those with the high-consistent rise (adjusted relative risk [aRR] 2.493, 95% CI 1.093-5.689) and high-late surge SBP trajectories (aRR 4.535, 95% CI 1.884-10.917) were associated with a significantly increased risk of BP nonrecovery at 6 weeks post partum. Similar associations were observed for DBP and MAP. For chronic hypertension with superimposed preeclampsia, women with high-late surge in SBP (aRR 2.792, 95% CI 1.081-7.214), DBP (aRR 4.043, 95% CI 1.327-12.324), or MAP (aRR 4.018, 95% CI 1.462-11.045) had a significantly increased risk of BP nonrecovery at 6 weeks post partum. Among women with chronic hypertension, those with the high-consistent rise trajectories of SBP (aRR 2.557, 95% CI 1.256-5.207), DBP (aRR 3.862, 95% CI 1.673-8.913), and MAP (aRR 3.714, 95% CI 1.682-8.201) had a significantly increased risk of BP nonrecovery at 6 weeks post partum. Among women with preeclampsia, only high-consistent rise SBP trajectory remained significantly associated with unrecovered BP post partum (aRR 3.355, 95% CI 1.140-9.873). The high-consistent rise and high-late surge trajectories of SBP, DBP, and MAP in gestational hypertension started at similar initial levels and crossed at approximately 22 weeks of gestation. The gestational BP trajectories in women with HDP are positively associated with the risk of unrecovered BP at 6 weeks post partum. Early identification of women at high risk for poor postpartum BP recovery through BP trajectory analysis may have important clinical implications for improving long-term cardiovascular outcomes in this population.

14. Demographic Profiles and Methodologies Used in the Generation and Validation of Resting Metabolic Rate Prediction Equations: Protocol for a Systematic Review.

期刊: JMIR research protocols 发表日期: 2026-Apr-30 链接: PubMed

摘要

Resting metabolic rate (RMR) prediction equations used today often rely on the consideration of binary sex. Significant intrasex variability and a lack of data on diverse populations raise concerns about these equations’ validity and generalizability. Existing systematic reviews have focused on specific populations like individuals with obesity or athletes, but none have systematically examined the demographic characteristics of participants used to derive these equations. Our central hypothesis is that the accuracy of RMR prediction is influenced by the demographic alignment between the equation’s derivation population and the individual. We present a systematic review protocol to critically evaluate the literature and participant demographic profiles that underpin current RMR prediction equations. Our objectives are to (1) determine the characteristics of participant populations, including reporting on gender and sex diversity, used in RMR equation research; (2) critically appraise the methodologies, findings, and reporting practices of studies that developed RMR equations for binary populations; and (3) use the Sex and Gender Equity in Research guidelines to assess sex and gender terminology and variable inclusion in the generative RMR prediction literature. Following a PROSPERO-registered protocol (CRD420251084400), we will conduct a comprehensive search across multiple databases, including Academic Search Premier, PubMed, and Web of Science. The final search string will be: ((resting metab* rate) OR (RMR) OR (basal metab* rate) OR (BMR) OR (metabol) OR (resting energy expenditure) OR (metab rate)) AND ((predict* equation) OR (predict* model) OR (predict* algorithm) OR (formula) OR (estimation equation)) AND ((demograph) OR (characterist) OR (age) OR (race) OR (ethnicity) OR (sex) OR (gender)). We will include peer-reviewed, English-language articles reporting studies that generated RMR prediction equations and reported human participant demographic characteristics. Exclusion criteria include studies not generating prediction equations, without demographic data, or involving animals. Data extraction will include reported participant demographics (eg, sex, gender, race or ethnicity, age, and body composition), RMR test protocols, and reported reliability or validity metrics. Risk of bias will be assessed using PROBAST (Prediction Model Risk of Bias Assessment Tool). This study was funded in June 2025 by the University of Nevada, Las Vegas Sports Innovation Initiative Catalyst Grant Funding Program and in July 2025 by the National Association for Kinesiology in Higher Education Hellison Interdisciplinary Research Grant. The databases were searched using the final search string between August 1, 2025, and August 8, 2025. Training of team members began on September 3, 2025, and concluded on October 20, 2025. Findings will be disseminated through a narrative synthesis submitted for publication, adhering to the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analyses) reporting guidelines. This review will identify gaps in the inclusivity and generalizability of current RMR prediction equations, informing future research and clinical applications. PROSPERO CRD420251084400; https://www.crd.york.ac.uk/PROSPERO/view/CRD420251084400. PRR1-10.2196/82482.

15. Facilitators of and Barriers to Global Digital Oral Health: Mixed Methods Study.

期刊: Journal of medical Internet research 发表日期: 2026-Apr-30 链接: PubMed

摘要

Digital oral health builds on the broader framework of eHealth, leveraging digital technologies to improve patient care, increase access to dental services, and enhance oral health outcomes. However, health care organizations and institutions encounter challenges in implementing digital oral health interventions across various levels. Addressing these challenges requires a comprehensive understanding of the barriers and facilitators that influence its successful adoption. This study aimed to explore the facilitators of and barriers to the implementation of digital oral health programs from the perspective of chief dental officers from countries across the World Health Organization (WHO) regions. This study is part of a broader investigation into global readiness for digital oral health. Participants were the 144 chief dental officers or designated oral health officials within ministries of health across the 6 WHO regions. An explanatory sequential mixed methods design was used across 2 phases. In the quantitative phase, an online survey was administered using the WHO’s global survey on eHealth instrument. Some items were modified slightly to be applied to the field of dentistry. Descriptive statistics were used to present the quantitative data. In the qualitative phase, data were collected through virtual interviews, using an interview guide developed based on preliminary findings from the quantitative phase, the technology acceptance model, and the eHealth readiness assessment tool. The qualitative data were analyzed using thematic analysis. The survey response rate was 70.1% (101/144). The qualitative phase involved in-depth interviews with 15 participants. The findings were integrated under 2 broad themes of facilitators and barriers. Perceived facilitators included the existence of national policies and guidelines on eHealth. Approximately 63.9% (53/83) of the respondents indicated the presence of a national oral health policy in their countries. Capacity building, motivation of health care providers and academic leadership, digital health training for students or professionals, and WHO support to implement the mOral Health program were the other facilitators. The strongest barriers were a lack of funding to develop and support digital health programs, lack of norms and standards to guarantee application interoperability, and lack of equipment and/or connectivity. Approximately 45.1% (37/82) of the participants reported having government-sponsored mobile health programs, while 31.7% (26/82) reported having no financial support for the implementation of national digital oral health programs. Furthermore, lack of evidence on the effectiveness and cost-effectiveness of programs was highlighted as a barrier by 73.8% (59/80) and 73% (57/78) of the participants, respectively. The results of this study enabled the identification of key barriers to and enablers of the implementation of digital oral health programs in WHO member countries. Supportive governmental policies and adequate funding and investment in digital infrastructure and technologies are essential to mitigate digital oral health-related challenges.

16. Time-Dynamic AI Models to Predict Quality of Life in Patients With Breast Cancer: Development and Validation Study Using the EORTC BALANCE Cohort.

期刊: Journal of medical Internet research 发表日期: 2026-Apr-30 链接: PubMed

摘要

Patients with breast cancer often experience health-related quality of life (HRQoL) impairments that remain difficult to predict on an individual level. Prediction models can aid in understanding individual survivorship trajectories. However, current prognostic models are based on fixed intervals, limiting their utility in clinical follow-up schedules. This study aimed to develop and externally validate time-dynamic machine learning (ML) models that predict clinically relevant HRQoL impairments in nonmetastatic patients with breast cancer. Using the pooled multicohort EORTC (European Organisation for Research and Treatment of Cancer) BALANCE (big data in patients with breast cancer) dataset (n=6316) containing repeated HRQoL measurements (EORTC QLQ [Quality of Life Core Questionnaire]-C30), we constructed over 70,000 patient assessment pairs. ML algorithms were trained using the earlier HRQoL assessment and clinical data to predict dichotomized impairments in QLQ-C30 domains at the later assessment between 2 weeks and 5 years ahead, reflecting the range of follow-up intervals available in the dataset. The best performing model was determined via the area under the receiver operating characteristic curve in the internal validation, and externally validated in an independent cohort of the BALANCE dataset, in which the calibration and predictive performance in risk groups (patients: postmenopause, with financial difficulties, with obesity, with 2 or more comorbidities, with lower educational status, and with frailty) were also evaluated. ML models showed good discrimination (area under the receiver operating characteristic curve 0.64-0.84) across most domains, especially for persistent symptoms such as fatigue, financial difficulties, or functioning scales. Gradient boosting models performed best, but tended to be overconfident, with poor calibration for low-prevalence symptoms such as diarrhea or constipation. Model performance varied by risk group (eg, lower education and frailty), though no group consistently performed poorly. Performance remained stable across time windows, with prior HRQoL being the strongest predictor at the respective scale level, while clinical variables such as the type of treatment were less important for prediction. Time-dynamic ML models can support personalized HRQoL prediction in breast cancer care. Future improvements should focus on calibration and fairness to enable equitable, clinically meaningful implementation.

17. Effects of Digital-Based Exercise Interventions on Concerns About Falling, Falls Efficacy, and Physical Performance Among Older Adults: Systematic Review and Meta-Analysis.

期刊: JMIR aging 发表日期: 2026-Apr-30 链接: PubMed

摘要

Falls are prevalent and serious health problems among older adults. Concerns about falling and reduced falls efficacy are common fall-related psychological impairments, representing 2 distinct emotional and cognitive constructs, respectively. The impact of digital-based exercise interventions on these specific constructs remains unclear. This systematic review and meta-analysis aimed to synthesize current evidence on digital-based exercise interventions for concerns about falling and falls efficacy among older adults, with a specific focus on determining their differential effects on emotional and cognitive constructs and evaluating their impact on physical performance. The PubMed, Web of Science, Cochrane Library, Embase, PsycINFO, CINAHL, CNKI, SinoMed, VIP, and Wanfang databases were systematically searched from their inception dates to May 2025. We searched for published randomized controlled trials on the effects of digital-based interventions on the fear of falling, concerns about falling, and falls efficacy among older adults. The study followed PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and was performed using Stata 17.0 software (StataCorp LLC). Eighteen studies involving 2435 participants were included. Meta-analyses revealed significant effects of digital-based exercise interventions on falls efficacy (standardized mean difference 0.70, 95% CI 0.51-0.90; P<.001), balance function (mean difference [MD] 4.03, 95% CI 2.57-5.49; P<.001), functional mobility (MD -1.65, 95% CI -2.52 to -0.77; P<.001), and physical function (MD 0.57, 95% CI 0.12-1.02; P=.006) among older adults. However, digital-based exercise interventions had no significant effect on concerns about falling, which is the emotional construct related to falls (standardized MD -0.12, 95% CI -0.28 to 0.05; P>.05). The meta-analysis assessed the efficacy of digital-based exercise interventions on fall-related psychological impairments among older adults and revealed that the effects differed across the constructs. These findings suggest that digital-based exercise interventions have potential benefits for improving falls efficacy and physical performance among older adults compared with controls. However, the effect of digital-based exercise interventions on concerns about falling, which is the emotional construct related to falls, remains uncertain among older adults.

18. Korean Medical Consultation With Open-Weight Large Language Models: Pilot Comparative Evaluation of Retrieval-Augmented Generation With Metadata Filtering.

期刊: JMIR formative research 发表日期: 2026-Apr-30 链接: PubMed

摘要

This study develops an open-source large language model-based chatbot tailored for Korean health consultations. The chatbot was implemented using the retrieval-augmented generation (RAG) technique alongside metadata filtering to enhance its performance. This study aims to analyze and compare the performance of a RAG-based chatbot with other leading language models in the context of Korean health consultations. A 10.4 GB Korean medical document corpus (487,277 segments) was constructed from official websites of major Korean hospitals, public health sources, and medical textbooks. This study quantitatively compared 5 open-source large language models (Qwen3:4B, Mistral:7B, Llama-3.1:8B, Gpt-Oss:20B, and Gemma3:27B) in 3 configurations: baseline (model only), RAG-only, and RAG with metadata filtering. The RAG system used a specialized Korean embedding model (upskyy/bge-m3-korean) and an Elasticsearch store. Performance was assessed by an emergency medicine specialist using a validation set of 226 questions across 7 common diseases and scoring responses based on accuracy, safety, and helpfulness. The application of RAG alone failed to yield statistically significant performance improvements and, in some cases (Llama 3.1: 8B and Gemma 3: 27B), resulted in decreased scores. However, the combination of RAG with metadata filtering yielded statistically significant (P<.05) performance increases in most models. Notably, the average score for Mistral:7B increased from 3.79, SD 0.08, to 4.10, SD 0.10, and Gpt-Oss:20B increased from 4.43, SD 0.05, to 4.51, SD 0.04, with the latter achieving the highest safety score (4.61, SD 0.03). The Gemma3:27B model, which possessed a high baseline performance (4.42, SD 0.03), was an exception, exhibiting no significant improvement (P=.14) even with filtering. The effectiveness of RAG for specialized domains such as Korean medical consultation is highly dependent on a metadata filtering process that controls the quality of retrieved information; simple information augmentation is insufficient. Furthermore, the benefit of RAG is limited when a model’s intrinsic knowledge (eg, Gemma3:27B) already meets or exceeds the quality of the external knowledge base. This finding indicates that performance enhancement strategies must account for both the retrieval mechanism’s quality and the model’s preexisting capabilities.

19. Enterocutaneous Fistula-Associated Sepsis and Mortality: Development and Validation of a Multimodal Artificial Intelligence Prediction Model.

期刊: JMIR medical informatics 发表日期: 2026-Apr-30 链接: PubMed

摘要

Predicting enterocutaneous fistula (ECF)-associated sepsis and mortality poses significant challenges in digital health care due to the disease’s complexity and heterogeneous clinical manifestations. Current approaches that rely on single-modal data or traditional scoring systems often fail to capture the intricate immune-inflammatory dynamics and multisystem involvement in patients with ECF. This study aims to develop an artificial intelligence (AI)-driven multimodal fusion model integrating clinical, imaging, and transcriptomic data for early prediction of ECF-associated sepsis and 28-day mortality, addressing the limitations of conventional single-dimensional models. This study leveraged publicly available datasets (Medical Information Mart for Intensive Care III [MIMIC-III], electronic Intensive Care Unit [eICU], and The Cancer Genome Atlas) to construct a multimodal framework. Clinical parameters were processed using Extreme Gradient Boosting, abdominal imaging features were extracted via convolutional neural networks, and transcriptomic profiles were analyzed with variational autoencoders. A Transformer-based fusion network was employed for joint prediction and validated through cross-validation and external testing. Key features were identified using Shapley Additive Explanations and Local Interpretable Model-Agnostic Explanations interpretability algorithms, while immune regulatory mechanisms were explored via weighted gene co-expression network analysis. The multimodal model achieved an area under the curve (AUC) of 0.89 for predicting sepsis and 28-day mortality, outperforming unimodal models (clinical-only model, AUC 0.72, and imaging-only model, AUC 0.78). Critical predictors included Sequential Organ Failure Assessment score, lactate levels, intra-abdominal free fluid on imaging, and immunoregulatory genes (programmed death-ligand 1 [PD-L1] and indoleamine 2,3-dioxygenase 1 [IDO1]). Mechanistic analysis revealed distinct immune reprogramming in patients with sepsis, characterized by increased regulatory T cells and M2 macrophages, along with downregulated cluster of differentiation 8+ (CD8+) T cells. This multimodal AI model offers an innovative digital solution in medical informatics, enabling precise early risk stratification for ECF-associated sepsis. By integrating multisource data and providing interpretable insights into immune-inflammatory pathways, the model enhances health care quality for patients with ECF and paves the way for personalized intervention strategies.

20. Evaluating Minority Representation in the All of Us Research Program: Progress and Ongoing Challenges.

期刊: American journal of public health 发表日期: 2026-Apr-30 链接: PubMed

摘要

Objectives. To evaluate trends in racial and ethnic representation in the All of Us (AoU) Research Program from 2017 to 2023 and assess regional disparities relative to US Census benchmarks. Methods. Using the AoU data repository, we compared yearly and cumulative racial/ethnic representation with 2020 US Census data. Odds ratios (ORs) were calculated to quantify underrepresentation by group, year, region, and sex at birth. Results. Non-Hispanic White individuals accounted for the largest percentage of the 619 830 participants (56.3%), followed by non-Hispanic Blacks (15.9%), Hispanics (14.9%), Asians (3.5%), and individuals in the multiracial/other category (9.4%). Asians and Hispanics were consistently underrepresented. Regional disparities were notable: Asian representation was lowest in the West (OR = 0.48; 95% confidence interval [CI] = 0.47, 0.49), and Hispanic underrepresentation was most pronounced in the South (OR = 0.54; 95% CI = 0.53, 0.55). Conclusions. Persistent underrepresentation of Asian and Hispanic participants highlights ongoing gaps as AoU recruitment continues. Continued efforts toward equitable participation will be important for achieving the scientific and ethical goals of precision medicine. (Am J Public Health. Published online ahead of print April 30, 2026:e1-e4. https://doi.org/10.2105/AJPH.2026.308441).

21. Protective effects of 23-valent pneumococcal polysaccharide vaccination against mortality among elder patients with type 2 diabetes mellitus.

期刊: Diabetic medicine : a journal of the British Diabetic Association 发表日期: 2026-Apr-30 链接: PubMed

摘要

Older adults with type 2 diabetes mellitus are at elevated risk for severe pneumococcal disease, experiencing higher rates of complications and mortality. However, the evidence for the protective benefits of the 23-valent pneumococcal polysaccharide vaccine (PPSV23) against mortality in this demographic remains limited. This retrospective study included 8649 elderly people with type 2 diabetes mellitus in Soochow, China, comprising 3247 PPSV23-vaccinated individuals and 5402 unvaccinated patients. Cox proportional hazards analyses were performed to calculate the adjusted hazard ratios (HRs) of the association between PPSV23 vaccination and the risk of all cause mortality, pneumonia-related mortality, cardiovascular disease-related mortality and cancer mortality. Inverse probability weighting (IPW) was applied to estimate the average treatment effect (ATE) of universal PPSV23 vaccination compared to unvaccinated. During the follow-up period, a total of 1557 deaths were recorded. Compared to unvaccinated elderly people with type 2 diabetes mellitus, those receiving PPSV23 vaccine exhibited significantly lower risks of all-cause mortality (HR: 0.47; 95% CI: 0.42-0.53), with reductions also observed in deaths related to cardiovascular disease (HR: 0.50; 95% CI: 0.41-0.62), pneumonia (HR: 0.62; 95% CI: 0.43-0.89) and cancer (HR: 0.54; 95% CI: 0.42-0.70). Furthermore, IPW estimates indicated that universal PPSV23 vaccination among the elderly people with type 2 diabetes mellitus could prevent an average of 11.4% of all-cause deaths (p < 0.001), 4.0% of cardiovascular disease-related deaths (p < 0.001), 0.8% of pneumonia-related deaths (p = 0.005) and 1.9% of cancer deaths (p < 0.001). PPSV23 vaccination is associated with a reduced risk of all cause mortality, cardiovascular disease-related mortality, pneumonia-related mortality and cancer mortality in elderly people with type 2 diabetes mellitus.

22. Advancing Force Readiness Through Overseas Tropical Medicine Training: Experiences from the Walter Reed Army Institute of Research-Armed Forces Research Institute of Medical Sciences.

期刊: Military medicine 发表日期: 2026-Apr-30 链接: PubMed

摘要

Walter Reed Army Institute of Research-Armed Forces Research Institute of Medical Sciences provides medical readiness training in the Indo-Pacific. While executing Thailand rotations, it is developing similar training opportunities in the Philippines. Increased funding and personnel support ensure that this program supports the force health protection readiness of military health professionals.

23. Prevalence and incidence of dysnatremia in European community-dwelling older adults-a secondary analysis of the DO-HEALTH trial.

期刊: European journal of endocrinology 发表日期: 2026-Apr-30 链接: PubMed

摘要

Dysnatremia is the most common electrolyte abnormality detected during hospitalizations and outpatient visits and is associated with adverse outcomes in older adults. However, data on its prevalence and incidence in community-dwelling older individuals remain limited. This study aimed to estimate the prevalence and incidence of dysnatremia in this population across 5 European countries (Austria, France, Germany, Portugal, and Switzerland). Observational analysis of DO-HEALTH, a 3-year multicenter clinical trial including 2157 community-dwelling, generally healthy adults aged 70 years and older. Sodium blood levels were collected at baseline, 12, 24, and 36 months. Dysnatremia was defined as sodium levels <135 mmol/L (hyponatremia) or >145 mmol/L (hypernatremia). Baseline prevalence and 3-year incidence were estimated overall and by predefined subgroups based on sex, age, country of residence, body mass index, prevalent chronic conditions, polypharmacy, and use of thiazide-like diuretics. At baseline, 2141 participants (99.3%) had available sodium data. The prevalence of dysnatremia was 3.4% (2.4% hyponatremia; 1.0% hypernatremia), with higher prevalence in participants aged ≥75 years (4.8%) and those using thiazide or thiazide-like diuretics (5.4%). Over 3 years, 150 participants (7.0%) experienced at least 1 episode of dysnatremia (3.8% hyponatremia; 3.2% hypernatremia). Higher incidence of dysnatremia was observed among participants living in Switzerland, using thiazide or thiazide-like diuretics, and with prevalent dysnatremia at baseline. Dysnatremia, previously linked to adverse outcomes in older adults, was observed in a non-negligible proportion of generally healthy, community-dwelling older individuals. These findings provide valuable epidemiologic data and identify subgroups that may warrant closer clinical attention.

24. Structural Advantage and White Men's Health and Well-Being.

期刊: American journal of public health 发表日期: 2026-Apr-30 链接: PubMed

摘要

Policies and programs aimed at reducing structural inequality can improve the health of both majoritized and minoritized populations. The United States was founded by men racialized as White, and this group holds substantial political, economic, and social advantages. Thus, it is paradoxical that non-Hispanic White American men do not collectively experience better health outcomes than minoritized racialized and gendered groups. Why do structural advantages fail to reliably and equally translate into health advantages for all men racialized as White? In our analytic essay, we theorize why and how the intersections of structural and psychosocial factors can disparately influence the health and well-being of the population at the top of racial and gender hierarchies. We argue that understanding White men’s health and well-being through the intersection of structural whiteness and hegemonic masculinity may enhance our ability to improve US population health. We illustrate why health researchers should continue applying an intersectional lens to understand and ameliorate the complex ways structural inequality produces health outcomes that vary by race, gender, class, and other social identities. (Am J Public Health. Published online ahead of print April 30, 2026:e1-e9. https://doi.org/10.2105/AJPH.2026.308430).

25. Keeping Sight of Albay: Vitamin A Blindness, Randomized Controlled Trials, and Cold War Foreign Aid Policy.

期刊: American journal of public health 发表日期: 2026-Apr-30 链接: PubMed

摘要

Physicians have long known that vitamin A deficiency causes pediatric blindness. However, in 1986, Johns Hopkins researchers examining the impact of vitamin A supplementation on overall child mortality in Albay, Philippines, encountered strong local opposition, forcing the study’s termination. Drawing on internal documents, interviews, and archival correspondence, this article uses the Albay study’s collapse as a case study to examine how Cold War‒era cultural, geopolitical, and social forces shaped the public health knowledge production process. This history offers insights into how policymakers might develop effective modern foreign aid projects, especially as funding priorities continue to evolve. (Am J Public Health. Published online ahead of print April 30, 2026:e1-e9. https://doi.org/10.2105/AJPH.2026.308447).

26. Safe Minimum Nurse Staffing Requirements for Hospitals: Evidence From Pennsylvania.

期刊: Medical care 发表日期: 2026-Apr-30 链接: PubMed

摘要

The Pennsylvania legislature is considering limiting the number of patients nurses care for to promote safe care. To determine whether variation in nurse workloads is associated with adverse consequences for patients, nurses, and hospital costs in Pennsylvania. Observational study of 547,689 medical and surgical patients and 2782 direct care nurses in 132 Pennsylvania hospitals. The independent variable was medical-surgical nurse staffing ratios. Patient outcomes included 30-day mortality, 30-day readmissions, and length of stay. Nurse outcomes included burnout, job dissatisfaction, intent to leave, and evaluations of hospital management and patient care. Hospital outcomes were HCAHPS Star Ratings and cost offsets associated with better staffing. Hospital nurse staffing ranged from 3 to 9 patients per nurse (average 5.9). Each additional patient per nurse was associated with higher odds of 30-day mortality (AOR: 1.08, 95% CI: 1.03, 1.13, P<0.001), longer length of stay (IRR: 1.02, 95% CI: 1.00, 1.04, P<0.05) and higher odds of readmission (AOR: 1.04, 95% CI: 1.01, 1.07, P<0.05). Worse staffing was associated with higher odds of nurse burnout, job dissatisfaction, and intent to leave, and lower patient satisfaction. Cost savings from patient outcomes and nurse retention were projected to offset costs of additional nurses needed for hospitals to meet a minimum safe nurse staffing level proposed in legislation. Large differences across Pennsylvania hospitals in the amount of nursing care patients receive are associated with negative consequences. A state policy establishing minimum safe nurse staffing requirements in hospitals is in the public’s interest.

27. Recruiting and Retaining Older Healthcare Professionals: Evidence-Based Strategies for a Resilient Workforce.

期刊: Policy, politics & nursing practice 发表日期: 2026-Apr-30 链接: PubMed

摘要

The global shortage of healthcare professionals is a critical challenge driven by demographic changes, workforce attrition, and increasing healthcare demands. Older professionals contribute valuable experience and interpersonal skills but are often underutilized due to stereotypes, health concerns, and challenges in adapting to new technologies. This systematic review, conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 reporting guideline, examined strategies to recruit and retain older healthcare professionals and to promote intergenerational collaboration. A comprehensive literature search was performed in PubMed, Medline, and Google Scholar for studies published before March 2025 that addressed recruitment and retention strategies, workplace diversity, and collaboration across generations. Of 224 records initially identified, 84 met the inclusion criteria and were synthesized narratively. Effective recruitment strategies included community-based outreach and flexible work arrangements, while retention measures such as phased retirement, mentoring programs, and workplace health initiatives supported knowledge transfer, job satisfaction, and workforce stability. Digital knowledge management and structured mentoring programs further facilitated intergenerational collaboration. A structured approach to workforce planning that integrates diversity and inclusivity can help mitigate healthcare workforce shortages by leveraging the strengths of different generations. Ensuring adaptable working conditions, intergenerational collaboration, and continuous knowledge exchange can strengthen workforce resilience and support the sustainability of healthcare systems. Future research should evaluate the long-term effects of these strategies on workforce stability and patient outcomes.

28. Advocacy Convergence in Medicine: Analyzing Legislative Priorities and Political Action Committee Overlap Among Major Medical Societies.

期刊: Urology practice 发表日期: 2026-Apr-30 链接: PubMed

摘要

Advocacy in health policy involves a broad coalition of medical professionals, including physicians, advanced practice providers, and patient advocacy stakeholders. These advocacy efforts shape federal policies that directly influence urology practice, including procedural reimbursement, prior authorization, telehealth access, and surgical liability. Medical societies are key intermediaries between physicians and policymakers, yet the extent of alignment in advocacy priorities across organizations remains unclear. We evaluated convergence in legislative priorities, lobbying activities, and political engagement among major medical societies to contextualize urology advocacy within the broader health policy landscape. This cross-sectional study analyzed advocacy efforts, legislative priorities, and Political Action Committee (PAC) contributions of ten U.S. medical and specialty societies from 2020-2024 using publicly available data from OpenSecrets, the Federal Election Commission, and organizational websites. Societies included the American Urological Association and nine other national medical societies selected based on national presence, advocacy activity, and clinical scope. Legislative priorities of each society were grouped into thirteen policy categories. Lobbying and PAC data were analyzed by agency targets, legislation, expenditures, and campaign recipients. All ten societies prioritized reducing administrative burdens, expanding telemedicine, supporting physician well-being, and advancing health equity. Most lobbied the Centers for Medicare & Medicaid Services and the Department of Health and Human Services in 2024. The American Medical Association reported the highest lobbying expenditures. PAC contributions across societies targeted legislators on the House Energy and Commerce, Appropriations, and Ways and Means Committees. Medical society advocacy agendas have substantial overlap, suggesting opportunities for coordinated efforts to shape health policies impacting payment structures, coverage decisions, and workforce sustainability in urology.

29. Associations Between Caregiver Feeding Practices and Food Neophobia in Children: A Systematic Review and Meta-Analysis Guided by the Vaughn Conceptual Framework.

期刊: Nutrition reviews 发表日期: 2026-Apr-30 链接: PubMed

摘要

Food neophobia limits dietary diversity in childhood and may have lasting implications for growth, development, and health. Caregiver feeding practices are considered a potentially modifiable factor for food neophobia in children, yet evidence regarding their associations remains fragmented and inconsistent. This study aimed to systematically synthesize and quantify the associations between caregiver feeding practices and food neophobia in children. We conducted a systematic search of PubMed, Web of Science, Embase, the Cochrane Library, CINAHL, and PsycINFO for studies published from inception to November 20, 2024. Eligible studies involved children younger than 18 years and were published in English. 2 reviewers independently screened titles, abstracts, and full texts. Data on study characteristics, caregiver feeding practice constructs, food neophobia measures, and effect estimates were extracted. Caregiver feeding practices were classified according to the Vaughn conceptual framework. Study quality was assessed using the Newcastle-Ottawa Scale and the Agency for Healthcare Research and Quality assessment tool. Meta-analyses were conducted using pooled correlation coefficients with fixed- or random-effects models as appropriate. 17 studies, with an overall total of 10 102 children with a mean age of approximately 6 years, were included. The “pressure to eat” (r = 0.17; 95% CI, 0.11-0.24) and “restriction” (r = 0.07; 95% CI, 0.01-0.13) were associated with higher food neophobia, while “modeling” was associated with lower food neophobia (r = -0.09; 95% CI, -0.13 to 0.04). Moreover, the association between “pressure to eat” and food neophobia was stronger in non-Asian than Asian populations. These findings suggest that caregivers and relevant health professionals should prioritize positive role modeling in caregiver feeding practices rather than relying on coercive feeding strategies, especially for non-Asian populations. PROSPERO registration No.[CRD42024602848].

30. Voices of Trust: A Thematic Analysis of Black News Media's Messaging to Promote COVID-19 Vaccination.

期刊: American journal of health promotion : AJHP 发表日期: 2026-Apr-30 链接: PubMed

摘要

PurposeThis descriptive study explores how a trusted information source within the Black community-the Black News Media-promoted COVID-19 vaccination during a time when this population experienced high rates of vaccine hesitancy and low COVID-19 vaccine uptake.ApproachTo explore the media’s role in promoting COVID-19 vaccination, a multi-level sampling method was used to identify newspaper articles for review.SettingNewspaper articles discussing COVID-19 vaccination published by newspapers primarily serving Black communities between March 2021 and October 2022.ParticipantsNewspaper publishers were identified through the Black Media Initiative -a resource that catalogs media outlets in the U.S that primarily serve Black communities. Publishers were selected based on their publishing frequency and online accessibility.MethodOne hundred fifty newspaper articles were randomly sampled from a sample of 906 articles. Using an inductive thematic analysis, this study examined the key themes used to encourage vaccination among Africans Americans.ResultsThe study found five key themes the Black News Media used to promote vaccination: Protecting others, particularly the vulnerable, the unvaccinated, deadly decisions, responsibility, and return to normalcy.LimitationsSampling constraints, including uneven outlet representation across regions and the exclusion of difficult-to-search archives, may have limited the diversity of perspectives and themes identified. Moreover, the review may have excluded some viable articles.ConclusionSeveral of the themes used by media aligned with frames recognized as effective in promoting vaccination, making them well-suited to address high levels of vaccine hesitancy and skepticism toward the COVID-19 vaccine within Black communities.

31. HER2 deficiency causes a developmental disorder with growth retardation and craniofacial malformations.

期刊: The Journal of clinical investigation 发表日期: 2026-Apr-30 链接: PubMed

摘要

The human epidermal growth factor receptor 2 (HER2) is a major therapeutic target in cancer. While the oncogenic effects of HER2 hyperactivation are well-characterized, the biological consequences of its deficiency remain poorly defined. Here, through exome sequencing analyses of a cohort of 720 families affected by isolated or syndromic orofacial clefts, we unexpectedly identified five distinct rare germline HER2 variants in five unrelated families with growth deficits, orofacial clefts, and other craniofacial, skeletal, and auditory anomalies. In Xenopus embryos, these variants failed to recapitulate the developmental effects of wild-type HER2. In cultured cells, they disrupted HER2 protein stability, membrane localization, or site-specific phosphorylation, resulting in diminished ERK signaling. Strikingly, knock-in mice expressing a patient-derived HER2 variant and mice maternally exposed to Tucatinib, a recently approved anti-HER2 drug, both replicated patient phenotypes: retarded growth and diverse craniofacial abnormalities, including ocular dysgenesis, short jaws, and cleft palate. Collectively, our findings define a developmental disorder that we designate GRACE syndrome (Growth Retardation and Craniofacial Malformations Caused by HER2 Deficiency), establish HER2’s essential role in human growth and craniofacial morphogenesis, and reveal that HER2-targeted therapies during pregnancy can induce craniofacial defects and lifelong growth impairment in fetuses. 5.

32. Neuron-Associated Transcriptional Enrichment Is Associated with Distinct Biological States and Predicts Poor Prognosis in Gastric Cancer.

期刊: Annals of surgical oncology 发表日期: 2026-Apr-30 链接: PubMed

摘要

The peripheral nervous system can contribute to tumor development, progression, and metastasis; however, the clinical relevance of neuronal features within the tumor microenvironment in patients with gastric cancer (GC) remains to be fully elucidated. Bulk transcriptomic and clinical data from publicly available databases were used to evaluate an xCell score that quantified the relative enrichment of neuron-associated gene expression programs in GC tumors. This allowed stratification into neuron score-high and neuron score-low groups within each cohort, with the upper two-thirds defined as high. Associations between neuronal enrichment and tumor biology were evaluated through analyses of neurotransmitter receptor expression, gene set enrichment, tumor microenvironment composition, genomic features, and patient survival. Neuron score-high GC exhibited characteristic enrichment of β-adrenergic, dopamine, and muscarinic acetylcholine receptor gene expression, consistent with enhanced neurochemical signaling potential. At the tumor cell level, the neuron score-high group was associated with activation of epithelial-mesenchymal transition (EMT) programs, whereas cell proliferation-related pathways were preferentially enriched in neuron score-low tumors. Neuron score-high tumors further displayed attenuated antitumor immune infiltration, increased stromal components, and elevated intratumor heterogeneity despite a lower mutation burden. Across both cohorts, neuron score-high tumors were associated with worse overall survival and remained independently associated with prognosis in multivariate analyses. Neuron score-high GC tumors were consistently associated with distinct patterns of neurotransmitter receptor gene expression, enhanced EMT programs with reduced cell proliferation, attenuated antitumor immune infiltration, increased intratumor heterogeneity, and worse prognosis. These observations identify the neuron score in bulk tumors as a potential indicator of GC biology.

33. The importance of meeting physical activity recommendations and limiting sedentary time in adult survivors of childhood acute lymphoblastic leukemia - associations with fatigue and HRQoL.

期刊: Journal of cancer survivorship : research and practice 发表日期: 2026-Apr-30 链接: PubMed

摘要

The aim was to investigate physical activity levels and associations between physical activity levels, sedentary time, fatigue, and health-related quality of life (HRQoL) in adult survivors of childhood acute lymphoblastic leukemia (ALL). This national cross-sectional study included 426 adult survivors of childhood ALL (diagnosed 1985-2007, 49% women, median age 32 [min-max 19-49]), who completed a questionnaire on physical activity (BHW-Q), sedentary time (SED-GIH-Q), fatigue (MFI-20), and HRQoL (SF-36). Associations were analyzed using linear regression. Overall, 44% of participants did not meet physical activity recommendations. Median weekly duration of vigorous-intensity and moderate-intensity activity was 45 min (Q1-Q3 15-105) and 120 min (Q1-Q3 45-175), respectively. Median sedentary time was 8 h per day (Q1-Q3 5-11). Not meeting recommendations was significantly associated with greater fatigue (total MFI-20 score β = 1.7, 95% CI 0.1 to 3.3, p = 0.033) and lower physical and mental health components of HRQoL (SF-36 PCS β = -3.3, 95% CI -5 to -1.5, p < 0.001; SF-36 MCS β = -4.2, 95% CI -6 to -1.8, p < 0.001). Sedentary time ≥ 7 h per day was significantly associated with lower mental HRQoL (SF-36 MCS β = -3.6, 95% CI -5.9 to -1.2, p = 0.003). Many adult survivors of childhood ALL had insufficient levels of physical activity and accumulated considerable sedentary time. Insufficient physical activity was associated with greater fatigue and lower HRQoL, while greater sedentary time was associated with lower mental HRQoL. However, given the cross-sectional design, causality cannot be inferred. Physical activity promotion is a potential strategy to reduce fatigue and enhance HRQoL among adult survivors of childhood ALL.

34. Assessing the Global, Regional, and National Burden of Childhood Lower Respiratory Infections From Nonexclusive Breastfeeding, 1990-2021: Global Burden of Disease, Injuries, and Risk Factors Study 2021 Analysis and Implications for Public Health Strategies.

期刊: Journal of human lactation : official journal of International Lactation Consultant Association 发表日期: 2026-Apr-30 链接: PubMed

摘要

Nonexclusive breastfeeding is a major risk factor for childhood lower respiratory infections, yet its global burden remains unquantified. Although exclusive breastfeeding is widely recommended, the attributable burden of early infancy lower respiratory infections linked to nonexclusive breastfeeding and cross-country performance gaps have not been systematically assessed. This analysis fills that gap by combining burden estimates with frontier benchmarking. Using the Global Burden of Diseases, Injuries, and Risk Factors Study 2021 database, we estimated deaths, disability-adjusted life years, age-standardized mortality rates, age-standardized disability-adjusted life-year rates, and population attributable fractions of lower respiratory infections attributable to nonexclusive breastfeeding across 204 countries and territories from 1990 to 2021. Temporal trends were assessed with joinpoint regression, and frontier analysis was applied to identify efficiency gaps. In 2021, nonexclusive breastfeeding accounted for 37,890 lower respiratory infection deaths and 3.41 million disability-adjusted life years globally, with boys carrying a higher burden. India, Nigeria, and Pakistan had the largest absolute numbers, whereas Chad, Somalia, and South Sudan had the highest standardized rates. Neonates (<28 days old) showed the highest mortality and disability-adjusted life-year rates, indicating greater vulnerability than with infants aged 1-5 months. Globally, age-standardized mortality rates and age-standardized disability-adjusted life-year rates declined significantly from 1990 to 2021 (average annual percentage change -4.87%), although sub-Saharan Africa and South Asia still bore the heaviest burden. Frontier analysis revealed substantial potential for further reduction in low- and low-middle sociodemographic index countries through improved breastfeeding and health system strengthening. Despite global progress, nonexclusive breastfeeding remains a major contributor to childhood lower respiratory infections, particularly among neonates and in low-sociodemographic index settings. Strengthening breastfeeding promotion and maternal-child health services is critical to reducing mortality, morbidity, and regional inequities. To achieve this, scaling evidence-based policies, such as Baby-Friendly practices, community lactation support, maternity protection, and strong enforcement of the International Code of Marketing of Breast Milk Substitutes is essential.

35. Haemochromatosis - a modern clinician's guide.

期刊: Internal medicine journal 发表日期: 2026-Apr-30 链接: PubMed

摘要

Haemochromatosis is an inherited disorder of iron metabolism affecting approximately 100 000 Australians. Iron overload may result in end organ dysfunction, most commonly manifesting as chronic liver disease, arthropathy and endocrinopathies. End organ complications can be prevented, minimised or reversed, with early diagnosis and initiation of treatment in the form of venesection. Our understanding of the pathogenesis and epidemiological characteristics of the disorder has evolved in recent decades, including identification of HFE gene variants and sex-specific differences in phenotypic expression of the disorder. This clinical perspective article summarises the up-to-date evidence regarding the pathophysiology, clinical manifestations and treatment recommendations for haemochromatosis.

36. Randomized, Placebo-Controlled Trial of B-Cell Depletion for Prevention of Corticosteroid-Requiring Chronic Graft-Versus-Host Disease.

期刊: Journal of clinical oncology : official journal of the American Society of Clinical Oncology 发表日期: 2026-Apr-30 链接: PubMed

摘要

Chronic graft-versus-host disease (cGVHD) is a multisystem alloimmune disorder associated with abnormal B-cell biology and aberrant antibody responses. As B-cell-directed therapy can effectively treat established cGVHD, we tested whether prophylactic B-cell depletion could prevent the development of corticosteroid-requiring cGVHD following allogeneic transplantation. We performed a randomized, placebo-controlled, and blinded trial comparing four doses of the B-cell-depleting antibody obinutuzumab (1,000 mg once on days 90, 180, 270, and 365 after transplantation) with placebo in transplant recipients receiving tacrolimus-based GVHD prevention at higher risk of cGVHD. The primary end point was the 1-year incidence of corticosteroid-requiring cGVHD. We measured antibody responses against Y chromosome-encoded minor histocompatibility (H-Y) antigens and correlated their occurrence with corticosteroid-requiring cGVHD incidence. One hundred seventy-eight participants were analyzed. The prophylactic administration of obinutuzumab resulted in profound B-cell depletion, a significant reduction in the incidence of steroid-requiring cGVHD at 1 year (13.3% v 35.2%; P = .0005), and an improvement in immunosuppression-free, relapse-free survival (48% v 34% at 2 years; P = .02). Neutropenia was more common in the obinutuzumab arm, but nonrelapse mortality was not different. In participants without preformed H-Y antibodies at the time of study intervention, obinutuzumab resulted in the most significant reduction in steroid-requiring cGVHD at 12 months (8.6%) compared with obinutuzumab participants with H-Y antibodies (40%) or placebo participants regardless of antibody status (41% with antibodies, 57% without antibodies). In allogeneic transplant recipients at higher risk of cGVHD, early B-cell depletion results in a significant reduction in the incidence of corticosteroid-requiring cGVHD.

37. Divergent Roles of Skeletal Muscle 11β-HSD1 in Age-Related and Chronic Kidney Disease-Associated Sarcopenia.

期刊: European journal of endocrinology 发表日期: 2026-Apr-30 链接: PubMed

摘要

Chronic kidney disease (CKD) is associated with increased incidence of sarcopenia and muscle weakness in aging patients. The glucocorticoid activating enzyme11β-hydroxysteroid dehydrogenase type 1 (11β-HSD1) within skeletal muscle in these patients has been implicated in driving this process. We hypothesised that skeletal muscle 11β-HSD1 is elevated in CKD and aging where it would represent a promising therapeutic target. We measured 11β-HSD1 activity in quadriceps biopsies from 17 CKD patients (eGFR <30 ml/min) and 14 age-matched controls (mean age 71±5 years). Muscle strength, mass, and gait speed were assessed in relation to tissue 11β-HSD1 activity. Primary human myotubes were treated with patient-derived sera to evaluate regulatory drivers. Murine models of CKD (adenine diet) and aging (21 months) in wild-type (WT) and 11β-HSD1 knockout (11βKO) animals were examined to model therapeutic targeting. Muscle 11β-HSD1 activity was not elevated with CKD, but increased with age (r=0.559, p=0.001), predicting lower grip strength (p=0.008). Markers of inflammation, including c-reactive protein and IL-6 strongly predicted 11β-HSD1 activity. Pro-inflammatory mediators such as TNFα, directly upregulated 11β-HSD1 activity in myotubes, whilst sera from CKD donors did not. Whilst mice with 11βKO deletion were not protected from CKD driven muscle atrophy, 11βKO animals showed marked protection against age related muscle loss. Skeletal muscle 11β-HSD1 activity is not induced by CKD itself, but increases significantly over aging, where it is a predictor of muscle weakness. Its targeted deletion, preserves muscle mass in aged mice, supporting its efficacy in preventing sarcopenia in an aging CKD population.

38. Detection of a Single Measles Infection Using Untargeted Ultra-Deep Metagenomic Sequencing of Wastewater in Cook County, Illinois.

期刊: NEJM evidence 发表日期: 2026-Apr-30 链接: PubMed

摘要

AbstractMeasles is a contagious, vaccine-preventable viral disease that can be shed into wastewater by infected individuals. In September 2025, as part of an ongoing, nontargeted, ultra-deep metagenomic sequencing effort of wastewater in Cook County, Illinois, we detected measles reads from a facility serving more than 1 million people. Out of more than 900 million reads sequenced from wastewater collected on September 14, 2025, 43 matched measles virus genotype B3. Subsequent genomic analysis linked these reads to a confirmed measles infection that was present in the community on that day, demonstrating that untargeted metagenomics appeared to detect a single measles infection in a large municipal wastewater stream.

39. Morphological Rather Than Abundance Factors Control Microplastic Accumulation in Wheat Grains: A Field-Based Study.

期刊: Journal of agricultural and food chemistry 发表日期: 2026-Apr-30 链接: PubMed

摘要

Most microplastic (MP) uptake studies are lab-based, lacking field validation. This study analyzes MP accumulation in wheat grains under conventional farming, linking it to soil MP properties. Two wheat varieties showed consistent accumulation trends. Py-GC/MS identified polyethylene terephthalate (PET) as the most abundant grain MP (5.70 ± 0.41 mg/kg), while polystyrene (PS) was least accumulated (0.82 ± 0.12 mg/kg) despite higher soil PS levels, indicating selective uptake. Grain MP content did not correlate with soil MP abundance but negatively correlated with particle size (p < 0.001): PET and PE (20-40 μm) accumulated more than polyvinyl chloride (PVC) (70-80 μm). MP shape also influenced uptake (p < 0.05); fibrous PS likely hindered absorption. This study is the first to identify MP shape as a key factor in plant uptake, offering new mechanistic insights.

40. Escherichia coli pathobionts and Crohn's disease: varied genetic paths leading to similar phenotypes.

期刊: Journal of bacteriology 发表日期: 2026-Apr-30 链接: PubMed

摘要

Crohn’s disease (CD), an inflammatory bowel disease that arises from an immune attack on the gastrointestinal tract, affects roughly 1.6 million Americans. The etiology of CD and the other major irritable bowel disease, ulcerative colitis, is not known, but host genetics and immunology, the gut microbiome, and environmental factors are all thought to be involved. In addition, adherent-invasive Escherichia coli (AIEC) strains, which are able to adhere to and invade epithelial cells and macrophages, are frequently found to be associated with CD. Besides their adherence and invasion properties, key features that distinguish AIEC from commensal E. coli include increased biofilm formation, increased antibiotic resistance, and survival/replication within macrophages. However, these pathobionts lack genetic features typical of frank pathogens. Thus, the potential role AIEC plays in CD pathogenesis is not clear. The E. coli pathobiont LF82, isolated from the ileum of a patient with CD, has been a well-studied, prototypic AIEC. Dozens of single-nucleotide polymorphisms (SNPs) distinguish LF82 and other AIEC from commensal E. coli, suggesting that some of these genetic features might account for particular LF82 phenotypes. In this review, we summarize changes in the CD gut, the association of AIEC with CD, genes and SNPs associated with AIEC, and recent work connecting a specific SNP within a bacterial RNA polymerase gene to the expression of genes associated with the LF82 lifestyle.

41. Disinfection Byproducts in the Long-Tail Exposome: Unmet Challenges for Water Quality and Human Health.

期刊: Environmental science & technology 发表日期: 2026-Apr-30 链接: PubMed

摘要

42. Atmospheric Autoxidation of Polycyclic Aromatic Hydrocarbons Offset Air Quality and Health Gains from Solid Fuel Restriction.

期刊: Environmental science & technology 发表日期: 2026-Apr-30 链接: PubMed

摘要

Residential solid fuel combustion (RSFC) emits hazardous pollutants threatening air quality and human health, prompting China to reduce RSFC in key urban areas and implement controls on anthropogenic VOCs and NOx. However, uncoordinated emission reductions could pose new atmospheric challenges. The presence of polycyclic aromatic hydrocarbons (PAHs) in RSFC emissions warrants significant attention. Existing strategies predominantly target primary emissions, overlooking transformation products that could exert broader environmental impacts on the regional scales. Here, we identified an unexpected rearrangement-driven autoxidation pathway of naphthalene tricyclic-peroxy-radicals (TPRs). Quantum chemical calculations, lab experiments, and atmospheric modeling show that under low-NO conditions, TPRs rapidly generate highly oxygenated products, whereas high-NO environments promote epoxide formation, representing a new class of secondary organic aerosol precursors. This mechanism also extends to other PAHs such as methylnaphthalene, anthracene, and phenanthrene. Incorporating a time-dependent perspective, risk assessments reveal that transformation products exhibit reduced carcinogenicity yet enhanced mutagenicity and respiratory and skin toxicity, indicating that failing to consider atmospheric processing leads to substantial underestimation of RSFC impacts. These findings underscore that mitigation strategies must address both primary emissions and secondary PAH transformations, especially under low-NO conditions, while accelerating clean-energy transitions in rural areas, improving combustion efficiency, and accounting for the regional transport of pollutants.

43. Treating Behavioral Addictions With Augmented Reality and Virtual Reality: Scoping Review.

期刊: Interactive journal of medical research 发表日期: 2026-Apr-30 链接: PubMed

摘要

The use of augmented reality (AR) and virtual reality (VR) to address addictive behaviors such as substance use disorders and gambling disorders has been growing. However, little has been done to explore the use of AR and VR in the treatment of other behavioral addictions. This scoping review aims to provide an overview of existing literature on AR and VR interventions for behavioral addictions. Specifically, the research questions are as follows: (1) What behavioral addictions or behavioral harms are being treated using AR and/or VR? (2) What AR and/or VR treatment interventions are being used to treat these behavioral addictions? This scoping review was conducted based on the framework first proposed by Arksey and O’Malley, later refined by Levac et al, and further outlined in the Joanna Briggs Institute (JBI) Manual for Evidence. The literature was searched in the following databases: CINAHL, PsycArticles, PsycInfo, PubMed, and Web of Science, with Google advanced search complementing the search on Feb 22, 2023. Studies were screened by 2 independent reviewers based on inclusion criteria (all ages; any behavioral addiction, problematic behavior, or behavioral harm; AR or VR treatments and interventions) and exclusion criteria (pornography, sexual, and paraphilic disorders). Discrepancies were resolved by third and fourth reviewers. As this study is a scoping review, risk of bias was not assessed. Data were extracted and presented in tabular form as well as through conceptual analysis as a narrative summary. A total of 9 studies were included in this review, 4 studies on video gaming and 5 studies on gambling behaviors. Participants’ age ranged from 12 to 65 years. Only the use of VR was identified. VR was used as a platform for cue exposure therapy and skills training in both gaming and gambling disorders. VR therapy was effective alone or in combination with other treatments and was comparable to traditional interventions. No adverse effect was reported in the studies. VR is efficacious in treating behavioral addictions and can replace or be used in conjunction with traditional methods. Future directions include using VR with other psychotherapy or relapse prevention, applying VR to treat other addictions, and investigating harmful side effects of VR use. The frequency and duration of sessions can also be optimized. A limitation of this study is that there may be other documents beyond those published and searched in gray literature that could not be included in this review due to time and resource restrictions. The use of AR in the treatment of behavioral addictions did not yield any results in this review. However, VR application in behavioral addiction is promising, potentially efficacious, and capable of multiple applications. RR2-10.4309/EGCN4808.

44. Self-Management Interventions and Work Participation in Individuals with Musculoskeletal Disorders: A Scoping Review.

期刊: Journal of occupational rehabilitation 发表日期: 2026-Apr-30 链接: PubMed

摘要

Many individuals with work disability due to musculoskeletal disorders struggle to achieve a sustainable return to work. Although self-management interventions offer promising avenues to support work participation, their content, delivery characteristics and evaluation approaches remain unclear. This scoping review aimed to map the self-management interventions evaluated in relation to work participation among individuals with work disability due to musculoskeletal disorders, including their components, delivery methods and evaluation approaches. A scoping review was conducted in 10 databases (Academic Search Complete, AMED, SPORTDiscus, Medline, PsycINFO, CINAHL, Embase, Scopus, Cochrane Library, Physiotherapy Evidence Database) from inception to July 2025. Primary studies involving working-age individuals with musculoskeletal disorders, a self-management intervention and an assessment of work participation were included. Out of 8310 records, 31 studies representing 23 self-management interventions were included with a median of 10 components (range 3-16). Most studies included non-specific musculoskeletal disorders (n = 13, 41.9%) or low back pain (n = 8, 29%). Less than half of interventions included content specific to work (n = 10, 43%), lifestyle changes (n = 9, 39%), resource utilization (n = 8, 35%), and communication skills (n = 7, 30%). Interventions were typically delivered in person (n = 12, 52%), individually (n = 14, 61%), and with clinician involvement (n = 15, 65%), while 43% (n = 10) incorporated digital health. Most studies focused on intervention effectiveness (n = 23, 72%), assessing work ability (n = 10, 30.4%), sick leave and return to work (n = 9, 39.1%), and work disability (n = 7, 30.4%). Fewer studies included process outcomes (n = 14, 45%) or participant views (n = 8, 26%). This review revealed considerable heterogeneity in self-management components, delivery and evaluation methods. It identifies key gaps, suggesting the potential value of workplace-integrated self-management interventions to better support work participation.

45. Generic and Disease-Specific Themes in Occupational Reflections of Patients in Cardiac, Cancer and Orthopedic Rehabilitation: An Interview Study.

期刊: Journal of occupational rehabilitation 发表日期: 2026-Apr-30 链接: PubMed

摘要

To explore occupational perspectives of patients with elevated risk of non-return to work (RTW) in cardiac, cancer, and orthopedic rehabilitation. What themes are relevant when patients in medical rehabilitation reflect on their occupational future, and to what extent are identified themes specific to medical specialty? Face-to-face interviews were conducted with 51 patients (63% female, median age 55) of elevated risk of non-RTW in post-acute rehabilitation after hospital stay for an acute cardiac (n = 20), cancer (n = 15), or orthopedic disease (n = 16). Six months after rehabilitation discharge, 41 (80%) participants were interviewed again, to analyze the significance and relevance of the collected themes after return to daily life. The transcripts of audio-recorded interviews were analyzed by a combination of flexible pattern matching and thematic analysis. In their occupational reflections, patients considered seven themes related to health (perception of health / health behavior and lifestyle), work (characteristics of professional career/reintegration options/motives for (non) RTW), and personhood (uncertainty about the future/perception of the environment). Disease-specific aspects were found in heart-related anxiety for cardiac patients, perceived uncertainty about the future for cancer patients, and workplace/work characteristics for orthopedic patients. 61% of the participants did not RTW within six months after rehabilitation discharge. Occupational reflections of all patients were characterized by the same set of themes, with some themes having more relevance depending on participants’ medical specialty. Perceived uncertainty, health issues and expected barriers led to missing plans for future health-management and RTW-strategies and highlight the need for an occupational planning tool.

46. Are Newly Graduated Physiotherapists in Quebec Prepared for Work Rehabilitation Practice? A Mixed Method Study.

期刊: Journal of occupational rehabilitation 发表日期: 2026-Apr-30 链接: PubMed

摘要

Physiotherapists are frontline providers in supporting the return-to-work process of individuals with musculoskeletal disorders. However, many report feeling unprepared for work rehabilitation following entry-level training. This study explored recent physiotherapy graduates in Quebec, Canada, perceived preparedness to practice in work rehabilitation and its influencing factors. A convergent mixed methods design grounded in a competency-based framework was used. Recent graduates from physiotherapy programs completed a cross-sectional survey rating their perceived preparedness across seven work rehabilitation competencies. Semi-structured individual interviews explored how their training prepared them for work rehabilitation practice. Quantitative data were analyzed descriptively, and interviews were thematically analyzed. Findings were integrated through a joint display to contextualize preparedness ratings with qualitative insights. Twenty-five recent graduates from five physiotherapy programs across the province of Quebec completed both the survey and the interview. Perceived preparedness was highest for competencies on person-centered care and collaborative treatment planning, and lowest for psychosocial factors management, collaboration with involved actors, compensation system navigation, and return-to-work support. Three overarching themes influenced perceived preparedness: (1) role perceptions in work rehabilitation, (2) enablers such as supportive curriculum elements, and (3) challenges including stigma toward injured workers and limited work rehabilitation-specific training. A fourth theme described strategies to improve work rehabilitation training. Recent physiotherapy graduates reported varying levels of perceived preparedness for work rehabilitation, with the lowest ratings associated with managing psychosocial factors, collaborating with involved actors, navigating compensation systems, and supporting return to work. These gaps were linked to limited work rehabilitation training, perceived role ambiguity, and exposure to stigma. Future research should develop strategies to improve work rehabilitation training in physiotherapy programs.

47. A Multimodal Latent Severity Axis for Alzheimer's Disease: Probabilistic PCA, Bayesian Trajectories, and Stage-Aware Timing Effects.

期刊: Neurology and therapy 发表日期: 2026-Apr-30 链接: PubMed

摘要

Multimodal Alzheimer’s disease (AD) cohorts capture cognition, function, neuroimaging, and fluid biomarkers, yet overall disease severity remains difficult to summarize on a single clinically meaningful scale. The apolipoprotein E ε4 (APOE ε4) allele is the strongest common genetic risk factor for late-onset AD, but its association with “progression” has been inconsistent because earlier placement along the disease continuum is often conflated with faster within-stage decline. Using data from the Alzheimer’s Disease Neuroimaging Initiative (ADNI), we analyzed an amyloid-positive baseline cohort (N = 1058) and a longitudinal subset (N = 932; ≥ 2 visits and ≥ 4 of 13 measures per visit). Measures included standardized cognitive and functional assessments, structural and functional neuroimaging, cerebrospinal fluid biomarkers of amyloid‑beta and tau pathology, and plasma neurofilament light protein as a marker of neuroaxonal injury. Magnetic resonance imaging (MRI) volumes were adjusted using amyloid-negative cognitively normal controls with quadratic age and intracranial volume terms. Probabilistic principal component analysis (PPCA) was used to derive a latent severity coordinate, defined as the first principal component (PC1). Hierarchical Bayesian random-intercept and random-slope models were used to estimate individual trajectories, partition APOE ε4 effects into baseline severity and within-stage rate, and generate genotype-stratified ages at prespecified severity landmarks. Axis stability was assessed with 100 bootstrap refits, and predictive performance was assessed with participant-level fivefold cross-validation. The PC1 explained 38.7% of baseline variance and produced a clinically interpretable multimodal severity axis. Stability was high across bootstrap refits, and residual association with age was minimal after MRI volume adjustment. Higher APOE ε4 dose was associated with greater baseline latent severity, whereas within-stage rate differences were smaller than the baseline severity-position effect. A latent symptomatic landmark was reached approximately 3.0-3.3 years earlier per ε4 allele. Adding APOE improved out-of-sample prediction by about 10% without loss of calibration. Probabilistic principal component analysis provides a stable, multimodal, biologically informed severity axis for longitudinal modeling in amyloid-positive ADNI. Within this framework, APOE ε4 was associated primarily with latent severity position and model-implied timing along the continuum, whereas within-stage rate differences were smaller. These findings support stage-aware longitudinal inference and methodological applications within this cohort, while external clinical calibration and validation remain necessary.

48. Genome Editing Technologies for Cancer Therapy.

期刊: Current gene therapy 发表日期: 2026-Apr-21 链接: PubMed

摘要

Cancer remains one of the leading causes of death worldwide, and the limitations of conventional therapies such as surgery, chemotherapy, and radiotherapy underscore the urgent need for innovative therapeutic strategies. While advances in early detection and treatment have improved outcomes in some regions, challenges such as micrometastasis, tumor relapse, and multidrug resistance continue to hinder long-term success. The multifactorial nature of cancer-driven by complex genetic mutations, diverse tumor microenvironments, and adaptive cancer cell behavior- demands more precise and effective solutions. Recent breakthroughs in molecular biology and genetic engineering have led to the emergence of genome editing technologies that offer promising avenues for targeted cancer therapy. This review highlights the evolution and application of key genome editing platforms, including meganucleases, zinc finger nucleases (ZFNs), transcription activator- like effector nucleases (TALENs), and the CRISPR/CAS9 system. Meganucleases were among the earliest tools with site-specific cutting ability, but limited versatility. ZFNs and TALENs offered greater modularity and target specificity through protein-DNA interactions. The CRISPR/CAS9 system revolutionized genome editing with its RNA-guided targeting, allowing for higher efficiency, simplicity, and flexibility in gene modification. These tools have enabled researchers to disrupt oncogenes, repair tumor suppressor genes, and manipulate signalling pathways involved in tumor progression, resistance, and metastasis. Moreover, ongoing advancements in delivery systems and gene repair mechanisms have further enhanced their therapeutic potential. We also discuss their translational potential from bench to bedside and explore future perspectives on how these technologies may revolutionize precision oncology, ultimately contributing to more effective treatment outcomes.

49. "I called people to carry me to the latrine": Podoconiosis patients' access to water, sanitation, and hygiene in Butaro, Rwanda.

期刊: PLoS neglected tropical diseases 发表日期: 2026-Apr 链接: PubMed

摘要

Podoconiosis is a preventable Neglected Tropical Disease (NTD) that results in significant lower limb swelling and chronic disability. Its management can be done at home by regularly washing feet with clean water and soap and using protective footwear. This study aimed to explore podoconiosis patients’ experiences with access to water, sanitation, and hygiene (WASH) and to identify barriers and facilitators of home-based management (HBM). In this qualitative phenomenological study, participants were recruited following a screening conducted in Butaro Sector (Rwanda) to identify individuals with lower limb lymphedema. Randomly selected individuals underwent a clinical assessment, and only those confirmed to have podoconiosis were invited for an interview. In-depth interviews, supplemented by observation and photographs, were conducted. Transcripts were inductively coded using Dedoose (version 9.0.80) and analyzed through thematic analysis. Overall, 26 interviews were conducted across all five cells of Butaro Sector. Poverty and physical discomfort were major barriers in accessing WASH and HBM essentials, with many relying on family or neighbors for support. Shame, laughter, and discrimination from community members further hindered access to WASH. However, some participants found a financial solution in selling animal and household waste. Moreover, participants demonstrated little or no knowledge about podoconiosis which influenced their treatment choices. Many attributed the disease to witchcraft, blood infection, or God’s will. Common care choices included traditional healers, self-care, or health centers. These findings demonstrate the need to integrate community education into podoconiosis management programs to address misconceptions and stigma while promoting income-generating activities to ensure consistent access to HBM essentials.

50. Symbiotic and Pathogenic Interactions in the Rhizosphere.

期刊: Molecular plant-microbe interactions : MPMI 发表日期: 2026-Mar 链接: PubMed

摘要

The rhizosphere is one of the most dynamic biological environments on Earth. Within this narrow zone surrounding plant roots, plants interact constantly with diverse communities of microorganisms including bacteria, fungi, oomycetes, and nematodes. These interactions range from mutually beneficial associations that enhance nutrient acquisition and stress tolerance to detrimental relationships that compromise plant health and agricultural productivity. Understanding the molecular and ecological processes governing these interactions is therefore central to plant biology and sustainable agriculture. This Focus Issue of Molecular Plant-Microbe Interactions brings together 14 research and review articles that explore the complex system of relationships that shape plant health in the rhizosphere. The studies span beneficial associations such as plant growth-promoting rhizobacteria and symbiotic microbes, as well as pathogenic interactions involving bacteria, fungi, oomycetes, and plant-parasitic nematodes. Collectively, these contributions highlight emerging concepts in microbial recognition, immune regulation, microbial community assembly, and effector-mediated host manipulation. By integrating perspectives from molecular genetics, functional genomics, microbiology, and ecology, this special issue highlights recent advances in our understanding of rhizosphere interactions and illustrates how these findings may inform new strategies for improving crop resilience and sustainable agricultural production. [Formula: see text] Copyright © 2026 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license.

51. Exclusive breast feeding practice and associated factors among Rural and Urban mothers of child aged 0-6 months in Tahtay Maichew District of Tigray, Ethiopia, 2023/2024: Comparative cross sectional study.

期刊: PloS one 发表日期: 2026 链接: PubMed

摘要

The most well- recognized method of feeding a baby is breastfeeding. Out of all the preventive measures, breastfeeding and supplemental feeding have the most impact on child mortality for infants and young children. Babies are shielded against acute infections by the mother’s antibodies found in breast milk, and it boosts a baby’s immune system, their reaction to immunizations and cognitive benefits. This was aimed to compare and identify the factors associated with exclusive breastfeeding practice among the rural and urban lactating mothers of the District. Exclusive breast feeding practice of this rural area was in line with the urban which was 68.1% (95% CI, 62.1-73) and 64% (95% CI, 53.5-74.4) respectively. This might be due to the similar primary health care policy intervention system both in the rural and urban areas of the Region. Besides of this, both the rural and urban mothers of the district were more benefited from the Ethiopia primary health care packages. A comparative cross-sectional study was conducted. A total of 346 lactating mothers were enrolled for the study. 5 rural and 1 urban Kebeles were randomly selected. From these the simple random sampling technique was used. The interviewer administered structured questionnaire was employed. Epi-Data Manager Version 4.6 was used to enter, encode, and clean the data for consistency and completeness. The data was analyzed using SPSS version of 22. Bivariable and multivariable logistic regression analysis were performed. A total of 346 lactating mothers were selected in both rural (258) and urban (88) areas of the district. The response rate was 248 (96.12%) in rural and 86 (97.72%) in urban. The prevalence of exclusive breastfeeding practice in the rural and urban areas was 68.1% (95% CI, 62.1-73) and 64% (95% CI, 53.5-74.4), respectively. According to the multivariable logistic regression analysis, in the rural mothers’ educational status [AOR = 2.46, 95% CI (1.3-4.6)], parity [AOR = 2.56, 95% CI (1.4-4.7)], and antenatal care visit [AOR = 2.35, 95% CI (1.0-5.4)] were associated factors. In the urban area, education on exclusive breastfeeding practice during antenatal care visits [AOR = 3.46, CI (1.2-10)], mode of delivery [AOR = 3.7, CI (1.2-11.5)] and education on exclusive breast feeding practice during postnatal care visit [AOR = 2.9, CI (1.0-8.1)] were associated factors. Based on the mean score, exclusive breastfeeding practice in the rural and urban areas was slightly above the mean. This result doesn’t show a significant difference both in the rural and urban areas. But this was lower than the notional and global recommendation level. It was substantially correlated with maternal educational status, parity, and prenatal care visits in the rural areas and with health education during prenatal care visits, method of birth, and postnatal care visits in the urban areas. We recommend that health care policy makers and health care providers strengthen the delivery of health education about exclusive breastfeeding practice during ANC visits and PNC visits, and they should advocate institutional delivery. Secondly, mothers should attend ANC and PNC and conduct institutional delivery so as to get information about exclusive breastfeeding practice.

52. Experiences of caregivers and healthcare providers regarding health services for children with Down syndrome in Karachi; Pakistan.

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

摘要

This study aimed to investigate the experiences and perceptions of caregivers seeking healthcare services for children with Down Syndrome, and those of healthcare providers offering these services in Karachi, Pakistan. A total of 23 In-depth interviews were conducted with the study participants comprising of 10 caregivers (mothers and fathers) and 13 healthcare providers (paediatricians and therapists). Participants were selected through purposive sampling and interviewed using a semi-structured interview guide at a private NGO and a tertiary care hospital. The collected data underwent deductive content analysis, guided by the socio-ecological framework, to comprehensively explore the various factors. Experiences clustered across socio‑ecological levels. Intrapersonally, caregivers moved from shock and grief to faith‑based acceptance that sustained caregiving. Interpersonally, delayed/missed diagnosis, inadequate antenatal recognition, and scarce post‑diagnostic counselling forced families to self‑navigate care amid inconsistent provider engagement. Organizationally, high costs prompted reliance on NGOs; limited specialized services, long waits, and therapist burnout constrained individualized therapy. Community factors included service concentration in Karachi, long travel/relocation, financial burden, and pervasive stigma that curtailed social inclusion and lowered parental expectations. Policy gaps included absent DS‑specific clinical/counselling guidelines and poor epidemiologic data; participants prioritized a national registry to enable follow‑up and coordination. Education was a dominant, unmet need restricted by school policies and costs and often overshadowed health concerns. This study emphasizes the urgent need for system-level reforms and coordinated interventions to improve care pathways for children with Down syndrome in Pakistan. These changes are crucial for ensuring equitable access to timely, quality care for affected families, improving health outcomes, and supporting fuller social inclusion.

53. Refining research outcomes: Lessons from the setup of an endpoint review committee and radiological review in tuberculosis observational diagnostic studies.

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

摘要

Most tuberculosis diagnostic validation studies use microbiological or combination reference standards to define tuberculosis. We convened an Endpoint Review Committee (ERC) to define outcomes in ERASE-TB, a longitudinal cohort study across three high tuberculosis-burden countries, aimed at validating novel diagnostics for early detection. Herein, we describe processes and outcomes of the ERC. ERASE-TB enrolled 2,109 household contacts of people with tuberculosis who were followed up 6-monthly up to 24 months with clinical, microbiological, and radiological assessments at each visit. Any participants with a chest X-ray suggestive of tuberculosis or a positive Xpert MTB/Rif Ultra were investigated and eligible for endpoint review. For these, the clinical presentation, radiological, and microbiological results were reviewed independently by two study clinicians; any discordant endpoint categorisations were assessed by the ERC (first individually; if discordant, during a consensus meeting). Tuberculosis outcomes relied on predefined definitions (confirmed, likely, possible, unlikely). The ERC comprised four members: a tuberculosis programme manager, clinicians, and a radiologist. Semi-structured interviews (n = 4) with ERC members explored experiences and challenges in tuberculosis classification. A total of 96 clinical summaries underwent review, 55 were agreed internally, with the majority being categorised as confirmed tuberculosis (34/55, 61.8%). Among the remaining 41, the ERC members agreed on only 14 (34.1%) classifications, with the majority being classified as confirmed tuberculosis (10/14, 71.4%). The discordant 27 were discussed at the consensus meeting; 9/27 were classified as likely tuberculosis (33.3%), and 7/27 as possible and unlikely (25.9%). Qualitative interviews highlighted the complexity of tuberculosis diagnosis, value of longitudinal measurements, and tensions between decision making for research as compared to clinical purposes. Standardized tuberculosis classification frameworks, longitudinal data, and real-time expert review can improve diagnostic accuracy and comparability across studies. Future research should integrate structured ERC processes prospectively to refine tuberculosis case definitions and ensure robust clinical and research outcomes.

54. How does law and policy support providers of NHS healthcare in England to respond to harm experienced by patients during the course of their treatment and care: A scoping review.

期刊: PloS one 发表日期: 2026 链接: PubMed

摘要

Many countries have implemented laws and policies to help healthcare providers address patient harm. However, there is limited research on their effectiveness, especially in the context of England#39;s National Health Service (NHS). This scoping review asks: How does law and policy support NHS healthcare providers in England respond to harm?. A scoping review methodology was applied to map and summarise the literature to date. MEDLINE, CINAHL, and Westlaw were searched to identify potentially relevant literature that had been published between 2000 and 2025. Literature was included if it addressed care delivery in England#39;s NHS and healthcare providers’ responses to patient harm. Two reviewers independently screened the literature identified from the search against the eligibility criteria. A grey literature search of the citations within the included records was then conducted to identify relevant law and policy that supports providers of NHS healthcare in England to respond to patient harm. A total of 121 records were reviewed: 63 peer-reviewed and 58 pieces of grey literature. Data were charted using a standardised data extraction form. Themes were developed through a combination of thematic and content analysis, then presented as a narrative synthesis. The first of its kind, this scoping review identified English laws and policies that support NHS healthcare providers in England to respond to patient harm. It revealed the incongruent yet interdependent relationship that exists between England’s legal systems, healthcare policies and the promoted NHS values. The scoping review highlighted how organisational culture can overshadow law and policy and be the defining factor in how providers of NHS healthcare in England respond to patient harm. The impact of law and policy in curating organisational culture and response to patient harm is an area requiring further research. Ethics approval was not required for this review.

55. Implementation fidelity of Ethiopia's Malaria test-and-treat guideline amid a resurgence in Amhara Region: A mixed-methods study.

期刊: PloS one 发表日期: 2026 链接: PubMed

摘要

Ethiopia has experienced a marked malaria resurgence in recent years, with the Amhara Region disproportionately affected. Although Ethiopia’s national strategy emphasizes test-before-treat and a public-private mix, implementation fidelity of the malaria test-and-treat guideline during resurgence has not been well characterized. This study assessed fidelity to malaria diagnosis and treatment guidelines in public and private health facilities in the Amhara Region within this resurgence context. We conducted a convergent parallel mixed-methods study from February to March 2025 in 53 health facilities (38 public, 15 private) in Amhara Region. The facility was the unit of analysis; one provider primarily responsible for malaria case management was interviewed per facility (n = 53). Implementation fidelity was operationalized using Carroll’s framework across three domains: content (adherence to key diagnostic/treatment steps), coverage (proportion of suspected cases tested before treatment, extracted from facility registers), and frequency (self-reported consistency of testing for febrile patients in the preceding month). Domain scores were standardized to 0-100 and averaged with equal weights to form a composite fidelity score; ≥ 75% indicated high fidelity. To explain quantitative patterns, we conducted 32 in-depth interviews and analyzed data using inductive thematic analysis with CFIR-informed interpretation. Quantitative analysis used nonparametric tests and parsimonious multivariable linear regression, with prespecified sensitivity analyses excluding the self-reported frequency domain. Overall mean implementation fidelity was 64.3% (SD 12.1); 40% of facilities had high fidelity (≥75%), and 13% scored <50%. Public facilities had higher fidelity than private facilities (median 67% [IQR 60-77] vs 63% [IQR 56-70]; Wilcoxon rank-sum p = 0.041). In multivariable analysis, higher fidelity was associated with higher participant responsiveness (β = 3.4, p < 0.001), stronger facilitation strategies (β = 2.8, p < 0.001), and lower perceived intervention complexity (reverse-coded; β = 2.1, p < 0.001). Interviews indicated that fidelity gaps were driven by diagnostic and treatment deviations (including non-species-specific prescribing), inconsistent counseling and follow-up mechanisms, supply constraints, and patient pressure, with challenges more frequently emphasized in private facilities. Implementation fidelity to Ethiopia’s malaria test-and-treat guideline in Amhara during resurgence was moderate, with lower fidelity in private facilities. Provider responsiveness, facilitation strategies, and lower intervention complexity were identified as factors associated with implementation fidelity. Strengthening supportive supervision and mentorship with explicit inclusion of private facilities, improving supply reliability, and simplifying decision supports may improve adherence during resurgence.

56. Characteristics and dynamics of malaria vectors around the Soum dam in Nanoro Health District, Burkina Faso.

期刊: PloS one 发表日期: 2026 链接: PubMed

摘要

Malaria is endemic in Burkina Faso, with seasonal transmission during the rainy season. Environmental changes such as dam construction may influence mosquito ecology and malaria transmission; however, entomological data from this area remain limited. This study aimed to characterize malaria vector dynamics, including species composition, blood meal sources, and sporozoite infection rates, in five villages at varying distances from the Soum dam located in the Nanoro Health District catchment area in Burkina Faso. From March 2022 to February 2023, mosquitoes were collected monthly via pyrethrum spray catches (PSCs) targeting indoor resting vectors. Mosquitoes were identified morphologically via taxonomic keys. PCR analyses were performed to identify species within the Anopheles gambiae complex, determine blood meal sources, and assess Plasmodium falciparum infection. A total of 11,378 Anopheles mosquitoes were collected, including 3,432 males (30.1%) and 7,948 females (69.9%). An. gambiae s.l. was the most abundant species (86.5%), followed by An. funestus (10.6%). Within the An. gambiae complex, 91.5% were An. coluzzii, 8.3% An. arabiensis, and 0.2% An. gambiae sensu stricto. The vector density was highest in Soum (49.7%) and decreased with distance from the dam. The overall sporozoite rate was 6.2%, with higher rates in Seguedin (9.5%) and Soala (8.7%). Among the tested mosquitoes, 34.7% fed on humans, 14.2% on animals, and 23.6% on both. Anopheles coluzzii was the predominant vector and showed moderate anthropophilic behavior. Despite higher vector density near the dam, infection rates were greater in distant villages, highlighting the complexity of vector dynamics in dam-associated areas and the need for localized control strategies.

57. Integrated monitoring of enveloped viruses in hospital environments: Detection, persistence, and implications for infection control.

期刊: PloS one 发表日期: 2026 链接: PubMed

摘要

Enveloped viruses, including coronaviruses, influenza viruses, and others, pose significant public health risks due to their ability to persist in various environments. This study investigates the persistence of enveloped viruses, particularly SARS-CoV-2, in three key environments: air, surfaces, and wastewater, with a focus on hospital settings. We present a systematic review of the literature on the environmental persistence of these viruses, complemented by a case study conducted in two reference hospitals in northern Iran. A total of 72 wastewater samples, 46 air samples, and 92 surface samples were collected from COVID-19 wards and analyzed using RT-PCR for the presence of viral RNA. Results indicate notable viral persistence, with detection rates of 21.74% in air samples, 26.09% in surface samples, and 63.89% in wastewater samples. This indicates substantial viral shedding from infected patients, particularly in influent samples, where treatment inefficiency contributed to higher detection. It is important to note that RT-PCR detects viral RNA, which does not necessarily indicate infectivity; however, its presence highlights routes of potential transmission and the need for vigilant environmental management. The findings highlight the critical need for enhanced environmental monitoring and the strict implementation of effective disinfection protocols to mitigate the risk of viral transmission in healthcare settings. The persistence of SARS-CoV-2 in hospital environments underscores the importance of addressing fomite transmission and optimizing ventilation strategies. Overall, this comprehensive approach provides valuable insights into the behavior of enveloped viruses in diverse settings and emphasizes the necessity of integrated surveillance strategies to aid infection control efforts and protect public health.

58. Knowledge of the risks, hygiene habits and perceived health issues associated with pesticide mixing and application among smallholder farmers.

期刊: PloS one 发表日期: 2026 链接: PubMed

摘要

Smallholder farmers’ exposure to pesticide can be minimized by their hygiene behaviour during pesticide application. The aim of this study was to determine knowledge of the risks, hygiene habits and perceived health issues associated with pesticide mixing and application among smallholder farmers in Nigeria. A cross-sectional study was conducted on 162 smallholder farmers from Ibarapa North Local Government Area, using a validated structured questionnaire through a two-stage sampling method. Data were analyzed using descriptive statistics and chi-square test at p = 0.05. Farmers’ mean age was 42.4 ± 12.3 years, 85.0% were male while 32.9% had tertiary education. Most (95.1%) farmers acknowledged that pesticides affect human health and 63.1% read, understood and followed pesticides label. Notably, only 4.9% acknowledged that banned or restricted pesticides cannot be used. Respondents identified pesticide exposure routes as inhalation (74.7%), dermal (15.4%), oral (1.9%) and eye contact (0.6%). Mean knowledge score was 7.9 ± 2.7 and 54.3% had poor knowledge of pesticide risk. Majority of farmers had direct skin contact with pesticide (83.3%) while 21.3% wore pesticide contaminated farm cloth home. Respondents’ use of personal protective equipment (PPE) during pesticide mixing and application were: goggles (10.1%), coverall (29.0%), head cover (22.9%) and gloves (41.8%). Additionally, unsafe disposal of empty pesticide containers on farm was common among the farmers (42.6%). Mean hygiene habit score was 5.8 ± 1.9 and 85.2% had unsafe hygiene habit. Respondents’ (90.9%) who had poor knowledge of pesticide risk was significantly (p = 0.025) higher among those who had unsafe hygiene habit during pesticide mixing and application. Reported symptoms by farmers included: dizziness > itchy eye > headache = skin irritation > nausea = coughing, during or after pesticide mixing and application. Farmers’ knowledge about pesticide risk and safe hygiene habit was poor. Farmers’ health may be at risk, hence appropriate hygiene habit and use of PPE should be strictly adhered to during pesticide mixing and application.

59. Risk of nephrotoxicity among dry cleaning workers exposed to perchloroethylene: A comparative cross-sectional study in Addis Ababa, Ethiopia.

期刊: PloS one 发表日期: 2026 链接: PubMed

摘要

Perchloroethylene, a chemical commonly used in the dry-cleaning sector, presents a potential risk to kidney health. This study measured urinary and blood nephrotoxic biomarkers among dry cleaners compared to hotel laundry workers to assess PCE’s impact. A multi-center comparative cross-sectional study was conducted with 164 randomly selected participants from 21 dry-cleaning shops and 26 hotel laundries. Data were collected through biological samples and structured questionnaires and with tests for statistical significance. The result showed that majority of the employees were females in both groups and the risk of nephrotoxicity was higher in dry cleaners as compared to hotel laundry workers. We found a significant mean difference in three biomarkers namely, Total Protein (TPU) with a Median & IQR value of (102 mg/dl &70.75 mg/dl) and (54.5 mg/dl &27.25 mg/dl), Urinary creatinine with a Median & IQR value of (193 mg/dl & 111.06 mg/dl) and (142.93 mg/dl & 78.17 mg/dl) and Urinary Calcium with a Median & IQR value of (2.60 mmol/l & 2.94 mmol/l) and (0.835 mmol/l & 0.79 mmol/l) for the exposed and the control groups respectively. However, a significant difference was not found in urinary protein to creatinine ratio, urinary sodium, Blood urea nitrogen and S. creatinine between the two groups, but higher value of sodium above range and higher BUN within range was observed in dry cleaners and factors like employment duration, PCE spillage, handling frequency, sex, and poor ventilation correlated with immediate symptoms. In conclusion, dry cleaners are at greater risk of kidney damage linked to PCE exposure, warranting implementation of safety measures and regular health monitoring to protect workers.

60. A Model to Assess the Costs and Consequences of Changes in Diet and Nutrition From Potential Population-Wide Policies: The Microsimulation of Nutrition, Diabetes, and Cardiovascular Disease (MONDAC).

期刊: Preventing chronic disease 发表日期: 2025-Oct-09 链接: PubMed

摘要

The prevalence of diabetes continues to increase - more than 38 million people in the US now have diabetes and 84 million have prediabetes. Because many new cases of incident diabetes may be attributed to suboptimal dietary quality, novel programs and policies to encourage healthy eating choices represent promising population-level approaches to reduce the number of new cases of diabetes. To help estimate the potential impact of such programs and policies, we created the Microsimulation of Nutrition, Diabetes, and Cardiovascular Disease (MONDAC), a model to estimate the impact of simulated population-level dietary changes on downstream outcomes: body mass index, diabetes incidence, cardiovascular disease (CVD) incidence, all-cause mortality, quality-adjusted life years, direct medical costs, and cost-effectiveness. We used 24-hour recall data from the National Health and Nutrition Examination Survey to categorize food and beverage consumption into 51 mutually exclusive categories to understand the effects of dietary changes. We simulated the energy intake and dietary quality effects that result from increasing, decreasing, or reallocating intake of these 51 food categories. Reductions in calories induce weight loss via an energy balance model. Weight loss and improvements in dietary quality drive annual reductions in diabetes and CVD risk. Mortality was modeled using a lifetable approach, and direct medical care costs were applied using estimates from the literature. We cross-validated MONDAC with existing models to assess reliability of estimates. We provide an example simulation for MONDAC, modeling a reduction in sugar-sweetened beverage consumption at the national level in the US. MONDAC provides a flexible approach to policy analysis to allow the user to simulate various food-related policies.

61. Exploring Parental Needs in the Year Following Perinatal Loss.

期刊: MCN. The American journal of maternal child nursing 发表日期: 链接: PubMed

摘要

To explore parents’ holistic needs in the year after a perinatal loss experience. We used Wagner’s Chronic Disease Model viewed through a holistic lens as a theoretical framework for this qualitative descriptive study. Wagner’s five domains of chronic care (evidence-based practice, empowerment, collaboration, connection, assessment) and the five aspects of holistic care (physical, psychological, social, spiritual, cultural) were used as a priori categories and subcategories throughout data analysis. Holistic themes were organized into the domains of the chronic care model to identify participants’ supportive needs throughout the progression of the year. Ten women who experienced perinatal loss from miscarriage, stillbirth, termination, and congenital anomalies were interviewed. Participant needs were primarily physical (bleeding, lactation) in the days following perinatal loss and transitioned into psychosocial and spiritual needs (navigating relationships, understanding grief, subsequent pregnancy) as time progressed. Participants overwhelmingly expressed a desire for continued professional support following their loss experience. Wagner’s Model provides a framework to inform evidence-based recommendations for assessing and addressing parents’ holistic needs with a collaborative approach to foster connection. Despite the ongoing needs of many grieving parents after perinatal loss, follow-up care is not standard practice. Adverse biopsychosocial outcomes associated with perinatal loss are well documented. The prevention of chronic biopsychosocial health conditions following perinatal loss requires a strategic, multiprofessional approach. Study findings may provide a framework for implementing follow-up care in the year after perinatal loss.

62. Determinants of non-communicable disease management among support staff in Putrajaya, Malaysia: The mediating role of attitude.

期刊: PloS one 发表日期: 2026 链接: PubMed

摘要

Non-communicable disease (NCD) is a major global health issue that contributes to morbidity and mortality problems across countries, including Malaysia. Individuals and social environment are increasingly recognized as critical factors that impact NCDs. Low-income households are a potentially vulnerable group in managing chronic diseases. Therefore, this study aims to examine the factors that influence the management of NCD. In addition, this study examines the role of attitude on the relationship between intrapersonal factor (knowledge) and NCD management. This study employs a cross-sectional survey of 200 support staff with NCD at selected ministries in Putrajaya, Malaysia. The data collected included socio-demographic information, knowledge of NCDs, attitudes towards NCDs, and the Chronic Illness Resources Survey (CIRS). Statistical Package of Social Sciences (SPSS) version 27 and Analysis of Moment Structures (AMOS) version 24 were employed to analyze the data through descriptive analysis and Structural Equation Model (SEM). The path analysis revealed that attitude, community, and societal factors significantly influence NCD management. Analysis of mediating effects indicated that attitude served as a significant mediator in the relationship between intrapersonal factor (knowledge) and NCD management. Hence, these findings provide a better understanding of influences and mediating effects, highlighting the need for tailored interventions to address this issue to improve NCD management.