公共卫生研究摘要 (2026-05-05)

共收录 54 篇研究文章

1. Trends, disparities, and multilevel interventions: A global review of HPV vaccination among university students.

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

摘要

Human papillomavirus (HPV) vaccination is a critical yet underutilized strategy for preventing HPV-related cancers in young adults. University students represent a key demographic for catch-up vaccination owing to their risk profile and transitional healthcare access. This review synthesized data from January 2015 to February 2026 to examine the trends, disparities, and determinants of HPV vaccine uptake in this population. Vaccination rates remain suboptimal worldwide, with pronounced disparities across sex, race/ethnicity, socioeconomic status, and geographic regions. Key barriers operate at multiple levels: individual (knowledge gaps, low perceived risk, hesitancy), interpersonal (lack of provider recommendations), and structural (cost, healthcare access). Promising evidence-based interventions include proactive campus health services, digital campaigns tailored to Generation Z, healthcare provider recommendations, and supportive policies. An integrated socioecological approach coordinating strategies across these levels is essential. This review highlights the urgent need for equity-focused multichannel interventions and policies to improve HPV vaccination coverage among university students worldwide.

2. Anti-SARS-CoV-2 response in alveolar blood sample and bronchoalveolar lavage fluid of individuals vaccinated with inactivated COVID-19 vaccines.

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

摘要

Mucosal antibody response in lower respiratory tract to COVID-19 vaccines is less studied. This cross-sectional study evaluated the respiratory mucosal antibody response in subjects vaccinated with Aikewei or CoronaVac inactivated COVID-19 vaccines. A total of 39 participants were enrolled June 7 to September 15, 2021, including 16 patients who underwent pneumonectomy and 23 patients who underwent bronchoscopy. IgG to nucleocapsid (N) and spike (S) protein of SARS-CoV-2 (anti-N/S IgG), receptor-binding domain (RBD) of S (anti-RBD IgG), and IgA to N (anti-N IgA) were measured with chemo-luminescence immunoassays. Three patients without vaccination and 10 patients vaccinated with one dose showed negative for these antibodies in peripheral or alveolar blood samples or bronchoalveolar lavage fluid (BALF). Of the 12 patients with pneumonectomy vaccinated with two doses, 11 (91.7%), and 10 (83.3%), and 1 (8.3%) were positive for anti-N/S IgG, anti-RBD IgG, and anti-N IgA in peripheral blood, respectively, whereas the positive rates in alveolar blood samples were 66.7% (8), 66.7% (8), and 0%, respectively, and the median level of anti-N/S and anti-RBD in alveolar blood samples was each significantly lower than that in peripheral blood (10.16 vs. 22.18 AU/ml; 10.24 vs. 15.47 AU/ml, both p = .001). Among patients with bronchoscopy, 92.9% (13) of 14 subjects vaccinated with two or three doses showed positive for both anti-N/S IgG and anti-RBD IgG and 7.1% (1) was anti-N IgA positive in peripheral blood; however, all these 14 subjects showed negative in BALF. Together, the results indicate that inactivated COVID-19 vaccines rarely induce mucosal antibody response in the lower respiratory tract.

3. Typical and Atypical Frequency-Based Subtypes of EEG Reactivity in Hospitalized Patients and Association With Comorbidities and Outcomes.

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

摘要

EEG reactivity (EEG-R) is currently classified as present, absent, or stimulus-induced rhythmic, periodic, or ictal discharges, per the American Clinical Neurophysiology Society’s 2021 Critical Care EEG Terminology. However, our previous study suggested that there may be other forms of EEG-R that warrant distinction, potentially associated with different comorbidities and outcomes. We, therefore, aimed to define “typical” vs “atypical” EEG-R, referring to increased power of arrhythmic alpha/beta frequencies vs delta frequencies after stimulation, respectively, and to identify their associated comorbidities and outcomes. This was a retrospective single-center study, examining adult patients admitted between 2015 and 2022, who underwent continuous EEG (cEEG) as standard-of-care work-up for their illnesses. Univariate testing and logistic regression were performed. The primary patient outcome at hospital discharge was categorized by the modified Rankin Scale (0-2: good; 3-6: poor). The primary independent variable was the presence of typical vs atypical EEG-R. Additional covariates included age, presence of critical illness, and acute intracranial and nonintracranial pathologies. A total of 238 patients with typical EEG-R (median age 54 years, female 50%) and 322 with atypical EEG-R (median age 60 years, female 50%) were identified. Patients with typical EEG-R more commonly underwent cEEG for spell capture of non-neurological episodes (20% vs 0%, Δ20%, 95% CI 15-25, p < 0.0001) or primary seizures (13% vs 2%, Δ11%, 95% CI 7-16, p < 0.0001). Patients with atypical EEG-R were more critically ill (88% vs 32%, Δ56%, 95% CI 49-63, p < 0.0001) with more intracranial (69% vs 45%, Δ24%, 95% CI 15-32, p < 0.0001) and nonintracranial pathologies (92% vs 38%, Δ54%, 95% CI 48-61, p < 0.0001) and concomitant altered mental status (47% vs 30%, Δ17%, 95% CI 9-25, p < 0.0001). These patients were hospitalized longer (median 24.0 vs 7.0 days, Hodges-Lehmann estimator 14 days, 95% CI 12-17, p < 0.0001) with higher rates of poor outcomes (74% vs 22%, Δ52%, 95% CI 45-59, p < 0.0001). In the logistic regression model, the inverse association between atypical EEG-R and good outcome remained significant after adjusting for other covariates (odds ratio 0.20, 95% CI 0.11-0.34, p < 0.0001). Granular, frequency-based assessments of EEG-R, such as the differentiation between typical vs atypical EEG-R, may provide further insight into the potential outcomes of patients with altered states of consciousness. Limitations of this study include the single-center retrospective nature.

4. Medical Assistance in Dying in ALS: Frequency, Survival, and Associations With Patient Characteristics in a Canadian Clinic.

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

摘要

Medical assistance in dying (MAiD) has been available across Canada since 2016 for patients with amyotrophic lateral sclerosis (ALS). We aimed to characterize MAiD use, identify associated factors, and compare survival and location of death in a Canadian ALS cohort. We retrospectively reviewed patients with ALS followed at a Canadian multidisciplinary clinic who died between January 1, 2019 and December 31, 2024. Patient characteristics were described by MAiD status. Factors associated with MAiD utilization were evaluated using regression analyses, and survival and location of death were compared between patients who did and did not pursue MAiD. Of 255 patients (median age 67 years [IQR 60-75]; 42% female), 55 (21.6%) underwent MAiD. Percutaneous endoscopic gastrostomy (PEG) use was inversely associated with MAiD utilization (OR 0.34, 95% CI 0.15-0.78), whereas demographic and disease characteristics were not associated with MAiD. Survival from diagnosis to death was shorter among patients who underwent MAiD (median 12 vs 14 months; p = 0.019), with no difference from symptom onset. Death at home was more frequent with MAiD (62% vs 35%; p < 0.001). MAiD is a common end-of-life option in ALS, reflecting patient values and is associated with lower PEG use, shorter postdiagnosis survival, and more frequent death at home.

5. Metabolomic Profiles of Inflammation Associated With Incident Ischemic Stroke Risk in Women.

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

摘要

Ischemic stroke (IS) accounts for 87% of all strokes and is a leading cause of disability worldwide. Women face higher lifetime IS risk and worse functional outcomes, yet predictive biomarkers remain limited. Moreover, inflammation is increasingly recognized as a contributor to IS pathogenesis, with inflammatory markers such as C-reactive protein (CRP) positively associated with IS. Yet, the metabolic pathways linking chronic inflammation to IS risk are poorly understood. We aimed to identify a metabolomic signature reflecting systemic inflammation and evaluate its association with incident IS in women. This study used nested case-control designs within the Nurses’ Health Study (NHS), a prospective cohort of US female registered nurses aged 30-55 at enrollment. Using elastic net regression in a derivation cohort with inflammatory biomarker (high-sensitive CRP, interleukin 6, tumor necrosis factor receptor 2, adiponectin) and metabolomic data, we developed a metabolomic signature index of inflammation (i-MSI). The i-MSI’s association with incident IS was examined in an independent NHS nested case-control study using conditional logistic regression, adjusting for cardiovascular risk factors. Generalizability to atherosclerotic disease was evaluated in a coronary heart disease (CHD) nested case-control study from the Women’s Health Initiative (WHI). The derivation cohort included 1,699 women (mean age 58 years, 94% White). The i-MSI comprised 102 metabolites, with lysophosphatidylcholine species-promoters of endothelial activation, vascular inflammation, and plaque instability-contributing most significantly. In the independent IS case-control study (454 cases, 454 controls; mean age 66 years), women in the highest compared with lowest i-MSI quartile had a multivariable-adjusted odds ratio (OR) of 1.76 (95% CI 1.02-3.03) for IS, whereas each 1-SD increase in the i-MSI was associated with an OR of 1.35 (95% CI 1.09-1.67). In the WHI study (793 cases, 795 controls; mean age 67 years), each SD increase in the i-MSI was associated with an OR of 1.20 (95% CI 1.05-1.37) for CHD. An inflammatory metabolomic signature was associated with higher IS risk, independent of traditional cardiovascular disease risk factors, with consistent findings for CHD. Future studies should replicate these findings in other populations and evaluate whether these metabolites can improve risk stratification and serve as biomarkers for atherosclerotic cardiovascular diseases.

6. What Does a Positive Alzheimer Disease Blood-Based Biomarker Result Mean in People With Mild Cognitive Impairment?

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

摘要

Blood-based biomarkers (BBMs) for Alzheimer disease (AD) offer widely expanded access to biomarker-informed diagnoses in community settings that have previously lacked such resources. However, integrating them into current clinical diagnostic practice presents challenges, particularly in the diagnosis of mild cognitive impairment (MCI). Limited data are available to guide clinicians on when to test, how to counsel patients with MCI and a positive AD BBM result about their risk of dementia progression, or which evidence-based dementia prevention strategies or treatments to recommend. This Perspective article outlines the key challenges faced by clinicians and patients when addressing a diagnosis of “MCI due to AD” and offers suggestions for appropriate pretest counseling and future research directions to address current knowledge gaps.

7. Eosinophil-derived COX-2 protects against experimental colitis through the PGE2-IL-22 axis.

期刊: Proceedings of the National Academy of Sciences of the United States of America 发表日期: 2026-May-12 链接: PubMed

摘要

Inflammatory bowel disease (IBD) is driven by a breakdown in immune regulation and epithelial barrier function, yet the contribution of eosinophils to this process has remained poorly defined and controversial. While eosinophils infiltrate the intestinal mucosa during both flares and remission, their role in shaping disease outcomes is unclear. Our RNA-seq analyses of colonic eosinophils isolated from dextran sulfate sodium (DSS)-treated mice revealed a significant upregulation of cyclooxygenase (COX)-2 (gene name, Ptgs2). Eosinophil-specific deletion of COX-2 (Ptgs2fl/fleoCre+/-) reduced IL-22 production and exacerbated DSS- and trinitrobenzene sulfonic acid (TNBS)-induced colitis, characterized by greater weight loss, higher disease activity, colon shortening, and epithelial injury. Administration of recombinant IL-22 reversed these phenotypes. Mechanistically, eosinophil-derived COX-2 enhanced IL-22 production by type 3 Innate lymphoid cells (ILC3s) through prostaglandin E2 (PGE2) signaling. Consistently, Ptgs2fl/fleoCre+/- mice exhibited reduced colonic PGE2 levels, while PGE2 analog treatment restored IL-22 production and mucosal protection. Our findings identify eosinophil-derived COX-2 and PGE2 as a critical regulator of IL-22 production during colitis, uncovering a eosinophil-ILC3 cross talk that safeguards the intestinal barrier and represents a promising therapeutic target in IBD.

8. Initiation of Medications for Alcohol Use Disorder Among Hospitalized Veterans : A Retrospective Cohort Study.

期刊: Annals of internal medicine 发表日期: 2026-May-05 链接: PubMed

摘要

Hospitalization for alcohol use disorder (AUD) offers an opportunity to initiate evidence-based medications for alcohol use disorder (MAUDs). To describe patterns and factors associated with hospital initiation of MAUD. Retrospective cohort study. Veterans Health Administration (VHA). Veterans hospitalized with a primary diagnosis of AUD in 2022 or 2023. Patients had MAUD initiated as an inpatient or within 7 days of discharge. Logistic regression models estimated the predicted probabilities of MAUD initiation based on hospital fixed effects and demographic and clinical characteristics. Among 29 041 hospitalizations for AUD of veterans without MAUD at baseline in 142 hospitals (median age, 55 years; 94% male), in 8932 hospitalizations (30.8%), MAUD was initiated as an inpatient or within 7 days; MAUDs were naltrexone (57.9%), acamprosate (16.5%), and injectable naltrexone (13.9%). Of MAUD initiations, 6221 (69.6%) were during an inpatient stay and the rest were within 7 days. Of the 6221 inpatient initiations, 97.7% had a prescription for MAUD within 30 days after discharge. In adjusted analyses, MAUD initiation was more likely for hospitalizations with a specialty addiction consultation and those receiving psychiatry versus medicine service. Initiation of MAUD was less likely for persons aged 65 years or older, men, American Indian or Alaska Native versus White veterans, frail veterans, veterans diagnosed with opioid use disorder, and those in the intensive care unit. The median hospital-level rate of MAUD initiation was 29.9% (IQR, 22.6% to 36.3%). Generalizability to other health care systems. Within the VHA, 30% of hospitalizations for AUD resulted in MAUD initiation as an inpatient or within 7 days of discharge, with substantial variation across hospitals and patient demographic and clinical factors. These data indicate a need to identify and disseminate successful hospital-based strategies to increase prescribing of MAUD. U.S. Department of Veterans Affairs and National Institute on Aging.

9. Temporal trends in cancer incidence in a Peruvian population of the Social Health Insurance between 2000 and 2020.

期刊: Medwave 发表日期: 2026-May-04 链接: PubMed

摘要

Cancer is one of the leading causes of disease burden in Peru, with significant regional disparities in incidence and mortality. The Moquegua region has experienced a sustained increase in risk factors and cancer burden without systematic studies to characterize its epidemiological profile. The objective of this study was to estimate the temporal trend in cancer incidence and describe its characteristics in the population insured by Social Health Insurance in Moquegua between 2000 and 2020. A retrospective study was conducted based on institutional records of patients with cancer confirmed by pathological anatomy at Hospital Base II, Moquegua. Crude and age-adjusted incidence rates were calculated. Additionally, a joinpoint regression model was applied to analyze temporal trends. The analysis was stratified by sex and anatomical location. Furthermore, five-year overall survival was calculated for the most common neoplasms. A total of 545 new cancer cases were identified during the study period. The overall age-adjusted incidence rate was 30.2 per 100 000 insured individuals, with a higher prevalence among women (55.2%). A significant upward shift was observed between 2013 and 2017. The most common sites were: breast (19.4%), prostate (18.0%), cervix (7.5%), colorectal (7.3%), and thyroid (7.0%). Breast cancer had the highest incidence rate; thyroid cancer had a survival rate close to 100%, while prostate cancer had the lowest overall survival rate. The incidence of cancer in Moquegua has shown an upward trend since 2013, possibly associated with improvements in diagnostic capacity. Rates were higher among women, with a predominance of neoplasms common at the national level. These findings underscore the need to strengthen cancer surveillance through a territorial approach and to improve access to early-diagnosis services and timely treatment. El cáncer representa una de las principales causas de carga de enfermedad en Perú, con importantes disparidades regionales en incidencia y mortalidad. La región de Moquegua ha experimentado un aumento sostenido de factores de riesgo y carga oncológica, sin contar con estudios sistemáticos que caractericen su perfil epidemiológico. Este estudio tuvo como objetivo estimar la tendencia temporal de la incidencia de cáncer y describir sus características en la población beneficiaria del Seguro Social de Salud en Moquegua entre los años 2000 y 2020. Se realizó un estudio retrospectivo a partir de registros institucionales de pacientes con cáncer confirmados por anatomía patológica en el Hospital Base II Moquegua. Se calcularon tasas de incidencia crudas y ajustadas por edad. Además, se aplicó un modelo de regresión para analizar tendencias temporales. El análisis fue estratificado por sexo y localización anatómica. Asimismo, se calculó la sobrevida global a cinco años en las neoplasias más frecuentes. Se identificaron 545 casos nuevos de cáncer durante el periodo. La incidencia ajustada global fue de 30,2 por 100 000 asegurados, con predominio en mujeres (55,2%). Se observó un cambio significativo hacia una tendencia creciente en el periodo de 2013 a 2017. Las localizaciones más frecuentes fueron: mama (19,4%), próstata (18,0%), cérvix (7,5%), colorrectal (7,3%) y tiroides (7,0%). El cáncer de mama tuvo la mayor tasa de incidencia, el cáncer de tiroides presentó una sobrevida cercana al 100%, mientras que el cáncer de próstata registró la menor sobrevida global. La incidencia de cáncer en Moquegua mostró una tendencia creciente desde 2013, asociada posiblemente a mejoras en capacidad diagnóstica. Las tasas fueron más altas en mujeres, con predominio de neoplasias comunes a nivel nacional. Estos hallazgos subrayan la necesidad de fortalecer la vigilancia oncológica con enfoque territorial y mejorar el acceso a servicios de diagnóstico temprano y tratamiento oportuno.

10. A Proposed Participatory Framework for Explainable AI in mHealth: Mixed Methods Study Integrating User and Stakeholder Requirements.

期刊: Journal of medical Internet research 发表日期: 2026-May-04 链接: PubMed

摘要

Artificial intelligence (AI) integration in mobile health (mHealth) apps offers health care access opportunities in low-resource settings, yet opaque AI recommendations undermine trust and adoption. Existing explainable AI (XAI) frameworks, designed in Western contexts, fail to address the linguistic, cultural, and infrastructural realities of South Asian populations, creating barriers where users cannot understand AI recommendations, clinicians cannot validate outputs, and developers lack implementation guidance. Thus, understanding explainability requirements among educated, digitally literate populations provides foundational insights for future development of inclusive mHealth technologies. This study aims to (1) investigate stakeholder perceptions of trust and explainability in AI-driven mHealth in Bangladesh; (2) identify demographic predictors of trust; and (3) develop and propose a context-adapted framework benefiting developers, policymakers, clinicians, and end users in resource-constrained settings. This study used a sequential mixed methods design that combined a quantitative survey (n=137) with a qualitative phase involving 20 stakeholders. This qualitative cohort consisted of developers (n=4), XAI experts (n=6), and clinicians (n=10) who participated through either focus groups or individual interviews. We used statistical analysis to examine demographic predictors and applied thematic analysis to identify explainability needs specific to each stakeholder group. Education level showed a significant effect on trust (F3, 133=2.81, P=.042). Completed undergraduate students reported lower trust (mean 3.14, SD 1.10) compared with current undergraduates (mean 3.66, SD 0.93), suggesting that undergraduate completion develops critical evaluation skills that may decrease uncritical acceptance of AI systems. Despite recognizing AI’s utility for preliminary guidance, users emphasized the necessity of human validation and expressed concerns about understanding AI’s decision-making logic. Interviews with different stakeholder groups revealed critical gaps. Developers acknowledged minimal explainability implementation in current mHealth apps, while medical professionals unanimously prioritized clinical judgment over automated outputs and advocated for physician-mediated AI systems. Synthesizing findings across all stakeholder groups revealed five core requirements: (1) Human-AI collaboration and clinical validation, (2) Transparent logic paths, (3) Contextual personalization, (4) Cultural and linguistic relevance, and (5) Trust calibration and ethical safeguards. The framework bridges stakeholder misalignments and offers actionable guidance for design, deployment, and policy alignment in resource-constrained environments. By situating explainability within the sociocultural realities of South Asia, this research advances XAI beyond algorithmic transparency toward equity, inclusion, and user empowerment in digital health.

11. Cultural Relevance and Acceptability of Cognitive Behavioral Therapy Techniques Adapted by AI or a Human Psychologist: Experimental Study.

期刊: JMIR formative research 发表日期: 2026-May-04 链接: PubMed

摘要

Evidence-based psychological interventions are usually not accessed by marginalized groups such as refugees. Culturally adapted psychological interventions have reported larger effect sizes than nonadapted psychological interventions. However, the cultural adaptation of interventions is a lengthy process, entailing a challenge. One potential solution to overcome this challenge is the use of artificial intelligence (AI). The aim of this study was to investigate and compare the perceived cultural relevance and acceptability of 2 common cognitive behavioral therapy (CBT) techniques when translated and culturally adapted by AI versus a human psychologist. In a 2×2 factorial design, the text generator type (AI vs human psychologist) and the CBT technique (cognitive restructuring vs behavior modification) were compared. CBT technique texts translated and culturally adapted either by AI or by a human psychologist were blindly rated using the Cultural Relevance Questionnaire and the Theoretical Framework of Acceptability. Raters were Arabic-speaking refugees and immigrants, aged between 18 and 69 years, residing in Sweden, Denmark, and Germany. Raters were randomly allocated to 1 of 4 conditions. Each condition consisted of 2 stimuli. Two-factor between-subject design analyses were used to analyze the data. A significant main effect of the text generator domain type (P=.02; η²=0.045) was found in the first rating, with texts adapted by the AI domain perceived as more culturally relevant than those adapted by the human domain. No significant main effect of the CBT technique was found in the first rating (P=.10; η²=0.022). There were no differences in the second rating. Regarding acceptability, no significant main effects of text generator domain type (P=.09; η²=0.024) or the CBT technique (P=.88; η²=0.001) were found in either of the ratings. CBT technique materials adapted by AI may be perceived as similarly culturally relevant as those adapted by a human psychologist. This finding implies the potential to accelerate the cultural adaptation of psychological interventions. However, AI still needs to be used with caution and in accordance with rigorous safety standards and robust frameworks.

12. Peer Support in Online Women's Health Communities: Mixed Methods Formative Analysis of Reddit Discourse.

期刊: JMIR formative research 发表日期: 2026-May-04 链接: PubMed

摘要

Stigmatized women’s health issues, such as polycystic ovary syndrome (PCOS) and endometriosis, are often marginalized or dismissed in traditional clinical settings. This drives individuals to seek peer support in anonymous online communities such as Reddit. While these digital platforms host critical discussions, they are often designed as static information repositories, failing to account for the complex emotional, temporal, and cultural dynamics that shape users’ support needs. There is a disconnect between the lived experiences of users-particularly feelings of clinical dismissal and the need for culturally specific advice-and the design of the sociotechnical systems they rely on. This study aimed to deconstruct support practices in online women’s health forums to provide a formative basis for designing more responsive digital health systems. We analyzed the intersections of discussion topics, emotional expression, temporal shifts (specifically the impact of the COVID-19 pandemic), and culturally situated discourse to identify unmet user needs and effective peer-support patterns. We conducted a large-scale, mixed-methods analysis of 4995 posts and 460,317 comments from 5 major women’s health subreddits (r/WomensHealth, r/TwoXChromosomes, r/BirthControl, r/Endometriosis, and r/PCOS). Computational methods included Latent Dirichlet Allocation for topic modeling, Valence Aware Dictionary for Sentiment Reasoning for sentiment analysis, and the NRC Emotion Lexicon for granular emotion classification. We segmented the data into pre-, during-, and post-COVID-19 periods to analyze temporal shifts. This quantitative analysis was complemented by a 2-phase qualitative thematic analysis to identify and characterize engagement patterns within 147 validated culturally situated threads. Our analysis revealed that the most prevalent and emotionally negative topic was “Pain & Doctor Visits,” which was uniquely characterized by high levels of fear and sadness linked to systemic clinical dismissal. The COVID-19 pandemic triggered a significant topical “turn inward,” with discussions shifting away from social or political issues and toward somatic concerns (eg, “PCOS” “Pain & Doctor Visits”). Paradoxically, this period saw a simultaneous rise in both negative emotions (eg, fear and sadness) and expressions of community trust. Critically, our qualitative analysis of culturally situated discourse uncovered a consistent three-stage “playbook” for effective support: (1) Affirmation to establish psychological safety and validate cultural experiences; (2) Information Scaffolding to provide actionable, culturally tailored advice; and (3) Intercultural Bridging to facilitate community-wide learning and empathy. Online health forums operate as essential, resilient sociotechnical infrastructures that actively compensate for failures and gaps in formal health care. The “Affirmation-Scaffolding-Bridging” model identified in our research provides a clear, formative framework for designing future digital health interventions. These findings can guide the development of new platforms that are emotionally aware, culturally responsive, and adaptive to user needs and external crises.

13. Extending inferences from a randomized trial to trial-eligible and treatment-candidate target populations: examples of generalizability and transportability.

期刊: Epidemiology (Cambridge, Mass.) 发表日期: 2026-May-04 链接: PubMed

摘要

When decision makers use evidence from a randomized trial to inform population-level decisions, the target population they envision rarely aligns with the population of individuals who enrolled in the trial. Here, we extend inferences from the VALIDATE-SWEDEHEART randomized trial (hereafter, the index trial), which compared the effects of bivalirudin and heparin during percutaneous coronary intervention on the risk of death, reinfarction, and bleeding, to two clinically relevant target populations: first, the trial-eligible population of individuals eligible for the index trial regardless of enrollment, and second, the treatment-candidate population of individuals who are considered candidates for bivalirudin and heparin under routine care, regardless of eligibility for the index trial. Using data from the index trial, we fit logistic regression models for the outcome at 180 days in each group based on assigned treatment. We then standardized risk estimates to the baseline covariate distribution of the trial-eligible and treatment-candidate target populations, which were characterized using data from Swedish healthcare registries. The estimated risk difference comparing bivalirudin vs. heparin was -1.1% (-3.1%, 0.9%) in the trial-eligible population and -1.0% (-3.0%, 1.0%) in the treatment-candidate population. The corresponding risk ratios were 0.92 (0.80, 1.07) and 0.93 (0.80, 1.07), respectively, aligning closely with estimates from the index trial. Absolute risks in each treatment group were, however, between 0.8 and 1.2 percentage points higher in comparison with the index trial. Estimated risk ratios for the broader trial-eligible and treatment-candidate populations generally align with the findings from the index trial. While trials provide essential evidence for healthcare, questions often arise about wider, clinically relevant populations beyond the population of trial participants. By leveraging data from trials and observational data sources, we can attempt to address questions in these wider target populations.

14. High Screen Exposure and Its Association With Physical and Mental Well-Being Among School-Going Children and Adolescents in Bangladesh: Cross-Sectional Study.

期刊: JMIR human factors 发表日期: 2026-May-04 链接: PubMed

摘要

In Bangladesh, as well as throughout the world, children’s screen time has significantly increased. Children spend a lot of time on the internet and digital screens for entertainment, education, and communication, which has increased their daily screen time. However, the potential detrimental impacts of excessive screen time on children’s mental, physical, and social health have drawn attention. This study aimed to explore the effect of high exposure to screens on the health and mental well-being of school-going children and adolescents in Dhaka, Bangladesh. This cross-sectional descriptive study was conducted from July 2022 to June 2024. A total of 420 school-going children and adolescents aged 6 to 14 years were enrolled from 3 English-language and 3 Bangla-language schools in Dhaka using a stratified random sampling technique. Anthropometric measurements, a semistructured questionnaire, and the Pittsburgh Sleep Quality Index, the Development and Well-Being Assessment scale, and the Strengths and Difficulties Questionnaire, all of which were validated in Bangla, were used to gather data. We considered students who were exposed to screens for less than 2 hours a day as the low-exposure group and those who were exposed for more than 2 hours a day as the high-exposure group. A total of 83.3% (350/420) of the students were in the high-exposure group, and their average screen time per day was 4.6 (SD 2.3) hours. Eye problems were reported by 35.7% (150/420) of the students, and a significant difference was found between the low- and high-exposure groups. In total, 96% (144/150) of the students with eye problems were from the high-exposure group, whereas 4% (6/150) were from the low-exposure group. Headaches were reported by 80% (336/420) of the students, and they were common in the high-exposure group (279/336, 83%). Moreover, students from the high-exposure group had a short duration and poor quality of sleep (mean 7.3, SD 1.4 hours), which was statistically significant. Furthermore, obesity was more predominant in the high-exposure group (P<.001). Our study revealed that, overall, 31% (130/420) of the students had at least one mental health problem and 9.8% (41/420) had more than one mental health problem using the Development and Well-Being Assessment scale, and mental health problems were greater in the high-exposure group than the low-exposure group. Although behavioral problems such as conduct issues (119/420, 28.3%) and peer difficulties (121/420, 28.8%) were observed among the participants, no statistically significant difference was found between the 2 groups. A collaborative and coordinated multistage approach is essential to create effective and acceptable guidelines and policies for the optimum and positive use of digital screens for the children of Bangladesh. Further prospective studies on a larger scale can be conducted to determine the impacts of screen time on aspects of health.

15. Sexual Well-Being of Young People in Times of Widespread Pornography Use: Protocol for a Multidisciplinary Research Framework.

期刊: JMIR research protocols 发表日期: 2026-May-04 链接: PubMed

摘要

Since the rise of freely accessible pornographic streaming websites, pornography consumption has become widespread and normative worldwide. In Flanders, early exposure-before age 13-has tripled over the past decade, and frequent use, particularly among young men, is common. While pornography consumption may support body satisfaction, self-exploration, and self-esteem, evidence on its effects on sexual development and sexual well-being remains limited. Public debates are polarized, swinging between moral panic and denial of potential risks. Care providers and helplines increasingly report young people struggling with pornography-related concerns, such as self-perceived porn-induced sexual dysfunctions. Adolescents and young adults from diverse backgrounds express a clear need for guidance in navigating sexually explicit media, particularly when communication with parents, teachers, or health care providers is difficult. This project aims to generate evidence-based insights into the complex relationships between pornography consumption, sexual development, and sexual well-being among young people. By producing actionable knowledge, it seeks to inform education, prevention, and care practices that help adolescents and young adults navigate sexually explicit media in ways that promote healthy and inclusive sexual well-being within Flanders’ ethnically and sexually diverse society. The project consists of four interconnected work packages: (1) examining pornography in relation to societal norms and inequalities, (2) exploring pornography within family-based sexual development, (3) investigating pornography’s role in health care contexts, and (4) developing evidence-based pornography literacy tools for education and prevention. A mixed methods approach will combine systematic scoping reviews, a nationally representative survey, laboratory studies, qualitative interviews and focus groups, and co-creation with key societal stakeholders. The project received funding from Research Foundation - Flanders in 2024, and researchers were appointed between September and November 2024. Scoping reviews began in January 2025 and concluded in October 2025. A large-scale survey will be conducted between January and March 2026, followed by subsequent stages of analysis, dissemination, and valorization, concluding in 2028. Although empirical results are not yet available, the project will deliver new evidence on how pornography consumption shapes sexual development and sexual well-being across diverse contexts. It will produce practical outputs for education, health care, and policy, and contribute to reducing stigma and misinformation around pornography use. By addressing pornography as a multifaceted social and sexual phenomenon, this multidisciplinary research will advance scientific understanding and promote more inclusive, evidence-based approaches to sexual health education, care, and policy.

16. AI in Clinical Decision Support Systems: Promising Applications and Strategies for Managing Data Challenges.

期刊: Journal of medical Internet research 发表日期: 2026-May-04 链接: PubMed

摘要

The translation of big data analytics and artificial intelligence (AI) into clinical decision support systems (CDSSs) has advanced from proof of concept to real-world clinical practice. AI-informed CDSSs show measurable improvements in diagnostic accuracy, risk stratification, resource use, and patient outcomes compared to traditional models, offering the potential to assist clinicians in managing symptom complexity and uncertainty in health care delivery. Despite this potential, access to large amounts of high-quality and granular data remains one of the most significant bottlenecks to AI-enabled CDSSs. We argue that as health care systems increasingly adopt data-driven decision support, addressing the challenges of data accessibility and protection is essential to realizing the full potential of AI in clinical medicine. We use selected case examples of AI-informed CDSSs in oncology, organ transplantation, diabetic retinopathy, epilepsy, spinal cord injury, rare disease diagnosis, and emergency medicine to illustrate opportunities and challenges related to AI’s potential to improve patient outcomes. We discuss public and semipublic, medical institutional and commercial, and government and national data sources that are currently available for the development of CDSSs and highlight the practical and ethical constraints associated with these data. We consider alternative data resources and ways in which health care systems can strengthen data ecosystems to increase AI-driven CDSS efficacy and implementation to improve patient outcomes.

17. Immunomodulatory Agent Adherence Trajectories and Survival Among Older Patients With Multiple Myeloma.

期刊: JCO oncology practice 发表日期: 2026-May-04 链接: PubMed

摘要

Immunomodulatory agents (IMiDs) are critical in treating multiple myeloma (MM). We aimed to identify patterns of adherence to IMiD treatment, patient characteristics associated with adherence, and the corresponding survival among Medicare beneficiaries with newly diagnosed MM. Using group-based trajectory modeling, we identified distinct adherence groups among patients with MM in the SEER-Medicare database. Multinomial logistic regression models were used to identify factors associated with each adherence group. Cox proportional hazards regression models were sued to evaluate the impact of different adherence groups on survival. We identified four distinct adherence groups among 4,452 patients with newly diagnosed MM between 2007 and 2019: (1) persistently-high (33.1%), (2) quick-decline-then-increase (17.5%), (3) moderate-decline (21.2%), and (4) quick-decline (28.2%). Factors related to poor-adherence groups included early treatment initiation years, patients with multiple comorbid conditions, hypercalcemia, renal failure, anemia, and bone disease and receiving a low-income subsidy. Patients age ≥85 years had higher odds of being in groups 3 and 4 than those age 66-69 years. Additionally, non-Hispanic Black patients were more likely to be in the quick-decline group than non-Hispanic White patients. Mortality was significantly associated with adherence. Patients in poor-adherence groups had a >20% increased mortality risk, compared with the persistently-high group. Old age, low-income subsidy recipients, and those with high comorbidity burden are less likely to be adherent to the IMiD treatment, and their survival outcomes are inferior compared with those in the high adherence group. Targeted intervention to assist adherence to their IMiD treatment may improve the survival for these populations with newly diagnosed MM.

18. Identifying Skill and Usability Barriers to Digital Health Tool Use Among Older Adult Patients in US Safety Net Clinics: Mixed Methods Study.

期刊: JMIR human factors 发表日期: 2026-May-04 链接: PubMed

摘要

Despite their benefits, digital health tools often face adoption barriers because of the digital divide. Identifying the fundamental user skills required to effectively navigate these tools and the usability barriers is essential to addressing disparities in use. This study aimed to identify the skill and usability barriers to using digital health tools. This study included English-, Spanish-, or Cantonese-speaking patients, aged ≥50 years, who received care at an urban safety net health system in the United States. Participants completed a survey examining sociodemographic characteristics and digital health tool use and were observed and video recorded as they navigated four digital health care tasks: (1) launch a video visit, (2) visit a health website through a URL, (3) log in to the patient portal, and (4) sign up for a patient portal account. Participants who could not independently perform the tasks received additional support. Tasks were conducted in English, while instructions and additional assistance were provided in each participant’s preferred language. Video recordings were thematically coded to identify the fundamental skills needed for effective digital tool use and usability barriers in the design of digital tools. We examined whether task independence was associated with participant demographics and thematic categories using Kruskal-Wallis, χ2, and Fisher exact tests. In total, 74% (34/46), 52% (31/60), 71% (44/62), and 70% (43/61) of participants (N=64) independently completed digital tasks 1, 2, 3, and 4, respectively. Older age, minoritized races and ethnicities, non-English language preference, lower educational attainment, access to cellular data only or no internet access, and lack of a portal account were associated with a higher likelihood of requiring assistance or being unsuccessful at completing each task (P<.001, except for older age [P=.004]). The qualitative coding of video recordings identified 3, 4, and 6 categories of typing, navigation, and human-computer interaction (HCI) skills, respectively, as fundamental skills required to independently complete digital tasks. χ2 and Fisher exact tests indicated significant associations between most typing, navigation, and HCI categories and independent task completion. We coded usability barriers as one of 6 learnability challenges or 3 operability challenges. This study identified that independent use of digital health tools requires fundamental typing, navigation, or HCI skills as well as high usability of digital tools. The inclusion of 4 different digital tasks added specificity to the type of skills and usability considerations necessary to ensure accessibility of digital health tools to diverse older adults. This study underscores the need for vendors to cocreate digital health tools with historically excluded end users in mind. As health care systems expand digital tool adoption, they must distinguish fundamental skill gaps from usability barriers, as each may require different intervention strategies.

19. One-Year Trajectory of Step Counts and Weight Loss in Adults With Overweight/Obesity: Retrospective Cohort Study.

期刊: JMIR mHealth and uHealth 发表日期: 2026-May-04 链接: PubMed

摘要

Being overweight and obese are major health concerns worldwide, contributing to lifestyle-related diseases such as hypertension, dyslipidemia, type 2 diabetes, and cardiovascular disease. Increasing physical activity is an effective strategy for weight management. However, earlier step count studies have remained limited to small populations, short-term measurements of 1-2 weeks, and mainly cross-sectional comparisons of average step counts. The effects of long-term step count changes on weight loss remain unclear. This study was conducted to assess the effects of long-term patterns of step counts on weight loss using data from the “Asmile” mobile health app in Japan. We hypothesized that participants with continuously increasing step counts over time would have a higher likelihood of significant weight reduction than participants who show steady or fluctuating patterns, even if their average step counts were similar. We analyzed data of 2778 Asmile users aged 40-74 years with BMI ≥25 kg/m² who underwent a specific health checkup during fiscal years 2019-2023 and who had valid step count records for 10-14 months. Step count trajectories, reflecting long-term trends in physical activity, were classified using a latent class mixed model into four patterns: UP (increasing), FLAT (steady), DOWN (decreasing), and UP/DOWN (increasing then decreasing). Logistic regression was applied to estimate odds ratios for achieving ≥3% weight loss, with step trajectory as the explanatory variable and weight loss as the outcome. Among participants, 1601 (57.6%) were men and 1177 (42.4%) were women, with respective mean ages of 65.8 (SD 7.9) and 64 (SD 8.2) years. Step count trajectories were distributed as 28.5% UP, 36.2% FLAT, 20.1% DOWN, and 15.2% UP/DOWN. Compared with the FLAT group, participants in the UP group had a significantly higher likelihood of achieving ≥3% weight loss (adjusted odds ratio 2.45, 95% CI 1.78-3.38). Long-term tracking of step counts using the Asmile app revealed distinct activity patterns. Continuous increases in step counts were associated with the greatest likelihood of weight loss, emphasizing the importance of sustained physical activity. These findings support the use of long-term step monitoring to guide interventions for obesity and lifestyle-related disease prevention.

20. mHealth-Based Gamification Interventions to Promote Health Among Older Adults: Scoping Review.

期刊: JMIR mHealth and uHealth 发表日期: 2026-May-04 链接: PubMed

摘要

Healthy aging has emerged as a global priority. However, older adults’ participation in health promotion programs remains low, and traditional health promotion models have achieved limited success in fostering sustained engagement among this population. Mobile health (mHealth)-based gamification interventions offer a promising way to address these challenges. However, no published reviews support or oppose the use of mHealth-based gamification interventions as health promotion strategies in older adults. The study aimed to identify mHealth interventions using gamification to promote health among older adults. Our scoping review was conducted following the Joanna Briggs Institute recommendations for scoping reviews and Arksey and O’Malley’s framework. The process followed PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines and PRISMA-S (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Literature Search Extension) checklist. A comprehensive literature search was conducted across 8 databases: PubMed, Scopus, Web of Science, Embase, Cochrane Library, CINAHL, PsycARTICLES, and IEEE Xplore Digital Library, from their inception to December 10, 2025. Two reviewers independently screened titles, abstracts, and full texts via Rayyan, with disagreements resolved by a third reviewer. This scoping review identified 11 studies. Only 1 article was published before 2022. The interventions were found to improve enjoyment and motivation (n=5), cognitive function (n=3), physical activity (n=2), and digital literacy (n=2). Individual studies also reported improvements in mental health (n=1) and adherence (n=1), a reduction in suicidal ideation (n=1), improvements in physical function (n=1), the promotion of social engagement (n=1), and the identification of mild cognitive impairment (n=1). Game elements used were ranked by frequency as progress, challenges, goals, levels, reward, sensation, storytelling or narration, leaderboard, surprise, and avatar. No research was found to use the game element of “social sharing.” mHealth types included augmented and virtual reality-based training systems, wearable devices, mobile phones, tablets, and Windows platforms and devices. Notably, only 4 studies applied theoretical frameworks, and 3 omitted the concrete approach to gamification. As the first scoping review to identify and map mHealth-based gamification interventions for older adults, this study highlights their potential as an innovative approach to health promotion. By systematically synthesizing evidence regarding intervention designs, gamification strategies, and preliminary health outcomes, it establishes a foundation for future inquiry. However, this review is limited by the small number of included studies, precluding broad generalizations. Future research should assess long-term impacts, integrate theoretical frameworks, establish reporting guidelines, design personalized social-interactive interventions, and expand to broader health domains. Ultimately, these insights provide targeted guidance for developing age-appropriate digital health solutions, contributing to the realization of active aging.

21. Effects of glucagon-like Peptide 1, glucagon, and Glucose-Dependent Insulinotropic Polypeptide on Fluid Secretion in Guinea-Pig Pancreatic Duct Cells.

期刊: Pancreas 发表日期: 2026-May-04 链接: PubMed

摘要

We examined the direct effects of glucagon-like peptide 1 (GLP-1), glucagon, and glucose-dependent insulinotropic polypeptide (GIP) on the physiological function of pancreatic duct cells by using interlobular duct segments isolated from the guinea-pig pancreas. The rate of fluid secretion was continuously measured by monitoring the luminal volume of isolated duct segments. cAMP production was measured in individual ducts by ELISA. Messenger RNA expression of GLP-1, glucagon, and GIP receptors in pancreatic duct cells was examined by quantitative reverse transcriptase-polymerase chain reaction. All of GLP-1, glucagon, and GIP concentration-dependently stimulated fluid secretion. While the potency of GLP-1 was equivalent to that of secretin in physiological (10 and 30 pM) to pharmacological concentrations, higher concentrations (over 100 pM) of GIP were required for significant stimulation. The potency of glucagon was relatively weak. While GLP-1 and secretin additively stimulated fluid secretion, GIP and secretin synergistically stimulated fluid secretion, when physiological concentrations were applied. On the contrary, glucagon inhibited secretin-stimulated fluid secretion in a competitive manner. GLP-1 (1 nM) significantly increased cAMP production in isolated pancreatic ducts. Messenger RNA expression of GLP-1, glucagon, and GIP receptors were detected in isolated ducts. GLP-1 receptor immunoreactivity was detected in epithelial cells of pancreatic ducts. Physiological concentrations of GLP-1 and GIP directly stimulate pancreatic duct fluid secretion via elevation of intracellular cAMP and interact with secretin in the guinea-pig. The physiological role of glucagon in the regulation of pancreatic duct fluid secretion is limited.

22. Novel biomarkers in acute kidney injury: their role in the diagnosis of kidney dysfunction and etiology definition, their potential as predictive markers of structural renal damage severity.

期刊: Internal and emergency medicine 发表日期: 2026-May-04 链接: PubMed

摘要

Acute kidney injury (AKI) is a life-threatening condition whose early diagnosis is crucial. The most used method to evaluate renal function is the glomerular filtration rate (eGFR). The detection of new circulating molecules has gained traction for the early identification of kidney damage. In this prospective observational study, 57 patients with acute kidney disease and 23 patients without acute renal damage were consecutively enrolled; urinary concentrations of NGAL, LFABP, CYR61, TIMP-2, IGFBP-7, and [TIMP-2 X IGFBP-7], and serum concentrations of PENK and KIM-1 were obtained in all patients. The primary endpoint was to assess the role of serum and urinary markers in distinguishing prerenal from renal pathogenesis of AKI. The secondary endpoint was to evaluate the possible association between urinary and serum concentrations of these markers and the severity of acute kidney injury. Urinary TIMP-2, NGAL, and IGFBP-7 concentrations were higher in patients with AKI compared with the control group, with statistical significance. Among patients with AKI, we found higher concentrations of LFABP, Cyr61, TIMP-2, NGAL, IGFBP-7, and [TIMP-2]x[IGFBP-7] according to AKI aetiology, with statistical significance maintained in multivariable logistic regression for IGFBP-7. The ROC curve confirmed that IGFBP-7 has a predictive role in the aetiological diagnosis of AKI. A significant association between urinary LFABP and TIMP-2 and serum KIM-1 concentrations (p = 0.0001) and the variation in creatinine values from baseline to enrollment was found. Furthermore, we found a statistically significant correlation between KIM-1 and the variation in creatinine levels from admission to discharge. This study highlights an association between the concentrations of the novel biomarkers and the aetiology of AKI, with a possible role for these molecules in stratifying patients with acute renal disease.

23. Flexible Strain-Temperature Dual-Modal Smart Patch Based on 3D Printing for Wound Healing Promotion and Health Monitoring.

期刊: ACS applied materials & interfaces 发表日期: 2026-May-04 链接: PubMed

摘要

For patients with open joint wounds, postoperative rehabilitation requires real-time and reliable monitoring of physiological parameters. Conventional elastomer- and textile-based wearable sensors often suffer from mechanical mismatch, limited breathability, or insufficient conformal adhesion, restricting their long-term use on wound sites. Although hydrogel-based sensors offer improved tissue compatibility, their practical application is challenged by dehydration and limited gas permeability associated with bulk structures. Here, we present an application-oriented hydrogel sensing platform designed to address these challenges through the integration of established material and structural strategies. A dehydration-resistant hydrogel system is constructed using a water/glycerol binary solvent and electrolyte to maintain long-term hydration and sensing stability (>1000 h). To improve breathability and mechanical compliance, a mesh-structured hydrogel sensor is fabricated via 3D printing. The fabricated sensor demonstrates good biocompatibility, promotes wound healing, and enables dual-mode strain and temperature sensing with reduced cross-interference under the tested conditions. It exhibits a gauge factor (GF) of 2.4 within the strain range of 47.5-135% and a temperature coefficient of resistance (TCR) of -4.2% °C-1 over the temperature range 22-32 °C. Integrated into a wireless smart patch and combined with machine learning, the system allows real-time monitoring and classification of rehabilitation movement patterns. This work demonstrates a system-level, application-driven integration for wearable monitoring with promising extended-use potential.

24. #MultipleSclerosis: Artificial intelligence-based sentiment and content analysis of Tweets.

期刊: Chronic illness 发表日期: 2026-May-04 链接: PubMed

摘要

ObjectivesThe aim is to uncover the perspectives of Twitter users on Multiple Sclerosis (MS) in English tweets by: (i) determining the sentiment of the text (ii) identifying the discussed topics.MethodsThe tweets were scanned in April 2023 using the keywords “multiple sclerosis, multiplesclerosis”. Artificial intelligence-based sentiment analysis was conducted on a total of 1168 tweets and content analysis was performed on 17.4% of these tweets.ResultsTweets of 44% are positive and 22.3% are negative sentiment. As a result of content analysis, three themes and their sub-themes were identified: (i) announcement sharing: invitation to support, promotion of academic publications, (ii) information sharing: information providers, information seekers, news providers, (iii) experience sharing: challenging MS, facilitated MS, emotionally impactful MS, comparative MS, misunderstood MS. Subjective content such as experiences is shared less frequently compared to objective content such as announcements and information.DiscussionThe findings of this study can serve as a guiding factor in supporting positive views, managing negative views, and promoting the expression of subjective experiences.

25. Interpretations of Menstrual Blood Appearance and Diagnostic Potential Among Social Media Users: Cross-Sectional Mixed Methods Social Media Listening Study.

期刊: Journal of medical Internet research 发表日期: 2026-May-04 链接: PubMed

摘要

Menstruation has long been framed primarily as a hygiene issue, with mainstream products and public messaging emphasizing concealment and disposal of menstrual blood (MB). This has contributed to a culture of silence in which conversations about menstrual health have been marginalized in public and clinical settings. Recent international guidance, including the World Health Organization’s call to reframe menstruation as a health issue, underscores the need for more open discourse. Simultaneously, social media has become a prominent space where menstruating individuals share experiences, seek advice, and challenge stigma. The resurgence of reusable menstrual products has increased users’ direct observation of MB, prompting questions about variations in color, texture, and smell. These developments highlight growing curiosity about MB yet reveal persistent information gaps regarding how MB is understood outside the clinical setting. This study aimed to examine how MB is represented in social media discourse and to explore individuals’ perceptions of MB’s potential use as a diagnostic tool. We conducted a cross-sectional, convergent mixed methods social listening study combining qualitative content analysis, social network analysis, sentiment analysis, and descriptive statistical analysis. Data were collected from TikTok (ByteDance), Facebook (Meta), Instagram (Meta), and Reddit using Mention and Apify. Between February 1 and 28, 2025, 6263 posts and videos were extracted using 3 strategies-group searches, hashtag searches, and social listening alerts. All data were anonymized, and demographic information was unavailable. After removing duplicates, non-English content, images, and posts without reference to blood, 349 posts were included. Coding followed a multistep deductive process in Atlas.ti. All posts were assigned with quotations, which were designated with one or more codes. Network analysis examined associations between appearance descriptors and reported health conditions. Sentiment analysis assessed perceptions of MB-based diagnostics. Among the included posts (n=349), most originated from Reddit and Facebook. Seeking help (154/349, 44.1%) was the most common type of post. Appearance descriptions (n=243 posts) focused on color, particularly brown, bright red, pink, and black; consistency, particularly coagulation; and smell, mainly unpleasant. Network analysis linked specific colors and textures to perceived conditions, including miscarriage, endometriosis, hormonal changes, polycystic ovary syndrome (PCOS), and infections. Discussion of MB as a diagnostic tool (n=80 posts) was less frequent but included predominantly positive quotations (110/115, 95.7%), emphasizing accessibility, noninvasiveness, and home-based sampling. Concerns (19/115, 16.5%) focused on inclusivity, stigma, and bodily autonomy. This study demonstrates that social media serves as an important source for discussion on MB-related topics and highlights a gap between public information needs and the available scientific evidence. The findings also indicate a strong interest in MB characteristics and support further research into its diagnostic potential. To our knowledge, this is the first study to analyze social media discussions on MB characteristics and its diagnostic potential.

26. Establishment and characterization of a Wolbachia (wAlbB)-infected Aedes aegypti line (Tw-Kao) for dengue control.

期刊: PLoS neglected tropical diseases 发表日期: 2026-May-04 链接: PubMed

摘要

Global trade and climate change are driving the geographic expansion of dengue vectors, contributing to the global spread of dengue. Conventional vector control measures have proven insufficient to prevent substantial disease burdens, highlighting the need for innovative and sustainable strategies. The release of Wolbachia-infected mosquitoes offers a promising alternative for dengue suppression. Here, we developed a locally derived Ae. aegypti line carrying the wAlbB strain (wAlbB-Tw-Kao) and systematically evaluated its fitness, viral interference, and potential for vector population control. The strain was generated through embryonic microinjection of cytoplasm containing the intact wAlbB endosymbiont from field-collected Ae. albopictus in Kaohsiung, Taiwan, resulting in a stably infected mosquito line with 100% maternal transmission. Whole-genome sequencing confirmed a high similarity to the reference wAlbB genome. Cross-mating experiments demonstrated complete cytoplasmic incompatibility (CI, 0% egg hatch) when wAlbB-Tw-Kao males were mated with uninfected females. Antiviral assays against dengue virus serotype 2 (DENV-2) and Zika virus showed significant reductions in viral titers in the midgut, salivary glands, and saliva. In cage experiments, increasing release ratios of wAlbB-Tw-Kao males led to significant suppression of wild-type populations, achieving up to approximately 90% reduction in egg hatch. These findings demonstrate the successful development of a locally derived wAlbB-infected Ae. aegypti line with strong CI, stable maternal transmission, and effective DENV and ZIKV blocking. These properties provide a foundation for future field-relevant evaluation under both suppression and replacement deployment frameworks.

27. Effects of Stand-Alone Digital Lifestyle Interventions on Weight-Related Outcomes in Adults With Overweight or Obesity: Systematic Review and Meta-Analysis of Randomized Controlled Trials.

期刊: Journal of medical Internet research 发表日期: 2026-May-04 链接: PubMed

摘要

Obesity is a major global health concern, and scalable digital solutions are urgently needed. While digital lifestyle interventions (DLSIs) have shown promise, prior meta-analyses often included hybrid formats with human support, limiting insights into the effectiveness of fully digital interventions. This study aimed to evaluate the independent effects of standalone DLSIs-defined as interventions delivered exclusively via digital platforms without in-person or adjunctive support-on anthropometric and dietary outcomes in adults with overweight or obesity. We searched MEDLINE, Embase, PsycINFO, Web of Science, and the Cochrane Library from inception through March 4, 2026. Eligible studies were randomized controlled trials (RCTs) evaluating stand-alone DLSIs in adults with overweight or obesity. Interventions were included if they targeted diet or physical activity exclusively through digital platforms. We included fully automated, asynchronous, or one-to-many synchronous systems without individualized support. Studies involving hybrid interventions, including one-to-one synchronous human interaction, nonadult populations, or non-RCT designs, were excluded. Two independent reviewers performed study selection and data extraction. Risk of bias was assessed using the Cochrane Risk of Bias 2.0 tool (Cochrane Bias Methods Group). Meta-analysis used a random-effects model with the Hartung-Knapp-Sidik-Jonkman method, and heterogeneity was assessed using I2 statistics. The certainty of evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation approach. A total of 19 RCTs involving 3556 participants were included. Stand-alone DLSIs significantly improved anthropometric outcomes compared to controls (standardized mean difference 0.26, 95% CI 0.14-0.38; 95% prediction interval [PI] -0.16 to 0.68; P<.001; 19 studies; n=3556; I2=56.1%), corresponding to an additional weight loss ranging from 2.62 kg to 6.55 kg, depending on the baseline body weight. Significant improvements were also found in dietary outcomes (standardized mean difference 0.26, 95% CI 0.04-0.48; 95% PI -0.29 to 0.81; P=.008; 8 studies; n=1365; I2=57.5%). Subgroup analyses for anthropometric outcomes revealed significant differences only by control group type (P<.001), with waitlist controls showing the largest effect. For dietary outcomes, no significant subgroup differences were found (P>.05). While most studies showed a low risk of bias, substantial statistical heterogeneity was observed in some outcomes. Consequently, the certainty of evidence for both outcomes was rated as moderate. This review is innovative as it is the first to isolate the pure efficacy of stand-alone DLSIs by excluding synchronous human support. Our findings provide moderate-certainty evidence that these tools are effective for weight management and dietary improvement without human intervention. While stand-alone DLSIs offer a highly scalable, cost-effective first-step intervention, the PIs included zero, and substantial heterogeneity was observed, suggesting that benefits may vary across settings. Future research should identify user characteristics that maximize engagement with unguided digital tools.

28. Prevalence of Social Media Addiction and Associations With Usage Patterns, Burnout, and Health Conditions Among Medical Trainees in China: Cross-Sectional Study.

期刊: Journal of medical Internet research 发表日期: 2026-May-04 链接: PubMed

摘要

Medical residency is a demanding training stage characterized by high levels of stress and burnout. As digital natives, current medical trainees (ie, residents) are frequent users of social media; however, little is known about how their personal (nonprofessional) use relates to burnout and social media addiction (SMA). This study aims to characterize the prevalence of SMA among Chinese medical trainees and explore its complex relationships with social media use patterns, occupational burnout, and related risk and protective factors. A nationwide cross-sectional survey was deployed through Wenjuanxing and disseminated via WeChat between August 29 and September 10, 2024. Data included demographics, physical and psychiatric health history, work variables (eg, training year and night shifts), personality traits, and social media use. SMA was assessed using the Bergen Social Media Addiction Scale. Logistic regression was performed to identify predictors of addiction, and mediation and moderation analyses were conducted to clarify the role of occupational burnout. Of 3621 medical trainees, 211 (5.8%) met the criteria for SMA (Bergen Social Media Addiction Scale ≥24, indicating addiction). Second-year medical trainees reported the highest addiction prevalence (92/1159, 7.9%). Logistic regression analysis revealed that higher burnout (odds ratio [OR] 1.41, 95% CI 1.23-1.62; P<.001), longer daily use (OR 1.39, 95% CI 1.23-1.56; P<.001), physical health problems (OR 1.56, 95% CI 1.13-2.16; P=.006), and psychiatric history (OR 2.00, 95% CI 1.41-2.84; P<.001) significantly increased the odds of addiction, whereas conscientiousness was protective (OR 0.92, 95% CI 0.86-0.99; P=.02). Social media use showed significant U-shaped associations with burnout, physical health problems, psychiatric history, personality characteristics, and mental health outcomes. For example, medical trainees using social media 1 hour or less (104/404, 25.7% with psychiatric history) and more than 4 hours daily (97/419, 23.2% with psychiatric history) both had higher risk profiles than moderate users. Mediation analysis showed that occupational burnout explained 28.1% of the effect of psychiatric history and 29.6% of the effect of physical health problems on addiction risk. This large-scale survey provides the first systematic characterization of SMA among Chinese medical trainees and elucidates its associated risks and protective factors. Burnout consistently emerged as a key and pervasive predictor of SMA, functioning both as an independent risk factor and as a mediator amplifying the impact of health-related vulnerabilities. Moreover, the findings highlight that both minimal and excessive daily social media use may signal distinct behavioral manifestations of distress, potentially reflecting different clinical phenotypes: digital disengagement under acute stress versus compulsive engagement driven by chronic burnout. Notably, while mental health symptoms exhibited U-shaped associations with usage, SMA risk increased progressively with daily duration. These results underscore the need for interventions that extend beyond simply monitoring usage duration, emphasizing strategies to reduce burnout and enhance the overall well-being of medical trainees.

29. Mobile Monitoring and Land Use Regression Modeling of Ultrafine Particle Spatial Distribution in Beijing, China, during August 2022-July 2023.

期刊: Environmental science & technology 发表日期: 2026-May-04 链接: PubMed

摘要

Ultrafine particles (UFP, <100 nm) may pose more significant health risks compared to larger particulate matter due to higher specific surface area and potential for deposition throughout the respiratory system. However, their spatial distribution remains poorly characterized, particularly in Asian megacities such as Beijing with high population density and diverse emission sources. We developed a high-resolution land use regression (LUR) model to predict UFP spatial distribution in Beijing during August 2022-July 2023, using stop-and-go mobile monitoring data from 164 sites. Time adjustments were validated and applied to adjust short-term observations to 1-year average concentrations. Four modeling approaches were compared to address high-dimensional covariates, with linear regularization showing the best performance (R2 = 0.73 and 0.65; RMSE = 971 and 1050 pt/cm3 in the full model and 10-fold cross-validation). Key predictors included population density, impervious surfaces, bus stop proximity, and Chinese restaurant density, indicating significant contributions from human activity and vehicular emissions. Predicted concentrations ranged from 1.5 to 22.5 × 103 pt/cm3, with hotspots concentrated in the urban core and along major roadways. This first quantitative assessment of UFP spatial variability in Beijing underscores the value of dense mobile monitoring and robust statistical modeling for UFP exposure assessment in densely populated urban areas.

30. Policy Surveillance of Safe Patient Handling and Mobility Laws to Reduce Injury among Healthcare Workers.

期刊: New solutions : a journal of environmental and occupational health policy : NS 发表日期: 2026-May-04 链接: PubMed

摘要

Safe Patient Handling and Mobility (SPHM) programs address the tasks associated with lifting, moving, transferring, and/or assisting patients in healthcare-related settings. Manual patient handling tasks are a major source of occupational injury among healthcare workers, often resulting in harm to the back and musculoskeletal system. We systematically used legal epidemiology policy surveillance methods to capture and evaluate all state-level SPHM policies for US healthcare settings, recording their scope of coverage and enforceable elements. Since 2006, eleven states have enacted SPHM policies to reduce healthcare worker injuries. Two states repealed them later. These policies tended to target higher acuity settings rather than lower acuity or long-term residential settings and favor administrative controls over engineering controls. Specifically, the most common policy interventions included mandatory training and SPHM committees, while interventions targeting SPHM equipment availability or use were less common. Researchers, labor unions, and policymakers should prioritize engineering controls that impact physical workplace safety when crafting SPHM policy interventions.

31. Dissecting shared genetic architecture between pan-cancer and aging-related traits: a genome-wide cross-trait analysis.

期刊: Biogerontology 发表日期: 2026-May-04 链接: PubMed

摘要

The association between aging and cancer has been extensively documented in observational studies, but their shared genetic basis remains unclear. Leveraging genome-wide association studies summary statistics of aging and pan-cancer (87,531 cases and 314,193 controls) within the European population, genetic correlation and Mendelian randomization analyses were used to estimate genetic correlations, and infer causal relationships between seven aging-related traits and pan-cancer. We further conducted cross-trait and colocalization analyses to identify shared causal variants and then mapped them to genes. Differential expression analysis, RT-qPCR assays, enrichment analysis, and survival analysis were performed to explore the expression profiles of candidate genes and potential pathways. A significant negative genetic correlation between mvAge and pan-cancer was observed (rg = -0.158, P = 7.41 × 10-7). Concurrently, Mendelian randomization results supported a negative impact of pan-cancer on mvAge. We further identified five shared causal variants between mvAge and pan-cancer, and mapped them to five genes (CPA5, IRF4, KLHDC10, TYR, and ZC3HC1). High expression of ZC3HC1 was observed in bladder cancer tissues or bladder cancer cell lines, and was notably associated with low survival probability in bladder cancer. Enrichment analysis between high-ZC3HC1 and low-ZC3HC1 groups highlighted pathways related to chromosome separation and cell cycle. Our findings revealed a shared genetic basis linking aging and pan-cancer. We identified five causal variants in three colocalized loci and mapped them to five shared genes (CPA5, IRF4, KLHDC10, TYR, and ZC3HC1). In an exploratory downstream analysis, we observed that ZC3HC1 was differentially expressed in bladder cancer tissues, and high ZC3HC1 expression was associated with poorer survival outcomes.

32. Stakeholders' views and recommendations on active participation of family members in direct ICU care: A qualitative study.

期刊: Intensive & critical care nursing 发表日期: 2026-May-03 链接: PubMed

摘要

This study aimed to explore the perceptions and recommendations of key stakeholders regarding the development and implementation of care partnerships with families to promote their active participation in the direct care of patients in Intensive Care Units (ICUs). Using a qualitative descriptive design, 16 semi-structured interviews were conducted with 20 participants, including 4 patient-family dyads, 8 clinicians (5 nurses and 3 physicians), and 4 healthcare managers (HMs). The interview guide was informed by conceptual frameworks relevant to enhancing Patient-and Family-Centered Care practices. Descriptive thematic analysis was performed using Miles and Huberman’s inductive approach. The analysis identified 4 key themes related to facilitators and barriers for enhancing active family participation in direct patient care, namely: (1) Challenges faced by families regarding active participation; (2) Importance of family education and support; (3) Navigating family active participation within institutional constraints; and (4) Factors shaping family active participation. Specific recommendations for improving active family participation from stakeholders were also documented. All participants view family participation in ICU care positively, but noted obstacles like restrictive visitation policies and the complex, high-acuity ICU environment. Family participation was principally influenced by clinician support, the quality of information provided, and nurses’ attitudes. These findings offer actionable recommendations to support family members’ active participation in the direct care of ICU patients. Patients value having family members present and appreciate their participation in direct care, while ensuring they do not feel pressured to assume that role. FCs are willing to take an active role in providing direct care to their loved ones in the ICU. However, they need to be invited and supported to develop the skills to do so. Healthcare managers and clinicians can play a role in fostering an open and supportive environment that not only strengthens patient support but also enhances communication, trust, and care continuity. Barriers, such as clinician training gaps, workforce shortages, and limited organizational support, warrant further attention to promote the meaningful integration of families into ICU care processes. Actionable strategies can be applied to strengthen and sustain family participation in ICU settings, including a structured PFCC training program and flexible visitor policies to outline the shared caregiver role.

33. Farmers And Ranchers: The Stress And Anxiety Fueled By Climate Change, And Interventions That Could Help.

期刊: Health affairs (Project Hope) 发表日期: 2026-May 链接: PubMed

摘要

Farmers and ranchers are on the front lines of climate change, facing escalating production pressures, economic uncertainty, and profound psychological impacts. Drawing on first-person experience and research in agricultural communities, this Commentary uses narrative to illuminate how climate grief-grief experienced in response to actual or anticipated loss resulting from climate change-affects farmers and ranchers and shapes their capacity for climate adaptation. In addition to this experiential framing, the authors include an illustrative example of a team-developed intervention designed to support farmers’ and ranchers’ mental health; this example is offered not as original research but as a practice-based case to stimulate the broader policy conversation. Taken together, these perspectives underscore the need to integrate mental health support into agricultural climate resilience efforts. Although programs such as the Department of Agriculture’s Farm and Ranch Stress Assistance Network represent important progress, current initiatives remain fragmented and underresourced. Research on mental health interventions related to climate change in general is sparse. Increasing investment and coherent policy are essential to ensuring that climate adaptation strategies address the full spectrum of challenges that farmers and ranchers face-physical, economic, and psychological.

34. Assessing The Implementation Of Climate And Health Adaptation In Pacific Island Jurisdictions.

期刊: Health affairs (Project Hope) 发表日期: 2026-May 链接: PubMed

摘要

Pacific Island Jurisdictions are highly affected by climate change. Across the health sector, implementation of planned adaptation strategies has been uneven. It has been constrained by limited human and financial resources and organizational capacity, inadequate climate-health risk assessments, and imprecise estimates about the effectiveness of climate-related interventions. To fill these gaps, this study assessed the degree of implementation of health adaptation activities in Pacific Island Jurisdictions, using a combination of implementation science and climate change adaptation frameworks. We found that Pacific Island Jurisdictions have made advances in the implementation of health adaptation activities such as establishing coordination mechanisms, building awareness, and conducting assessments. However, less progress has been made in operationalizing targeted policies, programs, and interventions, including monitoring, evaluation, and learning. Our findings offer the potential to increase resilience if applied by practitioners (for example, public health professionals) and decision makers to inform and seek support for additional health adaptation investments.

35. From Crisis To Strategy: Mainstreaming Climate Risk In Health Systems Planning.

期刊: Health affairs (Project Hope) 发表日期: 2026-May 链接: PubMed

摘要

Climate change poses a growing threat to health care systems worldwide, exposing weaknesses in infrastructure, workforce, and governance. Climate risk-defined by the interaction of hazard, exposure, and vulnerability-is both similar to and distinct from other systemic risks that health care systems must manage. We propose a risk-based framework that integrates insights from disaster risk management and health systems thinking to identify adaptation strategies. Our approach emphasizes understanding and addressing the upstream determinants of climate risk, including the intersectoral operating environment and social and environmental vulnerabilities that amplify health impacts. This perspective links climate risk reduction to the broader agenda of health equity. Within the health sector, climate change exerts simultaneous pressure on both demand and supply, challenging systems to move from reactive crisis response toward proactive, risk-informed planning. Established tools-such as strategic investment, workforce planning, and emergency preparedness-can be leveraged to manage climate-related risks while advancing core health policy goals. Framing climate change as a systemic risk encourages the integration of climate considerations into everyday policy and planning and strengthens health care system performance.

36. Participatory Systems Science To Identify Local Adaptation Strategies For Extreme Heat In King County, Washington.

期刊: Health affairs (Project Hope) 发表日期: 2026-May 链接: PubMed

摘要

Extreme heat is a complex public health problem driven by interactions at the individual, community, health system, and policy levels. Participatory systems science engages interested parties to examine the interconnected factors driving heat-related illness and to develop locally tailored adaptation strategies. This article describes how local government agencies and community members from an area with high heat exposure in King County, Washington, engaged in the participatory systems science approach of group model building to co-develop extreme heat solutions during 2024-25. Recommended solutions included community education on heat risk; health system policies that increase access to health care; policy-informed infrastructure changes that expand access to green space; and lifesaving direct support, including distribution of cool kits to unhoused people and energy assistance programs. The insights generated can inform heat adaptation efforts across jurisdictions. The methods described offer a scalable approach to co-designing policies and interventions that can inform national and global climate resilience strategies to reduce health risks from climate-related events.

37. The Chemical Constituents of Euphorbia tibetica and Their Bioactivities.

期刊: Chemistry & biodiversity 发表日期: 2026-May 链接: PubMed

摘要

In the phytochemical study of Euphorbia tibetica, one undescribed ring-opening secoiridoid ether terpenoid, named compound 1, along with 13 known compounds 2-14, was isolated. Their structures were elucidated by comprehensive spectroscopic analysis (HRESIMS, 1D, and 2D NMR) and comparison with published literature data. Biological research discovered that compounds 9 and 12 exhibited potent antichlamydial activity at 200 µM, while compounds 7 and 8 showed moderate activity against three different pathogenic fungi at 30 µg/mL. The results suggested that compounds 9 and 12 might be a promising class of therapeutic agents for chlamydial infections.

38. Menu Changes Under NYC's Revised Food Standards Were Associated With A Reduction In Greenhouse Gas Emissions.

期刊: Health affairs (Project Hope) 发表日期: 2026-May 链接: PubMed

摘要

Local policy makers increasingly have implemented nutrition standards for municipal programs to advance population health and climate change goals. Yet little is known about the impact of these policies. In 2008, New York City established nutrition standards for food purchased and served by city agencies, and in 2022, it revised the standards to limit meat and increase plant-based options. Using menu data from four agencies serving 77 percent of all city meals, we examined changes in their entrée offerings, as well as greenhouse gas and nutrition content associated with their total menu offerings, from fiscal year 2019 through fiscal year 2024. All agencies reduced the frequency of beef entrées offered on menus and increased the frequency of vegetarian entrées. Changes in total menu offerings were associated with an estimated reduction of 0.64 kilograms of carbon dioxide equivalent in greenhouse gas emissions per portion across all agencies and programs, while the nutrition content generally remained consistent. These findings suggest that municipal food standards can support greenhouse gas reductions without compromising nutrition, and they offer a model for other jurisdictions seeking to advance both population and environmental health goals.

39. Latino Climate And Health Dashboard: Community-Informed Implementation, Data, And Policy Action.

期刊: Health affairs (Project Hope) 发表日期: 2026-May 链接: PubMed

摘要

Latino communities in California experience disproportionate climate-related health risks, including extreme heat and air pollution. Despite the state’s leadership in climate and environmental justice policy, existing data systems often do not integrate climate exposures, health outcomes, or neighborhood-level vulnerability in ways that meaningfully inform policy action. This Analysis draws on insights from the Latino Climate and Health Dashboard, a publicly available, neighborhood-level data tool that documents disparities between Latino and non-Latino White neighborhoods across California. The dashboard was developed with advisory board guidance, using the EPIS (exploration, preparation, implementation, sustainment) framework to structure data development and engagement. After the dashboard’s release, we convened community policy dialogues (“policy pláticas”) in which community organization leaders, practitioners, advocates, and legislative staff interpreted the findings and identified five policy priorities: coordinated climate and air quality governance, sustained community monitoring and early warning systems, equitable cooling and infrastructure investments, stronger connections between climate policy and health outcomes, and climate-resilient access to health care and worker protections. A participatory data tool can support equity-oriented climate-health policy making and inform efforts to translate data into policy action.

40. A 'Communiversity' Seeks To Reduce Local Environmental Hazards.

期刊: Health affairs (Project Hope) 发表日期: 2026-May 链接: PubMed

摘要

Calvin Avant is partnering with residents, researchers, and activists to reduce environmental hazards in their communities.

41. Reimagining Disaster Response: A New Vision For Community Resilience In The Texas And Louisiana Gulf Coast.

期刊: Health affairs (Project Hope) 发表日期: 2026-May 链接: PubMed

摘要

The use of community-rooted resilience models by locally governed systems across the Gulf Coast of Texas and Louisiana demonstrates how preparedness, response, and recovery in historically disinvested communities can be strengthened in disaster-prone areas. Drawing on qualitative interviews of people in this region that were conducted in 2025, we present four case studies here, showing how community, health, and government partnerships maintain essential services, power, and communication during crises. These findings highlight policy gaps and the need for investment in equitable, community-based disaster infrastructure and long-term resilience capacity.

42. Aligning Health Policy With Climate Action: Evidence-Based Interventions To Decarbonize Care, Improve Climate Resilience.

期刊: Health affairs (Project Hope) 发表日期: 2026-May 链接: PubMed

摘要

The US health care system significantly contributes to climate change while increasingly facing its adverse consequences. Despite this dual challenge, policy efforts to incentivize carbon reduction and make care delivery climate-resilient remain fragmented. In this article, we identify policy interventions and other strategies that have the potential to accelerate the transition toward low-carbon, climate-smart health care systems. Drawing on academic literature and real-world implementation examples, we present a framework of strategies, highlighting the evidence in support of mechanisms such as green reimbursement models, integration of climate change into health professional education, and sustainable procurement standards. We further examine emerging policy levers, including circular economy practices and mandated carbon accounting. Last, we highlight opportunities for federal and state policy makers, payers, and health system leaders to guide future action. Ensuring that health policies actively support climate mitigation and adaptation is a moral and environmental imperative and a strategic opportunity to improve quality, reduce costs, and advance health equity.

43. Unequal Exposure: Examining Outdoor Work And Climate Exposure In The US.

期刊: Health affairs (Project Hope) 发表日期: 2026-May 链接: PubMed

摘要

Outdoor workers face growing exposure to poor air quality, wildfire smoke, and extreme heat, yet protections remain uneven across states and incomplete federally, and little is known about outdoor workers. We combined data from national labor-force surveys with occupation-based exposure data and county-level environmental indicators on air quality, wildfire, and heat waves to describe and compare outdoor and indoor workers. Outdoor workers accounted for 21.9 percent of the workforce in 2023. About 16.9 percent of outdoor workers lived in counties with the highest frequency of unhealthy air quality days, and nearly one-third lived in counties with the highest wildfire (32.4 percent) and heat wave (31.4 percent) risks. Compared with indoor workers, outdoor workers had higher rates of uninsurance, more self-employment, lower access to paid sick leave, and higher rates of work injuries. Results identified outdoor workforces with elevated climate-related risks and differences in coverage and job arrangements, informing federal, state, and local prevention, standards, and enforcement.

44. Extracorporeal versus conventional cardiopulmonary resuscitation for out-of-hospital cardiac arrests.

期刊: The Journal of invasive cardiology 发表日期: 2026-Apr-29 链接: PubMed

摘要

It remains unclear whether extracorporeal cardiopulmonary resuscitation (ECPR) is more efficacious than conventional cardiopulmonary resuscitation (CPR) at improving survival with favorable neurological outcomes among patients with out-of-hospital cardiac arrests (OHCA). The authors sought to determine the efficacy of ECPR vs conventional CPR among patients with OHCA in the pre-hospital setting. The authors searched MEDLINE, EMBASE, and the Cochrane Library for randomized controlled trials (RCTs) comparing ECPR with conventional CPR for patients with OHCA. The primary outcome was survival with a favorable neurological outcome at 6-month follow-up. Count data were pooled across trials through random-effects models with inverse variance weighting to estimate risk ratios (RRs) and 95% confidence intervals (CIs). A total of 3 RCTs (n = 420) were included. Most patients (85%) were male, and the mean/median age ranged from 54 to 59 years. At 6 months, 28.4% of the patients randomized to ECPR survived with favorable neurological outcomes compared with 18.6% of the patients randomized to conventional CPR (RR, 1.47; 95% CI, 0.43-5.09). Similar results were obtained for survival at hospital discharge (RR, 1.35; 95% CI, 0.35-5.19). Risk of Bias 2 analysis indicated low risk in 1 trial and some concerns in others. ECPR may be associated with improved survival with favorable neurological outcomes at 6 months compared to conventional CPR for the treatment of OHCA. However, the available evidence remains inconclusive, and additional trials are needed to definitively assess the efficacy of ECPR compared to conventional CPR for OHCA.

45. Protective effect of bevacizumab against interstitial lung disease in non-squamous non-small-cell lung cancer: a nationwide target trial emulation study.

期刊: Lung cancer (Amsterdam, Netherlands) 发表日期: 2026-Apr-28 链接: PubMed

摘要

We evaluated the association between bevacizumab use and interstitial lung disease (ILD), 180-day mortality, and venous thromboembolism (VTE) risks in patients with non-squamous non-small-cell lung cancer (NSCLC) receiving first-line platinum-based chemotherapy. Using the Japanese Diagnosis Procedure Combination database (2011-2023), we identified patients with stage III-IV non-squamous NSCLC who initiated platinum-based chemotherapy with pemetrexed, with or without bevacizumab. A target trial emulation framework was applied. The primary outcome was ILD requiring corticosteroid treatment within 180  days of chemotherapy initiation. The secondary outcomes included 180-day mortality, mortality within 30 days after ILD onset, and VTE. Propensity score overlap weighting was used to balance the baseline covariates. Fine-Gray models and Cox proportional hazards models were used to estimate subdistribution hazard ratios (SHRs) for ILD and VTE and hazard ratios (HRs) for mortality. Overall, 47,433 patients were analyzed (bevacizumab group: n = 12,101; non-bevacizumab group: n = 35,332). Bevacizumab use was associated with lower risks of ILD [SHR, 0.75; 95% confidence interval (CI), 0.67-0.84], 180-day mortality (HR, 0.61; 95% CI, 0.57-0.66), and mortality within 30 days after ILD (HR, 0.71; 95% CI, 0.57-0.88). The overall VTE risk was similar between the two treatment groups. The main results were consistent across subgroups stratified by the baseline platinum agent, ICI use, age group, and ILD history. In patients with advanced non-squamous NSCLC receiving first-line platinum-based chemotherapy, bevacizumab use was associated with lower risks of ILD and short-term mortality, without increased VTE risk.

46. HIPPA-DGCN: Survival analysis on whole slide images via hyper-image patches and position-aware dense graph convolutional networks.

期刊: Computer methods and programs in biomedicine 发表日期: 2026-Apr-28 链接: PubMed

摘要

Whole Slide Images (WSIs) are the gold standard for cancer diagnosis and prognosis. However, the enormous scale of WSIs presents significant challenges for effective information aggregation in survival analysis, limiting prognostic accuracy and clinical applicability. This study aims to develop a computationally efficient framework for accurate and interpretable survival prediction from WSIs. We propose HIPPA-DGCN, a novel framework that utilizes hyper-image patch clustering for feature distillation and a position-aware dense graph convolutional network for global context modeling. This architecture is designed to efficiently integrate pathological features with their spatial relationships. Extensive evaluation on seven public datasets (five from TCGA and two from CPTAC) demonstrates state-of-the-art performance. Our method achieves superior prognostic accuracy while drastically improving computational efficiency, reducing model parameters to 0.73M and computational cost to 0.08 GFLOPs per WSI. The model generates interpretable attention maps that highlight histopathological regions with significant prognostic relevance. HIPPA-DGCN provides an accurate, efficient, and interpretable solution for WSI-based survival analysis. Its lightweight architecture and robust performance make it particularly suitable for clinical deployment in resource-constrained environments, potentially enhancing cancer prognosis workflows.

47. Association between menstruation and spermatozoa persistence in sexual assault victims: a medicolegal case-control study in Southeast Sulawesi, Indonesia.

期刊: Legal medicine (Tokyo, Japan) 发表日期: 2026-Apr-21 链接: PubMed

摘要

Spermatozoa detection is an important component of forensic examination in sexual assault cases. Spermatozoa persistence in the vaginal environment is influenced by physiological factors, including menstruation. However, the effect of menstruation on spermatozoa detectability during medicolegal examinations remains insufficiently explored. This study aimed to evaluate the association between menstruation and spermatozoa persistence among sexual assault victims undergoing medicolegal examination in Southeast Sulawesi, Indonesia. A case-control study was conducted involving 240 female sexual assault victims examined within five days after the alleged assault. Cases consisted of victims examined during menstruation (n = 120), while controls were victims examined outside the menstrual period (n = 120). Bivariate analysis and multivariate logistic regression were performed to identify factors associated with spermatozoa detection. Spermatozoa were detected in 64.2% of menstruating victims and 47.5% of non-menstruating victims. Menstruation was significantly associated with increased odds of spermatozoa detection (adjusted OR 1.82, 95% CI 1.05-3.16; p = 0.032). Early examination (<24 h) was the strongest predictor (adjusted OR 2.70, 95% CI 1.50-4.86; p = 0.001). Age was not significantly associated with spermatozoa detection. A significant interaction between menstruation and time since assault was observed (adjusted OR 2.11, 95% CI 1.14-3.89; p = 0.018), indicating a stronger effect of menstruation in delayed examinations. Sensitivity analyses confirmed the robustness of these findings. Menstruation is associated with increased spermatozoa detection and appears to influence spermatozoa persistence in a time-dependent manner. These findings highlight the importance of considering menstrual status in the forensic interpretation of spermatozoa evidence.

48. Randomized controlled trial of job crafting as a digital health intervention for occupational burnout in psychological therapists.

期刊: Journal of consulting and clinical psychology 发表日期: 2026-Apr 链接: PubMed

摘要

Occupational burnout is common in the mental health care workforce, with negative consequences for professionals and patients. This study aimed to evaluate the efficacy of a digital health intervention to alleviate burnout in psychological therapists. This randomized controlled trial recruited 135 therapists working across 17 psychological services in England. The intervention involved six online group webinars based on principles of job crafting. Half of the participants accessed the intervention immediately (Group 1), and half were assigned to a waitlist control group (Group 2). After 6 weeks, Group 2 started the intervention. Participants completed measures of burnout (primary outcome), well-being, and job satisfaction at four time points (baseline, 6, 12, 36 weeks). Outcomes were compared between groups using mixed-effects models controlling for baseline severity and clustering by service. Differences between groups were statistically significant after 6 weeks, favoring job crafting versus waitlist control in burnout (d = 0.43, p < .001), well-being (d = -0.39, p = .023), and job satisfaction (d = -0.28, p = .006) measures. However, the magnitude of improvements relative to baseline levels declined over a 36-week period. A brief job crafting intervention led to short-term improvements in occupational health indicators. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

49. Children's voices in community-based promotion of childhood health and wellbeing and the responses of community stakeholders.

期刊: Social science & medicine (1982) 发表日期: 2026-Mar-28 链接: PubMed

摘要

Rising childhood obesity highlights the need for preventive strategies. Community-based approaches and the inclusion of children’s perspectives have been recommended; however, children’s involvement often remains symbolic, with little translation of their views into action. Aiming to guide involvement, this study explores the process of conveying 7-10-year-old children’s perspectives on leisure time and local health initiatives to adult community stakeholders and to examine stakeholders’ engagement with children’s perspectives. The study is part of the Danish project Generation Healthy Kids. We conducted 15 workshops with 57 children to explore their perspectives on leisure and health initiatives within their community. Using a modified Write, Draw, Show and Tell approach, we collected and thematically analyzed audio recordings, post-it notes, and drawings from workshops. Findings were presented to adult stakeholders in six communities and their responses documented. Children identified organized sports, activities with family and friends, and varied creative after-school activities as important for good leisure time, while negative influences included chores, conflicts, loneliness, injuries, and failures. They valued community initiatives including family, storytelling, exploration, and a festive atmosphere. Stakeholders responded to the perspectives with interest and requests for actionable, local insights. Further, there was a tendency among some stakeholders to maintain an adult perspective and focus on feasibility concerns when discussing the use of children’s perspectives in developing or refining local health initiatives. Our findings suggest that to support the process of translating children’s perspectives into action, consideration of participation levels, timing, and ethics is essential. Multimodal methods can be used to accommodate children’s diverse ways of expression and involving children earlier and more actively is recommended.

50. Assessing multilevel association of genderism on cognitive health of older adults across mesosystems and microsystems using the longitudinal aging study in India: An adaptation of the ecological systems theory and cumulative disadvantage/advantage framework.

期刊: Social science & medicine (1982) 发表日期: 2026-Mar-11 链接: PubMed

摘要

Structural and social determinants across chronosystems critically shape educational transitions and cognitive aging in India by influencing cognitive reserve through life-course. Drawing on Bronfenbrenner’s Ecological Systems Theory and the Cumulative Disadvantage/Advantage frameworks, we conceptualize genderism as a structural and social determinant of cognitive health operating across multiple ecological levels - national (macrosystem), regional/states (mesosystem), and household/family or individual (microsystem) - within India’s chronosystem. Using Wave 1 of the Longitudinal Aging Study in India (LASI, 2017-2018), we assessed cognitive health across five domains, i.e., memory, orientation, attention, object naming, and executive function among older adults in 36 states and Union Territories of India. Three-level regression models examined how microsystem operating at individual (e.g., age, sex, education, childhood SES, widowhood, health behaviors), and household level (monthly per capita expenditure, indoor air quality, urban/rural residence), and mesosystem operating at state-level (e.g., women’s education and employment rates) factors interact to shape cognitive health outcomes. Cognitive health outcomes showed wide gender gaps with regional sex disparities with the largest gap among those with education less than primary education (men: 24; women: 21) which reversed among those with post-secondary education (women: 33; men: 33). Widowed women and those with poor health indicators had significantly lower cognitive health scores. At the microsystem household-level, urban residence (β = 2.64), and households with cleaner cooking fuel use (β = 1.61) while at the mesosystem state-level, the % of women with at least primary education (β = 1.82) and the % of women who were employed (β = 0.62) were associated with improved cognitive health outcomes. The findings reveal how genderism across chronosystems accumulate over the life course highlighting the need for national-state-level policies that enhance women’s access to education, employment, health, and nutrition to mitigate gendered disparities in late life cognitive health among Indian adults.

51. Integrating Heart Health Intervention Into Home Visitation: Qualitative Analysis of Home Visitation Staff Perspectives.

期刊: Home healthcare now 发表日期: 链接: PubMed

摘要

Optimal cardiovascular health during pregnancy and postpartum is critical for reducing maternal morbidity and mortality. Although lifestyle interventions effectively promote cardiovascular health, strategies are needed to reach the maternal populations with the highest prevalence of cardiovascular disease risk factors. Evidence-based home visiting programs, though not initially developed to address cardiovascular health, offer a promising platform for reaching pregnant and postpartum women at high risk for later cardiovascular disease. This study explored home visitor perspectives on integrating cardiovascular health content into home visitation. Guided by the Social Ecological Model, semi-structured interviews (n = 10) and focus groups (n = 8) were conducted with home visitors, supervisors, and program managers (N = 33) from agencies in California and Rhode Island. Thematic analysis identified broad support for including heart health content, with participants emphasizing the value of culturally relevant, engaging, and flexible curricula that could be tailored to family needs. Organizational challenges included staff burden, training gaps, and funding for intervention sustainability. At the community level, strong relationships with healthcare providers and aligned messaging across systems were identified as key facilitators. Findings provide practical insights for the design and implementation of cardiovascular health interventions within home visiting and highlight the importance of addressing multi-level factors to support successful integration.

52. Early Detection of Ototoxicity in Home Healthcare.

期刊: Home healthcare now 发表日期: 链接: PubMed

摘要

Hearing is a vital part of human experience. It serves as a medium for communication, shapes perception of the world, and facilitates the formation of meaningful relationships. Thus, when hearing loss occurs, it can have a profoundly life-altering and detrimental impact on an individual. Hearing loss can be attributed to a variety of causes, including genetics, aging, medications, and disease processes. Commonly used medications, such as antibiotics, diuretics, and antineoplastics, can damage the inner ear’s delicate internal structures, leading to hearing loss-a condition known as ototoxicity. Early recognition and treatment are crucial in preventing irreversible damage from these medications, and nurses play a vital role in this process. In the home healthcare setting, nurses serve as advocates, fostering trusting relationships with patients to promote patient safety and ensure effective monitoring and education. Numerous studies have discussed ototoxicity and emphasized the need for consistent monitoring, guidelines, and protocols; however, there is a notable lack of research investigating nursing-based interventions and acknowledging the critical role of nurses in implementing these preventive measures in home healthcare. The objective of this manuscript is to discuss an individual’s experience with permanent hearing loss due to ototoxicity, highlighting the vital role nurses play in preventing these devastating effects. It emphasizes expanding the nurse’s role in home healthcare to improve the timely detection and monitoring of ototoxicity. Proposed strategies include nursing assessment checklists, structured patient education handouts, and symptom diaries. By outlining key nursing interventions and proposed evaluation strategies, this manuscript raises awareness of how medication-induced, irreversible hearing loss can be mitigated through proper patient education and nursing-based monitoring in the home healthcare setting.

53. Feasibility and Acceptability of a Virtual Home Assessment for Supporting People with Dementia to Live at Home.

期刊: Home healthcare now 发表日期: 链接: PubMed

摘要

This study aimed to examine the satisfaction with, and feasibility and acceptability of, a virtual home safety assessment implemented for people living with dementia and their caregivers by a trained Occupational Therapist (OT). Seventeen assessments were conducted. Nine caregivers and one patient completed a satisfaction survey. Ten caregivers and the OT assessor completed semi-structured interviews, which were analyzed using qualitative content analysis. Survey respondents reported high levels of satisfaction with the virtual assessment; the majority (90%) reported being comfortable with the virtual modality. Caregivers perceived that their assistance was required to conduct the assessment virtually, and care recipients responded well to technology. In comparison to in-person visits, the virtual assessment was considered easier for people living with dementia, easier to access, and equivalent to an in-person visit. Virtual home assessments are easy to implement, feasible, acceptable, and an effective way to identify and manage safety risks. Given the health system pressures that have led to long wait times for in-home safety assessments, virtual administration can build capacity for home safety assessments, allowing more patients to be assessed sooner, particularly in rural and underserviced areas where travel distances impede timely access to assessment.

54. The impact of non-pharmaceutical interventions on the socio-economic and demographic determinants of COVID-19 incidence: A spatial analysis of the pandemic in Toronto, Canada.

期刊: PloS one 发表日期: 2026 链接: PubMed

摘要

Socio-economic and demographic variables have been identified as determinants of transmission of, and susceptibility to, COVID-19. In this study, we analyse the heterogeneous impacts of non-pharmaceutical interventions on the socio-economic and demographic (SED) variables driving COVID-19 incidence in Toronto during the 2nd, 3rd and 4th waves of the pandemic. Spatial autoregressive models were used to explore associations between COVID-19 incidence and SED variables at neighborhood scale, accounting for vaccination levels. This approach helps clarify how SED factors and vaccine coverage drive COVID-19 incidence and how non-pharmaceutical interventions (NPIs) modulate these factors at neighborhoods’ level, while taking into account the pervious nature of boundaries at these scales to disease transmission due to population mobility, although without directly informing on behaviours, exposure, or vulnerability at individual level. Three distinct models were considered for each of the second, third and fourth COVID-19 waves, from late 2020 to late 2021. Associations highlighted by the models were interpreted with reference to the NPIs implemented. Level of scholarity, income, proportion of the population living alone, average number of children in families, and the proportion of the population whose mother tongue is not an official language showed significant relationships with COVID-19 incidence. Model results were different for each wave, reflecting the unequal impacts of NPIs at different time points, and for different population groups, depending on the nature of interventions and the SED determinants considered. Prioritization of population groups for testing, unequal gathering restrictions, selective closure of economic activities or work-from-home policies led to heterogenous impacts on incidence. The results highlight the unequal burden of the pandemic across populations and likely disparities in occupational exposure driven by SED factors, as well as their evolution with the implementation and lifting of NPIs. Populations with the lowest income and scholarity cumulate the highest risks of exposure and the highest risks of severe disease outcomes. Our results support the development of knowledge based public health surveillance programs integrating both non-communicable and infectious diseases cases, beyond their acute occurrences, along with their socio-economic characteristics.