公共卫生研究摘要 (2026-05-08)

共收录 57 篇研究文章

1. Host metabolism shapes the intestinal microbiota: a top-down paradigm of environmental selection pressure.

期刊: Gut microbes 发表日期: 2026-Dec-31 链接: PubMed

摘要

Intestinal homeostasis is not a stochastic microbial assembly but a deterministic outcome orchestrated by host-mediated metabolic gating. Traditional research has prioritized the microbiota’s impact on host physiology. However, the consistent expansion of facultative anaerobes, such as Enterobacteriaceae, observed in pathological states like intestinal inflammation, suggests that dysbiosis is fundamentally a consequence of impaired host regulation. Here, we propose a “top-down” paradigm of host metabolic regulation, framing the host as an “ecological engineer” that actively shapes the microbiome through metabolism. We detail three critical metabolic filters: (1) the maintenance of epithelial hypoxia via mitochondrial β-oxidation to suppress aerobic respiration; (2) the implementation of “nutritional immunity” to restrict glucose and inflammation-derived electron acceptors (nitrate and tetrathionate); and (3) the energy-dependent synthesis of the gel-forming mucin 2 (MUC2) mucus layer and antimicrobial peptides (AMPs). We argue that the breakdown of these filters leads to “niche opening,” which acts as the fundamental driver of dysbiosis. Finally, we discuss therapeutic strategies aimed at restoring host bioenergetics-including Peroxisome proliferator-activated receptor gamma (PPAR-γ) agonists, melatonin, and ketogenic diets-to rebuild the host’s ecological filtration capacity and fundamentally correct dysbiosis.

2. The association between weight-adjusted waist circumference index and risks of cardiovascular and all-cause mortality: a retrospective analysis based on the NHANES database.

期刊: Annals of medicine 发表日期: 2026-Dec 链接: PubMed

摘要

Nowadays, obesity has become a public health issue. Weight-adjusted waist circumference index (WWI) is gaining attention as a new obesity indicator. Evidence regarding the association between WWI and all-cause mortality and cardiovascular mortality among the general adult population in the United States remains limited. This retrospective cohort study analyzed 3,081 U.S. adults from the 1999-2018 NHANES database. Weighted Cox regression, trend chi-square test, Kaplan-Meier analysis, and comprehensive predictive performance assessments were used to explore the association between WWI and all-cause/cardiovascular mortality, and validate WWI’s predictive value versus BMI/waist circumference/body weight. Subgroup and interaction analyses were also performed. WWI was positively associated with all-cause (Model 3 HR = 1.944, p < 0.001) and cardiovascular mortality (Model 3 HR = 1.854, p = 0.013), with a significant linear upward trend in mortality risks with increasing WWI quartiles (all p < 0.001). WWI had higher AUC than traditional indices, with significant DeLong test differences, stable long-term predictive performance, and superior net benefit in clinically relevant DCA threshold ranges. This study demonstrates a significant association between WWI and all-cause mortality and cardiovascular mortality among the general adult population in the United States, Our findings suggest that older people, women, low-income and low-educated people, smokers have higher WWI, and people with high WWI also have higher prevalence of hypertension and diabetes, Integrating WWI into clinical risk assessment may help identify high-risk populations and guide targeted interventions to reduce mortality risk.

3. Medicinal food plants of Sabah (Eastern Malaysia): a source of potential natural products and nutraceuticals for the fight against cancer.

期刊: Pharmaceutical biology 发表日期: 2026-Dec 链接: PubMed

摘要

The pharmaceutical and nutraceutical industries are seeking structurally and pharmacologically novel anticancer molecules, as well as onco-protective nutraceuticals. One approach to achieving this goal is to study traditional pharmacopoeias, particularly those from regions where cancers are less common. Certain ethnic groups in Sabah (East Malaysia) appear to have a low incidence of cancer, and the study of their pharmacopeia could lead to the discovery of original anticancer molecules or nutraceuticals. This review presents a selection of 64 plants used for medicinal food in Sabah their potential for clinical uses. The data for this focused narrative review were gathered from Google Scholar, PubMed, ScienceDirect, Web of Science, PubMed, the Internet Archive, and Google books. For each plant the search string included the binomial denomination and the words “cytotoxic” or “tumors.” of the binomial denomination of each plant and “cytotoxic” and “tumors” was employed. Each result was examined and articles that did not contain information relevant to the topic or coming from non-peer-reviewed journals were excluded. Eight plant species, of which Helminthostachys zeylanica (L.) Hook., Pycnarrhena tumefacta Miers, Myrmecodia platytyrea Becc., and Mangifera pajang Kosterm, demonstrate activities in vitro and in vivo, which call for further research. Others constitute a source of cytotoxic natural products that warrant further investigation. There is currently a need to find oncopreventive nutraceuticals as well as original natural products for developing anticancer drugs. Such products could potentially be found among the medicinal and edible plants of Sabah. Further studies are needed.

4. Acute Kidney Injury and Risk of Adverse Neurocognitive Outcomes: A Systematic Review and Meta-Analysis.

期刊: Neurology 发表日期: 2026-Jun-09 链接: PubMed

摘要

Chronic kidney disease is a recognized risk factor for adverse neurocognitive outcomes, but the effect of acute kidney injury (AKI) on brain health remains less well defined. We conducted a systematic review and meta-analysis to evaluate associations between AKI and subsequent risk of stroke, delirium, and dementia. Eligible studies were identified by searching Ovid MEDLINE and Embase from inception (Ovid: January 1946; Embase: January 1970) until April 2025. Studies were included if they reported quantitative estimates with measures of precision for the association between AKI and delirium, stroke, or dementia in adult populations. Two reviewers independently screened and extracted data, and study quality was assessed using standardized criteria. Study characteristics, participant demographics, and adjusted effect estimates (hazard ratios [HRs] or odds ratios [ORs]) with 95% CIs were extracted. Pooled HRs and ORs with 95% CIs were calculated using random-effects models. Heterogeneity was evaluated with the χ2 test and I2 statistic, and sources of heterogeneity were explored through prespecified subgroup analyses and meta-regression. We identified 49 studies comprising 11,253,825 participants with 1,279,145 events. Individuals with AKI were at increased risk of stroke (pooled adjusted HR 1.35, 95% CI 1.20-1.52), delirium (pooled adjusted OR 1.76; 1.42-2.17), and dementia (pooled adjusted HR 1.64, 1.41-1.89). A gradient of risk across increasing AKI stages was demonstrated for stroke (stage 1: HR 1.11; 1.00-1.23; combined stages 2 and 3: HR 1.57; 1.35-1.81). AKI was also associated with higher in-hospital and 90-day mortality poststroke (pooled HR 2.13, 1.56-2.90, and 4.81, 2.55-9.08, respectively) and with 90-day disability (pooled adjusted OR 1.47, 1.22-1.76). Associations between AKI and all outcomes were directionally consistent across sensitivity analyses and pooled propensity score-matched studies. In this systematic review and meta-analysis, AKI was consistently associated with increased short-term and long-term neurocognitive risk, including stroke, delirium, and dementia. These findings suggest that AKI may identify individuals vulnerable to both acute and chronic brain injury. Further studies are needed to clarify mechanisms linking AKI to brain injury and to identify strategies to mitigate neurocognitive risk in this high-risk population.

5. Late-Onset Seizures: Etiology and Demographics in US Tertiary Care Epilepsy Centers.

期刊: Neurology 发表日期: 2026-Jun-09 链接: PubMed

摘要

Adults older than age 55 years have the highest incidence rate and are the fastest-growing population among people with epilepsy. The aim of this study was to characterize the etiologies of new-onset seizures in older adults and to examine how seizure etiology varies across demographic groups. We used data from 7 US epilepsy centers from 2021 to 2025 and compared findings with those of previous population-based studies, providing an updated view and highlighting opportunities for prevention and improved risk stratification. We retrospectively reviewed medical charts of 2,052 patients aged ≥55 years at the time of a first seizure, who were evaluated at 7 epilepsy centers between 2021 and 2025. We categorized seizures by etiology as follows: ischemic stroke, hemorrhagic stroke, tumor, neurodegeneration, provoked seizures, traumatic brain injury, and unknown. We examined differences in etiology by demographic strata (age, sex, race, and primary language) using chi-square tests, Kruskal-Wallis tests, analysis of variance, and Cuzick tests. The most frequent seizure etiologies among older adults were unknown (29.9%), ischemic stroke (15.4%), and provoked seizures (14.9%). Neurodegenerative disease was the etiology for 5.3% of cases overall but increased in prevalence with age, accounting for 18.5% among patients aged 85-89 years. Seizure etiologies also differed by sex and race. Men more commonly had seizures caused by cerebrovascular disease and traumatic brain injury, while women more commonly had seizures due to neurodegenerative disease. Black patients had higher proportions of ischemic stroke and neurodegenerative disease, while unexplained epilepsy was more common among White patients. The causes of late-onset seizures vary based on age, sex, and race. Nearly one-third of cases of epilepsy in older adults remain unexplained despite advances in imaging techniques, underscoring the need for further research on the mechanisms and health implications of late-onset unexplained epilepsy. Improved prevention of cerebrovascular disease and optimized management of provoked seizures may reduce the growing burden of epilepsy in older adults.

6. Right-Sizing Locoregional Management in the Era of Neoadjuvant Therapy for Breast Cancer.

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

摘要

The increasing use of neoadjuvant systemic therapy (NAC) has led to a significant paradigm shift in the locoregional treatment of breast cancer, with increasing emphasis on response-guided de-escalation. In current practice, both clinical and pathologic responses to treatment are being leveraged to minimize the extent and morbidity of local therapy while maintaining oncologic safety. In patients presenting with clinically node-negative (cN0) disease and high-risk biologic subtypes, sentinel lymph node biopsy (SLNB) omission after NAC is an area of evolving interest. For those presenting with clinically node-positive disease (cN+) yet who attain a pathologic complete response (pCR) in the lymph nodes after NAC, emerging evidence suggests that SLNB alone with omission of regional nodal irradiation (RNI) may be considered. Ongoing trials are evaluating whether cN+ patients with residual micrometastases or macrometastases after NAC may also be treated with SLNB alone, using RNI in lieu of axillary lymph node dissection to achieve adequate locoregional control. Parallel advances in radiation therapy (RT) are reshaping treatment decisions and sequencing, including when to deliver agents concurrently with radiation and when to hold them. Exceptional responders who attain a breast pCR and undergo breast conservation may have little or no residual tumor bed to justify tumor bed boost, and several trials are assessing the safety of radiation omission in these subgroups. Finally, premastectomy RT is being explored as a strategy to facilitate immediate breast reconstruction while avoiding radiation-related complications. Together, these developments highlight a shift toward individualized, response-adapted locoregional management in early-stage breast cancer.

7. Can Targeting Circadian Rhythms Help Prevent Alzheimer Disease?: Lessons From Down Syndrome.

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

摘要

8. The impact of cultural concordance between health professionals and patients: a narrative review.

期刊: The New Zealand medical journal 发表日期: 2026-May-08 链接: PubMed

摘要

The aim of this article is to summarise international evidence on the impacts of cultural/ethnic concordance between patients and health professionals and to discuss the implications for New Zealand. Database searches were conducted from August to September 2025 using Scopus, Embase and PubMed, using key terms related to health outcomes and cultural/ethnic concordance. A total of 25 relevant systematic reviews, meta-analyses and research studies were included for analysis. Overall, evidence is predominately from the United States of America and findings are variable. Cultural concordance is associated with improved communication quality, trust, satisfaction and perceived respect. Concordance is also associated with improved healthcare utilisation, medication adherence and uptake of preventative interventions. Some studies found concordance was associated with differences in clinical decision-making. Impact on clinical outcomes is mixed, with some studies finding concordance has a positive impact on caesarean section rates, diabetes management, surgical outcomes and addiction treatment, while others found no impact. Cultural concordance between patients and their health professionals matters, with evidence of impact on patient experience, communication quality, engagement and adherence, clinical decision-making and some clinical outcomes. Findings are inconsistent: the strength of association and groups which see the greatest benefit vary between studies. To reduce health inequities, we need to increase the diversity of the workforce and train all health professionals to provide non-racist, equitable care.

9. Regional and ethnic projections of gastric cancer incidence in Aotearoa New Zealand to 2045: identifying opportunities for targeted action.

期刊: The New Zealand medical journal 发表日期: 2026-May-08 链接: PubMed

摘要

Gastric cancer (stomach cancer) is an important contributor to morbidity and mortality in Aotearoa New Zealand, with marked ethnic inequities. Although national incidence rates are declining, Māori and Pacific peoples continue to experience higher rates than other groups. Demographic change and regional population growth are expected to influence future burden, yet no published projections provide estimates disaggregated by ethnicity and region. Gastric cancer registrations from 2001 to 2022 from the New Zealand Cancer Registry were linked to population estimates and projections stratified by age, sex, prioritised ethnicity and Health New Zealand - Te Whatu Ora region. Incidence was modelled using an age-period-cohort approach with time-based weighting to emphasise recent trends. Projections to 2045 were generated, and uncertainty was quantified using 1,000 non-parametric bootstrap iterations incorporating perturbation of population denominators. Gastric cancer cases are projected to increase by 47.7% to approximately 725 per year by 2045, despite a decline in the age-standardised rate from 5.9 to 5.3 per 100,000. All regions show increasing absolute numbers, with the Northern Region experiencing the largest rise. Māori and Pacific peoples have the highest current incidence and a large proportional increase in projected cases, although incidence rates decline modestly for all ethnic groups. Future case growth is driven mainly by demographic expansion and an ageing population. Absolute gastric cancer cases are projected to increase, particularly among Māori and Pacific populations and in regions experiencing rapid population growth. This has implications for early diagnosis and specialist service delivery. These projections support equity-focussed prevention and service planning, including Helicobacter pylori control, timely diagnostic pathways, and regional planning for specialist cancer services.

10. History of Treated Syphilis Before Pregnancy and Risk of Congenital Syphilis.

期刊: Obstetrics and gynecology 发表日期: 2026-May-08 链接: PubMed

摘要

To evaluate the odds of congenital syphilis in neonates of mothers with a history of adequately treated prepregnancy syphilis compared with those with no prepregnancy history of syphilis. We conducted a retrospective cohort study of deliveries within a large multihospital health care system in the southern United States from January 2015 to December 2023. Pregnant individuals were stratified based on whether there was a prepregnancy history of adequately treated syphilis infection. Propensity score full matching was performed, retaining all 382 patients with prior treated syphilis, with covariates including maternal age, neighborhood Area Deprivation Index, tobacco use, insurance payer, prenatal visits, and gestational age at delivery. The primary outcome was congenital syphilis as defined by Centers for Disease Control and Prevention case criteria; secondary outcomes included maternal syphilis infection during pregnancy and neonatal administration of a single intramuscular dose of penicillin-G. Among 57,925 pregnancies, 382 patients (0.66%) had a history of adequately treated syphilis before pregnancy. Congenital syphilis occurred in 26 of 382 (6.8%) pregnancies in women with prior treated syphilis compared with 40 of 57,543 (0.1%) without (adjusted odds ratio [aOR] 19.61; 95% CI, 4.57-84.25). This is equivalent to 6,806 per 100,000 live births in those with a prior history compared with 70 per 100,000 live births in those with no prior history. Maternal syphilis reinfection occurred in 68 of 382 (17.8%) with prior treated syphilis compared with 258 of 57,543 (0.4%) without (aOR 11.92; 95% CI, 5.89-24.10). A history of treated syphilis infection before pregnancy was associated with dramatically increased risks of congenital syphilis and maternal syphilis reinfection during pregnancy. These findings challenge assumptions about the protective effects of prior treatment and support enhanced surveillance strategies for this high-risk population.

11. Equity, regulation and Te Tiriti o Waitangi: a rapid review of Putting Patients First.

期刊: The New Zealand medical journal 发表日期: 2026-May-08 链接: PubMed

摘要

The Crown’s health workforce reforms, Putting Patients First: Modernising health workforce regulation (PPF),1 emerge in a political climate that is actively dismantling Māori health gains, undermining tino rangatiratanga and reframing equity as “needs not race”. Using rapid Tiriti review-an adaptation of critical Tiriti analysis-we assessed the proposal’s alignment with Te Tiriti o Waitangi. We found that PPF did not align well with the preamble or the articles of Te Tiriti. There was no equity analysis; no acknowledgement of hauora as taonga, limited Māori involvement in decision making, erasure of tino rangatiratanga and entrenched health inequities were disregarded. These findings highlight systemic silences and risk embedding monocultural practice, weakening accountability and further marginalising kaupapa Māori health models. We recommend that genuine patient-centred regulation must embed Te Tiriti, cultural safety and antiracism into regulatory standards and governance. Without these commitments, health workforce regulation perpetuates rather than remedies inequities, failing Māori and the wider population.

12. Paediatric periorbital and orbital infections: a decade of experience at Christchurch Hospital.

期刊: The New Zealand medical journal 发表日期: 2026-May-08 链接: PubMed

摘要

This study aims to describe the epidemiology, clinical features, microbiology and management of paediatric patients (<18 years) admitted to Christchurch Hospital with periorbital or orbital infections over a 10-year period. A retrospective review was conducted of all patients under 18 years admitted with periorbital and orbital infections between 2013 and 2023. Cases were identified using surgical theatre records and discharge coding, with data extracted from electronic medical records. Clinical, demographic, microbiological and management data were analysed descriptively. A total of 495 paediatric cases were identified, with 93% presenting with periorbital cellulitis and 7% with orbital cellulitis. Sinusitis was the predominant predisposing factor for postseptal disease, present in 83% of those cases. Orbital signs such as proptosis, pain with eye movement, reduced visual acuity and ophthalmoplegia were more frequent in orbital cellulitis. Orbital cases had longer hospital stays with a median of 4.5 days (range 2-33 days) compared to periorbital disease with a median of 1 day (range 0-8 days). Orbital cases also had a higher rate of surgical intervention (47%), most commonly functional endoscopic sinus surgery. Staphylococcus aureus was the most frequently isolated organism in both groups (45% periorbital, 42% orbital). Māori and Pacific children were disproportionately affected (comprising 20% and 10% respectively of periorbital cases and 17% and 19% of orbital cases). The presence of orbital signs should prompt urgent imaging to exclude orbital disease. Sinusitis remains a key risk factor for orbital cellulitis, and Māori and Pacific children are disproportionately affected.

13. Agreement between self-reported fractures in a clinical trial with New Zealand Accident Compensation Corporation claims data.

期刊: The New Zealand medical journal 发表日期: 2026-May-08 链接: PubMed

摘要

The aim of this article was to assess agreement between verified self-reported fractures in a clinical trial with Accident Compensation Corporation (ACC) claim data. In a 10-year randomised controlled trial of 1,054 women aged 50-60 years, participants self-reported fractures as they occurred or on routine 6-monthly questionnaires. Radiology imaging and reports were used to verify fractures, which were then compared with ACC claims data (ACC is the New Zealand no-fault accident claims organisation funded through levies). Initially, fracture claim data only were obtained, followed by all ACC claims for each participant for the study period. Three hundred and fifty-six self-reported fractures in 248 women were verified in the trial, whereas there were 328 ACC fracture claims from 238 women for the study period. Out of 356 trial fractures, 211 (59%) had a matching ACC fracture claim, and out of 328 ACC fracture claims 211 (64%) had a matching trial fracture. After obtaining all ACC claims, we identified a matching ACC claim for 340/356 (96%) trial fractures: 59% were fracture claims and 31% soft-tissue injury claims. Repurposing ACC fracture claims data for clinical trials has significant limitations and is likely to introduce false negative and false positive events. When tolerance for misclassification is higher (e.g., large non-randomised studies), ACC claims data may be useful because 60% of claims had a verified fracture, with higher proportions for major fracture types.

14. Insights into a large waterborne Campylobacter outbreak from a cross-sectional telephone survey.

期刊: The New Zealand medical journal 发表日期: 2026-May-08 链接: PubMed

摘要

To understand the impacts and responses of households during the Havelock North drinking water outbreak. Fifty days after the outbreak, cross-sectional telephone questionnaires were administered to a cohort of households. Seventy-six percent of the people surveyed indicated drinking unboiled tap water, with 35% of those developing diarrhoea, compared with only 3% of those who did not drink the water. Symptoms correlated with increasing quantities of water consumed, and 31% reported a relapse of diarrhoea after initial improvement. The attack rate among those less than 20 years old (41%), was higher than those aged 50 and over (22%). Individuals with diarrhoea had an average of 7 days off school or work. Only 27% of individuals with diarrhoea visited a doctor or hospital, but 72% were in households that purchased items from a pharmacy. Following the issue of a boil water notice, 82% of households boiled their water, and 67% purchased bottled water, with only 5% taking no precautions. A third of the 169 households surveyed continued one or both of these responses for at least 3 weeks after the boil water notice was lifted. Telephone surveys provided insights into the outbreak not otherwise obtainable from routine surveillance systems, including the attack rates among different demographics, size of the outbreak (5,540 cases within Havelock North), potential of pharmacy-based surveillance, compliance with public health messaging and the need to communicate to households when the water is safe to drink.

15. Hereditary Breast and Ovarian Cancer: Overview of Gene-Specific Risks and Challenges in Genetics Care Delivery.

期刊: Obstetrics and gynecology 发表日期: 2026-May-07 链接: PubMed

摘要

Breast and ovarian cancers are major public health challenges, with rising breast cancer incidence and persistently high ovarian cancer mortality. Approximately 10% of breast cancers and up to 25% of ovarian cancers are attributable to germline pathogenic variants (also called mutations) in cancer susceptibility genes, most notably BRCA1/2, but several other genes also contribute to risk of ovarian and breast cancers. Identification of pathogenic variants enables targeted prevention and early detection strategies, including enhanced surveillance and risk-reducing surgery, which can significantly decrease cancer incidence, morbidity, and mortality. We seek to review the specific risks of breast and ovarian cancer-associated genes and management strategies. Advances in sequencing technology, reduced sequencing costs, and legislative protections against genetic discrimination have expanded access to genetic testing, and clinical guidelines have broadened the pool of individuals recommended for testing. Despite these advances, most individuals with hereditary cancer syndromes remain undiagnosed, limiting the reach of precision cancer prevention. Underutilization of genetic testing is particularly pronounced among underserved populations, perpetuating disparities in health outcomes. Emerging health care delivery models have improved uptake and reduced barriers and can be considered for integration into obstetrics and gynecology practices. Ongoing research into the fallopian tube origin of high-grade serous ovarian cancer has prompted research that may expand risk-reducing surgical options. Collectively, these innovations mark a transformative era in hereditary cancer care, emphasizing access, multidisciplinary integration, and the urgent need for novel delivery models to ensure that the benefits of genetic testing reach all individuals at risk.

16. Dysphagia Management in Geriatric Medicine: Clinical Perspectives and Practice Patterns.

期刊: American journal of speech-language pathology 发表日期: 2026-May-07 链接: PubMed

摘要

Swallowing care in older adults involves multiple providers, but how non-speech-language pathologist (SLP) providers approach dysphagia management is unclear. This study explored perspectives on dysphagia management among geriatrics-focused health care providers. A 21-item mixed-methods online survey study was disseminated to geriatrics-focused, licensed health care providers (excluding SLPs) using Qualtrics software (Qualtrics). The survey was opt-in, and all responses were collected anonymously. Health care providers were identified through various methods, including online forum postings, local and national presentations, and the snowball method. Data were analyzed descriptively, and free-text responses were examined using inductive thematic analysis with a jointly developed codebook. Two coders completed manual coding in Excel, and a third reviewer resolved discrepancies. Eighty-two providers responded. Most felt confident (69.5%) and knowledgeable (81.7%) about dysphagia but wanted more training (74.4%), especially on interventions (75.6%). The primary screening barrier was poor integration into clinical workflows (52.4%), while perceived relevance to care (58.5%) was the primary screening facilitator. Though 92.7% of health care providers referred to SLPs when dysphagia was suspected, most did so for 1%-25% of patients (68.3%). Most respondents asked about swallowing in ≥ 50% of patients with dementia (69.6%). Thematic analysis revealed concerns that SLPs lack person-centered approaches, particularly regarding diet modifications. These concerns appeared related to other systems-level themes identified in the analysis, including limited interdisciplinary collaboration and constrained clinical resources. Our study suggests a need for better collaboration among health care professionals to improve swallowing-related care for older adults. It is likely that structural changes within the broader education and workplace systems will be necessary to improve collaboration and optimize current approaches to swallowing care.

17. Combined Oral Contraceptives and Stroke Risk in Individuals With Migraine With Aura.

期刊: Obstetrics and gynecology 发表日期: 2026-May-07 链接: PubMed

摘要

To estimate the effect of combined oral contraceptives (COCs) compared with non-estrogen-containing oral contraceptives on the risk of stroke among individuals with migraine with aura. Using U.K. primary care medical records with linked hospital data from the Clinical Practice Research Datalink, the authors evaluated the risk of stroke associated with use of COCs, containing estrogen and progestogen, compared with progestogen-only pills (POPs) among individuals with migraine with aura. The study included individuals aged 15-49 years who initiated either contraceptive of interest from 2000 to 2024, with no history of stroke, other thrombotic disease, or menopause at the time of initiation. Risk of ischemic and any stroke was compared after application of treatment and censoring weights using risk differences and ratios from the Kaplan-Meier estimator. Individuals were censored on medication discontinuation in primary analyses. Among the 12,429 initiators of COCs and 41,984 initiators of POPs included in the study, 1-year risk of ischemic stroke was 17.36 and 17.62 per 100,000 people, respectively. After weighting, the 1-year risk difference for ischemic stroke for COCs compared with POPs was 9.53 per 100,000 people (95% CI, -38.65 to 57.71). For stroke of any type, the risk difference was 3.49 per 100,000 people (95% CI, -45.17 to 52.16). Effects were larger with shorter follow-up periods (3-month ischemic stroke risk difference of 17.62/100,000 people) but were still imprecisely measured. Findings were similar when individuals were not censored at medication discontinuation (ischemic stroke intent-to-treat risk difference of 10.36/100,000 people). The risk of stroke in this reproductive-age population of individuals with migraine with aura was low overall and similar between users of COCs and POPs.

18. Prevalence of Postpartum Permanent Contraception Requests and Fulfillment Among Individuals Experiencing Incarceration and Individuals in the Community.

期刊: Obstetrics and gynecology 发表日期: 2026-May-07 链接: PubMed

摘要

To describe the prevalence of requests and frequency of fulfillment of postpartum permanent contraception among patients receiving prenatal care in a state prison system, compared with a multistate community population. We abstracted contraceptive preferences from electronic prenatal and delivery records among patients accessing prenatal care within the North Carolina Department of Adult Correction from 2016 to 2021 and compared it with previously abstracted data from a community sample of patients with Medicaid insurance who delivered in 2018 and 2019. We chose this comparison group because most incarcerated patients are Medicaid-eligible. Further, incarcerated patients would be excluded from the community sample because Medicaid coverage is suspended or terminated during incarceration. We described demographics, pregnancy and delivery characteristics, prevalence of permanent contraception requests, and fulfillment of requests. Among the samples, 15.1% (128/890) of patients in the prison clinic sample had a documented plan for permanent contraception, compared with 23.5% (2,307/9,837) of patients in the community sample (P<.0001, standardized mean difference [SMD] 0.21). Of prison clinic patients who requested permanent contraception and delivered while incarcerated, 25 of 86 (29.1%) received permanent contraception, compared with 1,096 of 2,076 (52.8%) in the community sample (P<.0001, SMD 0.48). Incarcerated patients request postpartum permanent contraception at lower frequencies than patients in the community; however, substantially fewer incarcerated patients received permanent contraception. Further study is needed to better understand the contraceptive goals and experiences of incarcerated individuals to promote reproductive justice and reduce health disparities.

19. Implementation and User Evaluation of the SANGYAN Digital Health Platform to Enhance Knowledge About COVID-19 and Other Health Conditions: Quasi-Experimental Study.

期刊: JMIR infodemiology 发表日期: 2026-May-07 链接: PubMed

摘要

The spread of misinformation during the COVID-19 pandemic highlighted the importance of evidence-based information. The SANGYAN podcast promotes evidence-based knowledge on health-related issues in multiple languages in a simple, cost-effective, and concise manner. This provides individuals access to the appropriate information in an accessible manner. The study’s goal is to assess user preferences for health information on a digital health platform designed to address COVID-19 misinformation. SANGYAN was developed by integrating the principles of social cognitive theory and information processing theory. The SANGYAN podcast was created to promote the importance of evidence-based information in order to address the spread of misinformation. The study design was a quasi-experimental study; prior to introducing the SANGYAN podcast, participants’ sociodemographic information was collected, and health literacy was assessed using the Rapid Estimate of Adult Literacy in Medicine, Revised scale. After listening to the podcast, participants were interviewed about its usability, and they completed the System Usability Scale and the Client Satisfaction Questionnaire - 8. Data were collected from a total of 500 participants, 250 each from the Rural Health Training Center and Panimalar Medical College Hospital & Research Institute. The participants were older than 18 years when they were included. Descriptive and bivariate analyses were performed. A total of 500 participants were enrolled in the study, 50% (250/500) from rural areas and 50% (250/500) from urban areas. The majority of the participants were 45 years to 64 years old (155/500, 31%), were women (289/500, 57.8%), had poor health literacy (384/500, 76.8%), and had a high school education or less than a high school certification (241/500, 48.2%). The mean overall System Usability System score was 70.9 (SD 17.73), with those aged 18 years to 24 years having the highest mean score (81.2, SD 15.48). High user satisfaction was present, with 97.6% (487/499) obtaining the desired information from the platform. The study revealed that the SANGYAN podcast provides information to diverse individuals, as it is multilingual, and was found useful by the participants.

20. Society for Research on Nicotine and Tobacco Europe Debate: Mandated reduction of nicotine in tobacco products is not the logical next step.

期刊: Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco 发表日期: 2026-May-07 链接: PubMed

摘要

21. Society for Research on Nicotine and Tobacco Europe Debate: The case for countries adopting a policy of reducing nicotine content of cigarettes and other smoked products to minimal levels.

期刊: Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco 发表日期: 2026-May-07 链接: PubMed

摘要

22. Artificial intelligence algorithm for real-time detection and counting of Trypanosoma cruzi parasites using smartphone microscopy.

期刊: PLoS neglected tropical diseases 发表日期: 2026-May-07 链接: PubMed

摘要

Chagas disease affects 6-7 million people worldwide and causes approximately 12,000 deaths annually. Diagnostic methods vary by disease stage, with serological tests commonly used in the chronic phase, while microscopy and molecular techniques like PCR and LAMP are employed in the acute phase. While microscopy remains the most accessible tool in resource constrained settings, its effectiveness depends on skilled personnel, creating diagnostic bottlenecks. To overcome these limitations, we developed a portable, smartphone-integrated AI system for real-time Trypanosoma cruzi detection in microscopy images. The platform combines a 3D-printed microscope adapter which aligns the smartphone camera with the microscope ocular to digitize images, with telemedicine-enabled annotation workflows, and lightweight AI models (SSD-MobileNetV2, YOLOv8) deployed on smartphone for real-time analysis. Trained on a diverse dataset of human samples (478 images from 20 samples), including thick/thin blood smears and cerebrospinal fluid) and murine thin smears (570 images from 33 samples), the SSD-MobileNetV2 model achieved 86% precision, 87% recall, and 86.5% F1-score on human samples, demonstrating robust performance across variable imaging conditions. We additionally piloted a real-world experiment with the proposed system. Three thin blood smears were scanned by a user operating the smartphone-based system, with predictions generated in real time. Model outputs were benchmarked against expert annotations as the ground truth. At the object level, the algorithm achieved a precision of 67.1%, a recall of 96.4%, and an F1-score of 79.1%, showing high sensitivity under operational conditions with a configuration possibly suitable for screening. This system could enable rapid, accurate parasite detection in field settings without advanced infrastructure, addressing critical gaps in early diagnosis and monitoring. Its modular design allows adaptation to other pathogens and cellular structures, offering a scalable solution for neglected tropical disease diagnostics. By bridging AI innovation with microscopy, this approach holds promise for advancing equitable healthcare delivery in endemic regions and aligning with global health priorities.

23. The latest Global Stroke Fact Sheet 1990-2023: Global Burden of Disease study.

期刊: Neuroepidemiology 发表日期: 2026-May-07 链接: PubMed

摘要

Stroke remains a leading cause of death and long-term disability worldwide despite substantial reductions in age-standardised rates over recent decades. Updated and comprehensive assessments of global stroke burden are essential to inform prevention strategies, health-system planning, and policy responses, particularly in the context of widening inequities between regions and the emergence of new environmental and metabolic risk factors. This review summarises the most recent Global Burden of Disease (GBD) 1990-2023 estimates for stroke, drawing on data from the 2025 GBD cardiovascular disease publication and the Institute for Health Metrics and Evaluation visualisation tools. Stroke burden was assessed for ischaemic stroke, intracerebral haemorrhage, and subarachnoid haemorrhage using standard GBD definitions. Estimates of incidence, prevalence, mortality, disability-adjusted life years (DALYs), and population-attributable fractions (PAFs) for 24 modifiable risk factors were analysed globally and across 21 GBD regions. In 2023, stroke was the second leading cause of death and the third leading cause of death and disability combined worldwide. Globally, there were 13.2 million incident strokes, 104.8 million people living with stroke, and 6.8 million stroke-related deaths, accounting for 156.5 million DALYs. Although age-standardised incidence, mortality, and DALY rates declined substantially since 1990, the absolute numbers of stroke events, deaths, and DALYs increased markedly, driven by population growth and ageing. Over 80% of stroke deaths and DALYs occurred in low- and middle-income countries. Ischaemic stroke accounted for 63.9% of incident cases, while haemorrhagic strokes contributed disproportionately to mortality and disability. Overall, 83% of the global stroke burden was attributable to modifiable risk factors, with high systolic blood pressure the leading contributor. Notably, the contribution of high ambient temperature, obesity, and lead exposure increased substantially between 1990 and 2023. Stroke remains largely preventable, yet its global burden continues to rise in absolute terms, with pronounced regional disparities. Intensified, region-specific prevention strategies targeting dominant risk factors, alongside equitable access to acute care and rehabilitation, are urgently required to reduce avoidable stroke-related death and disability worldwide.

24. Effectiveness of mHealth Interventions Aimed at Promoting Physical Activity and Reducing Sedentary Behavior on Work-Related Outcomes Among Workers: Systematic Review.

期刊: Journal of medical Internet research 发表日期: 2026-May-07 链接: PubMed

摘要

Mobile health (mHealth) technologies have gained popularity and may play a key role in promoting health-related behaviors. However, the impact of mHealth interventions on work-related outcomes remains unclear. We aimed to provide an overview of the effectiveness of mHealth interventions designed to encourage physical activity and decrease sedentary behavior on work-related outcomes. A search was conducted in MEDLINE, Web of Science Core Collection, the Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews, and Ichushi-Web for all publications up to September 12, 2025, without language or date restrictions. We included studies which (1) investigated the impact of mHealth interventions promoting physical activity and reducing sedentary behavior on work-related outcomes such as absenteeism, presenteeism, work productivity, work performance, and workability; (2) were designed as a randomized controlled trial or nonrandomized study of interventions; (3) were conducted among workers; and (4) were published as full-text original articles in Japanese or English. Two researchers independently conducted the screening of titles and abstracts, followed by a full-text review to confirm study eligibility and extract the data. We assessed the risk of bias using the Cochrane Collaboration Risk of Bias tool for randomized trials (RoB 2) and the Risk Of Bias In Nonrandomized Studies of Interventions (ROBINS-I). Findings were narratively synthesized. In total, 4022 records were identified from databases and other sources. After removing duplicates, 3631 studies were screened, and 17 studies (12 randomized controlled trials and 5 nonrandomized studies of interventions) met the inclusion criteria. Of the 17 eligible studies with 18,805 participants, 12 showed a favorable effect direction on ≥1 work-related outcome, but the majority exhibited a high or critical risk of bias, raising concerns about the quality of the research. There was considerable heterogeneity across studies. Scientific evidence suggests that health promotion efforts that incorporate mHealth components to encourage physical activity and reduce sedentary behavior may have a favorable impact on work-related outcomes. However, the low methodological quality of the studies and their high heterogeneity due to the participant characteristics, intervention content, use of diverse work-related assessment tools, and different follow-up periods make it difficult to draw definitive conclusions about the effectiveness of the interventions. This review is the first to comprehensively synthesize evidence on the impact of mHealth interventions on work-related outcomes, extending prior reviews that primarily focused on traditional workplace-based interventions without mHealth components. This review also contributes to the field by offering guidance for future studies, including the potential value of megastudy designs that evaluate multiple interventions within the same population over the same period on the same outcomes. As a practical implication, these findings suggest that mHealth technologies may serve as a complementary strategy for supporting occupational health and productivity.

25. A Sustainable Lifestyle Intervention Among Office Workers: Cluster Randomized Pilot and Feasibility Study.

期刊: JMIR formative research 发表日期: 2026-May-07 链接: PubMed

摘要

Society faces multiple challenges, including lifestyle diseases and global climate change. Framing health education within sustainable development may enhance motivation for behavior change because proenvironmental behaviors, as well as healthy behaviors, often rely on the same behavior change principles. Combining these perspectives may therefore reinforce health behaviors and climate-friendly choices. This pilot study aims to explore changes in dietary intake, diet-related carbon footprint, and physical activity among office workers receiving sustainable plus healthy lifestyle (sustainable lifestyle arm) or healthy lifestyle education (healthy lifestyle arm) alone. It also aims to assess the feasibility of the intervention functions, including workshop attendance rate, participants’ dietary goals, social support, and facilitators and barriers to behavior change. A 2-armed participant-blinded cluster randomized study, including an experimental intervention arm (sustainable lifestyle; n=19) and a control intervention arm (healthy lifestyle; n=14), was conducted in Sweden. The study lasted 8 weeks and included 6 workplace-based workshops and was framed by the behavioral change wheel and the socioecological model. Diet, carbon footprint, and physical activity were assessed using the web-based questionnaires Meal-Q and Active-Q. Attendance rate, individual goals, social support, and facilitators and barriers were assessed using printed questionnaires. The reduction of total diet-related carbon dioxide equivalents (CO2e) was 0.8 kg and 0.4 kg per day for the sustainable and healthy lifestyle arm, respectively. Also, there was a statistically significant interaction between time and lifestyle when the carbon footprint was expressed as a qualitative aspect of diet, that is, CO2e kg per 1000 kcal per day (P=.05). Moreover, the intake of vitamin C, a marker for fruits and vegetables, increased to 8.0 and 12.5 mg per 1000 kcal per day for the sustainable and healthy lifestyle arms, respectively. In addition, total sedentary time decreased by 0.4 hours per day in the sustainable lifestyle arm, but not in the healthy lifestyle arm. This indicates that the educational workshops in respective arms had different impacts on health behavior over time. Minor differences were found in dietary goals, with the sustainable lifestyle arm setting more goals related to ecological and vegetarian foods. No differences were seen between arms regarding barriers or facilitators. This study suggests that embedding healthy lifestyle recommendations within a sustainable development context may be an efficient way to reduce carbon footprint and increase healthy behavior among office workers. Given the ongoing global epidemic of metabolic diseases, climate change, and environmental degradation, promoting a sustainable lifestyle in a workplace context has the potential to counteract these trends.

26. One world, one goal: Advocacy and policy for a unified Parkinson's response.

期刊: Journal of Parkinson’s disease 发表日期: 2026-May-07 链接: PubMed

摘要

Parkinson’s disease is one of the fastest growing neurological disorders with regards to disability and death. Though this burden is felt globally, inequities in research, advocacy, prioritization and funding mean that the needs of people with Parkinson’s disease in low- and middle-income countries, and from marginalized communities in high-income countries, remain poorly recognized. Parkinson’s disease is increasingly being acknowledged as a global public health issue requiring a public health response. Global advocacy efforts, awareness-raising initiatives, research collaborations, partnerships and investment in Parkinson’s disease have therefore accelerated in recent years, with the positioning of people affected by PD as authoritative voices paramount to this drive. Yet despite this progress, inequalities in access to treatments, care and support persist. Responding to the global burden posed by Parkinson’s disease requires sustained, multi-sectoral, concerted action, building on an integrated and systems-oriented approach. The generation of momentum for a public health approach to Parkinson’s disease must be met with implementation at the country level, alongside sufficient allocation of resources, monitoring and evaluation. The approach offered in this paper builds on the five cross-cutting strategic objectives outlined in the World Health Organization’s Intersectoral global action plan on epilepsy and other neurological disorders 2022-2031 (IGAP) implementation toolkit, offering a platform to build a unified global response to Parkinson’s disease. Action should therefore center on the integrated themes of (1) prioritization and governance; (2) diagnosis, treatment and care; (3) promotion and prevention; (4) research and information systems; and (5) a tailored Parkinson’s disease-specific public health approach. A global response to Parkinson’s diseaseParkinson’s disease is one of the world’s fastest growing brain disorders. While Parkinson’s disease affects people across the globe, individuals living in low- and middle-income countries, and those from marginalized communities in higher income countries, do not receive the attention, care and support they need to live well. Parkinson’s disease has been recognized as an important global public health issue, including by the World Health Organization. As a result, international advocacy efforts, awareness campaigns, research efforts and investments have grown. People with lived experience are also increasingly involved in shaping these efforts, which is an important step forward. Despite this progress, there are still inequalities in who can access a diagnosis, treatment and care. Addressing the challenge of Parkinson’s disease requires long-term and coordinated action across many sectors. Efforts need to be integrated into broader health systems and supported by strong political commitment. The recognition of Parkinson’s disease as a public health priority must be met by plans to implement strategies, accompanied by monitoring to understand if the strategies are working. This paper offers recommendations that build on the World Health Organization’s approach to tackling neurological disorders through an ‘intersectoral global action plan’. These objectives provide a foundation for building a unified global response to Parkinson’s disease. The key areas for action include: (1) stronger prioritization and leadership; (2) improved access to diagnosis, effective treatment and care; (3) the promotion of brain health and disease prevention; (4) improved research and health information systems; and (5) tailored public health strategies specific to Parkinson’s disease. Together, these actions will help to reduce inequalities and ensure that all people impacted by Parkinson’s disease can receive the care and support they need, no matter where they live.

27. Strengthening Workplace Health Promotion Through Emergency Preparedness: A Normative Mediation Analysis.

期刊: Journal of prevention (2022) 发表日期: 2026-May-07 链接: PubMed

摘要

Workplace emergency preparedness is increasingly recognized as a cornerstone of occupational health promotion and prevention. Understanding the mechanisms through which institutional arrangements are associated with employees’ willingness to provide emergency assistance is essential for advancing prevention science and strengthening organizational safety culture. Guided by the Theory of Planned Behavior (TPB), this study tested a dual-mediation structural model using survey data from 147 frontline employees in a private-sector organization engaged in high-risk operational tasks. Perceived workplace institutional attitudes (PWIA) and attitudes toward incentive mechanisms (ATIM) were modeled as predictors; subjective norm attitudes (SNA) and attitudes toward emergency responsiveness (ATER) as mediators; and willingness to provide emergency assistance (WPA) as the outcome. Confirmatory factor analysis and robust maximum likelihood estimation were applied, with indirect effects examined using 5,000 bootstrap resamples. PWIA was associated with WPA primarily through SNA, underscoring the central role of normative reinforcement in linking institutional structures with preventive helping intentions. ATER alone did not significantly mediate the relationship, suggesting that efficacy beliefs may require normative support to translate into action. ATIM demonstrated a direct but limited association with WPA. These findings suggest that sustainable workplace emergency preparedness may depend on embedding supportive norms within organizational systems. Strengthening leadership expectations, peer modeling, and recognition practices can help normalize helping behaviors, offering actionable strategies for workplace health promotion and prevention.

28. Clinical and behavioral predictors of HIV-associated neurocognitive disorder among people with HIV who use substances: a secondary analysis of the HOPE trial.

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

摘要

This study examined behavioral, clinical, and hematologic factors associated with HIV-associated neurocognitive disorder (HAND) among people with HIV (PWH) using the International HIV Dementia Scale (IHDS) within a randomized clinical trial. This secondary analysis used data from the Hospital Visit as Opportunity for Prevention and Engagement for HIV-Infected Drug Users (HOPE) study, which enrolled 801 PWH who use substances from 11 U.S. hospitals. CD4 cell count, HIV-1 viral load, Global Severity Index (GSI), Global Assessment of Functioning (GAF), and Physical and Mental Component Scores (PCS, MCS) were assessed at baseline, 6 months, and 12 months. HAND was defined as an IHDS score ≤ 10. Multivariable linear and logistic regression models were used to identify baseline correlates of IHDS score and HAND, respectively. Linear mixed models were applied to evaluate the longitudinal changes in clinical outcomes. HAND prevalence was 76.3% (84.2% for females and 72.5% for males). Multivariable linear models revealed that obesity, CD4 cell counts < 200 cells/ µL, higher hemoglobin level and hematocrit, and higher GAF scores were significantly associated with IHDS score (p < 0.05). Furthermore, logistic models showed that recent alcohol use, obesity, viral suppression (≤ 200 copies/mL), hemoglobin and hematocrit levels, and GAF scores were associated with lower odds of HAND, whereas platelet count was linked to higher odds. Longitudinal analyses demonstrated significant increases in hemoglobin, hematocrit, PCS, and MCS over time, alongside decreases in platelet count and GSI. Compared with participants without HAND, those with HAND consistently exhibited lower hemoglobin, hematocrit, GAF, and GSI scores, and higher platelet counts and MCS scores across follow-up. These findings underscore the complex interplay between hematologic and mental health, substance use, and functional status in shaping neurocognitive outcomes among PWH. Targeting modifiable hematologic, behavioral, and psychosocial factors may help reduce HAND risk and improve long-term cognitive and functional outcomes. ClinicalTrials.gov ID: NCT01612169.

29. Dads and Digital Devices: Embodied and Spectral Presences in Diabetes Care in Greece and Denmark.

期刊: Medical anthropology 发表日期: 2026-May-07 链接: PubMed

摘要

Fathers to children with type 1 diabetes increasingly engage with digital technologies that monitor and regulate their child’s condition, yet the embodied and emotional dimensions of this care remain underexplored. Based on ethnographic fieldwork in Greece and Denmark, we show how diabetes technologies mediate new forms of paternal attunement, aligning care work with technological competence and culturally valued masculinities. Through routine device work and remote monitoring, fathers cultivate embodied and spectral forms of presence while navigating moments of connection and disruption.

30. Genital herpes diagnoses with connecting pharmacological prescriptions among enrollees 18 years and older in a large employer-based healthcare claims data, United States, 2019-2023.

期刊: Sexually transmitted diseases 发表日期: 2026-May-07 链接: PubMed

摘要

Genital herpes (GH) is caused by herpes simplex type 1 and type 2. GH affects 500 million people worldwide and is often managed with pharmaceutical therapies, counseling, and education. We examined diagnosed GH among individuals with employer-sponsored insurance in the United States from 2019-2023. Our analysis aims to describe: 1) demographics of employer-sponsored insurance enrollees diagnosed with GH between 2019 - 2023, and 2) prescription patterns for the treatment of GH and assess whether these prescriptions are aligned with the Centers for Disease Control and Prevention (CDC) Sexually Transmitted Infections Treatment Guidelines, 2015 and 2021. We analyzed 2019-2023 MarketScan® database containing commercially insured healthcare claims to characterize the demographics, treatment patterns of prescribers, and alignment to national guidelines. Episodes of care were identified by GH ICD-10 codes and national drug codes for drug therapy claims within 90-day of diagnosis date. Alignment with 2015/2021 CDC treatment guidelines was determined using antiviral name, dose, days’ supply, and quantity dispensed. A total of 178,531 in 27,319,749 enrollees with 202,666 episodes of diagnosed GH were identified in the 5-year span. Most of the diagnoses were in the South and enrollees aged 18-to-44 years. Among diagnosed GH episodes with available prescription data, 63.6% - 65.1% of the prescriptions were aligned with treatment guidelines. Valacyclovir was prescribed most often (76.3%-81.4%), with 64.5%-68.5% of those aligned with the 2015/2021 CDC treatment guidelines. Claims data suggest GH morbidity is highest in 18-34 years old, valacyclovir was the most common drug prescribed, and most prescriptions aligned with CDC recommendations.

31. Cough Audio Recognition for Early Detection of Respiratory Diseases: Algorithm Development and Validation Study.

期刊: JMIR medical informatics 发表日期: 2026-May-07 链接: PubMed

摘要

Coughing is a common clinical symptom and a protective respiratory reflex closely associated with various respiratory system diseases. The acoustic characteristics of cough sounds are influenced by underlying pathological factors, with distinct acoustic signatures corresponding to different etiologies. Through rigorous analysis of these sounds, rapid identification and preliminary diagnosis of related conditions may be achieved. This approach holds great potential for broad application in mobile health and ubiquitous health platforms. This study aimed to explore the application of acoustic analysis of cough sounds in the diagnosis of respiratory diseases to enhance the diagnostic efficiency of health care professionals. In this study, we conducted extensive data collection, including voluntary cough audio recordings from patients diagnosed with respiratory diseases (eg, chronic obstructive pulmonary disease, lung cancer, COVID-19, and pneumonia) and from healthy participants. A total of 2610 audio samples were collected. We incorporated a channel attention mechanism (CAM) into the final convolutional block of each residual block in the ResNet18 neural network, thereby constructing the CAM-ResNet18 neural network model. The recorded cough audio samples were converted into spectrograms to form the input dataset for model training. The CAM-ResNet18 model was trained on the training set of this dataset, with iterative parameter adjustments until convergence was achieved. Finally, spectrograms from the test set were fed into the pretrained model for accurate classification of the cough-related conditions. Experimental results on the collected audio dataset demonstrate that the proposed CAM-ResNet18 model achieves an accuracy of 83.9% and an average F1-score of 82.52% in classifying 5 types of cough sounds. In comparison, the traditional ResNet18 model achieves an accuracy of 78.16% and an average F1-score of 78.29%, indicating a clear performance improvement with the integration of the CAM. The experimental results validate the effectiveness of the proposed method, highlighting its significant potential for application in clinical diagnosis.

32. After pulling vaccine study, CDC leader calls for new journal.

期刊: Science (New York, N.Y.) 发表日期: 2026-May-07 链接: PubMed

摘要

Jay Bhattacharya clashes with epidemiologists over widely used design.

33. Copper Deficiency Disrupts Placental Development and Lipid Metabolism, Contributing to Fetal Growth Restriction†.

期刊: Biology of reproduction 发表日期: 2026-May-07 链接: PubMed

摘要

To investigate how copper deficiency during pregnancy affects placental structure, metabolism, and trophoblast function, contributing to fetal growth restriction (FGR). Pregnant C57BL/6N mice were treated with ammonium tetrathiomolybdate (ATTM) to induce copper deficiency, with two different dosages (30 and 60 mg·kg-1·d-1) administered daily from gestational day 1 to day 14. On day 15, assessments were made on fetal growth, placental development, and spatial metabolomics. In parallel, trophoblast cells (HTR8/SVneo) were subjected to copper chelation or SLC31A1 knockdown to model copper deficiency in vitro. Cell invasiveness and proliferation were evaluated using appropriate assays, along with the measurement of molecular markers to assess the impact of copper deficiency. Copper deficiency significantly reduced maternal serum copper levels, leading to FGR, as evidenced by shorter crown-rump lengths, lower fetal weights, and altered fetal-to-placental weight ratios. Structural abnormalities in the placental junctional zone, including reduced size and altered morphology, were observed. Metabolomic analysis revealed disrupted lipid metabolism, with alterations in glycerophospholipids and fatty acids, and lipid droplet accumulation. Copper deficiency impaired trophoblast migration and invasion, linked to decreased MMP2 and MMP9 expression in vivo and in vitro. In vitro studies also showed altered lipid metabolism in SLC31A1-knockdown trophoblast cells. Copper deficiency disrupts placental structure and lipid metabolism, impairs trophoblast function, and contributes to FGR, highlighting the critical role of copper in fetal development and maternal health.

34. From Pilot Trap to Institutional Capacity: A Governance Framework for Sustainable Clinical AI Implementation in Health Systems.

期刊: Journal of medical Internet research 发表日期: 2026-May-07 链接: PubMed

摘要

Clinical artificial intelligence (AI) applications frequently fail to transition from short-term pilot projects into sustained components of routine clinical care, a phenomenon referred to in this viewpoint as the pilot trap. This persistent gap reflects not only technical or regulatory limitations but also insufficient governance capacity within health care organizations. We argue that such capacity is not fully established before deployment; rather, it develops through implementation as real-world operational tensions clarify organizational ownership, accountability boundaries, and coordination mechanisms. Drawing on an 18-month implementation of a provincial clinical AI platform in China, we develop a 6-module governance framework encompassing institutional carrier formation, infrastructure governance, regulatory and ethical governance, interdisciplinary coordination, translational scaling, and lifecycle evaluation and oversight. These modules represent functional governance conditions observed during implementation rather than a prescriptive institutional architecture to be installed prior to deployment. We further introduce the concept of functional transferability and position the framework as an upstream complement to existing international governance standards, which typically specify what governance should achieve, but often assume that the organizational capacity to implement it already exists. Advancing clinical AI beyond demonstration, therefore, depends less on model performance alone than on the ability of health systems to develop and sustain the institutional capacity required for routine clinical use.

35. Physical Function and Residential Relocation of Older Adults Living With Chronic Conditions.

期刊: Journal of applied gerontology : the official journal of the Southern Gerontological Society 发表日期: 2026-May-07 链接: PubMed

摘要

Environmental Gerontology has shown that mobility difficulty can be a barrier to aging in place when the home environment is not physically accessible. However, difficulty may vary by underlying chronic conditions. Using data from a cohort of community-dwelling adults age 65 or older in the 2011-2019 National Health and Aging Trends Study, we found that mobility difficulty was associated with moving to housing with fewer environmental barriers. Mobility difficulty was not associated with moving to other destinations, such as housing with the same or more barriers, or nursing home. Those with dementia or cancer were more likely to move to a nursing home, and those with cancer were less likely to move to housing with the same or more barriers. However, having these chronic conditions did not change the relationship between mobility difficulty and relocation. These findings suggest that addressing mobility and reducing environmental barriers may promote aging in place.

36. Environmental uncertainty shapes human effort learning.

期刊: PLoS biology 发表日期: 2026-May-07 链接: PubMed

摘要

Humans show remarkable flexibility in adapting their behaviour to constantly changing environments. This flexibility relies on the ability to regulate motivation in response to changing motivational demands. Typically, the amount of effort required to achieve a certain goal is not precisely signalled by the environment but needs to be learnt from experience. By contrast, prior work examining motivated choices has usually directly instructed effort requirements. It therefore remains unclear how healthy individuals estimate and flexibly regulate effort and how they might achieve this in dynamically changing environments. In the current study, we examine how effort learning is shaped by different types of environmental uncertainty when motivational requirements are not explicitly instructed. Analogous to tasks in the reward learning domain, we designed a novel effort learning task that systematically manipulated two key sources of uncertainty: volatility and noise. Participants were asked to exert effort by squeezing hand-held dynamometers. We characterised effort learning across different stages of the effort production process (e.g., initiation of effort production, effort expectation, error-driven adjustment), which allowed us to capture the dynamics underlying effort estimation and regulation over time. Our findings reveal that humans are able to learn effort requirements by integrating both effort priors and sensorimotor feedback. We further show that effort learning is modulated by environmental statistics, with slower force initiation, weaker priors, slower learning, and faster within-trial force adjustments in high noise environments, but slower learning and slower within-trial force adjustments in high volatility environments. In summary, when effort information is not instructed, different sources of uncertainty about an action’s required effort are integrated into participants’ internal priors to flexibly guide effort exertion. Our work may provide a useful framework for understanding motivational disorders where abnormal effort learning and estimation may underlie the reduced willingness to exert effort for reward.

37. Investigating the Multifaceted Needs and Challenges of Family Caregivers of Individuals with Spinal Cord Injury: A Qualitative Study.

期刊: Occupational therapy in health care 发表日期: 2026-May-07 链接: PubMed

摘要

This qualitative study explored the challenges faced by family caregivers of individuals with spinal cord injury (fcSCI) and the contributing factors to these challenges. Thirteen field experts, including fcSCI and clinical and professional experts, participated. Ten vignettes showcasing various issues faced by fcSCI were used to facilitate the discussion. Thematic analyses of semi-structured interviews identified two themes: (i) decline in wellbeing: “It just weighs on you,” which explained the psychological, social, and physical challenges faced by fcSCI, and (ii) lacking caregiver preparedness:”There’s just so many things to know,” which describes the diverse responsibilities that fcSCI take. Findings emphasized the negative consequences of providing long-term care and the importance of improving caregiver readiness. Facilitating access to educational resources is an essential step in supporting family caregivers.

38. Serologic Evidence of Highly Pathogenic Avian Influenza A(H5N1) Virus Infection in a Veterinary Professional Exposed to an Infected Domestic Cat - Los Angeles County, California, December 2024-January 2025.

期刊: MMWR. Morbidity and mortality weekly report 发表日期: 2026-May-07 链接: PubMed

摘要

Since 2021, avian influenza A(H5N1) clade 2.3.4.4b viruses have spread widely among wild birds and domesticated poultry in the United States, with sporadic spillover into mammals. During November 2024-January 2025, 19 domestic cats in Los Angeles County, California, became ill after consumption of commercially purchased raw milk, raw meat, or raw pet food; nine cats tested positive for influenza A(H5N1) virus (clade 2.3.4.4b genotype B3.13). Overall, 139 persons were exposed to the 19 infected cats, and all were monitored for symptoms. Although 30 persons reported influenza-like illness symptoms, none received a positive influenza A(H5) reverse transcription-polymerase chain reaction (RT-PCR) test result. In April 2025, the Los Angeles County Department of Public Health and CDC invited all exposed persons to participate in an influenza A(H5N1) serosurvey to determine whether transmission of influenza A(H5N1) virus occurred, including in those without symptoms. Sera from 25 (18%) of the 139 exposed persons were tested. Among these, antibodies specific to A(H5N1) clade 2.3.4.4.b (antigenically similar to the clade 2.3.4.4.b influenza A[H5N1] virus isolated from the infected cats) were detected in serum from one veterinary professional, who was asymptomatic. This person did not use respiratory or eye protection during the exposure, did not report influenza-like illness after the exposure, and reported no other known risk factors for A(H5N1) infection. These findings represent serologic evidence of possible transmission of influenza A(H5N1) clade 2.3.4.4.b virus from a domestic cat to a human, highlighting concerns about potential cat-to-human transmission of influenza A(H5N1) virus and the importance of infection control practices in veterinary settings.

39. Management of ring chromosome 20 syndrome: Narrative review and consensus recommendations.

期刊: Epilepsia 发表日期: 2026-May-07 链接: PubMed

摘要

Ring chromosome 20 (ring 20) is a rare genetic condition usually presenting as developmental and epileptic encephalopathy. The disease is caused by fusion of the long and short arms of chromosome 20. Patients are symptomatic even if there is no loss of genetic material. Epilepsy in ring 20 is usually drug-resistant, with seizures often significantly debilitating and severely impacting quality of life. We assembled a taskforce of clinician-scientists with expertise in ring 20, as well as caregivers of individuals with ring 20. We then reviewed published literature on ring 20 with a focus on management with the aim of developing recommendations for the treatment of this disorder. Our review found that there are very few high-quality data available to guide treatment in ring 20. The majority of publications are individual case reports or small case series. Based on these limited data, as well as personal experience, we recommend the following. (1) The care team should be multidisciplinary and include at least an epileptologist and allied health specialists (e.g., speech therapist, occupational therapist, physiotherapist, psychologist); (2) patients and families should be referred for genetic counseling; (3) if patients are diagnosed with epilepsy, they and their families should be counseled that seizures are likely to be drug-resistant and life-long; (4) as there is a high incidence of non-convulsive status epilepticus (NCSE), there should be a low threshold for video-EEG monitoring if patients have a change in behavior or level of consciousness; (5) initial epilepsy treatment should be with an oral anti-seizure medication; (6) home rescue medication should be considered given the risk for prolonged seizures and NCSE; (7) for patients with drug-resistant epilepsy, ketogenic diet, vagus nerve stimulation, or deep brain stimulation could all be considered; and (8) caregiver burnout and stress should be screened for and supports provided.

40. Return to Work and Psychosocial Adaptation Trajectories in Young and Middle-Aged Patients with Stroke: A 12-Month Longitudinal Cohort Study.

期刊: Journal of occupational rehabilitation 发表日期: 2026-May-07 链接: PubMed

摘要

Return to work (RTW) is a key outcome of occupational rehabilitation for working-age stroke survivors, yet marked individual differences exist in RTW success and timing. This study aimed to identify longitudinal trajectories of psychosocial adaptation among young and middle-aged patients with stroke and to examine their bidirectional associations with RTW outcomes during the first year after discharge. In this prospective longitudinal cohort study, 237 stroke survivors aged 18-59 years were assessed at discharge and at 3-, 6-, and 12-month post-discharge. Psychosocial adaptation was measured using the Psychosocial Adaptation to Illness Scale-Self-Report (PAIS-SR). Latent class growth modeling identified distinct adaptation trajectories among patients who had not returned to work at 3 and 6 months (n = 189). Logistic regression and generalized estimating equations examined associations between adaptation trajectories and RTW status and timing. Three psychosocial adaptation trajectories were identified: a High Adaptation-Enhanced group (24.87%); a Medium Adaptation group (40.74%); and a Persistently Low Adaptation group (34.39%). RTW rates at 12 months differed significantly across trajectories (46.81%, 22.08%, and 24.62%, respectively; P = 0.008). Compared with the Persistently Low Adaptation group, patients in the High Adaptation-Enhanced group had higher odds of RTW (OR = 2.70, 95% CI 1.21-6.02). In the full cohort, earlier RTW was associated with significantly better psychosocial adaptation at 12 months. Psychosocial adaptation trajectories are a key determinant of successful return to work after stroke, while earlier RTW is associated with better subsequent adaptation. Early identification of patients at risk of poor adaptation and implementation of supported RTW strategies may enhance occupational rehabilitation outcomes.

41. Validating the Multidimensional Health Perceptions Questionnaire: A traumatic brain injury model systems Rasch analysis.

期刊: Rehabilitation psychology 发表日期: 2026-May-07 链接: PubMed

摘要

The Multidimensional Health Perceptions Questionnaire (MHPQ) is a comprehensive self-reported multidimensional measure of health perceptions that was previously validated in a sample of individuals with no specific health conditions. It has 8 subscales: Anticipated Discrimination and Judgment, Communication With Healthcare Providers, Spiritual Health Beliefs, Health Self-Efficacy, Trust in Social Health Advice, Trust in Medicine, How Health Affects My Life, and How Others Affect My Health. The study objective was to determine MHPQ structural validity among English-speaking adults with ≥ 1 year history of traumatic brain injury (TBI) who required inpatient rehabilitation. The MHPQ was administered via electronic survey (REDCap) or telephone interview to 250 participants enrolled in the TBI Model Systems National Database study. We conducted Rasch analysis per MHPQ subscale to confirm the structural validity of the MHPQ. The sample was 30.8% cisgender-female (68.4% cisgender-male, 0.8% Other gender), 18-90 years old (M = 45.8, SD = 16.2), 16.0% Hispanic/Latino, and White (68.0%), Black (18%), and all other races (2.0-5.2%). Internal consistency reliabilities ranged from acceptable to excellent across subscales (Cronbach’s alpha = .64-.91). Rasch analysis confirmed unidimensionality in all subscales, with 2 items removed to improve unidimensionality and fit indices (final 51 items). The MHPQ displayed excellent reliability via item (.77-.99) and person (.74-.87) separation indices per subscale. This study established psychometric evidence for the MHPQ as a measure to comprehensively characterize health perceptions among adults with chronic TBI, which could support more culturally responsive and person-centered care. Future work will validate the Spanish-language version of the MHPQ and evaluate subscale test-retest reliability. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

42. Development of treatment-specific outcome prediction models for intracranial aneurysm after coiling or clipping.

期刊: Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia 发表日期: 2026-May-06 链接: PubMed

摘要

Treatment-specific outcome prediction after intracranial aneurysm repair remains limited in resource-constrained settings, where complex case and access to endovascular care may differ among centers. We aimed to develop preliminary treatment-specific prediction models for in-hospital outcomes after endovascular coiling or microsurgical clipping in an comprehensive stroke center. Consecutive patients treated with coiling or clipping were analyzed. In-hospital endpoints were mortality, good functional outcome defined as Glasgow Outcome Scale-Extended (GOSE) 5-8, and recovery of Glasgow Coma Scale (GCS) to premorbid baseline. Separate multivariable logistic regression models were developed for each treatment-outcome pair after multiple imputation, bidirectional Akaike information criterion selection, and multicollinearity assessment. Discrimination was quantified using area under the curve (AUC), and bootstrap internal validation (500 resamples) was used to estimate optimism-corrected performance. The retrospective cohort (n = 436; 224 coiling, 212 clipping) was predominantly ruptured (86.9 %). In-hospital mortality was 11.2 % after coiling and 16.5 % after clipping. Good GOSE occurred in 47.3 % and 37.7 %, respectively, and GCS recovery occurred in 79.0 % and 65.1 %, respectively. Apparent AUCs for coiling and clipping were 0.826 and 0.815 for mortality, 0.707 and 0.793 for good GOSE, and 0.768 and 0.765 for GCS recovery. Notably, the retained predictor structure differed by treatment modality: coiling mortality retained age, hypertension, World Federation of Neurosurgical Societies (WFNS) grade, and dome height, whereas the better-performing clipping models incorporated GCS < 15, Intraoperative Monitoring (IOM) availability, aneurysm location, daughter aneurysm, and neck-related morphology. Bootstrap correction preserved the same overall performance ranking, with mortality models remaining the strongest and the coiling good-GOSE model the weakest. The National Brain Center - General Aneurysm Risk Utility for Decision Aid (NBC-GARUDA) provides preliminary treatment-specific in-hospital risk estimates, with the strongest performance observed for outcome prediction. However, discrimination was heterogeneous and weaker for the coiling favorable-outcome models; therefore, the calculator should be regarded as exploratory pending independent temporal and external validation.

43. The impacts of gender and race on workplace violence against nurses and nursing assistants: A scoping review of the literature.

期刊: International journal of nursing studies 发表日期: 2026-May-06 链接: PubMed

摘要

Workplace violence against health care workers is a global phenomenon has serious consequences for individuals involved, and for health care systems. Though this phenomenon has been widely studied, rates of violence remain high. Many studies tend to characterize workplace violence as a problem between individuals, largely failing to examine underlying social structures, including gendered power imbalances, that put some health care workers at greater risk of violence, both from recipients of care (patients and relatives/visitors) and from other health care workers. Intersectionality provides a useful framework to understand how overlapping social identities (e.g., gender, race) contribute to experiences of workplace violence. Our goal was to undertake a comprehensive review of the evidence on how gender and race, and their intersection, influence nurses’ and nursing assistants’ experiences of workplace violence and to identify gaps in the evidence to guide future research. We conducted a scoping review following the Joanna Briggs Institute method consisting of a systematic search of six databases on July 15, 2020, with updates on June 26, 2023, and September 18, 2025, for empirical, peer-reviewed studies available in English that examined workplace violence against nurses and/or nursing assistants; and that examined the concepts of gender and/or race. Two reviewers screened the studies and data were abstracted and analyzed using descriptive analysis and qualitative synthesis. Of the seventy-six included studies, only five looked at the intersection of gender and race, with the remaining seventy-one looking at gender or race as independent constructs. Included studies used a variety of methods and were from twenty countries, most from the Global North. The included studies came from diverse sociocultural and political contexts, and several studies highlighted how societal norms and power relations may legitimize or normalize certain types of workplace violence, influencing how violence is perceived, experienced and reported. We found a lack of definitional clarity made comparisons across studies difficult, and that political factors such as health system policies, resource constraints, and pandemic-related stressors may also influence exposure to violence. Workplace violence in health care is a complex issue that negatively affects nurses and nursing assistants. Our review shows that gender and race can considerably influence experiences of workplace violence, but an intersectional analysis remains underexplored. Theoretical and conceptual clarity are needed to guide future research that is sensitive to sociocultural and political contexts to guide the design of targeted policy interventions that prioritize heath care workers who are most at risk of exposure to workplace violence.

44. Missed nursing care in community-based health care: A scoping review.

期刊: International journal of nursing studies 发表日期: 2026-May-06 链接: PubMed

摘要

Missed nursing care is widely recognized as a complex phenomenon associated with care quality and patient safety. Although extensively studied in hospital settings, evidence on its determinants and consequences in community and home care remains limited. This scoping review synthesizes the available literature on missed nursing care in community-based care settings, identifying causes, consequences, and measurement tools. The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist and Joanna Briggs Institute guidance, using the Population-Concept-Context framework. PubMed, Scopus, and Web of Science were searched with no time restrictions. The search was completed on August 1, 2025. Data were extracted using a standardized form and narratively synthesized into thematic categories. Fifteen studies were included. The findings were synthesized into four main areas: (1) measurement tools and approaches used to assess missed nursing care; (2) prevalence and types of missed nursing care; (3) individual and interpersonal factors influencing missed nursing care; and (4) organizational, systemic, and contextual factors influencing missed nursing care. Two studies focused specifically on the development and psychometric validation of context-specific instruments for primary and home care settings. Across empirical prevalence studies, omissions most frequently concerned documentation, patient and family education, psychosocial support, and preventive or rehabilitative activities. Commonly reported associated factors included staffing constraints, workload pressure, burnout, communication fragmentation, and limited hospital-community integration. The literature on missed nursing care in community-based and residential long-term care settings remains limited, with restricted geographical diversity and heterogeneous measurement approaches that are not yet internationally standardized. Although context-specific instruments have recently been developed, further validation and cross-context testing are needed. Future studies should focus on assessing the impact of missed nursing care on care quality and developing strategies to address omissions in community and home nursing care.

45. Effectiveness of a universal digital-human parenting intervention in promoting early childhood development and protection: A pragmatic cluster randomized controlled trial.

期刊: PLOS digital health 发表日期: 2026-May 链接: PubMed

摘要

Delayed early childhood development and violence against children are major global challenges, particularly in low-resource settings. Universal digital-human parenting interventions may offer a scalable solution by overcoming barriers associated with traditional in-person programs. This study reports the first pragmatic randomized controlled trial evaluating a blended chatbot-based parenting intervention delivered within the Chinese preschool system. The trial was conducted in a lower-middle-income city in central China. Twenty-one preschool classes were cluster-randomized to a treatment group (n = 10) or waitlist control (n = 11). Primary caregivers of enrolled children participated following informed consent. The intervention comprised a 2.5-month chatbot-led digital parenting program supported by weekly or twice-weekly online group sessions facilitated by headteachers and social workers. Data were collected at baseline, post-intervention, and at 6- and 12-month follow-ups. Primary outcomes were caregiver-provided early learning and stimulation, and caregiver-perpetrated violence. Analyses followed the intention-to-treat principle using multilevel regression models. Equity effects related to caregiver and child disability were explored through moderation and subgroup analyses. Sustainability of impacts was assessed, and complier average causal effects examined the role of intervention completion. Between March 2024 and June 2025, 541 caregivers of children aged 3-6 years were enrolled (treatment: n = 272; control: n = 269), of whom 25.2% were male. Overall, 60.3% completed all chatbot modules. At post-intervention, the program significantly improved early learning and stimulation (β = 1.79, 95% CI [0.24, 3.34]) and reduced caregiver-perpetrated violence (IRR = 0.87, 95% CI [0.80, 0.96]). The intervention showed potential to advance equity for families affected by disability, with some effects sustained at follow-up. Complier analyses indicated reduced endorsement of corporal punishment and lower parental anxiety among participants completing at least 30 modules. Universal digital-human parenting interventions embedded in preschool systems can enhance early childhood development and reduce violence, highlighting the importance of human support and cultural adaptation to optimize engagement and outcomes.

46. Geographic clustering and population structures of Campylobacter jejuni and Campylobacter coli in South and Southeast Asian poultry systems.

期刊: Microbial genomics 发表日期: 2026-May 链接: PubMed

摘要

Poultry production is rapidly expanding across South and Southeast Asia to meet rising demand for human consumption. Campylobacter jejuni and Campylobacter coli are the leading causes of human bacterial gastroenteritis worldwide, with poultry serving as a primary reservoir posing significant risks to food safety and public health. This study investigated the genetic diversity of C. jejuni and C. coli isolates from chicken sampled in farms, along with markets (live bird markets and shops) and slaughtering facilities from Bangladesh, India, Sri Lanka and Vietnam. Core-genome multilocus sequence typing revealed strong geographical clustering of C. coli isolates, dominated by ST-828 clonal complex lineages largely confined within national borders. In contrast, C. jejuni isolates clustered more diffusely into multiple clonal complexes (ST-21, ST-45 and ST-257) that were shared between countries, reflecting greater ecological adaptability and frequent gene flow. Permutational multivariate ANOVA (PERMANOVA) supported these patterns; geography explained more genomic variation for C. coli than C. jejuni, while poultry breed type and production site contributed little overall. An exception was Sri Lanka, where C. jejuni showed an apparent ecological segregation between markets and slaughtering facilities, albeit with a limited within-country sample size. Genomic SNP-based analysis highlighted recombination as a significant evolutionary force maintaining distinct country-specific lineages in C. coli, while supporting a broader geographic mixing of C. jejuni. Pangenome analyses were consistent with more geographically structured accessory profiles in C. coli and a more dispersed pattern in C. jejuni, compatible with broader regional dissemination. Comparison with global reference genomes showed these isolates clustered with strains from diverse host species, highlighting the ability of C. jejuni to occupy multiple ecological niches and spread across borders. The distinct patterns of spatially clustered and dispersed lineage distributions for C. coli and C. jejuni, respectively, highlight the importance of understanding species-specific transmission dynamics to inform targeted intervention strategies. This understanding underscores the need for interventions along poultry production and distribution networks that can effectively mitigate the risks associated with campylobacteriosis.

47. Mass drug administration for soil-transmitted helminthiasis and schistosomiasis in selected districts of Rwanda: Coverage, implementation factors, and household water, sanitation, and hygiene conditions.

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

摘要

In Rwanda, about 1 in 3 people are affected by soil-transmitted helminthiases (38.7%) and 1 in 4 by schistosomiasis in high-risk areas (27.2% by point-of-care circulating cathodic antigen), both associated with poor water, sanitation, and hygiene (WASH). Mass drug administration (MDA) is the primary control strategy, but reported coverage may not reflect true reach. This study assessed MDA coverage of albendazole/mebendazole and praziquantel in selected districts, identified reasons for non-reach, examined factors associated with uptake, and described household WASH conditions. A cross-sectional, community-based survey was conducted in five purposively selected districts using a stratified cluster design. Survey-weighted estimates summarized treatment reach (offered the drug), uptake (swallowed the drug), and household WASH conditions. Survey-weighted logistic regression was used to identify individual and implementation factors associated with uptake. Albendazole/mebendazole uptake was 91.9% (95% CI: 84.3-96.0), closely matching reported coverage of 96%. The main reasons for non-reach were drug stockouts (23.7%), absence during MDA (15.8%), and unwillingness to take the drug (15.2%). Praziquantel uptake was 88.0% (95% CI: 78.7-93.6), consistent with reported coverage of 80%. For praziquantel, unwillingness to take tablets (29.6%) and absence during MDA (14.4%) were the most common reasons for non-reach. Receiving sufficient information about MDA to make an informed decision was associated with higher odds of uptake for both ALB/MBZ (adjusted odds ratios [aOR]: 5.17, 95% CI: 2.01-13.27) and PZQ (aOR: 3.58, 95% CI: 1.33-9.64). For ALB/MBZ, finding MDA participation easy (aOR: 11.41, 95% CI: 2.59-50.16), feeling comfortable with the MDA distributor (aOR: 10.05, 95% CI: 2.43-41.47), and feeling comfortable with the MDA location (aOR: 3.23, 95% CI: 1.25-8.39) were each independently associated with higher uptake. For PZQ, males had significantly higher odds of uptake compared to females (aOR: 2.64, 95% CI: 1.15-6.07). Among households, 65.6% used improved drinking water sources, 91.4% obtained water from public places, 50.7% treated their water, 84.4% had improved toilets, 51.6% had visibly clean toilets, and 62% lacked a handwashing station. MDA coverage in Rwanda exceeded WHO targets and closely matched reported estimates, reflecting strong implementation. Addressing remaining gaps in drug supply, MDA communication, and WASH infrastructure will be important to sustain and strengthen control of soil-transmitted helminthiases and schistosomiasis.

48. Best Practices for Hospital-Based Initiation of Medications for Opioid Use Disorder: A Consensus Statement.

期刊: JAMA network open 发表日期: 2026-May-01 链接: PubMed

摘要

Due to the impact of high-potency synthetic opioids on medication for opioid use disorder (MOUD) initiation, hospital-based addiction clinicians adapted their practice to improve care, with decisions often guided by limited evidence. To derive expert consensus on best practices for hospital-initiated MOUD among patients with OUD using high-potency synthetic opioids. This survey study used a 2-round Delphi process conducted from January to April 2025. National experts were hospital-based physicians or advanced practice clinicians who treated at least 100 hospitalized patients with OUD in the last 2 years and self-identified as an expert in methadone and buprenorphine initiation. Experts were purposively sampled based on practice location and addiction board certification. Data were analyzed from April 2025 to March 2026. The main outcome was consensus on the appropriateness of specific practices. Appropriateness was evaluated using a 9-point Likert scale from 1, indicating very inappropriate to 9, very appropriate. The presence of consensus was determined using the RAND/UCLA appropriateness method; if consensus was obtained, it was stratified into inappropriate (median 1-3), uncertain (median 4-6), or appropriate (median 7-9). Of 48 experts, 42 (87.5%; median [IQR] age, 41 [36.0-45.8] years; 25 [59.5%] female) completed round 1 and 41 of these (97.6%) completed round 2. Most were physicians (36 participants [85.7%]); of those, 30 (83.3%) were board certified in addiction medicine, 3 (14.3%) in addiction psychiatry, 2 (5.6%) in both, and 1 (2.4%) in neither. Experts treated a median (IQR) of 200 (100-315) hospitalized patients with OUD in the past year. There was consensus that buprenorphine and methadone initiation were appropriate, while the appropriateness of naltrexone initiation was uncertain. Consensus was reached that rapid methadone initiation was appropriate. Regarding buprenorphine initiation practices, experts reached consensus that high- and low-dose initiation were appropriate, traditional initiation was of uncertain appropriateness, and rescue was inappropriate. There was consensus that provision of non-MOUD full agonist opioids was appropriate to treat opioid withdrawal during methadone initiation, as a bridge during buprenorphine initiation, and to treat withdrawal among patients declining MOUD. In this survey study of hospital-based addiction specialty clinicians, consensus was reached on hospital-initiated MOUD and treatment of opioid withdrawal. These best practices can inform current clinical approaches and reflect the need for more robust research to evaluate effectiveness and safety.

49. Women's and multidisciplinary team members' experiences of care and discharge from an Irish specialist perinatal mental health service: A multiperspectival interpretative phenomenological analysis.

期刊: Midwifery 发表日期: 2026-Apr-30 链接: PubMed

摘要

Perinatal mental health is a critical public health concern. Women experiencing moderate to severe perinatal mental health conditions often require specialist support. Discharge from specialist services is a potentially challenging time; however, literature examining service discharge remains limited. Understanding multiple stakeholder perspectives of specialist perinatal mental health services is essential for informing evidence-based improvements. To understand women’s and multidisciplinary team members’ experiences of care and discharge from an Irish specialist perinatal mental health service. A multiperspectival interpretative phenomenological analysis study. Women (n = 6) who were discharged after receiving treatment from an Irish specialist perinatal mental health service and multidisciplinary team members (n = 6) working within this service participated in individual semi-structured interviews. Data were analysed using interpretative phenomenological analysis. This paper presents a multiperspectival synthesis with four themes and subthemes: (1) In sanctuary, I return to myself, (2) Building strength through collaboration, (3) A tailored discharge, and (4) On the path forward. Women felt a sense of safety and connection during their care, marking a turning point from feelings of isolation and perceived judgement. Women advocated for person-centred, flexible discharge approaches. Post-discharge community support provided women with a sense of stability, continuity, and confidence. The service provided a place of sanctuary where women received advocacy support until they regained self-agency. Individualised discharge care planning can enhance consistent communication and facilitate a supported, coordinated transition of care. Expanding community support, equitable care, and a national mother and baby unit are essential for the progress of Irish services.

50. Intensive longitudinal follow-up of cisgender and transgender women engaged in sex work during the three months following initiation of daily oral PrEP: A series of case-studies with mixed-method assessments.

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

摘要

Pre-exposure prophylaxis (PrEP) usage among cisgender and transgender women sex workers in Europe is low. This mixed-methods study examined the daily experiences of woman sex workers using PrEP, with emphasis on understanding the dynamic process of initiating and sustaining PrEP adherence. We employed an intensive longitudinal design with daily assessments of self-reported use of daily oral PrEP, side-effects, condom use, and number of clients over a 3-month period, followed by in-depth exit qualitative interviews that also explored PrEP initiation, communication with sex workers and clients, and stigma. Convenience sampling was used to enroll 15 sex workers (12 transgender and 3 cisgender women) presenting to a PrEP clinic in Madrid between November 2022 and January 2023, all from Latin America. We collected 1266 daily survey responses and 13 interviews. Quantitative results showed that average PrEP adherence was above 70%, with missed doses being randomly distributed, and that condom use and number of clients did not significantly change during the study period. Qualitative results showed that the main reason to start PrEP was concern about condom rupture and/or removal by clients. Facilitators of PrEP adherence included personal motivation, creation of daily routines, and use of personal alarms. Barriers to PrEP adherence included side effects from PrEP and its coingestion with other substances, and changes in daily routine related to work, and travel. Strict prescription protocols represented an additional layer of difficulty. Secondary gains included a feeling of empowerment and the opportunity to opt for condom substitution for economic benefit, personal pleasure, or the desire to foster a trusting relationship with long-standing clients. This involved few selected encounters and did not impact overall number of clients. PrEP communication was limited by PrEP and HIV stigma. We found a complex interplay of individual, occupational, and structural factors shaping early PrEP adherence among participants.

51. Exploring the prevalence of reasons adolescents feel unwelcome at school.

期刊: PloS one 发表日期: 2026 链接: PubMed

摘要

Cultivating positive school climates has been recognized as a global and Canadian priority for adolescent health, academic achievement, and development. Feeling welcome at school is an early contributor to overall positive school climate, although detailed understanding of different reasons adolescents may not feel welcome at school at the population-level is limited. The present study examined the prevalence of reasons students felt unwelcome at school and the characteristics of students endorsing each reason. Self-report survey data were used from students (N = 15,610, Mage ± SD = 15.6 ± 1.2, 48.1% girls) from 41 secondary schools in Ontario, Canada, that participated in the 2022-2023 wave of the COMPASS study. Frequencies calculated the prevalence of each reason for feeling unwelcome at school. Overall, 63.4% of students felt unwelcome at school for at least one reason. Appearance (29.6%), another reason (23.3%), marks at school (19.3%), emotional/psychological challenge (15.7%), and race/ethnicity/culture (10.6%) were the most common reasons for feeling unwelcome at school. Overweight perception, gender diverse identity, and low perceived relative financial affluence were overrepresented in participants that felt unwelcome at school relative to the overall sample. The many reasons adolescents feel unwelcome at school need to be addressed as schools focus on building positive and inclusive school climates, and should be considered across multiple levels (e.g., teacher training, students’ learning materials, policy).

52. Use of implementation science models, theories, and frameworks in pediatric rehabilitation: Protocol for a scoping review.

期刊: PloS one 发表日期: 2026 链接: PubMed

摘要

Implementation science frameworks - including process models, determinant frameworks, classic theories, implementation theories, and evaluation frameworks - are increasingly used to guide the translation of evidence-based interventions into practice. In paediatric rehabilitation, where interventions are complex and often require multidisciplinary collaboration, these frameworks can support systematic and context-sensitive implementation. However, the extent to which these frameworks have been used has not been comprehensively reviewed. Determine the extent, nature, and specific contexts of the existing literature on the use of implementation science models, theories, and/or frameworks (MTFs) in paediatric rehabilitation. This scoping review will follow the Joanna Briggs Institute (JBI) methodological guidance for scoping reviews. A comprehensive search strategy will be developed with a health sciences librarian and applied across multiple electronic databases: MEDLINE (Ovid), Embase, CINAHL, PsycINFO, ACM Digital Library, Web of Science, the Cochrane Central Register of Controlled Trials, PEDro, and RehabData. We will search English language articles published since 2006. Studies will be included if they report on the application of implementation science MTFs in the context of paediatric rehabilitation. Screening of titles and abstracts and full texts will be performed independently and in duplicate using Covidence. Discrepancies will be resolved through discussion or a third reviewer. Data will be extracted using a standardized form. Quantitative data will be summarized using numerical counts. Qualitative data will be analyzed using content analyses. This review will report on the use of implementation science MTFs in paediatric rehabilitation, identifying trends on the specific types applied, highlight gaps and/or underutilization across domains or developmental stages, and potentially uncover emerging frameworks. Finally, the results may inform the development of future implementation strategies and capacity-building initiatives within the field.

53. Prevalence, Associated Risk Factors, Knowledge, Attitude, and Practice of HIV/AIDS among Patients Visiting Metema Yohanness Primary Hospital, Northwest Ethiopia.

期刊: Journal of the International Association of Providers of AIDS Care 发表日期: 2026 链接: PubMed

摘要

IntroductionHIV/AIDS remains a major global public health challenge and continues to be a significant cause of morbidity and mortality, particularly in sub-Saharan Africa. In Ethiopia, HIV infection remains a major public health concern, yet evidence on its prevalence and associated factors is limited in some areas. This study aimed to assess the prevalence of HIV infection, associated risk factors, and the knowledge, attitude, and practice related to HIV/AIDS among patients visiting Metema Yohanness Primary Hospital, Northwest Ethiopia.MethodsA hospital-based cross-sectional study was conducted to assess HIV prevalence and associated factors. Given the binary nature of the outcome variable (HIV status: positive/negative), associations with independent variables were analyzed using logistic regression. Bivariable logistic regression analysis was performed to assess the association between HIV seropositivity and each independent variable, including socio-demographic, behavioral, biological, and practice related factors. Due to the small number of HIV-positive cases, multivariable logistic regression was not conducted to avoid model overfitting and unstable estimates. Crude odds ratios (CORs) with corresponding 95% confidence intervals were calculated to estimate the strength of associations, and a two-tailed P-value ≤ 0.05 was considered statistically significant.ResultsThe overall prevalence of HIV infection was (3.7%). The prevalence of HIV was marginally higher in women (3.94%) than in men (3.15%) and in urban dwellers (3.8%) than in rural ones (3.1%). Participants who were divorced or widowed had significantly higher odds of HIV infection than those who were single after controlling for potential confounders (COR = 4.62% and COR = 4.43%, respectively). The odds of being HIV-positive were 10.57 times higher for participants who reported having three or more lifetime sexual partners than for those who reported having no lifetime sexual partners (COR = 10.57%). The majority of respondents (94.5%) showed a good understanding of HIV/AIDS, and 63.3% had positive attitudes. Nonetheless, poor HIV preventive practices were reported by more than half of the participants (56.5%).ConclusionThis study demonstrated a notable prevalence of HIV infection in the study area, with significant associations observed with socio-demographic and behavioral factors. Although knowledge and attitudes toward HIV/AIDS were generally high, unsafe practices remained common. These findings highlight the need for strengthened, community-based HIV prevention, care, and support programs that focus on translating knowledge into safer practices, particularly among high-risk and vulnerable populations. Understanding HIV/AIDS in Metema Yohanness: How Common It Is, What Factors Increase Risk, and What People Know, Believe, and DoPlain Language SummaryHIV/AIDS is a serious health problem that affects many people in Ethiopia and around the world. This study looked at how common HIV is among patients visiting Metema Yohanness Primary Hospital and explored factors that may increase the risk of infection. We also assessed what people know about HIV, how they feel about people living with HIV, and their behaviors that could affect the spread of the disease. We collected information from 381 patients who came to the hospital for testing. Blood tests were used to determine HIV infection, and questionnaires were used to understand people’s knowledge, attitudes, and practices related to HIV. We also looked at 5 years of hospital records to see how HIV cases changed over time. Our study found that 3.7% of patients were HIV-positive. Women, older adults, urban residents, people who were divorced or widowed, illiterate individuals, and certain occupational groups were more likely to be infected. Behaviors such as having multiple sexual partners, high-risk sex, not using condoms, exchanging sex for money or gifts, and having a sexually transmitted infection were also linked to higher risk. Most participants (94.5%) had good knowledge about HIV, including how it spreads and how it can be prevented. About 63% had positive attitudes toward people living with HIV, but risky practices were common, showing that knowledge does not always translate into safe behavior. These findings suggest that health programs should focus on high-risk groups, promote safer sexual behaviors, and provide education and support to prevent HIV spread. Community-based care and effective condom promotion programs are important to reduce new infections and support people living with HIV in Metema Yohanness.

54. Development and validation of a risk prediction model for myocardial hypoperfusion after primary PCI in ST-segment elevation myocardial infarction.

期刊: Frontiers in cardiovascular medicine 发表日期: 2026 链接: PubMed

摘要

To analyze the determinants of myocardial hypoperfusion following primary percutaneous coronary intervention (PCI) in patients with acute ST-segment elevation myocardial infarction (STEMI) and to develop a risk prediction model. Clinical data from 434 patients with STEMI who underwent primary PCI at our hospital between January 2023 and June 2025 were retrospectively collected. Patients were randomly assigned to a training cohort (n = 304) and a validation cohort (n = 130) at a 7:3 ratio. Based on postprocedural myocardial perfusion, the training cohort was further divided into a hypoperfusion group (n = 103) and a normal perfusion group (n = 201). Candidate variables were screened using Boruta and least absolute shrinkage and selection operator (LASSO) regression, followed by multivariable logistic regression to identify independent predictors. A risk prediction model was constructed using R software and visualized as a nomogram. Model performance and clinical utility were evaluated using receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA). Multivariable logistic regression identified time from onset to primary PCI, atorvastatin dose before PCI, balloon deflation method during PCI, red cell distribution width (RDW), and monoamine oxidase (MAO) levels as independent predictors of myocardial hypoperfusion (all P < 0.05). The nomogram demonstrated good discrimination, with area under the curve (AUC) values of 0.855 (95% CI: 0.811-0.900) in the training cohort and 0.838 (95% CI: 0.764-0.912) in the validation cohort. Calibration curves indicated good agreement between predicted and observed outcomes. Decision curve analysis showed that the model provided greater net benefit than both treat-all and treat-none strategies across threshold probabilities of 0.01-0.99 in the training cohort and 0.07-0.99 in the validation cohort. Time from onset to primary PCI, atorvastatin dose before PCI, balloon deflation method during PCI, RDW, and MAO levels are important determinants of myocardial hypoperfusion following primary PCI in patients with STEMI. The proposed prediction model demonstrated favorable predictive performance and clinical utility, suggesting its potential value for early risk stratification.

55. Community education program on autism spectrum disorder: a case study of an ecosystem intervention involving family, school, NGO, and community stakeholders.

期刊: Frontiers in public health 发表日期: 2026 链接: PubMed

摘要

This paper documents the JC A-Connect: Jockey Club Autism Support Network community education program, which was a decade-long, territory-wide, and cross-sectoral initiative in Hong Kong, China. It was created in response to the rise of students with autism spectrum disorder (ASD) in mainstream schools which posed challenges to support their adaptation. The program came timely as the number of autistic students doubled during the project implementation period. Unlike other initiatives that directly served the autistic individuals, this program delivered at the wider social networks aiming to promote social inclusiveness and empower the family, school, and community stakeholders. Three core strategies were formulated: (1) Iconic Character and Storybooks-An iconic character, Bling Bling, was created by the company of Mr. Men Little Miss, and five storybooks were written to equip readers with strategies to communicate with autistic children. (2) Media Promotion and Online Learning-Traditional media and social media were employed to disseminate the sharing from experts and families with autistic children to offer a balanced and constructive understanding of ASD. Free online learning resources were created. (3) Events for Public Engagement and Community Inclusion-Events were organized to educate the public, empower professionals, create positive community experiences for families with developmental delays and disabilities, and encourage mutual appreciation and respect among students. The program organized 56 public events, and created 2 online courses, 47 media promotion, 12 newsletters and over 60 free resources. Participants reported that the program helped them learn about ASD, and they became supportive toward building an autism-friendly environment. There were four factors leading to positive outcomes: The use of an ecological model for program planning and implementation, a strategic stakeholder management plan, an attractive icon, and a sustainability mindset. Through this case study, we seek to share our experiences in developing a cross-sectoral health program and to inspire health professionals and policy makers to consider intervening at social systems for systemic changes in communities. We acknowledge that the development, implementation, and sustainability of our strategies require multidisciplinary expertise and financial investment, and this calls for strategic planning, community-wide participation, and shared ownership.

56. Integration of HIV, Hepatitis B, and C, and sexually transmitted infections services: A scoping review of the benefits and challenges.

期刊: PloS one 发表日期: 2026 链接: PubMed

摘要

Integrating clinical programs and services is a cost-effective approach that can improve health and system outcomes. This review aimed to provide an overview of the benefits and challenges of integrated programs for HIV, hepatitis B and C, and STI services worldwide and provide recommendations for research and practice. This scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. We searched electronic databases PubMed, Scopus, and Web of Science until May 2025 to extract relevant studies. Additionally, we reviewed reputable grey literature sources, such as WHO and UNAIDS, and references from included publications for further relevant articles. Studies that had eligible criteria were included. We applied a narrative approach to report the findings through an inductive approach. Out of 19,516 initially identified studies, 118 were selected. The benefits and challenges of integration were classified into six categories: integrated service delivery, medical information and technology, human resources, health outcomes, collaboration and partnerships, and financial/physical resources. The significant benefits of these classifications include improved health outcomes, cost-effectiveness, enhanced efficiency, prevention of transmission, use of comprehensive care, reduction of time for receiving necessary services, increased knowledge and awareness, and improved cooperation. However, integration has some challenges, including the need for sufficient infrastructure, budget, human resources, and the potential for increased stress and work pressure on employees. Prioritizing health is key to national development, requiring policies and resources for cost-effective patient and community benefits. This scoping review highlights the feasibility and advantages of integrating services for HIV, hepatitis B and C, and STIs. Our findings strongly support policymakers in prioritizing the planning and implementation of these integrated programs. An evidence-informed integration framework is needed to guide these actions effectively.

57. A novel application tunnel in combination with medical training reduces stress induced by frequent intraperitoneal injections and blood draws in mice.

期刊: PloS one 发表日期: 2026 链接: PubMed

摘要

Handling-induced stress represents a major burden on laboratory mice and is heavily influenced by the handling technique. As such, tail-handling induces much higher stress than cup- or tunnel-handling, which is further aggravated by interventions, e.g., injections, which require even harsher fixation methods. Previous studies demonstrated that habituation protocols can improve animal welfare during handling and interventions. Here, we developed a medical training program and an alternative fixation method using an application tunnel in the context of a liver cancer model, where frequent intraperitoneal injections in male C57Bl/6 mice over many weeks are needed to induce tumor development. The training regimen consisted of 5 sessions over 2 weeks, which gradually introduced the animals to being touched by handlers and restrained for procedures. The training program was completed once before the start of any interventions, additional training sessions were performed biweekly during the entire course of the experiments. The animals were randomized to receive injections either in the novel application tunnel or using conventional fixation. Training effect was continuously monitored by measuring the latency to interact with the experimenter, the surface body temperature and by activity tracking. The latency to interact rapidly decreased during initial training sessions in both groups, and this effect was sustained throughout the course of treatment. Body temperature did not change over the course of medical training and seemed to be more influenced by environmental influences. Activity tracking demonstrated that mice injected inside the tunnel were more active and returned to their normal activity levels after injections faster than conventionally restrained mice. Those mice also showed less signs of defecation and urination during interventions. Furthermore, the tunnel had a positive influence on the well-being of mice during blood draws demonstrated by reduced signs of pain and faster willingness to interact with the handler after the procedure. In conclusion, habituation of the mice to the interventions with medical training and the improved handling procedure during ip injections and blood draws durably reduces stress levels and improves welfare of mice.