公共卫生研究摘要 (2026-05-07)

共收录 57 篇研究文章

1. Efficacy of a Modular Lifestyle Intervention Through Occupation for Individuals With Rheumatoid Arthritis: A Randomized Controlled Trial With 6-Month Follow-Up.

期刊: The American journal of occupational therapy : official publication of the American Occupational Therapy Association 发表日期: 2026-Jul-01 链接: PubMed

摘要

Rheumatoid arthritis (RA) causes persistent symptoms that limit individuals’ ability to engage in meaningful daily occupations. Occupational therapy plays a key role in integrating lifestyle and behavioral strategies into comprehensive RA management. To examine the efficacy of a client-centered, modular lifestyle intervention (LI) on occupational performance and health outcomes of individuals with RA. A randomized controlled trial. Rheumatology outpatient clinic of a university hospital. Forty-five individuals diagnosed with RA were randomly assigned to an LI group (n = 23) or a control group (n = 22). The LI group received an eight-session, occupation-based LI; the control group received twice-weekly well-being check phone calls over 4 wk. The primary outcome was the Canadian Occupational Performance Measure (COPM) Performance score. Secondary outcomes included COPM Satisfaction, Disease Activity Score-28, visual analog scale for pain, Bristol Rheumatoid Arthritis Fatigue Multi-Dimensional Questionnaire, and Rheumatoid Arthritis Quality of Life Scale scores. Assessments were conducted at baseline, postintervention, and 6-mo follow-up. Compared with the control group, the LI group demonstrated significantly greater improvements in the primary outcome (COPM Performance) as well as in secondary outcomes including COPM Satisfaction, pain, fatigue, and quality of life. A delayed reduction in disease activity was observed at the 6-mo follow-up. The LI produced durable improvements in occupational performance and patient-reported outcomes, supporting its integration as a sustainable adjunct to pharmacological care for individuals with RA. Plain-Language Summary: People with rheumatoid arthritis often have difficulty completing daily activities because of pain, fatigue, and limitations in movement. This study explored whether a structured lifestyle program based on occupational therapy principles could help improve these challenges. All participants continued their usual medical treatment throughout the study. In addition, one group received an eight-session lifestyle intervention focused on meaningful daily activities, healthy habits, energy conservation, and participation in social and leisure activities. The control group received their usual medical treatment along with brief well-being check phone calls. Participants who received the lifestyle program showed greater improvements in performing and enjoying daily activities and reported lower fatigue levels than those in the control group. These findings suggest that adding an occupation-based lifestyle program to standard medical care may provide meaningful benefits for people living with rheumatoid arthritis.

2. Characteristics and Geographical Work Location of Early Career Nursing and Allied Health Practitioners Following a Rural Placement: Results From a Post-Graduate Survey.

期刊: The Australian journal of rural health 发表日期: 2026-Jun 链接: PubMed

摘要

To describe the characteristics and geographical work locations of early career nursing and allied health practitioners who undertook a rural placement. This study used quantitative data from a longitudinal survey design with students who consented to be involved in the longitudinal study after completing their rural placement. These students are followed up every 2 years after their rural placement. Nursing and allied health graduates working in their discipline of qualification (n = 706). The main outcome measure was health professionals work location: rurally based, doing some rural work (e.g., outreach) or metropolitan based. Multinomial regression results indicated that rural origin, older age and nursing professionals were statistically significant predictors of being rurally based in recently graduated health professionals. Nurses were 1.7 times more likely to work rurally compared to allied health professionals. For some allied health disciplines, around one third of the respondents were rurally based up to four years after graduation, ranging from 17% for psychology to 52% for social work. Collectively, allied health professionals were more likely to be providing ‘some rural work’ compared to nursing professionals, and over 20% of occupational therapists, speech pathologists and psychologists responding to the survey were employed to ‘do some rural work’. This study provided preliminary insights into work locations of early career allied health and nursing workforces following a rural placement. Findings suggest there is complexity to understanding the impact of a rural placement given the various factors involved, including rural background, age at graduation, available rural work opportunities and options for providing outreach to rural areas. This study highlighted the importance of rural origin, the need to support mature age students and the variation in allied health disciplines in the extent they practice rurally or provide some rural outreach. Continued follow-up of these professionals over time may help to identify key determinants of health professionals’ workplace locations.

3. Integrated climate effects on nitrogen cycles in global grasslands.

期刊: Science advances 发表日期: 2026-May-08 链接: PubMed

摘要

Grasslands play a crucial role in providing essential ecosystem services through biogeochemical processes. Improving grassland productivity and nitrogen use efficiency, reducing reactive nitrogen losses, and ensuring environmental sustainability represent major challenges, especially under the influence of global climate change. While previous studies have shown substantial effects of individual climate change factors on grassland nitrogen cycling, a comprehensive understanding of how grassland nitrogen cycling responds to multiple climate change remains limited. In this study, using data from 150 countries, we identified climate warming as the primary driver of increased nitrogen harvest, biological nitrogen fixation, and nitrogen surplus in global managed and undisturbed grasslands. These increases, with respective increments of 19.8, 8.8, and 28.2%, were determined by comparing scenarios with and without climate change from 1980 to 2020. Precipitation variability further amplifies these nitrogen increases, displaying notable spatial heterogeneity. Conversely, elevated atmospheric CO2 levels mitigate nitrogen surplus by enhancing plant nitrogen uptake. Under the SSP2-RCP4.5 scenario for the year 2050, nitrogen input, harvest, and surplus in global grasslands are projected to increase annually by 22.3, 7.2, and 15.1 million tonnes, respectively, compared to baseline scenarios. These climate-induced alterations in nitrogen budgets could incur additional costs up to USD $69 billion because of associated impacts on human health and ecosystem integrity. Our findings emphasize the urgent need for robust management strategies aimed at mitigating the negative effects of climate change on grassland nitrogen cycling, thereby supporting global sustainable development objectives.

4. A redox-sensitive phosphatase regulates glycolysis as a metabolic switch in the bacterial inner membrane.

期刊: Science advances 发表日期: 2026-May-08 链接: PubMed

摘要

Microorganisms rapidly adjust their metabolism to survive fluctuating environmental conditions, but how they coordinate glycolytic control with redox signals remains unclear. We found that the membrane phosphatase PgpA acts as a redox-sensitive switch to regulate glycolytic flux in Escherichia coli. PgpA dephosphorylates key glycolytic intermediates, glyceraldehyde-3-phosphate and glycerol-3-phosphate, to modulate central metabolism. This activity is controlled by a reversible disulfide bond that forms an inactive dimer under oxidative stress and restores activity when reduced. This redox-dependent regulation enables E. coli to fine-tune metabolism in response to changes in nutrients and oxygen availability. PgpA inactivation increases glucose uptake and promotes metabolism, while constitutive activation impairs growth under anaerobic conditions. We also found that PgpA influences redox homeostasis by regulating glutathione biosynthesis. These findings reveal a negative feedback mechanism in which PgpA integrates glycolysis with redox balance, serving as a central regulator of bacterial metabolic homeostasis in response to environmental changes.

5. Ecosystem technology (ecotech): Harnessing natural processes to address global challenges.

期刊: Science advances 发表日期: 2026-May-08 链接: PubMed

摘要

Over the past 80 years, biotechnology has advanced agriculture, health care, and economic development by harnessing biological processes from the organism inward, i.e., from the organ system to the molecular scale. Today’s global challenges, including biodiversity loss, climate change, and pollution, demand a complementary technological expansion inspired by processes operating from the organism outward, i.e., at the levels of populations, communities, ecosystems, and the biosphere. Here, we present the components of this technological expansion through ecosystem technology, or ecotech. We propose a framework for ecotech to integrate elements of ecology, engineering, and earth science and to function as a practical and conceptual convergence accelerator. Ecotech will advance critical environmental solutions by uniting independently evolving technologies, generating diverse fields of inquiry (e.g., ecomimicry, ecosystem materials science, ecosystem sensing and signaling), and inspiring innovation. To harness this innovation to improve nature restoration, carbon storage, water quality, ecosystem energy, and infrastructure resistance to disasters, ecotech is guided by cross-cutting actions to ensure scalability, equity, and accountability. When integrated into strategies across nongovernmental organizations, business, and governments, ecotech offers a pathway to advance climate adaptation, biodiversity recovery, and economic diversification and growth. By uniting ecology, engineering, and earth sciences at scale, ecotech transforms technology into a tool to confront humanity’s most urgent existential needs and secure a livable future.

6. Potential Celiac Disease as a Window Into Gluten-Mediated Enteropathy.

期刊: Journal of clinical gastroenterology 发表日期: 2026-May-07 链接: PubMed

摘要

Potential celiac disease is defined as having positive celiac serology in the absence of intestinal villous atrophy. This phenotype is common, accounting for ∼1 in 5 celiac patients. Many patients never develop the enteropathy characteristic of active celiac disease, and antibodies may even normalize despite continuing to consume gluten. There is no reliable way to predict who will go on to develop active celiac disease, and there is a lack of evidence on how best to manage these patients. By understanding biochemical and immunologic differences between potential and active celiac disease, we may learn how celiac disease develops and elucidate new targetable pathways to prevent or ameliorate villous atrophy.

7. [BVS Homeopatia Brasil: A historical review of its role in the visibility and access to homeopathic knowledge].

期刊: Revista medica del Instituto Mexicano del Seguro Social 发表日期: 2026-May-06 链接: PubMed

摘要

The Virtual Health Library on Homeopathy (BVS Homeopatia Brasil) represents a pioneering initiative in the organization, digitization, and dissemination of homeopathic knowledge in Latin America. This article presents a narrative review of its trajectory, from the informational invisibility of homeopathy during the 1970s and 1980s to its consolidation as the main specialized digital repository in the field. Key milestones are analyzed: the creation of the HOMEOINDEX database, the development of the HP category in the DeCS thesaurus, the leadership of Dr. Matheus Marim in the digital transition, and the institutionalization of the BVS through agreements with BIREME, Pan American Health Organization (PAHO), World Health Organization (WHO), and the Brazilian Ministry of Health. The article also describes its current features, recent technological updates, and the incorporation of artificial intelligence as an emerging challenge. The review identifies BVS Homeopatia as a successful model for democratizing access to scientific knowledge, sustained by interinstitutional cooperation and active community engagement. It concludes that its sustainability will depend on continued use by professionals and the general public, as well as on its capacity to adapt to the technological and epistemological transformations of the 21st century. La Biblioteca Virtual en Salud (BVS) Homeopatía Brasil representa una experiencia pionera en la organización, digitalización y difusión del conocimiento homeopático en América Latina. Este artículo ofrece una revisión narrativa sobre su trayectoria, desde la invisibilidad informacional de la homeopatía en las décadas de 1970 y 1980 hasta su consolidación como el principal repositorio digital especializado en el área. Se analizan los hitos fundamentales: la creación de la base HOMEOINDEX, el desarrollo de la categoría HP del DeCS, el liderazgo del Dr. Matheus Marim en la transición al entorno digital, y la institucionalización de la BVS mediante convenios con BIREME, la Organización Panamericana de la Salud (OPS), la Organización Mundial de la Salud (OMS) y el Ministerio de Salud de Brasil. Asimismo, se describen sus principales funcionalidades, el proceso reciente de actualización tecnológica y la incorporación de inteligencia artificial como reto emergente. La revisión identifica a la BVS Homeopatía como un modelo exitoso de democratización del acceso al conocimiento, sostenido por una red de cooperación interinstitucional y la participación de la comunidad. Se concluye que su sostenibilidad dependerá del uso continuo por parte de profesionales y del público general, así como de su capacidad para adaptarse a las transformaciones tecnológicas y epistemológicas del siglo XXI.

8. [Risk factors for cervical intraepithelial lesions among beneficiaries of second-level care].

期刊: Revista medica del Instituto Mexicano del Seguro Social 发表日期: 2026-May-06 链接: PubMed

摘要

Cervical cancer (CC) is a major public health problem, particularly in low- and middle-income countries. Although human papillomavirus (HPV) is the main causal agent, the relevance of various risk factors varies by context. To identify familial, sociodemographic, behavioral, and sexual history factors associated with squamous intraepithelial lesions (SIL) in women attending the Opportunistic Cervical Cancer Screening Program in the Regional Hospital with Family Medicine Unit No. 32 in Minatitlán, Veracruz, Mexico. An observational case-control study (1:2) was conducted in women aged 25-60 years with available cytology results. An anonymous questionnaire was applied, and data were analyzed using comparison tests and odds ratios (OR) with 95% confidence intervals (95% CI). A total of 119 women (37 cases, 82 controls) were included. No significant differences were found between groups for age, age at first intercourse, number of pregnancies, sexual partners, contraceptive use, or smoking. A strong association was found between the presence of SIL and a history of abnormal cytology (crude OR 2916; corrected OR 1322), as well as between SIL and a family history of cervical cancer (OR 2.73). Specific sexual practices showed no association. Some factors considered risk factors showed no association in this population. This highlights the importance of follow-up for abnormal cytology and the need for further longitudinal studies with context-sensitive approaches. el cáncer cervicouterino (CaCU) es un problema de salud pública, especialmente en países de ingresos bajos y medios. Aunque el virus del papiloma humano es el principal agente causal, la relevancia de diversos factores de riesgo varía según el contexto. identificar antecedentes heredofamiliares, sociodemográficos, hábitos y características de la vida sexual asociados a lesiones escamosas intraepiteliales (LEI) en mujeres del Programa de Detección Oportuna del Hospital General de Zona con Medicina Familiar No. 32, en Minatitlán, Veracruz, México. se hizo un estudio observacional de casos y controles (1:2) en mujeres de 25 a 60 años con resultado citológico disponible. Se aplicó un cuestionario anónimo y se analizaron los datos con pruebas de comparación y razón de momios (RM) con intervalos de confianza al (IC 95%). se incluyeron 119 mujeres (37 casos, 82 controles). No hubo diferencias significativas en edad, inicio de vida sexual, número de gestas, parejas sexuales, uso de anticonceptivos o tabaquismo. Se identificó una fuerte asociación entre la presencia de LEI y el antecedente de citología anormal (RM cruda 2916; RM corregida 1322), y entre LEI y el antecedente de CaCU en familiares directos (RM 2.73). Las prácticas sexuales específicas no mostraron asociación. algunos factores considerados de riesgo no mostraron asociación en esta población. Destaca la importancia del seguimiento de citologías anormales y la necesidad de estudios longitudinales con enfoque contextualizado.

9. [Infrared thermography outcomes in women with suspected breast cancer].

期刊: Revista medica del Instituto Mexicano del Seguro Social 发表日期: 2026-May-06 链接: PubMed

摘要

Breast cancer (BC) is the most common cause of death in women aged 40 to 75 years. Infrared thermography (IT) has been proposed as a noninvasive test useful in the detection of BC. To analyze the results of IT in women with suspected BC. An analytical, observational, longitudinal, and prospective study was conducted. Women aged ≥ 15 years with suspected BC were included, with BI-RADS (Breast Imaging Reporting and Data System) 4. Prior to the biopsy, breast temperature was measured using 2 thermographic sensors. The histopathological results of the breast biopsy were recorded and classified as inflammatory lesions, fibrocystic breast disease, premalignant lesions, and malignant lesions. A total of 104 women were analyzed, with BI-RADS 4A (64%), 4B (26%), and 4C (10%), and 4 were eliminated due to loss to follow-up. Mean age was 47.7 ± 12.2 years. 14% of cases showed a palpable lesion, with the right breast being the most affected (56%). The most common malignant lesion was ductal carcinoma (11%). The IT cutoff point for malignant lesion ≥ 33.4 °C showed a sensitivity of 0.69, specificity of 0.63, area under the curve (AUC) = 0.65 (95% confidence intervals [95% CI] 0.45-0.79), p = 0.03; with an odds ratio (OR) = 4.16 (95% CI 1.23-14.09), p = 0.01. The results of the IT showed moderate sensitivity and specificity for malignant lesions. The cutoff point ≥ 33.4 °C showed a 4-fold increased risk for malignancy. el cáncer de mama (CM) es la causa más frecuente de muerte en mujeres de 40 a 75 años. Se ha propuesto la termografía infrarroja (TI) como examen no invasivo de utilidad en la detección del CM. analizar los resultados de la TI en mujeres con sospecha de CM. estudio analítico, observacional, longitudinal y prospectivo. Se incluyeron mujeres ≥ 15 años con sospecha de CM, con BI-RADS (Breast Imaging Reporting and Data System) 4. Antes de tomar la biopsia, se midió la temperatura de las mamas mediante 2 sensores termográficos. Se registró el resultado histopatológico de la biopsia de mama y se clasificó como lesiones inflamatorias, mastopatía fibroquística, lesiones premalignas y lesiones malignas. se analizaron 104 mujeres, con BI-RADS 4A (64%), 4B (26%) y 4C (10%); se eliminaron 4 por pérdida en el seguimiento. La edad media fue de 47.7 ± 12.2 años. Del total, 14% mostró lesión palpable y la mama derecha fue la más afectada (56%). La lesión maligna más frecuente fue el carcinoma ductal (11%). El punto de corte para lesión maligna de TI ≥ 33.4 ºC mostró sensibilidad de 0.69, especificidad de 0.63, área bajo la curva (AUC) = 0.65 (intervalo de confianza del 95% [IC 95%] 0.45-0.79), p = 0.03; con razón de momios (RM) = 4.16 (IC 95% 1.23-14.09), p = 0.01. los resultados de la TI mostraron sensibilidad y especificidad moderadas para lesiones malignas. El punto de corte ≥ 33.4 ºC mostró un riesgo mayor de 4 veces para malignidad.

10. [Prevention of hypoparathyroidism with indocyanine green in transoral thyroidectomy: Pilot study].

期刊: Revista medica del Instituto Mexicano del Seguro Social 发表日期: 2026-May-06 链接: PubMed

摘要

The prevalence of hypoparathyroidism following thyroidectomy is estimated to range from 15%, with a higher incidence observed in transoral endoscopic thyroidectomy via vestibular approach (TOETVA). To describe the impact of intraoperative use of indocyanine green (ICG) to identify parathyroid glands in reducing postoperative hypoparathyroidism. A pilot, observational, comparative, longitudinal, and ambispective study was conducted in a cohort of 55 patients who underwent laparoscopic thyroidectomy via TOETVA. Calcium (Ca) and parathyroid hormone (PTH) levels were compared immediately and 24 hours after surgery. The mean age was 43.07 years (standard deviation ± 10.15). The average surgery time was 99.15 minutes (± 20.02), and the mean blood loss was 9.3 mL (± 15.9). The prevalence of biochemical postoperative hypoparathyroidism (PTH < 12 pg/mL) was 5.54%. Biochemical hypocalcemia occurred in 19 patients (34.5%), and 4 patients (7.3%) experienced clinical hypocalcemia with paresthesia. Patients were divided into 2 groups: with and without the use of ICG. No significant differences were found in the incidence of hypocalcemia or hypoparathyroidism between the 2 groups (p = 0.360 and p = 1.000, respectively). No differences were found in surgery time, blood loss, clinical hypocalcemia, or postoperative calcium and PTH levels. la prevalencia de hipoparatiroidismo posterior a una tiroidectomía se estima en un 15% de los casos, con una mayor incidencia en tiroidectomía endoscópica transoral por vía vestibular (TOETVA). describir el impacto del uso transoperatorio de verde de indocianina para identificar las glándulas paratiroides en la reducción del hipoparatiroidismo posquirúrgico. se realizó un estudio piloto, observacional, comparativo, longitudinal y ambispectivo en una cohorte de 55 pacientes sometidos a tiroidectomía laparoscópica tipo TOETVA. Se compararon los niveles de calcio (Ca) y hormona paratiroidea (PTH) inmediatamente después de cirugía y 24 horas después. la edad media fue de 43.07 años (desviación estándar ± 10.15). El tiempo quirúrgico promedio fue de 99.15 minutos (± 20.02) y la pérdida sanguínea media de 9.3 mL (± 15.9). La prevalencia de hipoparatiroidismo bioquímico postoperatorio (PTH < 12 pg/mL) fue 5.54%. Se presentaron 19 pacientes con hipocalcemia bioquímica (34.5%) y 4 de hipocalcemia clínica con parestesias (7.3%). Los pacientes se dividieron en 2 grupos: con y sin uso de verde de indocianina. Al comparar ambos, no se identificaron diferencias significativas en la incidencia de hipocalcemia ni de hipoparatiroidismo (p = 0.360 y p = 1.000, respectivamente). no se encontraron diferencias en el tiempo quirúrgico, el sangrado, la hipocalcemia clínica ni en los niveles postoperatorios de Ca y PTH.

11. Current Practices and a Novel Operational Framework for Planning Research on Digital Health Promotion Interventions From Development to Implementation: Scoping Review.

期刊: Journal of medical Internet research 发表日期: 2026-May-06 链接: PubMed

摘要

The UK Medical Research Council’s Guidance on Developing and Evaluating Complex Interventions (MRC GDECI) outlines a 4-phase framework for structuring research programs on interventions: development, feasibility, evaluation, and implementation. However, it provides limited practical direction on how researchers should select which phases to conduct or determine when and whether to progress between phases. This gap is particularly challenging in the context of digital health interventions (DHIs), given their fast-paced and rapidly evolving nature. This scoping review examined the research phases conducted, how researchers progressed through them, and the intervention characteristics associated with overall program structure and duration in DHI research, to inform the design of future research programs. We searched PubMed, Embase, CINAHL, PsycINFO, and ClinicalTrials.gov to identify complex DHIs promoting health among adolescents and young adults, implemented between 2017 and 2026, for which at least 2 phases of the MRC GDECI were reported, including the evaluation phase. For each eligible intervention, all related protocols, preprints, and published articles were retrieved to reconstruct the full research program. For each program, we analyzed the presence of each research phase, its organization (ie, phase arrangements), and the mechanisms guiding progression between phases (ie, progression mechanisms). Phase-specific and overall program durations were recorded. A total of 31 research programs, covering 31 interventions and reported in 130 articles, were included. Development, feasibility, evaluation, and implementation phases were reported in 26, 23, 31, and 7 research programs, respectively. Three types of phase arrangements were identified: sequential, iterative, and overlapping. Progression mechanisms between phases included automatic progression, conditional progression based on researchers’ appraisal of findings without prespecified criteria, and progression based on predefined quantitative criteria. Six main research program structures were observed, combining phase arrangements and progression mechanisms. Iterative arrangements were most common, observed in 22 research programs, followed by overlapping (n=10) and strictly sequential structures (n=7). Most progressions relied on researchers’ appraisal of findings without prespecified criteria. Justifications for phase iteration, omission, or progression decisions were rarely reported. The median program duration was 5.8 (IQR 3.8-6.6) years (n=13). Based on these findings, a novel 4-step operational framework and visualization tools were developed to guide the design and planning of DHIs, highlighting key considerations for each step, as well as the strengths, limitations, and risks associated with each phase arrangement and progression mechanism. This scoping review is the first to systematically examine phase arrangements and progression mechanisms in DHI research programs. Beyond descriptive reporting, it provides a conceptualization of research program structures and offers a flexible operational framework to support the concrete implementation of the MRC GDECI. Greater explicitness in decisions about program structure may enhance methodological rigor, reduce research waste, and improve the integrity and reproducibility of interventions. PROSPERO CRD42023401979; https://tinyurl.com/mvc265y3.

12. [Prevalence of hearing loss in a high-specialty medical unit].

期刊: Revista medica del Instituto Mexicano del Seguro Social 发表日期: 2026-May-06 链接: PubMed

摘要

Hearing impairment constitutes the fourth leading cause of disability on a global scale, predominantly affecting geriatric patients. In 2023, deafness was identified in the Hospital de Especialidades (Specialties Hospital) “Dr. Bernardo Sepúlveda” as the main reason for consultation in the Otorhinolaryngology Department, accounting for a total of 1755 cases, while it occupied second place in the Audiology Department with 1723 cases. To identify the prevalence of hearing loss in the Mexican population attended as beneficiaries in a high specialty medical unit in Mexico City in 2023. An observational, cross-sectional, retrospective, and descriptive study was carried out based on the records of patients who attended the Audiology Department from January 1 to December 31, 2023. Data were collected from the Electronic Medical Record, including age, gender, symptoms, diagnosis, type, severity and laterality of hearing loss. A total of 3396 patients with hearing impairment were obtained. The prevalence of hearing loss in 2023 in the Audiology Department was 68.6%, predominantly in female patients, with a superficial degree, sensorineural type and over 60 years of age. In the Hospital de Especialidades “Dr. Bernardo Sepúlveda”, 2 out of 3 patients who come to the Audiology Department present some degree of hearing impairment, mainly due to a sensorineural condition. el deterioro auditivo constituye la cuarta causa principal de discapacidad a escala global e impacta predominantemente a la demografía geriátrica. En el año 2023 se identificó a la hipoacusia dentro del Hospital de Especialidades “Dr. Bernardo Sepúlveda” como el principal motivo de consulta en el Servicio de Otorrinolaringología, al contabilizar un total de 1755 casos, mientras que ocupó el segundo motivo de consulta en el Servicio de Audiología con 1723 casos. identificar la prevalencia de hipoacusia en la población mexicana derechohabiente atendida en 2023 en una unidad médica de alta especialidad en la Ciudad de México. se hizo un estudio observacional, transversal, retrospectivo y descriptivo con base en expedientes de derechohabientes que acudieron al Servicio de Audiología en el periodo del 1 de enero al 31 de Diciembre de 2023. Se recabó por medio del expediente clínico electrónico la edad, el género, la sintomatología, el diagnóstico, el tipo, la severidad y la lateralidad de la hipoacusia. se obtuvo un total de 3396 pacientes con discapacidad auditiva. La prevalencia de pérdida auditiva en 2023 en el Servicio de Audiología fue de 68.6%; predominó en el género femenino, fue de grado superficial, de tipo neurosensorial y se presentó en la población mayor de 60 años. en el Hospital de Especialidades “Dr. Bernardo Sepúlveda”, 2 de cada 3 pacientes que acuden al Servicio de Audiología presentan algún grado de deterioro auditivo, principalmente por una condición neurosensorial.

13. Exploring Associations Between Well-Being, Mental Distress, and Five Dimensions of Social Capital in Rural Georgia.

期刊: Family & community health 发表日期: 2026-May-06 链接: PubMed

摘要

Understanding the relationship between social capital, mental health, and well-being is important for advancing health equity in rural communities. We examined 5 individual-level dimensions of social capital and their relationship with well-being and mental distress in rural Georgia. Mail-in population survey data were collected from 6 rural Georgia counties (n = 1374) from December 2018 to May 2019. We conducted bivariate and multivariable analyses, controlling for county. Social capital was significantly associated with improved well-being and inversely associated with mental distress. Findings support research that strengthens social capital through trust-building, strengthening neighborhood ties, and offering civic engagement opportunities.

14. Family-Based Childcare in Chicago: Opportunities to Advance Environmental and Social Justice for Children.

期刊: Family & community health 发表日期: 2026-May-06 链接: PubMed

摘要

Achieving environmental justice for children requires that their spaces promote health and well-being. In this study, we characterized the broader environmental context for family-based childcare (FCC) homes in Chicago, Illinois, to identify gaps in knowledge and directions for future work. Data on childcare providers were obtained from a state agency. Using public data sets, we characterized the physical, chemical, and built (PCB); nutritional; and social environments at the census tract level. We then described differences in neighborhood quality for census tracts containing only center-based care and those containing only FCC homes. Indicators of PCB environments were similar for all census tracts. Census tracts containing FCC homes only had higher median percentages of residents with low food access and households receiving nutrition assistance relative to census tracts with center-based care only. Indicators of the social environment, including educational attainment and violent crime, were also less favorable for census tracts with FCC homes only relative to those with center-based care only. Our analysis highlighted differences in neighborhood quality for FCC homes, which are an important resource for low-income and racially marginalized families. Our work highlights the need to examine how structural racism contributes to the broader environmental context and children’s health.

15. Premature Mortality and Accidental Death Among Young Adults in the United States: Association With the Social Determinants of Health.

期刊: Family & community health 发表日期: 2026-May-06 链接: PubMed

摘要

This study explored the association between the social determinants of health (SDOH) and the likelihood of premature mortality and premature accidental mortality. Data from the National Longitudinal Survey of Adolescent to Adult Health (ADD Health) linked with records from the National Death Index (NDI) were used to classify deceased respondents by their cause of death. First, logistic regression examined the association between accidental death/premature mortality, individual characteristics, and SDOH. Second, a 2-stage model then analyzed the likelihood of having an accidental cause of death conditional on premature mortality. Premature mortality odds were lower for female individuals (OR = 0.89), Black individuals (OR = 0.94), those who identify as Hispanic (OR = 0.56), college graduates (OR = 0.27), and married individuals (OR = 0.45). However, living in the South (OR = 1.19) and lower income (OR = 2.22) increased the odds. Accidental death odds were lower for female individuals (OR = 0.29), Black individuals (OR = 0.32), those who identify as Hispanic (OR = 0.87), and multiracial groups (OR = 0.06). College education (OR = 3.61) and lack of medical care (OR = 1.13) raised accidental death odds while marriage (OR = 0.20), lower income (OR = 0.12), and residing in the West or Midwest (OR = 0.13) decreased them. There was a significant association between the likelihood of accidental death and adverse SDOH, suggesting that they may serve as risk factors of premature accidental death.

16. A Structural Equation Modeling Approach to Exploring the Determinants of Regular Medical Checkups in a United States-Mexico Border Community: An Application of Andersen's Behavioral Model of Health Service Use.

期刊: Family & community health 发表日期: 2026-May-06 链接: PubMed

摘要

Regular medical checkups are essential for preventing and managing chronic diseases. However, significant disparities in the utilization of these checkups exist, particularly in the US-Mexico border communities. This study applies to Andersen’s Behavioral Model of Health Service Use to explore the factors influencing regular medical checkups utilization among residents in Brownsville, Texas. A total of 144 adult participants from Brownsville, Texas, completed a bilingual (English/Spanish) survey from March to September 2024. The survey assessed demographic characteristics, health status, enabling resources (eg, income, insurance), and need factors (eg, mental health status, chronic conditions). Structural Equation Modeling was used to analyze the relationships between these factors and the likelihood of receiving regular medical checkups. The study found significant positive associations between predisposing characteristics and regular medical checkups (P < .001), and between enabling resources and regular checkups (P < .001). However, need factors did not show a significant relationship with regular checkups. In addition, there was a negative interrelationship between predisposing characteristics and enabling resources (P < .001), whereas there was a positive association between enabling resources and need factors (P = .001). The findings highlight the importance of predisposing characteristics and enabling resources in influencing the utilization of regular medical checkups.

17. Youth Gangs, Gang Involvement, and Health: A Scoping Review and Directions for Research.

期刊: Family & community health 发表日期: 2026-May-06 链接: PubMed

摘要

Youth gangs and gang involvement are commonly associated with delinquency and legal system contact, but relations to health have received less attention despite known population disparities. Clarifying how and why gang-involved youth are at greater risk for adverse health will help inform the development of a research and practice agenda to address population-level inequities. A scoping review of US-based studies was conducted to assess what is currently known about the relationship between youth gangs, gang involvement, and health. A descriptive summary and reflexive thematic analysis of 69 studies illustrated important features of the current research literature on this topic, including the theoretical importance of gangs as social and cultural contexts for health; the utility of ecological and developmental theories for understanding the gang-health link; and the importance of gender, family, and neighborhoods for shaping health experiences and outcomes of gang-involved youth. Our analysis also revealed key gaps in the current literature that should be addressed to ensure this area of research holds practical utility for reducing health inequities in the youth gang population. Directions for research to address identified gaps are discussed.

18. Global trajectories of ICF research (2015-2025): a bibliometric synthesis of trends, innovations, and equity-driven paradigms.

期刊: Disability and rehabilitation. Assistive technology 发表日期: 2026-May-06 链接: PubMed

摘要

Purpose: This study provided a comprehensive bibliometric analysis of research related to the International Classification of Functioning, Disability, and Health (ICF) covering the years 2015 to 2025, using data sourced from the Web of Science Core Collection. Methods: By employing analytical tools such as VOSviewer, CiteSpace, and Bibliometrix, we examined a total of 3,193 publications to identify trends, collaborations, and the evolution of themes within this field. Results: Our key findings indicate a significant 32.2% increase in annual publications from 2020 to 2024. Our bibliometric analysis highlights the significance of influential journals and authors, underscoring the critical of interdisciplinary collaboration and methodological rigor in advancing research. The thematic evolution observed in the literature shows a transition from studies focused on specific conditions to more comprehensive frameworks that prioritize participation, quality of life, and the integration of technology, with a pronounced and growing emphasis on Assistive Technology,as a key environmental facilitator within the ICF model. Notably, high-impact publications by Cesari et al in 2018 and Cieza et al in 2019 have influenced scholarly discourse connecting clinical practice with policy implications, while thematic mapping has identified “disability” as a pivotal theme driving research in this area. Looking ahead, future research should focus on underrepresented populations, conduct longitudinal studies, and explore the integration of digital health solutions to enhance the real-world impact of findings in this critical field.Conclusion: This study underscores the ICF’s transformative potential as a comprehensive biopsychosocial framework. Standardizing disability assessment through the ICF promotes equity and interdisciplinary collaboration, while ongoing research increasingly provides evidence to inform practice, with potential to contribute to global health equity and functional outcomes for people with disabilities. The ICF framework promotes consistent disability evaluation through validated tools like WHODAS 2.0, enhancing comparability across clinical and policy domains. Rehabilitation should prioritise adopting ICF-based protocols to facilitate interdisciplinary data integration and evidence-based practice.Emerging trends emphasise AI, wearable sensors and telerehabilitation, enabling real-time monitoring and personalised interventions. Embedding ICF metrics into digital platforms can optimise functional outcomes and support preventive care models.Thematic evolution shows a shift from condition-specific focus to participation and quality of life. Rehabilitation must embrace holistic strategies, such as exercise interventions and risk assessments, to address individual needs and promote community integration.Despite ICF’s widespread adoption, disparities persist in low-resource settings and among marginalised groups. Rehabilitation policies should leverage ICF’s biopsychosocial model to develop culturally adapted tools and ensure equitable service delivery.Gaps in longitudinal data and database bias underscore the need for international collaborations and digital health integration. Prioritising scalability – such as embedding ICF into electronic health records – will maximise real-world impact and advance global health equity.

19. General Practitioners and Pharmacists' Perspectives on Electronic Prescribing for Multidose Drug Dispensing: Mixed Methods Study.

期刊: JMIR medical informatics 发表日期: 2026-May-06 链接: PubMed

摘要

Medication safety remains a significant challenge in health care, particularly for patients managing complex treatment regimens. In Norway, the introduction of electronic prescribing (e-prescribing) for multidose drug dispensing (eMDD) aims to improve medication adherence and minimize errors by seamlessly integrating with the national e-prescription infrastructure. This study aimed to investigate the challenges faced by general practitioners (GPs) and pharmacists in using eMDD in Norway. Additionally, it sought to gather their recommendations for system improvements to guide future development and nationwide implementation. A parallel mixed methods design was used, integrating both quantitative and qualitative data. A structured online survey was distributed to 54 pharmacies and 190 GP surgeries across Norway. The survey included a combination of multiple-choice and open-ended questions. Qualitative responses were analyzed thematically using NVivo, while quantitative data were processed using the built-in analytical tools in Nettskjema. A total of 70 health care professionals participated in the study, revealing 7 key themes: training, system and technology, communication and interaction, division of responsibilities, medication safety, time and resource use, and implementation challenges. GPs reported inadequate training and an overwhelming volume of communication, while pharmacists identified issues with system integration and unclear role definitions. Both groups emphasized the need for improved system usability, stronger interprofessional collaboration, and a more defined governance structure. While the eMDD system has the potential to improve medication safety and optimize workflows, its success depends on addressing technical inefficiencies, improving user training, and clarifying role responsibilities. Actively involving end users in system development and policy planning is critical for achieving effective national implementation and ensuring integration with broader eHealth initiatives, such as the Patient’s Medication List.

20. Factors Associated with Respite Care Use Among Veteran Caregivers: A Machine Learning Analysis.

期刊: The Gerontologist 发表日期: 2026-May-06 链接: PubMed

摘要

Respite care provides temporary relief to family caregivers yet remains underused, and the factors shaping its utilization among Veteran caregivers are not well understood. This evaluation examined caregiver‑ and Veteran‑specific characteristics associated with respite care use within the Department of Veterans Affairs (VA) Caregiver Support Program’s Program of General Caregiver Support Services (PGCSS). We analyzed survey and administrative data from 1,727 caregivers of Veterans enrolled in PGCSS who completed baseline surveys between 2018 and 2021. Caregivers were predominantly female (96%) with a mean age of 62 years; Veterans averaged 70 years. Respite use within two years of survey completion was identified through linked VA data. Guided by Andersen’s Healthcare Utilization Model, 34 caregiver and Veteran variables were evaluated with random forest models to identify characteristics that most strongly differentiated respite users from non‑users. Respite care was used by 23.5% of caregivers. Use was more common among older caregivers and Veterans (predisposing factors), among caregivers reporting greater burden, depression, or financial strain and Veterans with higher frailty, functional limitation, or dementia (need factors), and among caregivers perceiving stronger communication and collaboration with the clinical team (enabling factors). Model performance was strong (testing accuracy = 0.79 with all variables; 0.77 with the top 15), and results remained consistent in a sensitivity analysis limited to caregivers of Veterans who survived the two‑year follow‑up period. Both caregiving intensity and care‑recipient complexity characterize respite use even within a system of broad service availability. Findings provide a foundation for future hypothesis‑driven studies and inform efforts to align respite programs more closely with caregiver-Veteran needs.

21. Taking multidisciplinary team care from policy into primary care practice.

期刊: International journal for quality in health care : journal of the International Society for Quality in Health Care 发表日期: 2026-May-06 链接: PubMed

摘要

22. Person-Centered Dementia Care Strategies and Facilitators in Low-Resource Long-Term Care: Staff Insights.

期刊: The Gerontologist 发表日期: 2026-May-06 链接: PubMed

摘要

Person-centered care is considered best practice in dementia care, emphasizing autonomy, dignity, and relationship-based individualized care. However, little is known about how person-centered dementia care (PCDC) is implemented in low-resource long-term care (LTC) settings. This study identified PCDC strategies used by staff providing care for residents with dementia in low-resource LTC settings and key facilitators supporting the use of PCDC strategies. We conducted a qualitative analysis of semi-structured interviews with 27 staff (20 direct care staff and 7 administrators) from four LTC facilities (nursing homes and assisted living) in urban Maryland and rural New Hampshire. Participants were drawn from a larger study in federally designated medically underserved areas. Template analysis was used to analyze data and identify themes related to PCDC strategies and facilitators. LTC staff described PCDC strategies for residents with dementia across three domains: communication-based interactional approaches, preserving dignity and autonomy, and tailoring care to individual preferences. Key facilitators identified included fostering communication, responsiveness to residents’ needs, organizational support, and resource optimization. Despite limited resources, information-sharing systems, teamwork, engagement with care partners, positive attitudes, motivation, empowerment, adaptability, and dementia training facilitated PCDC implementation, highlighting that multilevel facilitators are key to delivering quality dementia care. Findings emphasize the importance of communication and teamwork, responsiveness to residents’ needs, supportive organizational structures, and resource optimization in implementation of PCDC in low-resource settings. Future research should incorporate the perspectives of residents and care partners and examine PCDC implementation across broader contexts.

23. Longitudinal regimes of arts and cultural engagement and frailty among older adults in the United States: a g-formula approach.

期刊: The journals of gerontology. Series B, Psychological sciences and social sciences 发表日期: 2026-May-06 链接: PubMed

摘要

A growing body of evidence links arts and cultural engagement (ACEng) with various health outcomes, however, its longitudinal relationship with frailty as a multidimensional clinical syndrome remains underexplored. This study aims to investigate the dynamic nature of ACEng and its impact on frailty, addressing critical methodological challenges. We analysed longitudinal data from 3,775 older adults (aged 50+) in the U.S. Health and Retirement Study (2005-2018). ACEng was measured as receptive cultural events (e.g. concerts, movies, museums) and two participatory activities, including (1) singing or playing a musical instrument (2) doing arts and crafts. Frailty was assessed using a 50-item frailty index covering nine health domains. Data were analysed using the g-formula approach. ACEng was highly dynamic, particularly for receptive activities. Late and sustained engagements across three ACEng activities were associated with lower levels of frailty at follow-up. However, most of these effects were sensitive to adjustments of time-varying frailty, except for sustained engagement in culture events. This sustained exposure was associated with a 0.35-point lower frailty compared to the never exposed (95% confidence interval: -0.53 to -0.17, p < 0.001). The relationship between ACEng and frailty is complex and shaped by dynamic, potentially bidirectional relationships. This underscores the importance of using longitudinal designs and causal methods to understand ACEng regimes and their health impacts, accounting for time-varying confounders. Future research should explore distinct active ingredients and underlying mechanisms between receptive and participatory activities and how they can be leveraged to mitigate frailty and other health outcomes.

24. Pathways of emergency care for severely ill children in Nigerian and Ugandan hospitals: A process mapping study.

期刊: PLoS medicine 发表日期: 2026-May-06 链接: PubMed

摘要

Child mortality remains high in countries with weak emergency care systems. Facility organisation for paediatric emergency care is heterogeneous and under-described. We examined how hospitals in Uganda and Nigeria are organised to deliver emergency care for neonates and children. We conducted a qualitative, multi-method study in 26 purposively selected secondary and tertiary facilities in Uganda and Nigeria from October 2023 to December 2024. Embedded researchers documented patient pathways, resources for care, and care processes for severely ill children (<15 years). We used inductive content analysis to generate organisational archetypes and describe different facets of the patient journey. We identified 4 recurring patterns of facility organisation and patient flow (‘archetypes’): outpatient department (OPD) ‘screen and treat’; OPD ‘screen and send’; emergency department (ED) ‘receive and treat’; and inpatient department (IPD) ‘receive and treat’. Across sites, formal triage systems were generally absent or rarely used. First contact and early sorting of children into these pathways frequently involved guards, lay bystanders, students, and caregivers. Duplication in assessment and treatment steps and misrouting from intended pathways occurred especially when initial care was spread across multiple locations. After-hours closure of OPDs shifted the place of entry to EDs or IPDs and could result in caregiver confusion. Administrative procedures (registration and payment) and recurrent stock-outs of medications and consumables could delay initiation of clinical processes. Referral pathways were inconsistent and some referrals were informal, undocumented, and enacted prior to patient stabilisation. Our findings are based on a purposive sample of facilities from Nigeria and Uganda, which may not be representative of other low-resource settings. Process mapping can help understand context and identify opportunities for intervention to improve facility care of severely ill children. We define organisational archetypes as heuristic tools for facility leaders and policymakers that can help facilities locate their configuration and recognise context-specific priorities. Potential low-cost opportunities for improvement include: building on existing adaptations (e.g., involving non-clinical staff and families in triage), formalising triage, streamlining non-clinical care processes that can delay clinical care (e.g., clearer signage and expedited administration), and strengthening referral systems.

25. [Cost-effectiveness of the Lose Weight, Gain Life program].

期刊: Revista medica del Instituto Mexicano del Seguro Social 发表日期: 2026-May-06 链接: PubMed

摘要

The Pierde Kilos, Gana Vida program (Lose Weight, Gain Life, LWGLP) promotes the development of skills for adopting healthy lifestyle habits among the population of the Mexican Institute for Social Security (IMSS). The cost-effectiveness analysis (CEA) aims to evaluate the potential benefit of an intervention. To assess the real-world cost-effectiveness of the LWGLP. A historical, longitudinal, retrospective cohort study was conducted, which included patients with diagnosis of overweight or obesity enrolled in the LWGLP, and they were compared with those receiving conventional treatment (CT). Patients enrolled in the program who did not complete it were excluded. A cost-effectiveness ratio was calculated, and the cost per kilogram of weight loss was estimated for both groups. A total of 31 patients from the LWGLP group and 31 from the CT group were included. The LWGLP group had an average weight loss of 4.2 kg compared to 0.4 kg in the CT group (p < 0.001). In the CEA, the LWGLP group lost a total of 109 kg, with a cost per kilogram loss of $1678.71 MXN (IQR 1221.83-4312.35). The CT group lost 19 kg, resulting in a cost per kilogram loss of $3701.18 MXN (IQR 2,176-6,452). The resulting cost-effectiveness index (CEI) was approximately $355.20 MXN additional per kilogram loss through the LWGLP. The LWGLP is effective in reducing weight, with a CEI of $355.20 MXN in additional cost per kilogram loss through the program. el programa Pierde Kilos, Gana Vida (PPKGV) promueve en la población del Instituto Mexicano del Seguro Social (IMSS) el desarrollo de habilidades para la adopción de hábitos de vida saludable. El análisis costo-efectividad (ACE) tiene como fin evaluar el beneficio posible de una intervención. evaluar el costo-efectividad del PPKGV en la vida real. se realizó un estudio de cohorte histórico, longitudinal, retrolectivo, en el que se incluyeron pacientes con diagnóstico de sobrepeso u obesidad inscritos al PPKGV y se compararon con aquellos que recibieron tratamiento convencional (TC). Se excluyeron los pacientes inscritos al programa que no lo concluyeron. Se hizo una relación costo-efectividad y se estimó el costo por kilo de peso perdido para ambos grupos. se incluyeron 31 pacientes del PPKGV y 31 con TC. El grupo del PPKGV presentó una pérdida de peso de 4.2 kg vs. 0.4 kg en el grupo de TC (p < 0.001). En el ACE, el grupo del PPKGV perdió un total de 109 kg, con un costo por kilo perdido de $1678.71 (RIC 1221.83-4312.35) MXN. El grupo no inscrito perdió 19 kg, con un costo por kilo perdido de $ 3701.18 (RIC 2176-6452) MXN. El índice costo-efectividad (CEI) resultante fue de aproximadamente $355.2 MXN por kilogramo perdido en efectividad. el PPKGV disminuye el peso y el CEI resultante fue de $355.2 MXN extras por cada kilo perdido en el PPKGV.

26. Experiential Course Learning, Wellness, and Higher Education: Qualitative Descriptive Study.

期刊: JMIR medical education 发表日期: 2026-May-06 链接: PubMed

摘要

Undergraduate students, including those preparing for health professions, report high rates of psychological distress and underuse of traditional counseling services. Credit-bearing wellness courses that combine psychoeducation with experiential learning may offer a scalable, curriculum-based approach to supporting student well-being. This qualitative study explored how undergraduate students described personal growth, coping, and lifestyle changes following participation in experiential wellness courses. An anonymous postcourse online survey captured open-ended responses from students enrolled across 6 wellness course sections. The courses emphasized stress physiology, evidence-based coping strategies, and weekly experiential assignments. Narrative responses from 110 participants were analyzed inductively using the reflexive thematic analysis developed by Braun and Clarke within a constructivist-interpretivist paradigm. A total of six themes were identified: (1) healthy habits and practical lifestyle change; (2) stress management skills and mental health techniques; (3) self-reflection, awareness, and personal growth; (4) relevance and immediate applicability; (5) peer connection and discussion-based learning; and (6) course structure and opportunities for improvement. Students described adopting new coping strategies, developing greater self-awareness, and perceiving course content as relevant and applicable to their daily lives. Students described experiential wellness courses as supportive of coping, self-awareness, and behavior change. These findings provide insight into how students engage with and interpret course-based wellness education. Curriculum-integrated approaches may represent a complementary strategy to support student well-being. Future research should examine these approaches across diverse populations and over time.

27. From Fitness to Cognition: Machine-Learning Prediction of Cognitive Performance Using Physiological Parameters in Healthy Adults.

期刊: Medicine and science in sports and exercise 发表日期: 2026-May-06 链接: PubMed

摘要

Current cognitive tasks are not suitable for frequent monitoring of cognitive function in healthy adults. Increasing evidence suggests that cardiorespiratory fitness, cardiovascular function, and autonomic regulation are associated with cognitive performance; however, these multidimensional relationships are challenging to interpret using traditional statistical methods. The present study examined the feasibility of using fitness-related physiological and cardiac autonomic indicators, together with interpretable machine-learning approaches, to assess relative cognitive performance in healthy adults. In a cross-sectional sample of 240 adults, 39 physiological variables were recorded as input features. Trail making test completion time was dichotomized at the median as the outcome variable. Four feature-selection strategies, correlation, mutual information, genetic algorithms, and recursive feature elimination, were combined with grid-tuned classifiers under stratified 5-fold cross-validation and probability calibration. A random forest model with ten RFE-selected features achieved 70.83 % accuracy, 71.38 % F1, and AUC = 71.2%, outperforming an untuned logistic-regression baseline model. SHAP-based interpretation indicated that older age, higher systemic vascular resistance, and higher resting heart rate shifted predictions toward the longer TMT-time group, whereas greater stroke volume, cardiac output, high-frequency power, and respiratory sinus arrhythmia shifted predictions toward the shorter TMT-time group. Physiological parameters related to cardiovascular and autonomic function showed moderate ability to discriminate relative TMT-based performance groups in healthy adults, supporting the feasibility of physiology-based cognitive assessment. Several key features identified by the model are modifiable through exercise and lifestyle interventions, suggesting potential translational value. With further validation and refinement, including evaluation of wearable-accessible physiological features, such models may support lower-burden monitoring and future personalized cognitive-health applications.

28. Transvaginal versus transabdominal extraction techniques in laparoscopic surgery: a systematic review and meta-analysis.

期刊: Minimally invasive therapy & allied technologies : MITAT : official journal of the Society for Minimally Invasive Therapy 发表日期: 2026-May-06 链接: PubMed

摘要

In laparoscopic surgery, specimen retrieval can require enlarging abdominal incisions, reducing the minimally invasive benefits. Transvaginal specimen extraction (TVSE) can offer a safer, more cosmetic alternative for women. This systematic review and meta-analysis evaluated the safety and outcomes of TVSE compared with transabdominal extraction, regardless of surgical indication. EMBASE, Scopus, PubMed, MEDLINE, Web of Science, and the Cochrane Library were searched from inception to April 2025. Studies were grouped by design, surgical specialty, and extraction method (port enlargement versus mini-laparotomy) to explore heterogeneity. Twenty-five studies were included for 2751 patients (1144 TVSE, 1607 transabdominal extraction) in general, urologic, or gynecologic surgery. TVSE was associated with lower postoperative pain (mean difference -0.98, 95%CI -1.30 to -0.66), rescue analgesia use (OR 0.38, 95%CI 0.28 to 0.51), postoperative complications (OR 0.55, 95%CI 0.34 to 0.89), shorter hospital stays (mean difference -1.04, 95%CI -1.77 to -0.30), and higher cosmetic satisfaction (mean difference 0.91, 95% CI 0.46 to 1.35), especially versus mini-laparotomy. Blood loss, intraoperative complications, and dyspareunia did not differ. TVSE is associated with improved postoperative outcomes when it replaces mini-laparotomy, whereas less benefit is observed versus laparoscopic port-site enlargement. Further randomized controlled trials are needed to confirm these findings.

29. Comprehensive Intervention to Promote Healthy Lifestyles and Prevent Cardiometabolic Diseases in Low-Income School Children From Mexico: Protocol for the ESCOLARISANO Randomized Controlled Trial.

期刊: JMIR research protocols 发表日期: 2026-May-06 链接: PubMed

摘要

Obesity is a serious public health issue affecting children in a progressively alarming manner; thus, nutrition education and behavior change interventions during childhood are a priority. Eating and physical activity behaviors are mainly influenced by the environment; therefore, lifestyle changes are often successful when interventions are implemented in places such as the home and school. Schools are fundamental for ensuring the development of students’ personalities, skills, abilities, and long-term behaviors. This study aims to measure the effect of an intervention designed for low-income Mexican schoolchildren, focused on promoting healthy lifestyles for the prevention of obesity and cardiometabolic diseases. The study design is a randomized clinical trial (NCT05945862), with intervention groups paired with control groups of the same grade. Four elementary schools were selected based on district socioeconomic status. The study will be carried out for 1 year in four phases: (1) initial measurements, including anthropometry, blood pressure, psychosocial diagnosis, family medical history, and behavior variables, such as nutrition knowledge, dietary intake, sleep time and quality, and physical activity; (2) intervention implementation based on social cognitive theory, the behavior change wheel with the capability, opportunity, and motivation influencing behavior theoretical framework, and the transtheoretical theory, covering topics related to nutrition and healthy eating, child health, personal and sleep hygiene, physical activity, psychosocial well-being, and motivation; (3) postintervention measurements, including initial and behavioral measurements and intervention indicators; and (4) 6-month postintervention evaluation using the same initial and behavioral measures as in phase 1. Baseline differences by age, sex, socioeconomic status, and location will be analyzed using chi-square tests (qualitative variables) and analysis of covariance (quantitative variables). Multiple linear regression will test potential baseline associations between dependent variables (anthropometrics and blood pressure) and independent variables (diet, exercise, sleep time, family interaction, psychosocial well-being, and perception of childhood obesity). For comparing changes between the intervention and control groups at postintervention and at 6-month postintervention in anthropometrics, blood pressure, and behavioral variables, we will use multilevel mixed-effects regression models, given the hierarchical structure of participants nested within schools and the repeated measurements over time. SPSS and STATA software will be used with a significance level of P<.05. From October 2023 to August 2024, a total of 451 participants were recruited from 4 different elementary schools in Sonora, México. As of February 2026, the data collected are in the process of being captured and analyzed. The protocol is a comprehensive program designed for schoolchildren in Mexico, intended to be an effective strategy for promoting healthy lifestyles and preventing cardiometabolic diseases. It is important to continuously adapt the intervention before implementation and to evaluate it to ensure its sustainability and expand its impact on other elementary schools, improving the health and well-being of schoolchildren.

30. Digital Episodic Future Thinking Intervention (Luminaut): Co-Design and Iterative Development Study.

期刊: JMIR human factors 发表日期: 2026-May-06 链接: PubMed

摘要

Digital health interventions can be effective at changing behavior, but achieving long-term adherence remains a challenge. One psychological barrier to health behavior change is future discounting, or the tendency to prefer smaller, short-term rewards over larger, long-term rewards. Episodic Future Thinking (EFT) can disrupt future discounting and is a promising technique for improving health behavior, but such interventions have not been co-designed to address end user needs. This study aimed to co-design an app with end users to deliver an EFT intervention aimed at promoting health behavior change in those in the prerisk phase for chronic conditions. Community members participated in up to 2 series of face-to-face co-design workshops. A prototype of the app was reviewed, and insights were gathered to understand (1) the optimal characteristics of the app and (2) the concepts of future discounting and EFT. Themes were generated using inductive thematic analysis. Participants were South Australian adults (n=30) who were predominately affluent women (27/30, 90%) aged 25-44 years (mean 36.37, SD 5.65 years). Feedback generated from the first workshop series resulted in 26 suggestions of which 15 informed iterative app development. Higher-level principles were identified and categorized into 5 overarching themes: concept acceptance, triggers and barriers, personalization, gamification, and user-friendly interface. This study used co-design methodology to develop an app-based EFT intervention. Ongoing engagement with end users and key stakeholders (eg, health care professionals) is needed to ensure that the app meets changing needs. Future work will aim to evaluate its effectiveness in a large-scale clinical trial.

31. Digital Health-Based Peer Support Ecosystem for Gestational Diabetes Mellitus in Vietnam (VALID II Study): Multistakeholder Cocreation and Pilot Study.

期刊: Journal of medical Internet research 发表日期: 2026-May-06 链接: PubMed

摘要

Gestational diabetes mellitus (GDM) is associated with fetal overgrowth, increased risks of perinatal morbidity and mortality, and long-term complications for mother and child, including cardiovascular disease and type 2 diabetes. Innovative, peer-based digital health interventions are emerging globally as a potential approach to assist and empower women in effective self-care and well-being during pregnancy. However, there remains substantial potential to develop and evaluate culturally sensitive digital health interventions for pregnant women with GDM, especially in low- and middle-income countries. This study aimed to bridge the gap between the World Health Organization (WHO) self-care framework and local practice by designing and piloting the “Healthy Pregnancy” intervention, a multiplatform digital ecosystem for women with GDM in northern Vietnam, through a staged cocreation and pilot refinement process. Between December 2022 and February 2024, drawing on the WHO’s conceptual framework for self-care and cocreation approach, we iteratively developed “Healthy Pregnancy,” a digital health intervention, in 4 stages: (1) formative studies and self-care construct prioritization, (2) cocreation processes with key stakeholders, (3) development and design translation, and (4) pilot testing and final refinement. In stage 1, we identified gaps in current digital health interventions in low- and middle-income countries, explored the sociocultural realities of women with GDM in Vietnam, and prioritized 7 self-care constructs. In stage 2, we conducted a cocreation workshop to enable key stakeholders to co-design the foundational infrastructure for the potential intervention. In stage 3, we established a multicomponent digital intervention ecosystem with explicitly defined operating workflows. Finally, in stage 4, we gathered suggestions for a digital health intervention from a pilot test group of pregnant women with GDM, to refine and optimize the system schematic and information flow before moving to the real intervention. By applying a cocreation approach across all stages of development of the “Healthy Pregnancy” digital health intervention, from problem identification to solution development and evaluation, we developed a locally tailored GDM self-care model. This process not only addressed gaps in standard care but also empowered pregnant women through a supportive, multiple-stakeholder environment. This study demonstrates a rigorous cocreation pathway for systematically translating WHO self-care constructs into a feasible, culturally adapted digital ecosystem for GDM in Vietnam and offers a transferable, people-centered design process alongside a practical blueprint for integration into routine maternal care.

32. [Psychoeducation among women with breast cancer and emotional symptoms].

期刊: Revista medica del Instituto Mexicano del Seguro Social 发表日期: 2026-May-06 链接: PubMed

摘要

Breast cancer (BC) is the most frequent neoplasm. As a consequence of the oncologic treatment, there are diverse adverse effects, as the emotional ones. Treatment options for emotional symptoms like anxiety, depression or stress are limited. To analyze the effectiveness of psychoeducational workshops among women with BC over the anxiety and depression symptoms. A randomized clinical trial by blocks with 42 BC patients in stages II and III of the disease, distributed into 2 groups of 21 cases (intervention) and 21 controls. There were 9 psychoeducational workshops performed weekly. It was carried out an initial and final measurement according to the Hospital Anxiety and Depression Scale (HADS). For the intervention group, the median score for anxiety was 9.09 at the beginning of the study and 5.85 at the end (p = 0.0005). In the control group, the median for anxiety was 8.7 and 6.7 at the end (p = 0.0494). According to the depression symptoms, the median for the intervention group was 5 at the beginning and 3.2 at the end (p = 0.0216). For the control group, the median was 4.7 at the beginning and 4.6 at the end (p = 0.6359). The psychoeducational workshops demonstrated effectiveness to decrease the symptom burden for anxiety and depression. Early education and counselling for recently diagnosed BC patients should be considered part of the treatment to prevent and decrease these symptoms. el cáncer de mama (CM) es la neoplasia más frecuente. Como consecuencia del tratamiento oncológico, se pueden presentar diferentes efectos adversos, como los emocionales. Las opciones de tratamiento para síntomas como ansiedad, depresión o estrés son limitadas. analizar la efectividad de talleres psicoeducativos en pacientes con CM sobre los síntomas de ansiedad y depresión. ensayo clínico aleatorizado por bloques en 42 pacientes con CM en estadios II y III, distribuidas en 2 grupos de 21 casos (intervención) y 21 controles. Se llevaron a cabo 9 talleres psicoeducativos semanalmente. Se hizo una medición inicial y una final con la Escala hospitalaria para ansiedad y depresión (HADS). para el grupo de intervención, la mediana del puntaje de ansiedad al inicio del estudio fue de 9.09 a 5.85 final (p = 0.0005). En el grupo control, la mediana para ansiedad fue de 8.7 a 6.7 final (p = 0.0494). Respecto a los síntomas de depresión al inicio, la mediana en el grupo de intervención fue de 5 a 3.2 final (p = 0.0216). En el grupo control, la mediana fue de 4.7 al inicio a 4.6 al final (p = 0.6359). los talleres psicoeducativos demostraron un efecto en la disminución en los puntajes de ansiedad y depresión. La educación y consejería oportunas en pacientes con reciente diagnóstico de CM deben ser consideradas como parte del tratamiento para prevenir o disminuir dichos síntomas.

33. Tooth loss and long-term dementia risk: A nationwide population-based cohort study in the Republic of Korea.

期刊: Community dental health 发表日期: 2026-May-06 链接: PubMed

摘要

Objective: Evidence linking tooth loss to dementia is limited by cross-sectional designs and short follow-ups. This study examined the association between tooth loss and long-term dementia incidence in a nationwide cohort in the Republic of Korea, from a dental public health perspective. Basic research design: Observational cohort study. Participants: Data from 112,070 adults aged ≥40 years in the National Health Insurance Service-Health Screening Cohort who completed general and oral health examinations in 2005-2006 and were followed for up to 15 years. Main outcome measures: Tooth loss was categorized as 0, 1-7, 8-14, or ≥15 missing teeth. Incident all-cause dementia, Alzheimer’s disease, and vascular dementia were identified using diagnostic codes. Cox models estimated adjusted hazard ratios (aHRs) with sensitivity analyses requiring ≥2 diagnoses and subgroup analyses by sex and age. Results: Over a mean 13.5-year follow-up, 7616 participants (6.8%) developed dementia, with higher cumulative incidence observed across increasing levels of tooth loss. Higher aHRs were observed with increasing levels of tooth loss; participants with ≥15 missing teeth had the highest estimates (1 diagnosis: aHR 3.23, 95% CI 2.85-3.64; ≥2 diagnoses: aHR 2.01, 95% CI 1.77-2.28). Associations were similar for Alzheimer’s disease and weaker for vascular dementia. Conclusion: Tooth loss was associated with higher long-term dementia risk, supporting its role as a potential population-level oral health indicator relevant to dental public health surveillance and prevention strategies.

34. Meta-analysis of preclinical evidence supporting phage therapy against Stenotrophomonas maltophilia.

期刊: Future microbiology 发表日期: 2026-May-06 链接: PubMed

摘要

To systematically and quantitatively assess the efficacy of phage therapy against multidrug-resistant Stenotrophomonas maltophilia in preclinical models. A systematic search of PubMed, Scopus, ScienceDirect, Google Scholar, and Wiley Online Library was conducted for preclinical studies on phage therapy against established S. maltophilia infections with survival outcomes. Data were pooled using a fixed-effects model, with subgroup and sensitivity analyses. www.crd.york.ac.uk/prospero identifier is CRD420251059693. Among 6,277 references, six studies met the inclusion criteria; one study was excluded after sensitivity analysis. The overall pooled Odds Ratio (OR) for phage therapy efficacy was 21.10 (95% CI: 9.09-49.02; p < 0.001). Subgroup analysis by Multiplicity of Infection (MOI) showed dose-dependent effects, with the highest efficacy at MOI = 100 (OR =143.68, 95% CI: 11.95-1726.78; p < 0.001) followed by MOI = 10 (OR =60.13, 95% CI: 6.29-575.09; p < 0.001). Burst size analysis indicated larger burst sizes increased effect magnitude, with the highest at 41.67 (OR =31.27, 95% CI: 7.32-133.49; p < 0.001). Phage therapy shows strong preclinical efficacy against multidrug-resistant S. maltophilia. It represents a rapid, targeted, and antibiotic-sparing approach, supporting future antimicrobial stewardship efforts and informing the design of clinical applications. Stenotrophomonas maltophilia (S. maltophilia) is a hospital-acquired bacterium that is difficult to treat because it resists most antibiotics, especially in people with weakened immune systems. This study reviewed laboratory and animal research on the use of bacteriophages (“phages”) as a potential treatment for this pathogen. Phage therapy shows promise as a rapid, targeted, and antibiotic-sparing approach. Its effectiveness is influenced by key factors such as the dose of phages and their ability to produce viral particles during infection. These findings highlight the potential of phage therapy as an alternative to conventional antibiotics and support further studies to translate this strategy into clinical use.

35. Understanding Vaccine Hesitancy in Louisiana Through Social Media Listening and Community Feedback: Cross-Sectional Study.

期刊: JMIR infodemiology 发表日期: 2026-May-06 链接: PubMed

摘要

The rise of social media has significantly impacted public health programs, with platforms such as YouTube, Facebook, X (formerly known as Twitter), Instagram, and, more recently, TikTok being used to promote health information, raise awareness about disease outbreaks, and support disease prevention programs. However, the diverse and often unverified nature of the content on social media can make it challenging to discern accurate information, contributing to user uncertainty, which may in turn contribute to low vaccination rates in some regions. This is especially true in Louisiana as its COVID-19 vaccination rates were among the lowest in the country in 2022. Therefore, understanding public sentiment on social media and developing targeted campaigns to counter unverified information is essential for advancing public health campaigns. The goal was to gain insights into the underlying factors that contribute to Louisiana’s low vaccination rates for routine immunizations by (1) performing social media listening to develop an infodemic management plan and (2) promoting accurate information via a social media campaign. Social media listening was conducted using Meltwater, a media monitoring and social media listening platform, supplemented by Google Alerts and Google News to identify if vaccine-related stories or sentiments were attracting unusual attention. Additionally, a social media campaign aimed at educating Louisiana residents about disease manifestation, symptoms, vaccines available for disease prevention, and potential side effects was developed. Posts were published 2 to 3 times a week and boosted for 7 days. From November 13, 2023, to June 11, 2024, social media listening identified at least 15 unique, noteworthy stories that signified sentiment spikes. These conversations were predominantly related to vaccine hesitancy, with users expressing opposition to vaccines or reluctance to engaging with vaccine-related information. Sentiment spikes included themes related to mistrust of vaccines and concerns about their safety and efficacy. The social media campaign received 69,600 impressions, reached 43,429 users, and received 652 reactions and likes, 62 shares, and 105 comments. Most of the audience was female, with higher engagement from older users on Facebook and younger users on Instagram. Finally, posts related to hepatitis B, rotavirus, and measles, mumps, and rubella vaccines received the most attention. Social media has become a key tool for digital health, helping to implement disease prevention programs and promoting advances in medicine. However, unverified information remains a major reason for the aversion to vaccination despite the dissemination of information from reputable public health organizations, health professionals, hospitals, and medical centers. To address this, information that is accessible, understandable, and culturally competent must be circulated to mitigate disinformation and improve attitudes toward vaccination. More research is needed to evaluate the effectiveness of social media campaigns in reducing vaccine hesitancy and improving willingness to adopt public health recommendations to increase vaccination rates.

36. AI and Internet of Things for Chronic Obstructive Pulmonary Disease Remote Monitoring: Systematic Review of Exacerbation Prediction and Key Physiological Variables.

期刊: JMIR medical informatics 发表日期: 2026-May-06 链接: PubMed

摘要

Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide, with frequent exacerbations of COPD (ECOPD) significantly impacting patient health and health care systems. Predicting ECOPD early would increase patients’ quality of life and decrease the economic burden. The advancement of wearable technologies and Internet of Things (IoT) sensors has enabled continuous remote monitoring (RM), offering new opportunities for early ECOPD prediction. However, effectively leveraging wearable data requires robust artificial intelligence (AI) frameworks capable of processing heterogeneous physiological and environmental information. This systematic review aims to provide a comprehensive overview of both hardware and software solutions for predicting ECOPD using RM. From the reviewed literature, we first focus on key physiological and environmental variables essential for COPD monitoring that can be extracted from wearables and IoT sensors. Second, we describe the wearable and IoT devices currently deployed in COPD management. Finally, we review machine learning, including deep learning models, used for ECOPD prediction, discussing limitations for real-world implementation. By bridging AI-driven data processing with real-world sensor applications, this review aims to outline the current landscape, existing challenges, and future directions for developing effective RM solutions for ECOPD predictions. A comprehensive search was conducted following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines to identify studies using AI or machine learning techniques for predicting ECOPD in in-home contexts. This review identified 26 studies that met the inclusion criteria. Twenty studies aimed at predicting or detecting exacerbations at the onset. The variables tracked most frequently were heart rate (n=9), peripheral oxygen saturation (n=9), and symptoms (n=8). Daily or weekly sampling was most common (n=14). Most studies (n=13) applied machine learning models-primarily random forest (n=5), CatBoost (n=2), decision trees (n=2), and support vector machines (n=2). Deep learning was used in 3 papers, while the remaining applied rule-based logics and probabilistic models. Wearables and IoT were used in only 6 out of 20 studies. Six papers analyzed changes in vital parameters during prodromal phases, defined as the period shortly before the onset of an exacerbation. Three studies collected data continuously, 2 daily, and 1 compared once-daily versus overnight monitoring; 4 of these 6 used wearable devices. Overall, current evidence highlights the potential of continuous monitoring of physiological and environmental variables for early ECOPD prediction, offering advantages over questionnaires or once-daily measurements. While wearables and IoT devices show promise, their use remains limited. Many studies rely on balanced datasets that do not mirror real-world exacerbation patterns and lack external validation across diverse populations. Future research should emphasize large-scale validation, integration of multimodal data, and translation of AI models into clinically feasible tools to enable timely intervention and improve COPD management.

37. The Challenge of a Global System for Coordinating Exposomics: Aligning Regional Projects and Infrastructures.

期刊: Environmental science & technology 发表日期: 2026-May-06 链接: PubMed

摘要

38. Lactate transport inhibition therapeutically reprograms fibroblast metabolism in experimental pulmonary fibrosis.

期刊: Science translational medicine 发表日期: 2026-May-06 链接: PubMed

摘要

Myofibroblast differentiation, essential for driving extracellular matrix synthesis in pulmonary fibrosis, requires increased glycolysis. Although glycolytic cells must export lactate, the contributions of lactate transporters to myofibroblast differentiation are unknown. In this study, we investigated how monocarboxylate transporters (MCTs) 1 and 4, key pulmonary lactate transporters, influence myofibroblast differentiation and experimental pulmonary fibrosis. Our findings revealed that inhibiting MCT1 or MCT4 using RNA interference or small molecules reduced transforming growth factor-β1 (TGFβ)-stimulated myofibroblast differentiation in lung fibroblasts from healthy donors and patients with idiopathic pulmonary fibrosis. Small-molecule MCT inhibitors also decreased bleomycin-induced pulmonary fibrosis in C57Bl6/N mice aged 10 to 12 weeks. Through bioenergetic analyses, stable isotope tracing, metabolomics, and imaging mass spectrometry in both human cells and mice, we demonstrate that inhibiting lactate transport enhanced oxidative phosphorylation, reduced reactive oxygen species production, and diminished glucose metabolite incorporation into fibrotic lung regions. Furthermore, we introduce VB253, an MCT4 inhibitor, which ameliorates pulmonary fibrosis in both young and aged mice, with comparable efficacy to established antifibrotic therapies. These results underscore the necessity of lactate transport for myofibroblast differentiation, identify MCT1 and MCT4 as promising pharmacologic targets in pulmonary fibrosis, and support further evaluation of lactate transport inhibitors as a therapy for patients with limited treatment options.

39. Point-of-care early infant HIV diagnosis at birth in a pragmatic cluster-randomized trial in Mozambique and Tanzania: A comparative cost and cost-effectiveness study.

期刊: PLoS medicine 发表日期: 2026-May-06 链接: PubMed

摘要

Timely access to early infant diagnosis (EID) is crucial for newborns with HIV, as late diagnosis can delay lifesaving antiretroviral treatment (ART). We assessed the comparative cost and cost-effectiveness of integrating point-of-care EID at birth into routine care in primary healthcare settings. This pre-specified secondary analysis was nested in the cluster-randomized LIFE study conducted at 28 primary healthcare facilities in Mozambique and Tanzania from October 2019 to September 2021. We estimated the health system cost of point-of-care birth plus 4-8-week HIV testing (very early infant diagnosis; VEID) compared to standard-of-care (SoC) testing at 4-8 weeks only, both with immediate ART initiation. We assessed the cost-effectiveness of VEID relative to SoC with respect to ART initiation within one week of life using Bayesian hierarchical models. As this is an intermediate outcome, incremental cost-effectiveness ratios (ICERs) cannot be directly compared to available life-year-based cost-effectiveness thresholds. To contextualize results, we derived the minimum life-years gained per early ART initiation required for VEID to meet standard thresholds in a break-even analysis. VEID was associated with a higher cost and resulted in earlier ART initiation than SoC in both countries. In Mozambique, VEID increased the proportion of infants initiating ART within one week of life by 90.0 (95% CrI [67.5, 98.5]) percentage points at an incremental cost of $2,632 (95% CrI [$2,249, $3,062]) per infant with HIV. In Tanzania, VEID increased early ART initiation by 59.9 (95% CrI [20.9, 89.5]) percentage points at an incremental cost of $6,263 (95% CrI [$5,394, $7,243]) per infant with HIV. The ICER was $2,924 and $10,458 in Mozambique and Tanzania, respectively and was sensitive to intrauterine transmission rate. These findings were limited by the lack of long-term health outcome data and reliance on an intermediate outcome. Based on the break-even analysis, we estimated that VEID would need to yield 6-32 life-years gained per additional early ART initiation to meet standard thresholds. Adding birth testing improved early ART initiation but was unlikely to be cost-effective relative to standard thresholds given current prices, vertical transmission rates, and knowledge of long-term health benefits. Cost-effectiveness could be achieved at current costs if early ART translates to substantial long-term health benefits or if targeted to infants at high risk of vertical transmission.

40. Leveraging the Metabolic Fingerprint of Sleep Deprivation and Sleep Restriction for Forensic Applications: A Machine Learning Study in Oral Fluid Metabolomics.

期刊: Journal of proteome research 发表日期: 2026-May-06 链接: PubMed

摘要

As sleep loss leads to accidents and impaired safety, a direct metabolic marker would be beneficial for forensic interpretation. In a sufficiently powered, randomized, controlled, crossover trial under realistic conditions, we examined the salivary metabolome of 20 young men (habitual sleep duration 7-9 h) following three interventions: one night of total sleep deprivation, four consecutive nights of sleep restriction to 6 h, and control (8 h of sleep). Oral fluid specimens were repeatedly collected and analyzed using liquid chromatography coupled to mass spectrometry. Logistic regression models were trained to classify unseen samples without reference samples from the same individual. Acute sleep deprivation exhibited a unique metabolic fingerprint that could be detected precisely (F0.5 = 0.90) when using only 12 molecular features. This fingerprint was more pronounced in samples collected in the morning/midday hours. Nevertheless, at all time points, the overall correct predictions by far outweighed the incorrect ones. Four nights of sleep restriction did not lead to exploitable metabolic changes. This study presents a metabolic fingerprint of acute sleep deprivation in oral fluid under realistic conditions and explores practical implications and limitations of its machine learning-aided classification. Metabolomics-based, reference-free sleep loss detection holds potential for applications in forensic, clinical, and occupational contexts.

41. Effectiveness of Blood Flow Restriction Training in Neurological Rehabilitation: A Systematic Review and Meta-analysis.

期刊: Sports medicine - open 发表日期: 2026-May-06 链接: PubMed

摘要

Muscle weakness is a common impairment following neurological disorders, yet traditional high-load training aimed at addressing this is often impractical or unsafe for these patients. Blood flow restriction (BFR) training has emerged as a viable method, capable of eliciting physiological adaptations comparable to high-load training while using significantly lower mechanical loads. This study aimed to summarize the clinical applications of BFR training for neurological disorders and assess its effectiveness and safety in improving muscle strength and functional outcomes. The systematic review and meta-analysis followed PRISMA guidelines. PubMed, Embase, PEDro, Cochrane, CINAHL, CNKI were searched for intervention studies comparing BFR with diverse control interventions. The primary outcomes were muscle strength and functional outcomes. Sensitivity analyses, subgroup analysis and meta-regression were also performed. Thirty-seven studies involving 963 participants were included, with individuals having stroke (n = 639), Parkinson’s disease (n = 18), multiple sclerosis (n = 128), spinal cord injury (n = 170), cerebral palsy (n = 1), peripheral nerve injury (n = 2), and transverse myelitis (n = 1). Our results revealed that the addition of BFR significantly increased muscle strength, with effect sizes of 0.752 (95% CI 0.49-1.02). Significant improvements were also observed in balance, Fugl-Meyer Lower Extremity assessment, and Modified Barthel Index. Subgroup analyses revealed that onset time was a crucial factor for the effectiveness of BFR on clinical outcomes. Furthermore, BFR training demonstrated overall safety in neurological rehabilitation. These findings support the effectiveness of BFR training in improving muscle strength and functional outcomes in neurological rehabilitation, without any significant adverse events. However, further high-quality research is needed to validate the efficacy of BFR and refine its training protocols for individuals with neurological disorders.

42. Validating cancer-specific and generic quality of life (QoL) instruments among patients with head and neck cancers: incorporating the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Head and Neck Module with generic QoL instruments.

期刊: Psicologia, reflexao e critica : revista semestral do Departamento de Psicologia da UFRGS 发表日期: 2026-May-06 链接: PubMed

摘要

Head and neck cancers can significantly affect health-related quality of life (QoL). Using a novel approach, the present study validated a Taiwanese version of the revised European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Head and Neck Module (QLQ-HN43). The present study was a cross-sectional study with the data collected from November 2021 to March 2022, and included 290 participants (82.7% males, mean age = 58.9 years [SD = 11.03]) from a medical center. Internal consistency was examined using Cronbach’s α. Confirmatory factor analysis (CFA) was conducted testing different models. Two generic QoL measures (the World Health Organization Quality of Life Questionnaire Brief version [WHOQOL-BREF] and EuroQol Five-Dimension [EQ-5D]), were used to assess concurrent validity. Known-groups validity was used to indicate how the QLQ-HN43 could differentiate individuals with mild-to-moderate problems from those with severe problems associated with QoL. Internal consistency was acceptable for QLQ-HN43 subscales (.68 < α < .94). CFA results showed appropriate fit indices, particularly for each individual model and the incorporated model containing both QLQ-HN43 and WHOQOL-BREF. The concurrent validity of the QLQ-HN43 was supported by the significant correlations with WHOQOL-BREF (r=-.111 to - .508; p-values<.05) and EQ-5D utility in CFA findings (r=.276 to .655; p-values<.01). Significant differences were found between those at the initial stages of the disease and those at the advanced stage, supporting known-group validity. The QLQ-HN43 scale has acceptable psychometric properties for Taiwanese individuals with head or neck cancers. The feasibility of incorporating EQ-5D with the QLQ-HN43 needs further investigation.

43. Return-to-Work self-efficacy in cancer survivors: A scoping review.

期刊: Work (Reading, Mass.) 发表日期: 2026-May-06 链接: PubMed

摘要

BackgroundWhile enhancing return-to-work self-efficacy (RTW-SE) is known to improve return-to-work (RTW) outcomes in other populations, its conceptualization, measurement, and application within cancer populations remain unclear.ObjectiveThe objective of this scoping review is to examine the empirical literature regarding how RTW-SE has been described, measured, and addressed among cancer survivors.MethodsData Sources: Seven databases were searched. In total, 1208 articles were identified and screened by title and abstract. After full-text review, 29 articles were included in the final data extraction and analysis for this scoping review. Data Extraction: Data related to sample characteristics, study design and objectives, and psychometric properties of RTW-SE measures used were extracted from full texts. Data Synthesis: Descriptive statistics were used to synthesize data extracted from the articles.ResultsTen different instruments were used across the 29 articles, with the RTWSE-11 (n = 9) being the most frequently used. Articles explored the relationship between RTW-SE and various outcome variables including employment status, and expected time to RTW. Several articles also examined the extent to which RTW-SE predicted RTW, time to RTW, and work ability. Six articles tested psychosocial interventions, with half also incorporating a physical component to improve RTW-SE. None of the articles reported information about thresholds for meaningful change for RTW-SE.ConclusionsThis scoping review summarizes the current literature that describes the role of RTW-SE among cancer survivors who are in the process of returning to work. Future research is needed to determine the predictive validity and sensitivity to change of RTW-SE measures.

44. Enneagram at work: A novel scale for measuring occupational personality characterictics.

期刊: Work (Reading, Mass.) 发表日期: 2026-May-06 链接: PubMed

摘要

BackgroundMeasuring occupational personality traits plays a critical role in enhancing individuals’ professional awareness, identifying strengths and stress factors, promoting workplace harmony, ensuring safety, and supporting career satisfaction and success. The Enneagram approach offers a comprehensive framework for evaluating personality dimensions relevant to professional settings.ObjectiveThis study aimed to develop a valid and reliable scale to assess individuals’ occupational personality traits based on the Enneagram typology.MethodA methodological research design was employed between July and September 2023. The sample consisted of 300 participants from various occupational groups in Gaziantep.Data were analyzed using SPSS 22 and AMOS 22. Content validity and construct validity (via exploratory and confirmatory factor analyses) were used to evaluate scale validity, while internal consistency and reliability analyses were performed for reliability assessment.ResultsThe content validity index was found to be 0.93. Exploratory factor analysis indicated strong sampling adequacy (KMO: 0.817-0.908), significant Bartlett’s test (p < 0.001), eigenvalues between 3.029-4.183, and total variance explained ranging from 42.31% to 50.71%. Confirmatory factor analysis demonstrated that most fit indices fell within acceptable to excellent ranges. Reliability analyses revealed high internal consistency (Cronbach’s alpha: 0.786-0.844), satisfactory split-half reliability (r: 0.690-0.783), and consistent scoring.ConclusionThe developed Enneagram-based occupational personality scales were found to be both valid and reliable, providing a useful tool for understanding professional personality characteristics and supporting personal and organizational development.

45. Examining Suicidality in Youth With Disabilities: 2021-2023 National Survey on Drug Use and Health.

期刊: The Journal of adolescent health : official publication of the Society for Adolescent Medicine 发表日期: 2026-May-05 链接: PubMed

摘要

To assess associations between disability severity, multimorbidity (number of disabilities), and suicidality among US adolescents, including suicidality specifically attributable to COVID-19. We analyzed 28,402 adolescents (ages 12-17 years) from the 2021-2023 National Survey on Drug Use and Health. Survey weights and design variables produced estimates representative of the US civilian, noninstitutionalized adolescent population. Disability severity (none, mild, moderate/severe) was derived from self-reported functioning across six domains-vision, hearing, cognition, mobility, self-care, and communication. Multimorbidity was the count of moderate/severe disability domains (0, 1, 2, ≥3). The primary outcome was past-year suicidality, categorized as none, any ideation or plan (general suicidality), and COVID-19-attributed suicidality. In the weighted sample, 45.5% had mild disability and 17.9% had moderate/severe disability. Relative to peers without disabilities, youth with mild disability had higher odds of general suicidality (adjusted odds ratio [AOR] = 2.25; 95% confidence interval [CI]: 1.82-2.77), whereas their elevated odds of COVID-19-attributed suicidality were not statistically significant (AOR = 1.64; 95% CI: .99-2.72). Youth with moderate/severe disability had higher odds of general suicidality (AOR = 3.81; 95% CI: 3.02-4.81) and of COVID-19-attributed suicidality (AOR = 2.58; 95% CI: 1.50-4.44). A dose-response by disability count was observed; adolescents with three or more disabilities had the highest risk of general suicidality (AOR = 2.20; 95% CI: 1.45-3.33). During the COVID-19 era, adolescents with disabilities-particularly those with greater severity or multiple disabilities-faced elevated risk for suicidality. Findings underscore the need for disability-informed suicide risk screening and uninterrupted access to mental-health services, including flexible, accessible care modalities during periods of system disruption.

46. Comparison of Coronary Computed Tomography Angiography and Invasive Coronary Angiography in Nonobstructive Coronary Artery Disease: The Brazilian Coronary ARtery Disease (BARD) Study.

期刊: Arquivos brasileiros de cardiologia 发表日期: 2026-Mar 链接: PubMed

摘要

The prognosis of nonobstructive coronary artery disease (CAD) is not well established. Comparative data between coronary computed tomography angiography (CCTA) and invasive coronary angiography (ICA) are limited. To compare CCTA- and ICA-derived information in nonobstructive CAD regarding detection and clinical outcomes. We followed 4,004 adult patients who underwent either ICA (n = 2,355) or CCTA (n = 1,649) for a median of 9 years. The primary endpoint was a composite of all-cause mortality, acute coronary syndrome/acute myocardial infarction, and stroke. Propensity score matching was performed to compare outcomes between groups. The significance level was set at 5%. The overall event rate was 6.9%. ICA was associated with worse outcomes than CCTA (hazard ratio [HR] 0.54; 95% CI 0.42-0.68; p < 0.001). Patients with nonobstructive CAD had worse outcomes than those without CAD (HR 1.73; 95% CI 1.32-2.27; p < 0.001). Normal coronary findings on CCTA were associated with better outcomes than normal findings on ICA (HR 0.39; 95% CI 0.24-0.62; p < 0.001). Event rates increased proportionally with plaque burden. In 1,187 matched pairs, CCTA was associated with improved survival (HR 0.57; 95% CI 0.42-0.78; p < 0.001). CCTA more closely reflects clinical outcomes than ICA. Nonobstructive CAD carries a substantial risk regardless of imaging modality. O prognóstico da doença arterial coronariana (DAC) não obstrutiva não está bem estabelecido. Dados comparativos entre angiotomografia coronariana (ATC) e angiografia coronariana invasiva (ACI) são limitados. Comparar as informações derivadas da ATC e da ACI na DAC não obstrutiva quanto à detecção e aos desfechos clínicos. Acompanhamos 4.004 pacientes adultos que realizaram ACI (n = 2.355) ou ATC (n = 1.649) por uma mediana de 9 anos. O desfecho primário foi um composto de mortalidade por todas as causas, síndrome coronariana aguda/infarto agudo do miocárdio e acidente vascular cerebral. Foi realizado pareamento por escore de propensão para comparar os desfechos entre os grupos. O nível de significância foi fixado em 5%. A taxa global de eventos foi de 6,9%. A ACI esteve associada a piores desfechos em comparação à ATC (hazard ratio [HR] 0,54; intervalo de confiança [IC] 95% 0,42-0,68; p < 0,001). Pacientes com DAC não obstrutiva apresentaram piores desfechos do que aqueles sem DAC (HR 1,73; IC 95% 1,32-2,27; p < 0,001). Achados coronarianos normais na ATC estiveram associados a melhores desfechos do que achados normais na ACI (HR 0,39; IC 95% 0,24-0,62; p < 0,001). As taxas de eventos aumentaram proporcionalmente à carga de placa. Em 1.187 pares pareados, a ATC esteve associada à melhora da sobrevida (HR 0,57; IC 95% 0,42-0,78; p < 0,001). A ATC reflete mais de perto os desfechos clínicos do que a ACI. A DAC não obstrutiva apresenta risco substancial independentemente da modalidade de imagem.

47. Atrial Cardiomyopathy Detected by Electrocardiogram: Association with Stroke in a Brazilian Electronic Cohort.

期刊: Arquivos brasileiros de cardiologia 发表日期: 2026-Mar 链接: PubMed

摘要

Atrial cardiomyopathy (AC) is a condition detectable by electrocardiogram (ECG) that may play a significant role in the pathophysiology of the etiology of strokes, independently of atrial fibrillation (AF). To evaluate the association between ECG markers of AC (prolonged P-wave duration >120 ms and P-terminal force in V1 (PTFV1) >4,000 µV·ms) as well as the occurrence of mortality and hospitalization due to stroke. This retrospective cohort study included patients from Belo Horizonte who underwent ECGs between 2006 and 2018. Patients aged ≥40 years, in sinus rhythm, and without a previous history of stroke at baseline ECG were included. Clinical and ECG data were linked to mortality (SIM) and hospitalization (SIH) public databases. Cox regression was used to calculate hazard ratios (HRs), and incremental adjustment models for age, sex, cardiovascular risk factors, and left ventricular hypertrophy were employed. Statistical significance was set at p<0.05. 245,588 patients were included. 26.3% had prolonged P-wave duration >120 ms, and 10.1% had elevated PTFV1 >4,000 µV·ms. Mean follow-up duration was 3.5 years. AC was associated with mortality and hospitalization due to stroke (HR 1.24; 95% CI, 1.12-1.36 for P-wave duration >120 ms; p<0.001; HR 1.20; 95% CI, 1.05-1.38 for PTFV1 >4,000 µV·ms; p<0.001). ECG markers of AC are associated with death or hospitalization due to stroke, as well as cardiovascular mortality and incident AF in a large, representative Brazilian cohort, highlighting their prognostic value. A cardiomiopatia atrial (CA) é detectável pelo eletrocardiograma (ECG), e está relacionada à fisiopatologia do acidente vascular encefálico (AVE), independentemente de fibrilação atrial (FA). Avaliar a associação entre marcadores de ECG para CA (duração da onda P > 120 ms e a Força Terminal da Onda P em V1 > 4.000 μv × ms, PTFV1) e mortalidade e hospitalização por AVE. Este estudo de coorte retrospectivo incluiu pacientes que realizaram ECGs entre 2006 e 2018. Foram critérios de inclusão: idade ≥ 40 anos, ritmo sinusal e ausência de histórico de AVE prévio ao ECG basal. Dados clínicos e de ECG foram pareados aos Sistemas de Informação de Mortalidade (SIM) e o Sistema de Informações Hospitalares (SIH). A regressão de Cox foi utilizada para calcular razões de risco (HRs), ajustadas para idade, sexo, fatores de risco cardiovascular e hipertrofia ventricular esquerda. A significância estatística foi estabelecida em p<0,05. Dos 245588 pacientes, 26,3% apresentaram duração da onda P>120 ms, enquanto 10,1% apresentaram PTFV1 >4.000 µV·ms. O tempo médio de seguimento foi de 3,5 anos. A CA se associou à mortalidade e internação por AVE (HR 1,24; IC 95%, 1,12–1,36 para onda P >120 ms; p<0,001; HR 1,20; IC 95%, 1,05–1,38 para PTFV1 >4.000 µV·ms; p<0,001). Marcadores eletrocardiográficos de CA estão associados a morte ou internação por AVE, bem como a mortalidade cardiovascular e a incidência de FA em uma grande coorte brasileira, o que destaca seu potencial como marcadores prognósticos.

48. Performance of the MAGGIC Score in Individuals with Heart Failure: Validation in a Brazilian Population.

期刊: Arquivos brasileiros de cardiologia 发表日期: 2026-Mar 链接: PubMed

摘要

The Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC) score is a risk stratification tool used to predict mortality in heart failure (HF). However, potential sex-related differences in its performance and its applicability to the Brazilian population remain uncertain. To evaluate sex-based differences in the performance of the MAGGIC score and to validate the score in a Brazilian HF cohort. This retrospective cohort study included 866 patients followed at a HF outpatient clinic. The primary outcome was 3-year all-cause mortality. The MAGGIC score was calculated for each patient. Discrimination was assessed using the area under the receiver operating characteristic curve, and calibration was evaluated using the Hosmer-Lemeshow test. Analyses were performed for the overall cohort and stratified by sex. A p-value < 0.05 was considered statistically significant. The overall 3-year mortality rate was 33.4% (36.4% in men and 27.8% in women; p = 0.010). Predicted mortality was 20.9% (mean score 18.3 ± 7), with 22.7% for men and 19.1% for women. The score demonstrated good discrimination (area under the curve = 0.72; 95% CI: 0.686-0.754), with similar performance in men (0.704 [0.661-0.747]) and women (0.733 [0.674-0.792]). Calibration showed good agreement: overall chi-square (χ2) = 1.1 (p = 0.998), men χ2 = 0.9 (p = 0.999), and women χ2 = 1.3 (p = 0.995). Observed mortality was higher in moderate-risk groups, with no significant difference between moderate- and high-risk groups (p = 0.236). The MAGGIC score showed good performance in a Brazilian HF cohort, with no significant sex-based differences, although higher observed mortality was identified among moderate-risk patients. O escore Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC) é uma ferramenta de estratificação de risco utilizada para prever mortalidade na insuficiência cardíaca (IC). Entretanto, possíveis diferenças relacionadas ao sexo em seu desempenho e sua aplicabilidade à população brasileira permanecem incertas. Avaliar diferenças baseadas no sexo no desempenho do escore MAGGIC e validar o escore em uma coorte brasileira de IC. Este estudo de coorte retrospectivo incluiu 866 pacientes acompanhados em um ambulatório de IC. O desfecho primário foi mortalidade por todas as causas em 3 anos. O escore MAGGIC foi calculado para cada paciente. A discriminação foi avaliada por meio da área sob a curva característica de operação do receptor, e a calibração foi avaliada pelo teste de Hosmer-Lemeshow. As análises foram realizadas para a coorte total e estratificadas por sexo. Considerou-se valor de p < 0,05 como estatisticamente significativo. A taxa global de mortalidade em 3 anos foi de 33,4% (36,4% em homens e 27,8% em mulheres; p = 0,010). A mortalidade predita foi de 20,9% (escore médio de 18,3 ± 7), sendo 22,7% em homens e 19,1% em mulheres. O escore demonstrou boa discriminação (área sob a curva = 0,72; intervalo de confiança de 95%: 0,686-0,754), com desempenho semelhante em homens (0,704 [0,661-0,747]) e mulheres (0,733 [0,674-0,792]). A calibração mostrou boa concordância: qui-quadrado (χ2) global = 1,1 (p = 0,998), χ2 para homens = 0,9 (p = 0,999) e χ2 para mulheres = 1,3 (p = 0,995). A mortalidade observada foi maior nos grupos de risco moderado, sem diferença significativa entre os grupos de risco moderado e alto (p = 0,236). O escore MAGGIC apresentou bom desempenho em uma coorte brasileira de IC, sem diferenças significativas relacionadas ao sexo, embora tenha sido identificada maior mortalidade observada entre pacientes de risco moderado.

49. Efficacy of a Salt Substitute on the Incidence of Hypertension: A Systematic Review with Meta-Analysis.

期刊: Arquivos brasileiros de cardiologia 发表日期: 2026-Mar 链接: PubMed

摘要

A potassium-enriched salt substitute, in which part of sodium chloride is replaced with potassium chloride, has shown considerable potential as a population-level strategy to reduce sodium intake and prevent cardiovascular disease. In recent years, research has focused primarily on individuals with hypertension, demonstrating that salt substitutes can influence blood pressure (BP). To perform a meta-analysis quantifying the magnitude of BP reduction in patients with hypertension using regular salt compared with those using a salt substitute. PubMed, Scopus, and Web of Science were searched for randomized controlled trials (RCTs) comparing regular salt with a salt substitute. Mean differences (MD) with 95% CIs were calculated using a random-effects model. Heterogeneity was assessed using the I2 statistic. A p-value < 0.05 was considered statistically significant. Four RCTs involving 1,430 participants were included, of whom 725 (49.57%) received the salt substitute. The use of a salt substitute was associated with a significant reduction in systolic BP (SBP) (MD, -5.75 mmHg; 95% CI, -6.98 to -2.39 mmHg; I2 = 37%; p < 0.01) and a significant reduction in diastolic BP (DBP) (MD, -1.62 mmHg; 95% CI, -2.34 to -0.91 mmHg; I2 = 0%; p < 0.001). In patients with hypertension, the use of a salt substitute is associated with a significant reduction in both SBP and DBP compared with regular salt. Um substituto do sal enriquecido com potássio, no qual parte do cloreto de sódio é substituída por cloreto de potássio, tem demonstrado considerável potencial como estratégia em nível populacional para reduzir a ingestão de sódio e prevenir doenças cardiovasculares. Nos últimos anos, as pesquisas têm se concentrado principalmente em indivíduos com hipertensão, demonstrando que os substitutos do sal podem influenciar a pressão arterial (PA). Realizar uma metanálise para quantificar a magnitude da redução da PA em pacientes com hipertensão que utilizam sal comum em comparação com aqueles que utilizam um substituto do sal. PubMed, Scopus e Web of Science foram pesquisados em busca de ensaios clínicos randomizados (ECRs) que compararam sal comum com um substituto do sal. Diferenças médias (DM) com intervalos de confiança (ICs) de 95% foram calculadas utilizando um modelo de efeitos aleatórios. A heterogeneidade foi avaliada por meio da estatística I2. Um valor de p < 0,05 foi considerado estatisticamente significativo. Quatro ECRs envolvendo 1.430 participantes foram incluídos, dos quais 725 (49,57%) receberam o substituto do sal. O uso do substituto do sal foi associado a uma redução significativa da PA sistólica (PAS) (DM, −5,75 mmHg; IC 95%, −6,98 a −2,39 mmHg; I2 = 37%; p < 0,01) e a uma redução significativa da PA diastólica (PAD) (DM, −1,62 mmHg; IC 95%, −2,34 a −0,91 mmHg; I2 = 0%; p < 0,001). Em pacientes com hipertensão, o uso de um substituto do sal está associado a uma redução significativa tanto da PAS quanto da PAD em comparação com o sal comum.

50. [Federal out-of-hospital spending on mental health from 2001 to 2022: what do the numbers reveal?].

期刊: Ciencia & saude coletiva 发表日期: 2026-Mar 链接: PubMed

摘要

This article analyzes the management of Federal expenditure on mental health between 2001 and 2022, reflecting on how this management denies and reaffirms the principles of Brazilian Psychiatric Reform. It involves research, based on publicly accessible data available on Ministry of Health databases, i.e. the I.T. Department of the SUS, the Integrated Public Health Budget System, and the Electronic System of the Citizen Information Service between 2001 (when Law No. 10,216 was enacted) and 2022 (the last year of the Bolsonaro government). Federal spending on mental health, in relation to total spending on health services, fell in the five years, from an average of 2% to 1.7%. Out-of-hospital expenditure on mental health reached 80%, and funding for Brazil’s community-based psychosocial care centers (CAPS) increased but saw a reduction in spending on other areas. The management of federal spending reveals the progress, limitations, and setbacks in Brazilian Psychiatric Reform, especially in redirecting resources to institutionalizing healthcare actions, and making mental health expenditure “invisible” within the health budget, which makes the social control of policy application difficult. Este artigo analisa a direção dos gastos da União com saúde mental entre 2001 e 2022, refletindo como essa direção dialeticamente nega e reafirma os princípios da Reforma Psiquiátrica brasileira. Trata-se de pesquisa documental, a partir de dados de acesso público disponíveis nos bancos de dados do Ministério da Saúde (Departamento de Informática do Sistema Único de Saúde do Brasil; Sistema Integrado de Orçamento Público da Saúde, bem como informações obtidas por meio do Sistema Eletrônico do Serviço de Informações ao Cidadão) entre 2001 (ano da Lei nº 10.216) e 2022 (último ano do governo Bolsonaro). Os gastos federais com a saúde mental, em relação aos gastos totais com ações e serviços de saúde, apresentaram decréscimo nos últimos cinco anos, passando da média de 2% para 1,7%. Os gastos extra-hospitalares em saúde mental alcançaram o percentual de 80%, e houve crescimento dos gastos com custeio de CAPS, mas tal crescimento foi acompanhado de redução em gastos com outras ações. O direcionamento dos gastos federais apontou para avanços, limites e retrocessos no processo de consolidação da Reforma Psiquiátrica, em especial ao redirecionar recursos para dispositivos assistenciais de cunho institucionalizante, e invisibilizar gastos com saúde mental no orçamento da saúde, dificultando o controle social na condução da política. Este artículo analiza la dirección del gasto federal en salud mental entre 2001 y 2022, reflexionando sobre cómo esta dirección niega y reafirma dialécticamente los principios de la Reforma Psiquiátrica Brasileña. Se trata de una investigación documental, basada en datos públicos de las bases de datos del Ministerio de Salud (Departamento de Informática del Sistema Único de Salud de Brasil; Sistema Integrado de Presupuesto Público de Salud, así como información obtenida por medio del Sistema Electrónico del Servicio de Información al Ciudadano) entre 2001 (año de la Ley n.º 10.216) y 2022 (último año del gobierno de Bolsonaro). El gasto federal en salud mental, en relación con el gasto total en acciones y servicios de salud, disminuyó en los últimos cinco años, de un promedio del 2% al 1,7%. El gasto extrahospitalario en salud mental alcanzó el 80%, y se observó un crecimiento en el gasto en CAPS, pero este crecimiento estuvo acompañado de una reducción en el gasto en otras acciones. La asignación del gasto federal indicó avances, limitaciones y retrocesos en el proceso de consolidación de la Reforma Psiquiátrica, especialmente al redirigir recursos a la institucionalización de dispositivos de atención e invisibilizar el gasto en salud mental en el presupuesto de salud, lo que dificulta el control social en la ejecución de la política.

51. Socioeconomic inequalities in health-related risk and protective behaviors among pregnant women diagnosed with gestational diabetes mellitus.

期刊: Revista gaucha de enfermagem 发表日期: 2026 链接: PubMed

摘要

To estimate the association between sociodemographic and economic factors, prenatal care, and health-related risk and protective behaviors among pregnant women with gestational diabetes mellitus. This was a cross-sectional study with data collected between November 2023 and March 2024 from 391 pregnant women in a maternity hospital in Belo Horizonte, Minas Gerais, Brazil. Data collection was carried out through interviews using a semi-structured questionnaire. Poisson regression was used for data analysis. Fruit consumption was significantly higher among pregnant women aged over 35 years (PR: 1.29; 95% CI: 1.03-1.63) and those with higher education (PR: 1.66; 95% CI: 1.11-2.50). Vegetable consumption was significantly higher among those with higher education (PR: 1.47; 95% CI: 1.00-2.15) and without government assistance (PR: 1.39; 95% CI: 1.08-1.77). Physical activity was more prevalent among women with an income greater than three minimum wages (PR: 2.38; 95% CI: 1.36-4.16). Furthermore, women with higher income had a lower prevalence of alcohol consumption (PR: 0.25; 95% CI: 0.07-0.85). Unfavorable socioeconomic conditions are associated with risk behaviors among pregnant women with gestational diabetes, particularly alcohol consumption. Conversely, more favorable socioeconomic conditions are associated with health-protective factors, especially fruit and vegetable consumption and physical activity.

52. Effect of capsule invasion on recurrence and survival in axillary lymph node metastases of breast cancer.

期刊: Revista da Associacao Medica Brasileira (1992) 发表日期: 2026 链接: PubMed

摘要

The aim of this study was to investigate the effect of capsule invasion on recurrence and survival in breast cancer patients with axillary lymph node metastases. This retrospective study included 135 breast cancer patients with axillary lymph node involvement who underwent surgery between 2009 and 2018. The relationships between capsule invasion and various clinicopathological factors-including demographic parameters, tumor stage, surgical technique, histological type, number of involved lymph nodes, tumor size, estrogen receptor, progesterone receptor, human epidermal growth factor receptor 2, and Ki-67 index-were analyzed using chi-square, Kaplan-Meier, and Fisher’s exact tests. Additionally, multivariate Cox regression analysis was performed to assess the independent prognostic value of capsule invasion for recurrence. A p<0.05 was considered statistically significant. Capsular invasion was observed in 64 of 135 patients (47.4%). Recurrence occurred in six patients with capsule invasion compared to only one patient without capsule invasion. Multivariate Cox regression analysis, controlling for positive lymph node count, tumor size, grade, and receptor status, confirmed that capsule invasion was an independent predictor of recurrence [HR 3.45, 95%CI 1.12-10.65, p=0.032]. No significant association was found between tumor size and capsule invasion (p>0.05). During follow-up, 20 patients died (9 with and 11 without capsule invasion), with no significant difference in 5-year survival or mean survival time between groups (p=0.972, Kaplan-Meier analysis). Grading of capsular invasion showed a significant correlation with recurrence (p=0.026). Although lymph node capsule invasion in breast cancer with axillary lymph node involvement does not significantly impact overall survival, it independently and significantly elevates the risk of recurrence, as demonstrated by multivariate analysis.

53. Skeletal muscle mass and overhydration are associated with in-hospital mortality in acute heart failure patients.

期刊: Revista da Associacao Medica Brasileira (1992) 发表日期: 2026 链接: PubMed

摘要

The aim of the study was to determine the association between low muscle mass and abnormal fluid distribution with in-hospital mortality in patients with acute heart failure. In a prospective cohort study at the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran in Mexico City, patients with acute heart failure who underwent thoracic or abdominal computed tomography within 72 h before or after admission between September 2017 and July 2024 were included. The exclusion criteria were an illegible computed tomography scan, an incorrect bioimpedance analysis lecture, the presence of cancer, COVID-19, chronic kidney disease with renal replacement therapy, or dismissal of a diagnosis of acute heart failure. Bioelectrical impedance analysis was performed within the first 24 h of hospitalization to measure phase angle and impedance ratio for evaluating hydration status. The skeletal muscle area was measured using a single axial slide at L3 for abdominal computed tomography and the T4 level for thoracic computed tomography. This study included 134 patients, with an overall hospital survival rate of 83.6%. The mortality group had a lower abdominal skeletal muscle area (86.5 vs. 111 cm2, p=0.024), smaller pectoral skeletal muscle area (18.9 vs. 26 cm2, p=0.005), lower phase angle (3 vs. 3.9, p=0.010), increased impedance ratio (0.89 vs. 0.86, p=0.002), greater prevalence of reduced pectoral muscle mass (40.9 vs. 12.5%, p<0.001), and abnormal fluid distribution according to impedance ratio (86.4 vs. 57.1%, p=0.016). In survival analyses, the interaction effect of pectoral skeletal muscle area and increased impedance ratio had the lowest survival probability (log-rank test, p<0.001). Low skeletal muscle mass and abnormal fluid distribution are associated with in-hospital mortality in patients with acute heart failure.

54. Risks that cause illness, voices that warn: leadership strategies in supporting healthcare workers.

期刊: Revista gaucha de enfermagem 发表日期: 2026 链接: PubMed

摘要

to identify the obstacles in the work process and the strategies used by leaders in supporting healthcare workers involved in incidents related to psychosocial risks. an exploratory, descriptive, and qualitative study conducted between January 2023 and September 2024, with ten leaders at a university hospital in southern Brazil. Data were collected from records of the occupational health and psychology services, the human resources department, the institution’s strategic operational management software, as well as from semi-structured interviews, which were subjected to Thematic Content Analysis. twenty-three psychosocial incidents with repercussions for workers were identified. Two categories emerged from the interviews: Worker support; focusing on the challenges and strategies for its effective implementation, and Participatory management, aimed at building environments that promote worker’s involvement and shared responsibility. the main factors that interfere with the effective support to healthcare workers following incidents involving psychosocial risks. The strategies adopted by leadership, although present, require improvement and greater systematization to ensure adequate psychosocial support, favoring the promotion of the team’s health and safety.

55. Home isolation capacity after Covid-19 diagnosis in vulnerable communities of two Brazilian cities: TQT Covid-19 Study.

期刊: Revista de saude publica 发表日期: 2026 链接: PubMed

摘要

To investigate factors associated with self-reported capacity to comply with home isolation after Covid-19 diagnosis in vulnerable communities in two Brazilian cities. Cross-sectional study, with data from a study on the implementation of an intervention based on strategies of testing, isolation, quarantine, and telemonitoring (TQT) of Covid-19 in Primary Health Care in vulnerable neighborhoods (TQT Covid-19 Study). Demographic, socioeconomic, and behavioral data were used to perform descriptive and logistic regression analyses, aiming to evaluate the factors associated with home isolation capacity. The sample consisted of 324 participants, most of them women (72.5%) and who self-reported to be Black or mixed-race (85.2%). Regarding level of education, 20.1% had up to elementary school degree; 42% had high school degree; and 37.9% had higher education or graduate degree. The density of people per room was high in 57.1% of households. In the multivariate analysis, high household density (≥ 0.5 residents/room) was significantly associated with reduced isolation capacity (ORa = 0.41; 95%CI 0.20-0.82). Other sociodemographic and behavioral variables, including age, sex, race/skin color, level of education, history of Covid-19 infection, access to health services, and preventive behaviors, did not present a statistically significant association. According to the study, housing conditions, especially high household density, can be a determinant for adherence to home isolation. Thus, innovative prevention strategies should combine educational and structural actions that consider the household context of vulnerable families.

56. [Water, sanitation, and hygiene (WASH): a study of Brazilian rural public elementary schools].

期刊: Cadernos de saude publica 发表日期: 2026 链接: PubMed

摘要

This study investigated the lack of access to water, sanitation, and hygiene (WASH) at Brazilian rural public elementary schools through a cross-sectional comparative study of the years 2011 and 2023. The distribution, temporal evolution, and determinant factors of this lack were assessed through descriptive analysis and binomial logistic regression, using the School Census of Basic Education as the main database. The results reveal persistent regional inequalities: the North region had the highest odds ratios for the absence of all WASH services in both years analyzed. Schools located on indigenous lands, with less than 10 students or with high dropout rates and low passing rates, had a greater likelihood of health exclusion. On the municipal level, the high proportion of the rural population and low Municipal Human Development Index - Income stood out as determinants. Despite occasional advances in access to water, setbacks in other services indicate stagnation or the worsening of inequalities. The results reveal that, after more than ten years, rural Brazil is still far from meeting the 4.a.1 target of the Sustainable Development Goals, which stipulates universal access to WASH in the school environment. By revealing the main institutional and regional obstacles, this study contributes to the planning of public policies that are more equitable and sensitive to the specificities of rural areas in Brazil. Este estudo investigou a ausência de acesso à água, ao saneamento e à higiene (WASH, acrônimo em inglês) nas escolas públicas rurais de Ensino Fundamental brasileiras, um estudo transversal e comparativo referente aos anos de 2011 e 2023. Por meio de análise descritiva e regressão logística binomial, avaliou-se a distribuição, a evolução temporal e os fatores determinantes dessa ausência, utilizando como principal banco de dados o Censo Escolar da Educação Básica. Os resultados revelam desigualdades territoriais persistentes: a Região Norte apresentou as maiores razões de chance de ausência de todos os serviços de WASH em ambos os anos analisados. Escolas localizadas em terras indígenas, com menos de 10 alunos ou com taxas elevadas de abandono e baixos índices de aprovação, apresentaram maiores chances de exclusão sanitária. No nível municipal, destacaram-se como determinantes a elevada proporção de população rural e o baixo Índice de Desenvolvimento Humano Municipal - renda. Apesar de avanços pontuais no acesso à água, retrocessos em outros serviços indicam estagnação ou agravamento das desigualdades. Os resultados reforçam que, passados mais de dez anos, o Brasil rural ainda está distante de cumprir a meta 4.a.1 dos Objetivos de Desenvolvimento Sustentável, que preconiza a universalização do acesso ao WASH no ambiente escolar. Ao revelar os principais entraves institucionais e territoriais, o estudo contribui para subsidiar políticas públicas mais equitativas e sensíveis às especificidades do território rural brasileiro. Este estudio investigó la falta de acceso al agua, al saneamiento y a la higiene (WASH, por sus siglas en inglés) en las escuelas públicas rurales de educación primaria brasileñas, un estudio transversal y comparativo referente a los años 2011 y 2023. Mediante un análisis descriptivo y una regresión logística binomial, se evaluó la distribución, la evolución temporal y los factores determinantes de esta falta, utilizando como base de datos principal el Censo Escolar de Educación Básica. Los resultados revelan desigualdades territoriales persistentes: la región norte presentó las mayores probabilidades de ausencia de todos los servicios de WASH en ambos años analizados. Las escuelas ubicadas en tierras indígenas, con menos de 10 alumnos o con altas tasas de abandono y bajos índices de aprobación, presentaron mayores probabilidades de exclusión sanitaria. A nivel municipal, se destacaron como factores determinantes la elevada proporción de población rural y el bajo Índice de Desarrollo Humano Municipal-Renta. A pesar de avances puntuales en el acceso al agua, los retrocesos en otros servicios indican un estancamiento o un agravamiento de las desigualdades. Los resultados refuerzan que, tras más de diez años, el Brasil rural aún está lejos de cumplir la meta 4.a.1 de los Objetivos de Desarrollo Sostenible, que aboga por la universalización del acceso al WASH en el ámbito escolar. Al revelar los principales obstáculos institucionales y territoriales, el estudio contribuye a respaldar políticas públicas más equitativas y sensibles a las especificidades del territorio rural brasileño.

57. Covid-19 testing in Primary Health Care: professionals' perceptions.

期刊: Revista de saude publica 发表日期: 2026 链接: PubMed

摘要

To analyze the perceptions of Primary Health Care (PHC) professionals regarding Covid-19 testing in basic health units (BHUs). This qualitative study, part of a formative research project, involved 22 semi-structured interviews and 4 focus groups with professionals working in PHC in a Brazilian capital city. Among other criteria, the professional most directly involved in pandemic response measures in each BHU was selected. Content analysis was performed using a deductive analytical approach, in which the findings were organized into categories defined based on the components of the health system (population; infrastructure; organization of services; service delivery or care model; and management). Reports commonly referred, in the population component, to the challenges arising from the limitations of PHC coverage; in the infrastructure component, the insufficiency of human resources and physical infrastructure was highlighted, which in turn required changes in the organization and provision of services, with repercussions on the care model. The contributions also revealed that at some points during the pandemic there was a disruption of the work process, especially in family health teams. In the management component, weaknesses in communication flows between the health secretariat and the BHU were identified, although this was less frequently mentioned. The perception that expanding and decentralizing testing in BHUs was necessary was confirmed. The findings point to the importance of coordinating the pandemic response and effectively decentralizing the actions adopted, of preparedness plans and strengthening PHC and its professionals, as well as investments in infrastructure and team training, and advances in actions aimed at occupational health. The pandemic revealed the importance of advancing the health economic-industrial complex and, fundamentally, strengthening and defending the Brazilian Unified Health System.