公共卫生研究摘要 (2026-05-09)

共收录 52 篇研究文章

1. Genomic insights into multidrug-resistant bacteria: Emergence of mcr-1.1 in Escherichia coli, blaKPC-2 in Klebsiella pneumoniae and Serratia marcescens from clinical settings.

期刊: Virulence 发表日期: 2026-Dec 链接: PubMed

摘要

This study presents a comprehensive genomic analysis of multidrug-resistant (MDR) clinical isolates from Anhui Province, China, focusing on Escherichia coli, Klebsiella pneumoniae, and Serratia marcescens. The E. coli strain EC385 belong to ST1011 and rST1640 harbors multiple resistance and virulence determinants and five plasmids, including IncI2 and IncHI2, with a co-occurrence of mcr-1.1 with blaTEM-141, qnrS1, fosA3, rmtB, and dfrA14. Among K. pneumoniae isolates, KP304 (ST15/rST19202) and KP297 (ST15/rST19202) were carrying IncFII(pBK30683) and IncFIB plasmids, while KP69 (ST11/rST31218) harbored five plasmids, including IncHI1B and IncR. Notably, KP304, KP297, and KP69 exhibited MDR due to acquisition of blaKPC-2 along with other multiple resistance determinants including fosA6, tet(A), blaTEM-1B, blaCTX-M, aac(6)-Ib-cr (KP304 and KP297), and qnrS1 (KP69). In the current finding, S. marcescens is reported to carry blaKPC-2, alongside IncFII(pBK30683) and IncR plasmids. These findings highlight the genomic diversity and alarming spread of resistance mechanisms in clinical pathogens, emphasizing the urgent need for surveillance to combat the antimicrobial resistance.

2. Cost-Effectiveness of Individualized Occupational Therapy for Inpatients With Schizophrenia: Two-Year Follow-Up of a Multicenter Randomized Controlled Trial.

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

摘要

Schizophrenia typically requires long-term treatment, making cost-effective interventions essential, yet the cost-effectiveness of individualized occupational therapy (IOT) remains unclear. To compare the cost-effectiveness of IOT plus group occupational therapy (GOT) with GOT alone for inpatients with schizophrenia over 2 yr. Secondary analysis of data from a multicenter, two-arm, parallel randomized controlled trial. Fourteen clinical facilities. Sixty-two inpatients with schizophrenia who completed 2-yr follow-up. GOT alone or IOT+GOT during 3 mo of hospitalization. Quality-adjusted life-years (QALYs) and total medical costs from a health care payer perspective over 2 yr. Compared with GOT alone (n = 30), IOT+GOT (n = 32) produced greater cumulative QALYs (M difference = 0.156) and lower total medical costs (M difference = -¥290,784). The incremental cost-effectiveness ratio was -¥3,304,420 per QALY gained. Incremental net benefit was positive at willingness-to-pay thresholds of ¥5,000,000 and ¥6,000,000 per QALY. The cost-effectiveness acceptability curves showed a 94.2% probability of cost-effectiveness at a threshold of ¥6,000,000. Cost data were complete for approximately 40% of participants; missingness was addressed using multiple imputation, with complete-case sensitivity analysis yielding directionally consistent findings. IOT+GOT was more cost-effective than GOT alone over 2 yr, supporting its wider adoption as an economically sound rehabilitation strategy for clients with schizophrenia. Given the extent of missing cost data, the results should be interpreted with appropriate caution. These findings offer long-term economic evidence to inform mental health policies and resource allocation in psychiatric care. Plain-Language Summary: Schizophrenia often requires long-term treatment, resulting in substantial health care costs. This study examined whether adding individualized occupational therapy to standard group occupational therapy offers a more cost-effective approach for inpatients with schizophrenia. Sixty-two patients were followed for 2 years after receiving either group occupational therapy alone or a combination of individualized occupational therapy and group occupational therapy during hospitalization. The results indicated that patients who received individualized occupational therapy and group occupational therapy experienced greater improvements in quality of life and slightly lower total medical costs. Furthermore, the cost-effectiveness analysis showed a 94.2% probability that the intervention would be cost-effective under Japan’s commonly accepted willingness-to-pay threshold. These findings suggest that individualized occupational therapy combined with group occupational therapy is a potentially cost-effective strategy for schizophrenia rehabilitation. This evidence supports the integration of individualized occupational therapy into standard psychiatric rehabilitation programs and may inform future mental health policy and resource allocation.

3. Pornography: What Occupational Therapists Need to Know for Clinical Practice.

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

摘要

Occupational therapists are increasingly likely to encounter clients who intentionally view sexually explicit media (i.e., pornography). Pornography use may be adaptive, neutral, or maladaptive depending on several variables: whether its use is causing the client distress; whether it is affecting their daily occupations and relationships; its degree of congruence with their values; and environmental constraints, such as client privacy, isolation, and disability. In this column, we argue that all occupational therapists should be prepared to work with clients who use pornography and to recognize how pornography use as a health management or leisure activity may support or interfere with participation, routines, roles, safety, and client well-being.

4. Strategy Use Among People With Parkinson's Disease During the Weekly Calendar Planning Activity.

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

摘要

Cognitive impairment is a common manifestation of Parkinson’s disease (PD) that can limit participation. A clearer understanding of how people with PD (PwPD) use strategies to support their functional cognition can guide interventions designed to promote occupational performance. To investigate strategy use by PwPD during a functional cognitive task and how it relates to task performance. Cross-sectional within and between groups. Participants’ homes. PwPD without dementia (N = 51) were allocated into two groups according to Montreal Cognitive Assessment score: ≥26 for those with PD and normal cognition (PD-NC; n = 27) and ≤25 for those with PD and mild cognitive impairment (PD-MCI; n = 24). Performance outcomes (accuracy, total time, and efficiency) and strategy use on the Level 2 Adult/Older Adult version of the Weekly Calendar Planning Activity (WCPA). In the whole PD group, increased strategy use correlated with higher accuracy and longer total time, and four specific strategies correlated with higher accuracy (p < .04). The PD-NC group had higher accuracy and used more strategies than the PD-MCI group (p < .02), including three strategies associated with higher accuracy (cross off entered appointments, enter fixed appointments first, cross off free day; p < .03). In the PD-NC group, increased strategy use correlated with higher accuracy and longer total time (p < .02). Strategy use and WCPA performance outcomes did not correlate in the PD-MCI group (p > .10). This study adds to the understanding of how PwPD select and use strategies to support their functional cognition and suggests that PwPD could potentially benefit from interventions to optimize strategy use in occupational performance. Plain-Language Summary: People with Parkinson’s disease experience changes in thinking and memory that affect their ability to participate in daily activities, and they use fewer strategies to support their cognition than their peers without Parkinson’s disease. We investigated the strategies people with Parkinson’s disease use to support their thinking and memory during a simulated functional activity, the Weekly Calendar Planning Activity. We sought to understand whether the strategies they used were related to better performance on the activity, and we explored differences in strategy use between people with Parkinson’s disease with normal cognition and those with Parkinson’s disease with possible mild cognitive impairment. We found that people with Parkinson’s disease who used more strategies performed more accurately. Participants with Parkinson’s disease with normal cognition used strategies that supported their accuracy but took longer to complete the task. Participants with Parkinson’s disease with possible mild cognitive impairment used fewer strategies and ones that did not support their performance. Our findings indicate that people with Parkinson’s disease may benefit from interventions focused on selecting and using strategies to improve their daily functioning.

5. Multidimensional Sleep Health of Toddlers With Down Syndrome: A Descriptive Study Guided by the Pediatric Sleep Health Framework.

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

摘要

Sleep health supports child development and family well-being. Toddlers with Down syndrome experience elevated sleep difficulties, yet few studies have examined their sleep within a multidimensional framework. To apply the Pediatric Sleep Health framework (Peds B-SATED) to characterize multidimensional sleep health and sleep-related practices of toddlers with Down syndrome (12-36 mo). Secondary analysis of cross-sectional descriptive data. Clinics and organizations serving families of children with Down syndrome. Twenty-four mothers of children with Down syndrome were recruited. Parent-reported Brief Infant Sleep Questionnaire items mapped onto the Peds B-SATED domains (Behavior, Satisfaction, Alertness, Timing, Efficiency, Duration). Descriptive statistics summarized sleep profiles and parental practices. Fifty percent of the sample demonstrated multidomain sleep difficulties; 33% had difficulties in a single domain, and 17% had none. Behavior was the most problematic domain (63%), followed by satisfaction and efficiency (29% each), timing (25%), and duration (13%). Most children had structured sleep behaviors (consistent bedtimes/routines ≥80%; falling asleep independently, 70%; limited prebedtime screen exposure, 67%) and high parental satisfaction. Most children woke up happy and took one daytime nap (>90%). Sleep timing and efficiency were characterized by early bedtimes (median lights-out 8 p.m.; median wake 7 a.m.), no night awakenings (71%), and mean sleep latency of 13.5 min. Mean 24-hr sleep duration was 12.5 hr. A multidimensional approach to characterizing sleep health reveals heterogeneous sleep profiles across domains and offers clinicians and researchers an in-depth view of intervention targets for toddlers with Down syndrome. Plain-Language Summary: This study examined the sleep health of toddlers with Down syndrome ages 12-36 months by using the Pediatric Sleep Health framework, which looks at multiple aspects of sleep, including routines, quality, timing, and duration. Parents of 24 children completed a questionnaire about their child’s sleep, and then we mapped their responses to this sleep health framework. We found that most children went to bed and woke up early, slept about 12.5 hr per day, and were described as good sleepers. However, many children had at least one area of difficulty, most often related to bedtime behaviors (63%). In general, about 17% had no sleep-related concerns, whereas the remainder experienced challenges in one or more areas. These findings show that even when overall sleep appears good, specific sleep behaviors may still benefit from attention. Using a multidimensional sleep health framework can help identify these patterns and better describe sleep health of young children with Down syndrome.

6. Nonpharmacological Sleep Interventions for Children With Angelman Syndrome: A Scoping Review.

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

摘要

Sleep is a fundamental occupation that supports children’s health and learning and family well-being. Children with Angelman syndrome (AS) experience some of the most severe and persistent sleep disturbances of any neurogenetic disorder, highlighting an underexplored need for nonpharmacological, occupation-centered interventions. To identify and synthesize current knowledge on nonpharmacological sleep interventions for children with AS, describe intervention strategies and reported outcomes, and outline implications for occupational therapy practice. We searched Web of Science, APA PsycINFO, PubMed, and CINAHL from inception through September 1, 2025, and reviewed AS foundation websites for gray literature. We included studies of nonpharmacological sleep interventions with children with AS. The first author screened titles and abstracts; two reviewers independently screened full texts and charted data using Joanna Briggs Institute and Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidance. Three studies were synthesized: one randomized controlled trial, one single-case experimental design, and one case report. Interventions were primarily behavioral or caregiver mediated; one involved a short-term sedative adjunct in a behavioral program. Collectively, these studies demonstrated improvements in sleep initiation, duration, and continuity, and caregivers reported reduced stress and high satisfaction with feasibility. Behavioral and caregiver-mediated sleep strategies consistently improved children’s ability to fall asleep and remain asleep while supporting family functioning. Findings suggest that sleep is a modifiable occupation and highlight opportunities for occupational therapy practitioners to adapt and deliver family-centered interventions that establish healthy sleep routines and supportive environments. Plain-Language Summary: Angelman syndrome (AS) is a rare neurodevelopmental condition that often causes severe sleep difficulties among children. Our scoping review looked at strategies to improve sleep for children with AS without using medication and considered their relevance to occupational therapy practice. We identified three studies, and the results were encouraging. The most effective approaches involved establishing consistent bedtime routines, gradually adjusting sleep schedules, and coaching parents to manage sleep behaviors. When these strategies were used, children with AS fell asleep faster, slept longer through the night, and woke up less often. Parents reported less stress and greater confidence in managing their child’s sleep. These nondrug methods are practical for families to use at home and align with occupational therapy’s focus on daily routines, the environment, and family well-being. Occupational therapy practitioners can guide caregivers to create structured, calming bedtime routines that promote better sleep, participation, and overall quality of life. Positionality Statement: Joseph Barrett is a parent of a child with Angelman syndrome, which informed the motivation for this study but not its examination or interpretation. Shelly J. Lane is a professor in the Department of Occupational Therapy at Colorado State University. Throughout the review, we maintained reflexivity and transparency to support objectivity and methodological rigor. To minimize bias, we used predefined eligibility and data-charting templates, conducted calibration for full-text screening, and resolved discrepancies through consensus.

7. Multiple Sclerosis and Outpatient Physician Care in the Last Years of Life: A Population-Based Study.

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

摘要

Patients with multiple sclerosis (MS) require increasing health care support, particularly in the last year of life. Despite the benefits of palliative care in addressing symptom burden and improving quality of life, its integration into MS care remains inconsistent. This study aimed to characterize health care utilization and palliative care access among people with MS in the last years of life and to identify key factors associated with hospital death and receipt of palliative care. A retrospective cohort study was conducted using linked health administrative databases in Ontario, Canada. The cohort consisted of all decedents aged 18 years or older who died in Ontario between April 2016 and March 2020, and we compared health care utilization in decedents with MS to the rest of the cohort. The identification of MS cases was based on a validated algorithm. Demographics, health care utilization, palliative care involvement, and medical interventions were analyzed. Predictors of palliative care receipt and hospital deaths were evaluated using multivariable logistic regression models. MS decedents (n = 1,975; mean age 68 years; 66.4% female) were younger and had fewer comorbidities than non-MS decedents (n = 500,904; mean age 77). High percentage of MS decedents had outpatient neurology visits in the last 5 years of life (49.4%) but a steep decline closer to death (2.7% in the last month). Palliative care use was similar (58.0% vs 56.9%) but occurred earlier in MS (61.9% vs 59.6% in the last 5 years). Multivariable regression showed that rural residence was associated with increased odds of hospital death (odds ratio [OR] 1.81, 95% CI 1.21-2.70) and lower odds of receiving palliative care (OR 0.74, 95% CI 0.55-0.99), while receiving palliative care within the last 5 years of life reduced the odds of hospital death (OR 0.47, 95% CI 0.37-0.60). Higher comorbidity and increased outpatient visits to urology were associated with a greater odd of receiving palliative care (OR 3.64, 95% CI 2.50-5.29 and OR 1.47, 95% CI 1.20-1.80). Although palliative care receipt was comparable between MS and non-MS decedents, rural disparities and high hospital deaths persist. Earlier palliative integration, particularly through neuropalliative care, could improve quality of life and reduce hospitalizations.

8. Bridging the Gap: Baló Concentric Sclerosis-Like Leukoencephalopathy in Chronic Cocaine Use: A 1-Year Clinical and Imaging Follow-Up of 2 Cases.

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

摘要

Cocaine use is occasionally associated with development of acute leukoencephalopathy but only rarely do the magnetic resonance imaging (MRI) features resemble Baló concentric sclerosis, a demyelinating disorder traditionally considered within the multiple sclerosis spectrum. Here, we report 2 patients with history of cocaine use living in the same geographic area who were referred for acute multifocal leukoencephalopathy with a Baló-like pattern.Patient 1, a 31-year-old woman originally from the Philippines with chronic cocaine use history, presented with 1 week of rapidly worsening nonfluent aphasia, neglect, severe right hemiparesis, and numbness on the same side. Two months later, patient 2, a 25-year-old man originally from Morocco with chronic cocaine use history, presented with acute left leg weakness, confusion, and neglect. In both patients, brain MRI revealed multiple T2-hyperintense rounded lesions in the white matter, characterized by a concentric target-like appearance and gadolinium-enhanced incomplete ring pattern. In patient 1, a stereotactic biopsy confirmed a demyelinating inflammatory process with microcystic degeneration, increased cellularity, and macrophage/CD4+ lymphocyte infiltration. Both patients were treated with high-dose IV corticosteroid, resulting in significant clinical and radiologic improvement sustained at 1-year follow-up. Although corticosteroids yield promising outcomes, long-term prognosis hinges on sustained treatment adherence and abstinence from cocaine.The temporal and geographic proximity of these cases, occurring within 2 months in the same Italian province (covering an area of approximately 70 miles), raises the possibility of a shared toxic exposure which might explain the unique pathology and provide clues to the immune mechanisms that drive Baló-like demyelination.

9. Unique Considerations in Rare Gynecologic Tumors: Gestational Trophoblastic Neoplasia, Germ Cell Tumors, and Clear Cell Ovarian Cancers.

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

Rare cancers are usually defined as an incidence of <6/100,000 persons per year. Gynecological oncology is characterized by a paradoxical high prevalence of rare cancer subtypes, especially in ovarian tumors. Ovarian germ cell tumors, clear cell ovarian cancer and gestational trophoblastic disease encompass this set of gynecologic tumors. The WHO classification distinguishes epithelial cell tumors (85% of malignant tumors) from non-epithelial tumors, sex cord stromal tumors (8% of malignant tumors), and germ cell tumors (6% of malignant tumors). The current treatment for these tumors is similar to that for ovarian cancer but advancing quickly to incorporate targeted therapy. Gestational trophoblastic tumors are usually curable, even when widely metastatic disease is present. Ovarian clear-cell carcinoma (OCCC) remains a challenging disease characterized by intrinsic chemoresistance and distinct molecular features. A more biologically aligned treatment strategy has emerged. Continued integration of molecular selection and microenvironmental modulation will likely define the next phase of therapeutic development in OCCC. The clinical features, staging, and current treatment of each of these tumors is reviewed.

10. Cognitive Function Assessment Using a Virtual Reality Serious Game System in Patients With Stable Schizophrenia: Prospective Cohort Study.

期刊: JMIR serious games 发表日期: 2026-May-08 链接: PubMed

摘要

Cognitive impairment is a core and enduring deficit in schizophrenia, severely affecting social functioning and quality of life. Traditional assessments such as the MATRICS Consensus Cognitive Battery face limitations in validity and engagement. Virtual reality (VR) serious games may offer an immersive alternative, and machine learning (ML) can uncover complex behavioral patterns. However, integrating VR-based assessment with ML for discriminating stable-phase schizophrenia remains unexplored. This prospective cohort study aimed to examine whether a VR serious game (“Fruit Pioneer”) can effectively assess cognitive function in stable schizophrenia, verify its correlation with the standard Brief Cognitive Assessment Tool for Schizophrenia (B-CATS), and test the discriminative capacity using ML models. We hypothesize that (1) patients with schizophrenia will show poorer VR game performance than healthy controls (HCs), (2) VR metrics will correlate with B-CATS scores, and (3) ML models will help classify patients with schizophrenia and HCs using VR data. A total of 42 patients with stable schizophrenia and 65 HCs (aged 18-40 years) were enrolled. Exclusion criteria included color blindness, visual impairment, substance abuse, and comorbid chronic physical diseases. Finally, 39 patients with schizophrenia and 64 HCs were included. Materials included the VR serious game “Fruit Pioneer,” B-CATS (Digital Symbol Substitution Test, Trail Making Test Part A, Trail Making Test Part B, and Animal Fluency), Simulator Sickness Questionnaire, and Game Experience Questionnaire. Data were collected via standardized VR gameplay and paper-based assessments. Logistic regression and a support vector machine (SVM) model were built using VR metrics. Patients with schizophrenia performed worse on all B-CATS subtests (all P<.001). They also showed lower VR total scores (median 467, IQR 376-544 vs median 683, IQR 616-753; P<.001), longer reaction times (median 1.11, IQR 0.995-1.23 vs median 1.03, IQR 0.96-1.1; P=.006), lower gaze hit rates (median 0.515, IQR 0.442-0.554 vs median 0.552, IQR 0.497-0.592; P=.01), and higher bomb penalty scores (median 150, IQR 95-170 vs median 108, IQR 85-131; P=.002). In the schizophrenia group, VR metrics correlated with B-CATS results, whereas this relationship was minimal in HCs. Classification performance of the SVM (average area under the curve [AUC]=0.874, 95% CI 0.860-0.888) was comparable to logistic regression (average AUC=0.854, 95% CI 0.838-0.870). This study demonstrates the innovative integration of a VR serious game with ML to assess cognitive function in stable schizophrenia. Unlike prior VR studies focused mainly on validation, our approach combines behavioral metrics with an SVM model, achieving effective classification. The findings support the potential of a scalable digital assessment correlated with standard tests. In clinical practice, this system may serve as an engaging alternative to traditional methods, facilitating long-term cognitive monitoring and personalized rehabilitation strategies.

11. Machine Learning-Based Multidimensional Oximetry for Obstructive Sleep Apnea Screening: Development and External Validation.

期刊: JMIR medical informatics 发表日期: 2026-May-08 链接: PubMed

摘要

Obstructive sleep apnea (OSA) affects nearly one billion people globally and poses a substantial public health threat. Effective and accessible methods for OSA risk identification are urgently needed. This study aims to develop and externally validate a machine learning model derived from multi-parameter pulse oximetry (SpO2) for OSA screening, and to evaluate its performance, interpretability, and robustness across sex and age subgroups. Of 4156 screened participants, 2195 underwent polysomnography (internal cohort) and 446 received home sleep apnea testing (external cohort). Eight SpO2-derived parameters, including oxygen desaturation index (ODI), hypoxic burden (HB), and ST90 (percentage of sleep time with SpO2 < 90%), were used to construct models. Six machine learning algorithms were trained, with F1-score as the primary metric and area under the curve as the secondary metric. Model interpretability was assessed using Shapley additive explanations and intrinsic feature importance scores. Nonlinear parameter-risk relationships were observed between oximetry indices and OSA probability. The 4-parameter ODI-HB-MinSpO2-ST90 model achieved optimal performance (F1-score = 0.9516, area under the curve = 0.9879), surpassing all single-parameter models. Shapley additive explanations analysis identified ODI, HB, and MinSpO2 as key predictors. The ODI-HB-MinSpO2-MeanSpO2 configuration demonstrated superior performance in female and younger subgroups, whereas the ODI-HB-MinSpO2-ST90 model remained optimal for male and older participants. Categorical boosting outperformed other algorithms across multiple metrics and remained robust in both subgroup and external validation analyses. The multi-parameter oximetry model based on the categorical boosting algorithm provides a simple and accurate tool for OSA screening. Sex- and age-stratified strategies can further enhance its clinical applicability.

12. Impact of an Education Training Package to Anganwadi Workers for Improving Oral Health Knowledge Among Mother-Child Dyads in Kerala, India: Protocol for a Mixed Methods Implementation Study.

期刊: JMIR research protocols 发表日期: 2026-May-08 链接: PubMed

摘要

Maternal and child oral health remains a significant public health concern in India, contributing to early childhood caries, adverse pregnancy outcomes, and long-term health complications. Anganwadi workers (AWWs), under the Integrated Child Development Services Scheme (ICDS), are well positioned to promote preventive oral health behaviors. However, oral health education is not part of their core training. This protocol outlines an implementation research study to develop, deliver, and evaluate a contextualized oral health education training package through AWWs for mother-child dyads in Kochi, Kerala. The objectives of this study are to (1) assess the current oral hygiene knowledge, attitude, and behavior and identify barriers and facilitators for implementing the oral health education training package among AWWs, parents, and other key stakeholders; (2) evaluate the oral health education training package for coverage, acceptability, adoption, fidelity, and scalability; and (3) assess the impact of an oral health education training package on the improvement in oral health knowledge, attitude, and behavior among mothers. A mixed methods implementation study will be conducted across 100 Anganwadi centers in 3 phases following the Exploration, Preparation, Implementation, and Sustainment framework. Phase 1 will assess baseline oral hygiene practices and identify contextual barriers and facilitators using structured questionnaires and qualitative interviews. In phase 2, AWWs will be trained using a structured oral health education package and will deliver oral health messages to mother-child dyads during routine sessions. Implementation outcomes-acceptability, coverage, adoption, fidelity, and scalability-will be evaluated using observation checklists and program tracking tools. Phase 3 will assess the impact by evaluating changes in maternal oral health knowledge, attitude, and behavior through preintervention and postintervention questionnaires administered to a subsample of mothers. Dissemination of findings and planning for long-term integration into ICDS will also be undertaken. The study obtained funding in May 2024. The data collection commenced in April 2025. A total of 101 Anganwadi centers have been enrolled. Permissions, stakeholder meetings, baseline data collection, preparation of the teaching module, and training of AWWs (September 2025) have been completed. Follow-up visits to assess implementation parameters are ongoing. Data collection is expected to be completed in April 2026, followed by data analysis in May 2026 and dissemination by July 2026. This study is expected to generate practical insights into the feasibility of integrating oral health education into ICDS through AWWs. The intervention will be embedded within existing ICDS touchpoints and supported by centralized training, travel allowances, and regular supervision. Findings are expected to inform a scalable, community-based model aligned with national policy priorities for oral health promotion. Clinical Trial Registry of India CTRI/2025/07/090759; https://tinyurl.com/32yu6avz. DERR1-10.2196/91171.

13. Subtypes of Type 2 Diabetes and Prediabetes: Mortality and Excess Life Lost in South Asians.

期刊: Diabetes care 发表日期: 2026-May-08 链接: PubMed

摘要

Current definitions of type 2 diabetes (T2D) and prediabetes do not capture their pathophysiological heterogeneity. We investigated data-driven subtypes of T2D and prediabetes and evaluated their associations with mortality. We analyzed data from 14,036 South Asian participants from the CArdiometabolic Risk Reduction cohort using unsupervised k-means clustering based on five variables: age, BMI, HbA1c, insulin resistance, and β-cell dysfunction. For each subtype of T2D or prediabetes, we estimated Cox hazard ratios (HRs) for all-cause and cardiovascular disease (CVD) mortality and excess years of life lost compared with normal glucose tolerance. Among 2,639 participants with T2D, three subtypes emerged: severe insulin-deficient diabetes (SIDD; 23.0%), mild insulin-deficient diabetes (MIDD; 54.5%), and severe insulin-resistant diabetes (SIRD; 22.5%). Among 4,992 participants with prediabetes, two subtypes were identified: insulin-deficient prediabetes (IDPD; 66.0%) and insulin-resistant prediabetes (IRPD; 34.0%). Over a median follow-up of 10.6 years, 1,076 deaths occurred (405 due to CVD). Compared with normal glucose tolerance, SIDD had the highest all-cause mortality (HR 3.34; 95% CI 2.39-4.68), followed by MIDD (1.39; 95% CI 1.05-1.84), and SIRD (1.67; 95% CI 1.15-2.41). Among prediabetes subtypes, IDPD was associated with increased all-cause (HR 1.32; 95% CI 1.03-1.68) and CVD mortality (HR 1.53; 95% CI 1.00-2.34), whereas IRPD was not. Excess years of life lost were greatest for SIDD (17.7 years), followed by MIDD (12.8 years) and SIRD (12.0 years). Insulin-deficient subtypes made up a high proportion of individuals with T2D and prediabetes and were associated with higher mortality hazards and excess years of life lost.

14. Cultural adaptation to Shawi and psychometric analysis of the Patient Health Questionnaire (PHQ-9) in adults from the Alto Amazonas, Peru.

期刊: Medwave 发表日期: 2026-May-08 链接: PubMed

摘要

Depression is currently one of the most impactful mental health conditions worldwide, with more than 280 million reported cases. However, there is a critical lack of data on Indigenous populations due to language barriers and the absence of culturally adapted assessment tools, limiting timely diagnosis and appropriate care. The aim of this work is to culturally and linguistically adapt the Patient Health Questionnaire-9 (PHQ-9) into the Shawi language and to evaluate its psychometric properties among Indigenous adults in Alto Amazonas, Peru. A rigorous cultural adaptation process was carried out, including translation by bilingual experts and back-translation. Validation involved expert technical review and a pilot phase conducted within the participating community. Content validity was assessed using Aiken’s V coefficient as a statistical indicator. The internal structure was evaluated using confirmatory factor analysis and structural equation modeling. The sample consisted of 432 members of the Shawi community. The instrument showed excellent content validity (V = 0.90 to 1.00). Confirmatory factor analysis supported a unidimensional model with good fit (comparative fit index: 0.98; root mean square error of approximation: 0.06) and adequate internal consistency (α = 0.80; ω = 0.81). In addition, invariance of the PHQ-9 was demonstrated across age, sex, educational level, and marital status, supporting its applicability across different population subgroups. The Shawi version of the Patient Health Questionnaire-9 has proven to be a reliable and valid tool for detecting depressive symptoms in this Indigenous population. This advancement represents a significant contribution to reducing mental health disparities by facilitating culturally appropriate diagnoses and improving care in historically underserved Amazonian communities. En la actualidad la depresión representa una de las condiciones de salud mental con mayor impacto, son más de 280 millones de casos reportados en el mundo. Sin embargo, en poblaciones originarias existe una carencia crítica de datos debido a barreras lingüísticas y ausencia de instrumentos adaptados, lo que limita el diagnóstico y la atención oportuna. El objetivo de este trabajo es adaptar cultural y lingüísticamente el Cuestionario de Salud del Paciente - 9) a la lengua shawi y evaluar sus propiedades psicométricas en adultos indígenas de Alto Amazonas, Perú. Se realizó un proceso riguroso de adaptación cultural que incluyó traducción por expertos bilingües y retro-traducción. La validación incluyó la revisión técnica de expertos y una fase piloto realizada dentro de la comunidad participante. Para determinar la validez de contenido, se recurrió al uso de coeficiente V de Aiken como indicador estadístico. Para la estructura interna se usó análisis factorial confirmatorio y modelamiento de ecuaciones estructurales. La muestra estuvo integrada por 432 miembros de la comunidad shawi. El instrumento mostró excelente validez de contenido (V = 0,90 a 1,00). El análisis factorial confirmatorio validó un modelo unidimensional con buen ajuste (índice de ajuste comparativo: 0,98, error cuadrático medio de aproximación: 0,06) y adecuada consistencia interna (α = 0,80; ω = 0,81). Además, se demostró la invarianza del PHQ-9 por edad, sexo, nivel educativo y estado civil, lo que respalda su aplicabilidad en distintos subgrupos de la población. La versión shawi del Cuestionario de Salud del Paciente - 9 ha mostrado ser una herramienta confiable y válida para detectar síntomas depresivos en esta población indígena. Este avance representa un aporte significativo en la reducción de brechas en salud mental, al facilitar diagnósticos culturalmente pertinentes y contribuir a mejorar la atención en comunidades amazónicas históricamente desatendidas.

15. Intervals For Oscillometric Arterial Pressure Monitoring During Noncardiac Surgery: the '2.5-Minute Versus 5-Minute' Randomized Clinical Trial.

期刊: Anesthesiology 发表日期: 2026-May-08 链接: PubMed

摘要

Guidelines recommend measuring arterial pressure at least every 5 minutes during surgery. However, it remains unknown whether shortening the measurement interval of intermittent oscillometric arterial pressure monitoring can help reduce intraoperative hypotension. This trial tested the primary hypothesis that oscillometric arterial pressure monitoring at 2.5-minute versus 5-minute intervals reduces intraoperative hypotension in noncardiac surgery patients under general anesthesia. In this single-center trial, 264 noncardiac surgery patients were randomized to oscillometric arterial pressure measurements with an upper-arm cuff at 2.5-minute or 5-minute intervals during surgery. The primary outcome was the amount of intraoperative hypotension quantified as the time-weighted average mean arterial pressure (MAP) <65 mmHg during surgery. Secondary outcomes included the administered time-weighted cumulative amount of norepinephrine indexed to body weight. Of the 264 patients randomized (132 to each group), the primary outcome analysis included 132 patients in the 2.5-minute group and 131 in the 5-minute group. The median time-weighted average MAP <65 mmHg was 0.00 (0.00, 0.04) mmHg in patients assigned to the 2.5-minute group and 0.00 (0.00, 0.21) mmHg in patients assigned to the 5-minute group (estimated location shift -1.40x10-5 [95% CI: -6.64x10-5 to 2.93x10-6] mmHg; P=0.27). Seven patients (5.3%) in the 2.5-minute group had at least one 1-minute episode of a MAP <50 mmHg versus 13 patients (9.9%) in the 5-minute group (P=0.24). The median time-weighted cumulative amount of norepinephrine indexed to body weight patients were given during surgery was 0.05 (0.03, 0.08) µg kg-1 min-1 in the 2.5-minute group and 0.05 (0.02, 0.08) µg kg-1 min-1 in the 5-minute group (P=0.40). In our trial of patients having elective low-to-moderate risk surgery under general anesthesia, arterial pressure was tightly controlled with norepinephrine, and the amount of intraoperative hypotension was low - irrespective of the randomized arterial pressure measurement interval. Although oscillometric arterial pressure monitoring at 2.5-minute intervals - compared to 5-minute intervals - did not reduce the time-weighted average MAP <65 mmHg, we cannot exclude that monitoring at 2.5-minute intervals helps reduce profound hypotension.

16. The Digital Exposome: A Life Course Framework for Health in the Digital Age.

期刊: Journal of medical Internet research 发表日期: 2026-May-08 链接: PubMed

摘要

Digital technologies are reshaping human behavior, health care delivery, and population health; however, their cumulative effects across the lifespan remain underexplored. This viewpoint argues that exposures arising from interactions with digital technologies should be formally integrated into exposome science as a distinct, measurable component of the human environment. Our aims are to (1) redefine the digital component of the exposome (the digital exposome) within the broader exposome framework, (2) examine its life course implications for health and equity, and (3) outline a research and policy agenda to enable its systematic measurement and integration into clinical and public health practice. Digital technology-related exposures can confer benefits such as enhanced health monitoring, personalized interventions, improved access to care, and the promotion of healthy behaviors. However, they may also introduce potential risks, including mental health challenges, cognitive and circadian disruptions, sedentary lifestyles, exposure to misinformation, and widening inequities among vulnerable populations. Despite their ubiquity, digital technology-related exposures remain poorly integrated into clinical medicine, epidemiology, or public and global health policies. Drawing on interdisciplinary evidence from exposure science, epidemiology, and digital phenotyping research, we propose a refined conceptual definition of the digital exposome grounded in the classical exposome domains. We propose redefining the digital exposome as the full spectrum of exposures resulting from interactions or proximities with digital technologies and their combined influence on health across the lifespan. This framework conceptualizes digital technology-related exposures as a dynamic set of environmental influences operating through sociotechnical, behavioral, and biological pathways over the life course. To operationalize this framework, we discuss practical approaches using validated behavioral instruments, objective device use logs, ecological momentary assessments, smartphone-based digital phenotyping, and wearable sensing technologies. Systematic measurement, large-scale longitudinal studies, and harmonized exposure metrics are needed to characterize the cumulative health impacts of digital environments more accurately. Emerging tools such as digital markers or biomarkers and digital phenotypes offer promising opportunities to link real-world technology use with physiological and biological outcomes, thereby supporting precision medicine and population health strategies. Ethical governance, privacy safeguards, and equity considerations must be embedded from the start, drawing on emerging exposomethics frameworks. Recognizing the digital exposome as a modifiable determinant of health offers a foundation for evidence-based guidance, prevention strategies, and policy interventions suited to increasingly digital societies. By integrating digital technology-related exposures into exposome science, clinical practice, and public health research, this viewpoint seeks to foster interdisciplinary dialogue, guide future empirical work, and support the development of safer and more equitable digital environments across the lifespan.

17. The Actionable Innovation Day Approach: Participatory Model for Advancing Critical Care Innovation.

期刊: Journal of medical Internet research 发表日期: 2026-May-08 链接: PubMed

摘要

Health care innovation is essential for improving patient outcomes, enhancing system efficiency, and preparing for future challenges; however, meaningful progress is often hindered by entrenched barriers such as resistance to change, fragmented interdisciplinary collaboration, and constrained financial and human resources. These persistent obstacles make it difficult for health care systems to translate creative ideas into sustainable, real-world improvements, underscoring the need for structured approaches that support collaboration and reduce implementation friction. To address these challenges, we developed the Actionable Innovation Day (AID) approach, a structured, participatory model designed to generate consensus-based, low-cost recommendations that are feasible for system improvement. The first regional AID event in Eastern Ontario gathered 57 multidisciplinary participants, including clinicians, administrators, patient partners, and industry leaders, for a full-day series of presentations, facilitated discussions, and targeted breakout sessions focused on critical care. Through guided deliberation and collaborative analysis, participants synthesized diverse perspectives into a prioritized set of improvement opportunities. The process yielded 28 actionable recommendations across 4 domains: health care innovation, regionalized care, critical care practices, and the use of artificial intelligence. A postevent survey (86% response rate) showed strong agreement, with 23 recommendations rated above 4 on a 5-point scale. The highest-ranked proposals emphasized the value of strengthening research-industry-clinical partnerships, integrating families more intentionally into intensive care unit rehabilitation and recovery processes, and implementing centralized regional coordination to optimize critical care capacity. Together, these findings illustrate not only the feasibility of the AID model but also the AID model’s ability to surface strategic, context-appropriate solutions that resonate across stakeholder groups. The AID process offers a scalable and adaptable template for advancing health care innovation through collaborative, real-world problem-solving. While this initial event focused on critical care, the underlying principles of structured engagement, iterative consensus building, and interdisciplinary co-design are broadly applicable to many sectors of health care. We encourage institutions, regional networks, and health system leaders to adopt and tailor the AID framework to their own local priorities, recognizing that inclusive innovation processes can accelerate system improvement even in resource-limited settings. Ultimately, the AID approach serves as both a methodology and a call to action: by empowering teams to collectively identify, refine, and champion actionable ideas, health care organizations can build the capacity and culture necessary to drive meaningful and sustained innovation across diverse clinical and operational domains.

18. Tailoring Implementation Strategies for the Acute Coronary Syndrome Quality Improvement Programme at Primary Care Level in East, West and Central China.

期刊: Health policy and planning 发表日期: 2026-May-08 链接: PubMed

摘要

Acute coronary syndrome (ACS) remains a leading contributor to cardiovascular disease burden in China, and ST-segment elevation myocardial infarction (STEMI) is the most severe ACS. To improve early identification and timely treatment of STEMI patients, the Chest Pain Unit (CPU) program was established to strengthen referral pathways to qualified facilities. This study explores key barriers and facilitators to the CPU implementation and proposes context-specific strategies to optimize its delivery and scale-up. We conducted a qualitative study using semi-structured interviews in three purposively selected, representative counties across eastern, central, and western China. A total of 61 key informants from 36 township hospitals, participated in the study. All interviews were audio-recorded, transcribed verbatim, and thematically coded guided by the Consolidated Framework for Implementation Research (CFIR) 2.0 using Atlas.ti 9. Implementation strategies were mapped and refined using Expert Recommendations for Implementing Change. We identified 46 barriers and 50 facilitators, spanning all 5 domains of CFIR. Technical deficiencies, residents’ lack of health-seeking awareness, financial difficulties, inefficient awareness campaign, and limited professional knowledge are respectively the most significant barriers for five domains. We developed a three-pronged strategy framework including innovation optimization, external empowerment and internal improvement to inform future practice. Accordingly, the most urgent strategies encompass enhancing technical capacity, expanding financing mechanisms, empowering communities, implementing mass media campaigns, strengthening patient adherence through structured follow-up, and providing continuous practical training. We recommend the proposed strategies should be taken into full consideration to facilitate timely detection and intervention of ACS in primary healthcare context.

19. The Ties That Bind: The Relationships Among Members in Nine Ohio HEALing Communities Coalitions.

期刊: Journal of public health management and practice : JPHMP 发表日期: 2026-May-08 链接: PubMed

摘要

Community coalitions in 9 Ohio counties implementing the Communities that Heal (CTH) intervention to reduce opioid overdose deaths in the HEALing Communities Study (HCS). To evaluate 9 Ohio HCS coalition network structures using social network analyses to assess organizational positionality (eg, connectedness, centrality, density), perceptions of value and trust, and associations between positionality and trust and value. With Visual Networks Lab (VNL), cross-sectional data were collected during the early intervention from August 31, 2022, to November 8, 2022, using a validated survey tool and Program to Analyze, Record, and Track, Networks to Enhance Relationships (PARTNER) to measure organizational connections and attributes. Nine counties located throughout Ohio that were randomized into the second wave of the HCS. 153 member organizations from across the 9 Ohio coalitions. Coalition size ranged from 16 to 27 member organizations. No organization served on more than one coalition. Count of organizational partnerships (ties), perceived value, and trust scores. Coalition structure varied across counties, displayed in network maps indicating the number and type of connections by organization. At the coalition level, the mean number of ties ranged from 2.94 to 7.13. Coalition connectedness (density) ranged from low (0.17) to moderate (0.31). Mean trust scores were higher: 3.25 to 3.53 (of 4) while mean value scores ranged from lower to fair: 2.61 to 3.07 (of 4). Degree centrality (most connections) ranged from 0.3 to 0.6; closeness centrality (shorter connections) ranged from 0.2 to 0.5. Trust and value were correlated in 8 coalitions; associations among centrality, trust, and value scores varied considerably. Variations in coalition structures likely reflect differences in community context. Understanding coalition structure, including by sector, and perceptions of trust and value, may enhance coalition leadership’s ability to improve collaboration and enhance coalition capacity to meet objectives.

20. Longitudinal Trajectories of Health-Related Quality of Life and Life Satisfaction After Major Burn Injury: A Multicenter Cohort Study.

期刊: Journal of burn care & research : official publication of the American Burn Association 发表日期: 2026-May-08 链接: PubMed

摘要

Advances in burn care have markedly improved survival after major injuries. However, survivors often experience significant physical and psychosocial sequelae. We aimed to characterize long-term health-related quality of life (HRQoL) among burn survivors to inform expected trajectories, rehabilitation needs, and common impairments. Adult burn survivors from a multicenter, longitudinal cohort study were stratified into 20-49.9%, 50-69.9%, and ≥70% total body surface area burn size groups. Patient-reported physical and mental HRQoL and life satisfaction were assessed using validated outcome measures at discharge (pre-injury recall), 6, 12, 24 months, and 5 years post-injury. Standardized summary scores were derived using validated bridges. Mixed-effects linear regression models evaluated longitudinal changes and between-group differences. A total of 1,113 participants were analyzed. All outcomes declined early after injury but improved progressively thereafter. Notably, by 24 months, mental health and life satisfaction approached pre-injury levels across all burn size groups. Physical health deficits were greater with increasing burn size, with significant net differences relative to the 20-49.9% reference group (p<.0001). Mental health and life satisfaction outcomes showed minimal between-group differences overall, though individuals with the largest burns exhibited significantly better relative mental health at 24 months (p<.05). Although outcomes improve over time following major burn injury, persistent physical deficits support the classification of major burns as a chronic condition. These findings characterize burn size-specific recovery trajectories and demonstrate that, despite persistent physical deficits, mental health and life satisfaction can return to near pre-injury levels even after the most extensive injuries.

21. Stress-to-Light Conversion in an Earth-Abundant Oxide Semiconductor.

期刊: Advanced science (Weinheim, Baden-Wurttemberg, Germany) 发表日期: 2026-May-08 链接: PubMed

摘要

Stress-to-light conversion in solids represents a unique photonic functionality, yet it has never been realized in a chemically simple and sustainable material. Zinc oxide (ZnO) is an earth-abundant compound widely used in cosmetics, food supplements, paints, and medicinal products since prehistoric times. It is also a promising semiconductor for electronics and photonics owing to its high transparency, high electron mobility, and wide bandgap, more than three times that of silicon. Here, we show that the sustainable semiconductor ZnO exhibits strong near-infrared (NIR) luminescence under elastic stress when defect-engineered to stabilize a p-type state. This transformation overcomes the intrinsic n-type character of ZnO through the partial substitution of Zn2+ with Li+ or Na+, introducing deep-level defects that enable stress-driven NIR emission and ferroelectricity. These coupled electronic and structural effects reveal a previously unknown light-emitting function in a simple oxide lattice. Our findings establish a rare-earth-free, self-powered platform for NIR photonics, offering scalable opportunities for biophotonic signaling and infrastructure health monitoring.

22. Communication-Based Teaching on Childhood Obesity and the Planetary Health Diet in Medical Education: Proof-of-Concept Study Comparing 4 Information Sources.

期刊: JMIR formative research 发表日期: 2026-May-08 链接: PubMed

摘要

Childhood obesity constitutes a complex medical and psychosocial challenge that requires both nutritional knowledge and sensitive, relationship-oriented doctor-patient communication. The Planetary Health Diet links individual health promotion with environmental sustainability and represents a relevant framework for contemporary medical education. This proof-of-concept study investigated how different information sources influence medical students’ acquisition, structuring, and application of knowledge on childhood obesity and the Planetary Health Diet within a communication-based teaching setting, including the exploratory use of artificial intelligence-based tools. A total of 359 second-year medical students participated in a mandatory communication seminar during the 2023-2024 academic year. Following a precourse knowledge assessment and a brief theoretical introduction, students worked on a standardized counseling scenario addressing childhood obesity. In small groups, students used only 1 assigned information source (ChatGPT, Google Search, scientific papers, or instructional videos) to prepare a counseling approach. Group outcomes were assessed using a predefined scoring system based on a sample solution, complemented by thematic content analysis. All information sources enabled students to acquire relevant knowledge on childhood obesity and the Planetary Health Diet. However, groups differed with regard to the depth, differentiation, and structuring of their responses. The ChatGPT group achieved the highest conformity scores with the sample solution and provided the most additional information, followed by the Google and video groups, while the paper group achieved the lowest scores. Prior to the course, students reported limited knowledge of the Planetary Health Diet and little practical experience in counseling children with obesity and their families. Communication-based teaching formats provide an effective framework for introducing medical students to complex topics such as childhood obesity and sustainability-related nutrition early in their training. Easily accessible digital tools, including artificial intelligence-based systems, may facilitate knowledge acquisition and elaboration; however, their use requires explicit didactic framing, critical source evaluation, and reflection on the complexity of chronic conditions to support responsible and realistic learning outcomes in future physicians.

23. Age- and cognitive load-related variability and entropy of gait: integrating coefficient of variation, median absolute deviation, and permutation entropy of spatiotemporal parameters into the Semmelweis Study gait assessment framework.

期刊: GeroScience 发表日期: 2026-May-08 链接: PubMed

摘要

Aging profoundly alters the neuromotor and cognitive systems that support gait control, leading to increased variability and instability that predict functional decline and dementia risk. In this pilot study, conducted to inform the design of the Semmelweis Study gait assessment pipeline, we examined how aging and cognitive load influence the magnitude and temporal organization of gait fluctuations. The Semmelweis Study is a large, prospective workplace cohort at Semmelweis University designed to identify the determinants of unhealthy aging and the mechanisms that preserve functional resilience across the life course. One hundred three adults aged 23-87 years completed single- and dual-task walking trials on a 20-foot pressure-sensitive walkway. Gait variability was quantified using the median absolute deviation (MAD) and coefficient of variation (CoV) of key spatiotemporal parameters, while permutation entropy (PE) captured the complexity of stride-to-stride dynamics. Aging was associated with progressive increases in both the variability (MAD, CoV) and changes in orderliness (PE) of gait fluctuations, particularly under dual-task conditions, suggesting a dual contribution of neuromotor degradation and compensatory recruitment of higher-order control processes. The amplification of these effects during cognitive load highlights the vulnerability of cognitive-motor integration with advancing age. By integrating robust, relative, and nonlinear variability metrics within a unified analytical framework, this study provides a multidimensional characterization of gait control and establishes sensitive indicators for detecting early functional decline. Within the translational framework of the Semmelweis Study, these quantitative gait measures-together with vascular, metabolic, and cognitive assessments-are expected to serve as informative components of a comprehensive biomarker system aimed at identifying early determinants of unhealthy brain aging and guiding preventive strategies to promote healthy longevity.

24. Effectiveness and safety of physical exercise and health education for the management of osteoporotic vertebral fractures: a systematic review and meta-analysis.

期刊: Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA 发表日期: 2026-May-08 链接: PubMed

摘要

Osteoporotic vertebral fractures (OVFs) are the second most common fractures in osteoporosis, often leading to reduced functional capacity, chronic pain, and lower quality of life. Physical exercise and health education are considered promising options for managing these symptoms. To determine the effectiveness and safety of exercise and health education compared to usual care in patients with OVFs. A literature search up to April 2024 was conducted in PubMed, Scopus, Web of Science, and the Cochrane Library. Clinical trials involving adults with OVFs were included, focusing on physical capacity (primary outcome) and other health outcomes. Study selection, bias assessment, and data extraction were independently conducted by two authors, with a third author resolving conflicts. Nineteen studies were included in the meta-analysis of exercise interventions. Exercise interventions were analyzed using a standardized mean difference (SMD) meta-analysis, with additional sensitivity analyses. Physical exercise significantly improves functional capacity (SMD -0.41; 95% CI -0.69 to -0.14; p 0.003), aerobic capacity, balance, trunk muscle strength, pain, and quality of life in patients with OVF. No significant effects were observed on thoracic posture or fear of falling. Adverse event risk was low (6%), comparable to usual care or daily activities. Health education interventions (two studies) were synthetized narratively, both showing improvements in pain, mobility, and patient knowledge. Physical exercise is effective and safe in the recovery of OVFs; thus, its prescription is recommended. Most interventions focus first on core strength and motor control and then on aerobic and resistance training. Further evidence is needed to demonstrate the effectiveness of health education.

25. Covert hepatic encephalopathy as a multi-organ syndrome: the gut-liver-muscle-brain axis, diagnosis, treatment, and multidisciplinary care.

期刊: Journal of gastroenterology 发表日期: 2026-May-08 链接: PubMed

摘要

Covert hepatic encephalopathy (CHE) is a highly prevalent complication of liver cirrhosis. Despite the absence of overt symptoms, CHE is strongly associated with impaired quality-of-life, overt hepatic encephalopathy, and mortality. Over the past two decades, evidence regarding the pathophysiology, diagnosis, and treatment of CHE has accumulated considerably, and clinical guidelines recommend screening in patients with cirrhosis. Nevertheless, diagnostic and therapeutic algorithms have not been fully implemented in real-world practice, and many patients remain undiagnosed and untreated. Understanding the natural history of CHE is essential to improve cirrhosis care, as it provides a framework for appropriate screening, treatment decision-making, and patient counseling. CHE is a multi-organ syndrome with complex interactions between the liver, gut, skeletal muscle, kidneys, and brain, with impaired ammonia handling and systemic inflammation acting as central drivers of this organ crosstalk. Hyperammonemia induces astrocytic dysfunction, brain edema, and neuroinflammation, while systemic inflammation, oxidative stress, sarcopenia, gut dysbiosis, and altered microbial metabolites, including bile acids and short-chain fatty acids, further modulate disease expression. In this review, we summarize current understanding of CHE pathophysiology, diagnostic testing, including psychometric batteries and point-of-care tools, such as the Stroop test and animal naming test, and therapeutic options, ranging from lactulose and rifaximin to microbiome-targeted approaches, including fecal microbiota transplantation. We also highlight major challenges in CHE management, including limited implementation of testing, inadequate biomarkers, diagnostic difficulties in geriatric cirrhosis, and unmet needs in fall and driving risk management, and emphasize the importance of multidisciplinary team-based approaches to improve patient outcomes.

26. Oral Bioinspired Peroxisome-Engineered Probiotics for Modulating Gut Microbiota Homeostasis and Alleviating Cardiac Chemotherapy Toxicity.

期刊: Advanced science (Weinheim, Baden-Wurttemberg, Germany) 发表日期: 2026-May-08 链接: PubMed

摘要

Anthracyclines such as doxorubicin (DOX) are widely used in cancer chemotherapy but their clinical utility is severely limited by cumulative, dose-dependent, and largely irreversible cardiotoxicity. Mounting evidence suggests that DOX disrupts intestinal barrier integrity and microbial homeostasis, aggravating systemic oxidative stress and accelerating myocardial injury through the gut-heart axis. Probiotics offer a potential strategy to stabilize the intestinal microenvironment, yet their fragile nature and poor survival in the gastrointestinal tract hinder clinical translation. Here, we present an orally administrable bioinspired peroxisome engineered probiotic (BPEP) as a safe and effective therapeutic platform. Ruthenium-based nanozymes with superoxide dismutase-like and catalase-like activities were encapsulated in a lipid shell to form bioinspired peroxisomes (BP) and covalently anchored onto Escherichia coli Nissle 1917. The lipid shell enhances probiotic resistance to gastric acid, bile salts, and reactive oxygen species, improving gastrointestinal survival and colonization. Acting as a living carrier, probiotics deliver BPs to the intestinal barrier, where they synergistically scavenge reactive oxygen and nitrogen species, restore tight junction integrity, and remodel microbial communities. In a chronic DOX-induced cardiotoxicity mouse model, oral administration of BPEP effectively alleviated oxidative stress, preserved intestinal barrier function, stabilized microbial homeostasis, and ultimately improved cardiac function. This work establishes a bioinspired probiotic-nanozyme hybrid strategy that overcomes the intrinsic limitations of natural probiotics and provides a promising approach for mitigating chemotherapy-related cardiotoxicity via the gut-heart axis.

27. Endemic Channel Parametrization in Dengue Surveillance: Methodological Assessment of Retrospective Windows, Outbreak Trends, and Zero-Case Periods in Colombia.

期刊: JMIR public health and surveillance 发表日期: 2026-May-08 链接: PubMed

摘要

The endemic channel is a surveillance method that presents statistical indicators and visual representations of a disease’s historical dynamics. Its epidemic curve defines the central tendency of cases and their expected variation, providing 3 levels (ie, “safety,” “warning,” and “epidemic”) to assess the epidemiological status of a region. Parameters include the central tendency used as the epidemiological warning threshold (EWT), the size of the retrospective window, and the handling of previous outbreaks and zero values in data. The absence of clear guidelines for the selection of these parameters may compromise reproducibility and hinder outbreak definitions and responses for endemic diseases such as dengue. This study aimed to review the parameters of the endemic channel used for the definition and monitoring of dengue outbreaks in Colombia while quantitatively assessing the performance of the method. We reviewed institutional epidemiological bulletins in Colombia and quantitatively assessed the endemic channel in two main aspects: (1) the impact on the EWT of parameter selection regarding the retrospective data window, previous epidemic years handling, and zero-value handling, using a statistical framework; and (2) the endemic channel’s performance based on the windows of opportunity, outbreak detection capacity, and the ratio of warnings that correspond to actual outbreaks. The endemic channel’s performance is higher as transmission increases due to more robust data that facilitate a timely detection of outliers, while lower-transmission areas show a sharper rise in cases when outbreaks are missed, indicating limited detection capacity. Reducing the retrospective data window improved metrics across all transmission profiles by 6.34% on average, while extending it decreased performance due to changes in detection capacity. There was no significant difference (P value >.01) in performance when data from epidemic years were included or excluded for municipalities with high or very high transmission levels. Instead of adding an entire unit, shifting the data by 0.001 prevents the estimation of null values for the EWT and thresholds and significantly improves performance across all transmission levels (P value <.01) by 23.07% on average. The endemic channel’s performance varies with the outbreak definition and the municipality’s transmission level. Encouraging an optimal retrospective window is challenging, as data are computed over the years. Nevertheless, the improved performance with shorter retrospective windows is likely due to reduced overlap in seasonal outbreaks. Shifting data by a limiting-to-zero value, instead of adding a complete unit, improves performance and can be easily integrated into existing surveillance templates. Windows of opportunity should be considered when selecting the parameter combination. Finally, reassessing outbreak definitions and method parameters underpinning surveillance tools is essential to ensure their validity and effectiveness, especially when used to inform early warning systems and public policies.

28. Heterogeneity in adverse events associated with lumateperone: a study on potential subgroup-specific differences.

期刊: The international journal of neuropsychopharmacology 发表日期: 2026-May-08 链接: PubMed

摘要

Lumateperone, a novel atypical antipsychotic, has emerged as an illuminating hope for patients with schizophrenia and bipolar disorder. While prior studies have employed spontaneous reporting databases and identified over 100 novel adverse events associated with lumateperone, the differences in these adverse events across subgroups remain unclear. This study provides a comprehensive evaluation of the adverse event profile of lumateperone using the Food and Drug Administration Adverse Event Reporting System database, focusing on the potential differences in reporting adverse events across subgroups. Based on the results of clinical characteristics and signal detection, the potential differences in reporting lumateperone-associated adverse events across specific subgroups regarding report year, reporter type, sex, age, outcome, indication, and concomitant drug were analyzed using the ROR algorithm and Fisher’s exact test with Bonferroni correction. The observed differences were further validated using sensitivity analyses, stratified analyses, and comparative analyses. This study identified 1762 reports and 5074 adverse events associated with lumateperone. Notably, females had a higher frequency of reporting nervous system disorders. Tardive dyskinesia was more frequently resulted in serious consequences. Moreover, bipolar disorder patients more frequently reported nervous system disorders, while schizophrenia patients more frequently reported psychiatric disorders. This study underscores the need for future confirmatory studies into the potential sex, outcome and indication differences in adverse events associated with lumateperone. The findings should be considered preliminary and require further validation.

29. Association Between Adjacent Disc Vacuum Phenomenon and Adjacent Vertebral Fracture After Balloon Kyphoplasty for Osteoporotic Vertebral Fractures: A Retrospective Multicenter Study.

期刊: Global spine journal 发表日期: 2026-May-08 链接: PubMed

摘要

Study DesignRetrospective observational study.ObjectivesTo determine whether the preoperative adjacent disc vacuum phenomenon (ADVP) is associated with an increased risk of adjacent vertebral fracture (AVF) after balloon kyphoplasty (BKP) for osteoporotic vertebral fractures.MethodsThe clinical and radiological data of 124 consecutive patients who underwent BKP at T11-L2 were retrospectively reviewed. ADVP was defined as radiolucent gas within the intervertebral disc space on preoperative computed tomography (CT). Patients were classified as ADVP-positive or ADVP-negative. The incidence of AVF was compared between the groups, and independent risk factors were assessed using multivariate logistic regression. Multiple imputation was performed, and propensity score matching (PSM) was used to adjust for potential confounding factors because bone mineral density data were partially missing.ResultsADVP was identified in 48 patients (38.7%). AVF occurred in 21 patients (16.9%) and was significantly more frequent in the ADVP-positive group than in the ADVP-negative group (31.2% vs 7.9%; P < 0.01). Univariate analysis showed that the presence of ADVP and longer symptom duration were significantly associated with AVF. Multivariate logistic regression identified ADVP as an independent risk factor for AVF (odds ratio 4.97; 95% confidence interval 1.71-14.5; P = 0.003). This association remained consistent after multiple imputation and PSM.ConclusionsPreoperative ADVP is associated with an increased risk of AVF after BKP. Incorporating the assessment of ADVP into preoperative CT evaluation may help identify patients at a higher risk of AVF.

30. Correction to "Environmental Occurrence, Source Identification, and Health Hazards of Ultrashort-Chain PFAS in the Yangtze River Delta".

期刊: Environmental science & technology 发表日期: 2026-May-08 链接: PubMed

摘要

31. Feasibility of Integrating Wearable Devices and Ecological Momentary Assessment for Real-Time Environmental Exposure Estimation: Proof-of-Concept Study.

期刊: JMIR formative research 发表日期: 2026-May-08 链接: PubMed

摘要

Environmental exposures such as heat and air pollution are critical determinants of health, yet traditional assessment methods rely on stationary monitors or residential address proxies that fail to capture the exposures that individuals experience throughout the day. This pilot study aimed to assess the feasibility of integrating ecological momentary assessment (EMA), wearable devices, and continuous GPS tracking to capture real-time environmental exposures and to explore associations with concurrent health outcomes. In total, 7 young adults (aged approximately 16 to 24 years; 5/7, 71% female) wore Fitbit Charge 6 watches from July 2025 to August 2025 (mean 28.1, SD 1.1 days), recording sleep quality and duration, resting heart rate, breathing rate, heart rate variability, and physical activity. GPS location measured at up to 5-minute intervals (mean 19.7, SD 25.8 measurements per day) was linked to ambient temperature, humidity, and air pollution data (particulate matter <2.5 um or <10 um in diameter, nitrogen dioxide, sulfur dioxide, ozone, and carbon monoxide) derived from monitoring stations, satellites, and climate models using data-integration algorithms accessed via an application programming interface. EMA surveys administered 3 times per day captured participants’ emotional states and location (inside or outside). Feasibility targets were ≥3 GPS measurements per day, ≥1 survey completed per day, and complete sleep data on ≥50% of days. We examined exploratory bivariate correlations between environmental exposures, physiological measures, and self-reported mood, adjusting for multiple comparisons using false discovery rate correction. Of the 7 participants, 5 (71%) met predefined feasibility targets. Mean compliance included 565 (SD 457) GPS coordinates per participant, 1.4 (SD 0.2) EMA surveys per day, and complete Fitbit sleep data on 64% (SD 27%) of days. Surveys identified barriers to compliance, including perceived complexity of the system and forgetting to put the Fitbit watch back on after removing it. Exploratory correlations (6/7, 86% of participants with complete Fitbit data) revealed associations between nitrogen dioxide and heat exposure and reduced heart rate variability (a marker of parasympathetic tone), and between air pollutants (sulfur dioxide) and increased negative emotions. Heat exposure showed a paradoxical pattern of lower self-reported sadness but reduced heart rate variability with higher levels of heat exposure. Given the small sample size, these correlations should be considered preliminary and hypothesis generating rather than definitive findings. This study demonstrates that the multimodal integration of wearable devices, GPS tracking, and EMA is feasible for capturing real-time environmental exposures and concurrent health outcomes in young adults. This approach addresses critical exposure misclassification issues in environmental health research that relies on residential addresses as proxies. Preliminary patterns suggest complex relationships between environmental exposures and both physiological and emotional outcomes, warranting further investigation in larger, more diverse samples. This approach could inform future personalized environmental health interventions.

32. Sustaining Physical Activity in Chronic Obstructive Pulmonary Disease: A Qualitative Study of Perspectives on a Personalized Community-Based Physical Activity Program (PICk UP).

期刊: Physical therapy 发表日期: 2026-May-08 链接: PubMed

摘要

Sustaining pulmonary rehabilitation (PR) benefits in community-dwelling individuals with chronic obstructive pulmonary disease (COPD) is challenging. The objective of this study was to explore the experiences of individuals with COPD participating in a PersonalIzed CommUnity-based Physical Activities program (PICk UP) and to identify which behavioral change techniques supported sustained physical activity. This was a qualitative pre-post intervention study (NCT04223362 | NCT04711057). The study was conducted in a community setting. This study recruited individuals with COPD assigned to the PICk UP intervention. Participants enrolled in a 6-month, post-PR, community-based program comprising gym, senior exercise classes, pool exercise classes, or Chi Kung. Participants’ perspectives on impacts of the PICk UP program, motivators, facilitators and barriers to adherence were collected through pre-post focus groups. Data were analyzed using deductive and inductive reflexive thematic analysis. The “capability, opportunity, motivation, behavior” (COM-B) framework was used to identify behavioral change techniques. Fifteen individuals with COPD participated (14 male, 70 (8) years, FEV1 57.1% (18.1%) predicted). Five main themes emerged, focusing on physical activity choice, barriers, facilitators, effects, and suggestions: (1) one size doesn’t fit all; (2) organizational factors and system-level support enabling adherence; (3) it doesn’t come easy; (4) a positive feedback cycle sustained physical, psychological and social benefits; and (5) the more, the merrier. The PICk UP intervention supported physical activity through 13 behavioral change techniques, across 5 intervention types (education, persuasion, training, environmental restructuring and enablement), collectively addressing all 6 components influencing behavior. Individuals with COPD reported lasting PR benefits after the PICk UP and were willing to remain physically active. Participants emphasized the importance of diverse physical activity options and support from peers, health, and fitness professionals. To sustain physical activity beyond PR, interventions should prioritize intersectoral partnerships and embed ongoing social support. These findings underscore PICk UP’s effectiveness, positioning it as a promising and replicable model for promoting long-term physical activity in individuals with COPD.

33. Medical Marijuana Initiation and Simulated Driving Performance Among Mid-to-Late-Life Adults With Chronic Pain: Prospective Observational Feasibility Cohort Study With Matched Controls.

期刊: JMIR formative research 发表日期: 2026-May-08 链接: PubMed

摘要

Marijuana initiation among adults aged 50 years and older has increased substantially. Although acute tetrahydrocannabinol exposure can impair psychomotor function, less is known about how real-world medical marijuana initiation relates to functional tasks such as driving in mid-to-late life. The objective of our study was to evaluate the feasibility of recruiting and retaining adults aged 50 years and older, who are newly registered for medical marijuana, and matched non-marijuana-using controls, into a longitudinal high-fidelity driving simulator protocol, and to explore preliminary associations between medical marijuana initiation and simulated driving performance. This prospective, nonrandomized feasibility cohort study enrolled adults aged 50 years and older who are newly registered in the Florida Medical Marijuana Use Registry, along with age-, race-, and sex-matched controls. Assessments occurred at baseline (T1; preinitiation) and at 1 month (T2). Primary feasibility outcomes included recruitment, retention, simulator completion and tolerance, and exposure verification. Exploratory outcomes included reaction time and divided attention (DA) performance, which are measured using an immersive, high-fidelity driving simulator. Recruitment and exposure verification procedures were feasible, but simulator sickness contributed to substantial missing data. Exploratory analyses suggested group differences in select DA outcomes at T2. At T2, reaction time to DA situation 3 (DA3) was significantly shorter in the medical marijuana group (n=14, mean 2.57, SD 1.63) than in the control group (n=7, mean 5.79, SD 4.32; t19=-2.50, P=.02, g=-1.11, 95% CI -2.04 to -0.16). These findings should be interpreted cautiously, given the small sample size, missing data, and multiple comparisons. A prospective protocol examining medical marijuana initiation and simulated driving among mid-to-late-life adults is feasible, but future studies should incorporate design and analytic refinements to address simulator sickness and missing data and to better characterize exposure timing and patterns.

34. The formaldehyde dispute - Part A: acute and chronic inhalation toxicity and the evolution of scientific knowledge.

期刊: Critical reviews in toxicology 发表日期: 2026-May-08 链接: PubMed

摘要

Formaldehyde is a simple, highly reactive aldehyde whose inhalation toxicity has been characterized through more than five decades of human, animal, and mechanistic research. Across this literature, inhalation was illustrated to follow a concentration-dependent continuum of effects confined to the tissues of initial contact. Controlled human chamber studies reported no measurable pulmonary impairment below 0.3 ppm, the onset of mild ocular and nasal irritation at 0.3 to 0.5 ppm, and reversible sensory irritation observed at concentrations approaching 1 ppm. These findings were consistent with observations from community and occupational investigations. Chronic inhalation bioassays in rats and mice identified a sharp transition between adaptive epithelial responses and sustained cytotoxic injury within the nasal epithelium. Continuous exposure to concentrations ≤2 ppm produced minimal and reversible histopathologic changes, whereas exposures ≥6 ppm were associated with persistent epithelial necrosis, regenerative proliferation, and nasal squamous cell carcinomas localized to regions of highest vapor flux in the rat nasal cavity. In these studies, tumors were not observed at concentrations that did not overwhelm local tissue repair capacity. Computational dosimetry, DNA-protein crosslink kinetics, and biologically based dose-response (BBDR) modeling indicated that these outcomes arose from localized tissue injury rather than from cumulative systemic dose. Despite the extensive experimental database, disagreement has persisted for several decades regarding the appropriate approach for conducting a quantitative risk assessment of formaldehyde. Its non-linear, concentration-response, high endogenous background levels, and pronounced interspecies differences would indicate that the use of the Linear-No-Threshold (LNT) model is not appropriate for identifying acceptable levels of exposure. Nonetheless, EPA proposed an 8-hour occupational exposure value (OEV) of 0.11 ppm and 0.17 ppm for a 15-minute OEV. This review synthesizes the human, experimental, and mechanistic evidence underlying formaldehyde’s acute and chronic inhalation toxicity. Using a classic approach to risk assessment, we propose that an OEV of 0.3 ppm (8 hr TWA) and a short-term limit (15 min) of 1.0 ppm are sufficiently low to protect the vast majority of workers from temporary irritation, as well as chronic effects (such as cancer). This recommendation is supported by three significant reviews of formaldehyde and at least seven rigorous human exposure studies conducted over the past 35 years.

35. The formaldehyde dispute - Part B: scientific critique of EPA's formaldehyde occupational exposure values (OEVs) and proposed alternative occupational exposure limits (OELs).

期刊: Critical reviews in toxicology 发表日期: 2026-May-08 链接: PubMed

摘要

In 2024, the U.S. Environmental Protection Agency (EPA) finalized its Integrated Risk Information System (IRIS) Toxicological Review and Toxic Substances Control Act (TSCA) Risk Evaluation for formaldehyde. After analyzing all the data that they deemed relevant, TSCA relied on IRIS’s proposed inhalation reference values to establish an 8-hour occupational exposure value (OEV) of 0.11 ppm derived from epidemiological evidence of nasopharyngeal cancer. They also developed a 15-minute OEV of 0.17 ppm based on the goal of preventing sensory irritation. In an earlier draft of EPA’s TSCA Risk Evaluation, they initially proposed an 8-hour OEV of 0.011 ppm derived from residential exposure studies of children, but this was withdrawn. This review examined EPA’s methodology, the nearly 40 years of scientific literature underlying the EPA’s conclusions, and the more than 300 public comments, which were submitted to the draft IRIS Toxicological Review (Docket ID: [EPA-HQ-ORD-2010-0396]) and draft TSCA Risk Evaluation (Docket ID: [EPA-HQ-OPPT-2023-0613]). A minimum of five significant flaws were identified and discussed: (1) heavy reliance on epidemiological studies which had serious confounding factors and design limitations; (2) application of default uncertainty factors which were too high given the robust human data; (3) use of exclusion criteria which dismissed high-quality studies from being considered; (4) the use of a linear no-threshold (LNT) model despite decades of substantial evidence for a threshold-driven mode of action (MOA); and (5) neglect for a validated biologically based dose-response (BBDR) model which may have been the most robust ever developed. Based on our weight-of-evidence evaluation of toxicological, mechanistic, and epidemiological data, we propose occupational exposure limits (OELs) of 0.3 ppm (8-hour TWA) and 1 ppm (15-min STEL). These values are grounded in controlled human exposure studies of asthmatics and non-asthmatics and supported by an internationally accepted BBDR model estimating an approximately 1 in 940,000 increased cancer risk for workers. As such, these OELs protect against sensory irritation, asthma, and other adverse effects, as well as carcinogenicity. They are also aligned with limits adopted by other domestic and international regulatory bodies. Immediately before this paper was accepted, EPA released their Updated Draft Risk Calculation Memorandum: Formaldehyde for public comment, which proposed to drop their promulgated OEVs (0.11 ppm and 0.17 ppm) and adopt an 8-hour OEV of 0.3 ppm to protect against sensory irritation and cancer, similarly to what was recommended in this paper.

36. Wildland fire smoke, severe maternal morbidity, and health equity: A population-based cohort study in California.

期刊: The Science of the total environment 发表日期: 2026-May-07 链接: PubMed

摘要

Despite the recent increase in the intensity and frequency of wildland fires in the United States, there is limited investigation into the impact of wildland fires on pregnancy-related mortality and morbidity. This study examined associations between maternal exposure to wildland fire smoke and severe maternal morbidity (SMM), or potentially life-threatening complications related to pregnancy or delivery, in a population-based cohort of California birthing people between 2007 and 2018. We measured pregnancy smoke-day burden using the Hazard Mapping System smoke product and wildland fire-specific fine particulate matter (PM2.5, particles ≤2.5 μm) using bias-corrected Community Multiscale Air Quality Model results, linked to birthing people’s residential locations. Logistic regression models estimated severe maternal morbidity risk associated with pregnancy smoke-day burden and average wildland fire-specific PM2.5, during the whole pregnancy and within each trimester, adjusting for individual-level sociodemographic and health covariates. To investigate whether the impact of wildland fire smoke was more pronounced among racially marginalized populations, we conducted stratified analysis by race and ethnicity. In a sample of 4,584,110 individuals with singleton births, exposure to high pregnancy smoke-day burden and average wildland fire-specific PM2.5, compared to low exposure, was associated with elevated risk of SMM (OR = 1.16, 95% CI: 1.13-1.19; OR = 1.12, 95% CI 1.09-1.14, respectively). Exposure during the second and third trimesters was more strongly associated with SMM, compared to first trimester exposure. Exposure to pregnancy smoke-day burden was most strongly associated with SMM among births to Asian and Pacific Islander individuals, and exposure to wildland fire-specific PM2.5 was more strongly associated with SMM among births to Asian and Pacific Islander and Black individuals. Results demonstrate the urgency to understand how wildland fire smoke affects maternal health, as well as its role in shaping racial and ethnic inequities in SMM.

37. Strategies for Documenting Information in the Medical Record: Managing Confidentiality, Privacy, and Staff Disagreements.

期刊: The primary care companion for CNS disorders 发表日期: 2026-May-07 链接: PubMed

摘要

The Psychiatric Consultation Service at Massachusetts General Hospital sees medical and surgical inpatients with comorbid psychiatric symptoms and conditions. During their twice-weekly rounds, Dr Stern and other members of the Consultation Service discuss diagnosis and management of hospitalized patients with complex medical or surgical problems who also demonstrate psychiatric symptoms or conditions. These discussions have given rise to rounds reports that will prove useful for clinicians practicing at the interface of medicine and psychiatry. Prim Care Companion CNS Disord 2026;28(3):25f04146. Author affiliations are listed at the end of this article.

38. Assessing COVID-19 Testing Strategies in K-12 Schools in Underserved Populations.

期刊: Journal of public health management and practice : JPHMP 发表日期: 2026-May-07 链接: PubMed

摘要

The COVID-19 pandemic presented an unprecedented challenge for operations of schools in the US. In addition to masking and distancing, weekly testing for SARS-CoV-2 was recommended for students and staff during high SARS-CoV-2 transmission levels to provide an additional mitigation strategy to limit transmission. To assess testing strategies (weekly screening vs. symptomatic only) on SARS-CoV-2 infection rates in public middle and high schools predominantly attended by underrepresented minorities. During the 2021-2022 school year, a cluster randomized trial was conducted among 16 middle and high schools from 5 public school districts. These schools were randomized into one of 2 intervention groups: Weekly screening testing + symptomatic testing (S + S) or symptomatic testing only. Public schools in St. Louis (Missouri). Students, staff, and family members of 16 middle and high schools. Weekly screening + symptomatic testing or symptomatic only testing. Any positive test across all weeks [yes/no], number of tests, number of positive tests, and positivity test rate for each participant. One thousand three hundred ninety individuals participated in this study. From the S + S schools, 894 (64.3%) individuals participated: 200 (15%) students, 353 (43%) staff, and 290 (37.5%) household members. Among the 496 (35.7%) participants from the symptomatic only schools, 183 (13%) students, 203 (47%) staff, and 83 (40%) household members participated. A total of 183 participants tested positive during the study period. When comparing school-based testing strategies, the positivity rates were not different between the 2 groups (P = .25). This study did not show a benefit of weekly screening testing. Underlying disease risk or effectiveness of testing is considered however, notably the finding may be attributed to the inherent differences of identifying positive cases in each testing strategies. Finally, the participation rate in the study at the schools was low, which limits this finding.

39. Towards primary health care education reform: A reflexive thematic analysis of nursing supervisors' perceptions, experiences and challenges.

期刊: Nurse education today 发表日期: 2026-May-06 链接: PubMed

摘要

Aim To explore Primary Health Care nurses’ experiences of supervising nursing students on clinical placements and their perceptions of academic preparation for placement and future employment. Primary Health Care nurses are essential workers within sustainable health systems but pre-registration educational preparation and access to clinical experiences can be limited. Previous research correlates positive clinical experiences with workforce intentions. Furthermore, nursing supervisors are pivotal to maximising student experiences and education, yet little is known about their perceptions, challenges, and views about how current curriculum prepares students to commence professional careers in primary care. Understanding their perceptions may inform curriculum, improve placement experiences and develop a sustainable future workforce. A qualitative study using Braun and Clarke’s reflexive thematic analysis. Nursing supervisors who attended the Australian Primary Health Care Nurses Association conference 2025 participated in a focus group session. One large focus group with 24 participants, divided across five tables for focused discussion, was conducted over 90 min. Facilitators documented verbatim conversations. Summary group feedback was documented through field notes and audio recordings. Data were transcribed, collated and analysed using Braun and Clarke’s six-phase framework. Participants described the rewards and challenges of supervision, including workload pressures, professional behaviour concerns, and limited support and training for supervisors. They perceived curricula left students underprepared, with knowledge gaps in communication, critical reasoning, and scope. They interpreted workforce sustainability as hindered by inequities and stigma; however, stronger education, greater scope, and increased autonomy and flexibility could improve attraction and retention. Participants called for systematic reform to reorient nursing education and placements towards Primary Health Care. National collaboration between industry and universities is essential to strengthen curricula, expand autonomy and scope, and promote Primary Health Care as viable career options. Without reform, the Primary Health Care workforce could face future sustainability challenges.

40. Readability of Self-Reported Measures in Psychosis.

期刊: The primary care companion for CNS disorders 发表日期: 2026-May-05 链接: PubMed

摘要

Objective: To identify the readability levels of measures used in assessing psychosis. Methods: Measures were identified through a literature search. Fourteen measures met the inclusion criteria (written in English, developed in the US between 1997 and 2024, and publicly available) and were analyzed using 4 validated formulas: Gunning Fog, Simple Measure of Gobbledygook, FORCAST, and Flesch Reading Ease Score. Measures with an average readability score exceeding 6.00 were above the recommended reading level. Results: All measures exhibited mean readability scores above the recommended sixth-grade level. The mean reading levels of the instruction and item sections were 9.08 (SD=1.44, range, 7.13-10.70) and 9.06 (SD=1.98, range, 7.08-13.79), respectively. Conclusion: The findings indicate that measures used in assessing psychosis are written above the recommended reading levels and do not conform to suggested standards. The study highlights a significant gap in the readability of psychosis assessment measures, emphasizing the need for improvements to ensure accurate symptom assessment and effective treatment monitoring for individuals with psychotic disorders. Prim Care Companion CNS Disord 2026;28(3):25m04077. Author affiliations are listed at the end of this article.

41. Bidirectional Association Between Premenstrual Disorders and Psychiatric Disorders.

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

摘要

Premenstrual disorders (PMD) often co-occur with psychiatric conditions and exhibit overlapping symptoms. However, the direction and extent of this association remain poorly understood, particularly beyond major affective disorders. To investigate whether bidirectional associations exist between PMD and a broad range of psychiatric disorders and conditions. In this cohort study, Swedish nationwide and regional registers were used to identify women diagnosed with PMD from January 1, 2001, to December 31, 2022. Each identified woman was matched to their unaffected full sisters and to 10 unaffected controls. A nested case-control design was used to examine psychiatric disorders diagnosed prior to PMD, and a matched cohort design was used to assess incident psychiatric disorders occurring after PMD. The mean (SD) follow-up was 8.2 (5.8) years. Data were analyzed March 2025 to February 2026. Clinical diagnosis of PMD and 14 subtypes of psychiatric disorders. Bidirectional associations were estimated using odds ratios (ORs) and hazard ratio (HRs) with 95% CIs. Among 3 630 028 eligible women followed up for a mean (SD) of 8.2 (5.8) years, 104 972 were diagnosed with PMD (mean [SD] age, 35.4 [8.1] years). Of women with PMD, 50 176 (47.8%) had a previous psychiatric disorder diagnosis, compared with 309 802 (29.5%) of 1 049 720 unaffected controls, representing an approximately doubled risk (OR, 2.41 [95% CI, 2.38-2.44]). Similarly, women with psychiatric disorders were twice as likely as women without psychiatric disorders to receive a subsequent PMD diagnosis (36.6% vs 21.1%; HR, 2.23 [95% CI, 2.19-2.27]). In sibling analyses, these bidirectional risks were attenuated but the associations remained (OR, 1.95 [95% CI, 1.89-2.01]; HR, 1.82 [95% CI, 1.74-1.90]). The highest bidirectional risks were for depression (OR, 2.19 [95% CI, 2.15-2.22]; HR, 2.70 [95% CI, 2.63-2.76]) and anxiety (OR, 2.26 [95% CI, 2.22-2.30]; HR, 2.43 [95% CI, 2.37-2.48]), with additional associations for attention-deficit/hyperactivity disorder (OR, 2.01 [95% CI, 1.94-2.09]; HR, 3.55 [95% CI, 3.32-3.80]), bipolar disorder (OR, 2.01 [95% CI, 1.93-2.10]; HR, 3.36 [95% CI, 3.07-3.67]), and personality disorder (OR, 2.01 [95% CI, 1.94-2.09]; HR, 3.34 [95% CI, 3.00-3.72]), but not for schizophrenia (OR, 1.01 [95% CI, 0.88-1.16]; HR, 1.00 [95% CI, 0.59-1.72]). In this nationwide cohort study conducted in Sweden, bidirectional associations were found between PMD and psychiatric disorders and conditions, highlighting the need for sex- and menstrual cycle-informed care in psychiatry. Further research is needed to understand the underlying mechanisms shared between PMD and psychiatric disorders.

42. Limited 'heft' of weight-based outcomes in predicting influenza A virus disease severity in ferrets.

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

摘要

Studies evaluating viral pathogenicity in small mammalian models often quantify disease severity using the magnitudes of temperature rise and weight loss post-challenge. However, no rigorous assessment on the transformation of serially collected data into features suitable for predictive models has been conducted. Using data aggregated from ferrets inoculated with a diverse panel of influenza A viruses (IAV) spanning a broad range of clinical outcomes, we assessed statistical correlations and predictive performance of temperature and weight loss, summarized by conventional and novel approaches. Conventional summary metrics (peak values or area under the curve) were weak and inconsistent correlates of overall disease severity and viral titers. Novel dynamic weight metrics capturing onset, duration, slope, and volatility over 14 days showed lower coefficients of variation than conventional summary approaches. However, inclusion of novel metrics did not meaningfully improve the predictive performance of machine learning models for disease severity outcomes in IAV-inoculated ferrets. Mixed-effects models indicated that weight loss post-IAV infection is driven by time and viral burden, with temperature contributing little additional information. Collectively, these findings support that derived metrics are at least comparable, if not enhanced, to conventional summaries for data science analyses of serially generated clinical data from in vivo pathogen studies. However, because pathogen disease severity in mammals is multifactorial, models that rely solely on weight and temperature metrics without additional quantitative measures of clinical perturbation within-host are unlikely to achieve strong predictive performance.

43. Hiding in plain sight: A call to prevent cutaneous leishmaniasis transmission in the United States.

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

摘要

Cutaneous leishmaniasis (CL), once considered a travel-associated tropical disease, is increasingly transmitted within the United States, particularly in southern regions. Despite mounting evidence of local transmission, public health recognition and preventive infrastructure remain limited. This Viewpoint highlights the urgent need to shift the U.S. CL response from questioning endemicity to preventing transmission. We review ecological, clinical, and surveillance data demonstrating the presence of competent vectors, animal reservoirs, and autochthonous human cases. Diagnostic delays, underreporting, and insufficient provider training contribute to missed prevention opportunities. Climate change and peri-urban rodent-human contact data further heighten future risk. A coordinated response is essential, including national notifiability, expanded diagnostics, integrated vector and reservoir surveillance, clinical education, and One Health-focused research. Without immediate action, CL risks becoming an entrenched, neglected zoonosis in the United States.

44. The Prevalence and Characteristics of Operative Tandem Spinal Stenosis: A Retrospective Database Study of 4,484 Patients at a Single Center.

期刊: Spine 发表日期: 2026-Apr-29 链接: PubMed

摘要

A retrospective database study. To clarify the prevalence and characteristics of Operative Tandem Spinal Stenosis (O-TSS)-the condition requiring surgery in at least two different spinal regions (cervical, thoracic, or lumbosacral)-focusing on patients with a history of thoracic spine surgery. While repeat surgery for adjacent or same-level disease is well-documented, the characteristics of patients requiring surgery in different spinal regions-defined here as O-TSS-are not well understood, particularly regarding the thoracic spine due to lower surgical volumes. We analyzed 4,484 patients who underwent primary surgery for degenerative spinal disease at a single institution over a 20-year period (2000-2019). O-TSS was defined as a history of surgery in ≥2 different spinal regions (cervical, thoracic, or lumbosacral), including both concurrent and subsequent identification of multi-regional lesions. Prevalence and surgical intervals were analyzed across cohorts. The overall prevalence of O-TSS was 5.0% (224/4,484; 95% CI, 4.4%-5.7%). The prevalence among patients with a history of thoracic surgery was a striking 42.0% (95% CI, 34.7%-49.7%), significantly higher than in the cervical (16.0%) and lumbosacral (6.0%) cohorts (P<0.0001). Intriguingly, while older age and male sex were associated with O-TSS in the cervical or lumbosacral cohorts, these factors were not significant in the thoracic cohort. Furthermore, the high prevalence in thoracic patients was consistent across different pathologies (myelopathy, OPLL/OLF, and disc herniation). The mean interval to a subsequent surgery was shortest after a thoracic procedure. Patients with a history of degenerative thoracic spine surgery represent a unique population with a significantly high prevalence of O-TSS (42.0%). This high prevalence appears to be independent of patient demographics or the specific underlying pathology. Maintaining a high index of clinical suspicion for additional lesions is warranted in this specific population.

45. Post-Transbronchial Microwave Ablation Bronchopleural Fistula-A Case Series and Unique Insight.

期刊: European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery 发表日期: 2026-Apr-01 链接: PubMed

摘要

This case series aims to evaluate the incidence, mechanisms, and management of bronchopleural fistula (BPF) following transbronchial microwave ablation (TMWA) for lung tumours and to explore innovative strategies for prevention and treatment. A retrospective review was conducted on 173 patients who underwent 209 sessions of TMWA from March 2019 to May 2025 at a single centre. Four cases of BPF confirmed by imaging and clinical presentation were analysed. Data collected included procedural details, mechanisms of BPF formation, management strategies, and patient outcomes. Techniques such as intraoperative fibrin glue injection and endobronchial valve placement were documented. BPF occurred in 4 patients (1.9%) and was associated with mechanisms including extensive ablation zone with cavitation, tissue contraction, and inadvertent pleural puncture. Treatments varied from conservative drainage and antibiotics to targeted endobronchial interventions, with all BPF successfully resolved. The use of innovative techniques, such as intraoperative fibrin glue injection, demonstrated promising results with minimal invasiveness. Patients with BPF experienced longer hospital stays compared to those without complications. Although rare, BPF is a significant complication after TMWA, often requiring individualized management. Early recognition through vigilant monitoring and advanced imaging facilitates prompt intervention. Further prospective studies are needed to refine prevention and management strategies for this serious complication.

46. Real-world patient characteristics and clinical outcomes in patients with myelofibrosis in Japan.

期刊: PloS one 发表日期: 2026 链接: PubMed

摘要

Anemia is associated with increased morbidity, mortality, healthcare resource utilization, and costs in myelofibrosis. This longitudinal, retrospective, and descriptive cohort study used a Japanese health administrative database (Medical Data Vision) to examine treatment patterns, transfusion burden, healthcare resource utilization, and costs in patients with myelofibrosis and a subset treated with a Janus kinase inhibitor. Ruxolitinib (a Janus kinase inhibitor) was the first targeted therapy for myelofibrosis in Japan (2014). Patients were identified from April 1, 2015 to June 30, 2022. In the overall myelofibrosis cohort, myelofibrosis diagnosis was the index date; in the Janus kinase inhibitor-treated subgroup, the first date of Janus kinase inhibitor use was the index date. Of the 836 patients with myelofibrosis, median age: 73 years at or before index; female: 38.0%; median follow-up: 576 days; anemia: 59.9%; thrombocytopenia: 18.7%. At index, 37.9%, 6.6%, and 55.5% of patients were transfusion-dependent, -requiring, and -independent, respectively. Median overall survival from myelofibrosis diagnosis was 83.3 months from the index date. Of 281 patients who received a Janus kinase inhibitor, median age: 74 years at or before index; female: 39.5%; median follow-up: 592 days; anemia: 66.9%; thrombocytopenia: 22.8%. All patients who received a JAK inhibitor were treated with ruxolitinib; mean dose was 15.6 mg/day and median duration of treatment was 14 months. The proportion of patients who were transfusion-dependent, -requiring, and -independent in this subgroup was 47.0%, 9.3%, and 43.8%, respectively. Median overall survival from myelofibrosis diagnosis was 53.9 months from first Janus kinase inhibitor administration. This real-world study showed the clinical characteristics and outcomes of Japanese patients with myelofibrosis.

47. An evaluation of the clinician-facing research dashboards from the Toronto Adolescent and Youth (TAY) Cohort Study in mental health care.

期刊: PLOS mental health 发表日期: 2026 链接: PubMed

摘要

Dashboards that integrate patient research data for clinical use can streamline information sharing and support clinical care, yet their application in mental health care is underexplored. This study evaluated the clinician-facing dashboards developed from the Toronto Adolescent & Youth (TAY) Cohort Study at the Centre for Addiction and Mental Health (CAMH), guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. Dashboard reach was assessed through quantitative analyses, while semi-structured interviews with seven clinicians were conducted to explore perceptions of effectiveness, adoption, implementation, and maintenance. Quantitative analyses demonstrate that dashboards are completed for 69% of participants. Following the initial implementation phase, the average time from participant consent to dashboard completion decreases to six months. Qualitative findings suggest that dashboards can serve as a supplementary information source that may aid in supporting clinical decision-making and the integration of patient-reported research data into care. Clinicians also identified areas for improvement, including delays in dashboard completion, difficulty locating dashboards, and inefficient dashboard completion notifications. Clinicians suggested that addressing these areas through improved accessibility, timely data availability, and aligned communication strategies can increase uptake and sustainability. These findings emphasize the value of engaging end users and conducting ongoing evaluation to optimize the integration of research data into clinical workflows using dashboards to enhance mental health care. Future research should further examine factors influencing dashboard use across mental health care settings.

48. Socioeconomic inequalities and the COVID-19 pandemic in France: Territorial analyzes based on epidemic wave and metropolitan area.

期刊: PloS one 发表日期: 2026 链接: PubMed

摘要

Previous studies have highlighted the relationship between socioeconomic inequalities and the general population’s risk of contracting or dying from COVID-19 during the 2020-2023 pandemic. In France, socioeconomic inequalities vary across metropolitan areas; few studies have investigated whether this variation explains the spatial disparities observed in COVID-19 incidence and testing rates during the pandemic. We examined the relationship between socioeconomic profiles and these two rates across all 22 metropolitan areas in France for eight of the country’s nine epidemic waves. For each metropolitan area, we used socioeconomic variables from census data to define socioeconomic profiles through principal component clustering. We then used spatialized generalised additive mixed models to analyze associations between these profiles and both testing and incidence rates, for each epidemic wave from July 2020 to March 2023. Finally, we performed meta-regressions to study the distribution of testing and incidence rate ratios among the various socioeconomically deprived and privileged profiles within each of the 22 metropolitan areas, according to COVID-19 vaccination rate. Testing rates were lower in socioeconomically deprived metropolitan areas than in privileged ones, except during wave 4 (July-October-2021), when testing rates were more similar. Incidence rates were higher in deprived areas (waves 2-4, July-2020 to October-2021), but this pattern reversed between waves 6-9 (March-2022 to March-2023). Meta-regressions indicated that high vaccination coverage was associated with a narrower gap in testing between deprived and privileged areas. Moreover, for each metropolitan area, the higher the level of deprivation in a zone within the deprived profile, the greater the deprived-privileged gap in under-testing. The impact of socioeconomic inequalities on testing and incidence patterns during the COVID-19 pandemic in each metropolitan area in France was driven by the most deprived zones; this impact varied across epidemic waves. Higher vaccination rates and government health measures (lockdowns, mandatory health pass) may have reduced this variation.

49. Enhancing tuberculosis care in the private sector: Role of innovative private sector engagement model under programmatic settings in India.

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

摘要

India’s private sector plays a crucial role in the country’s tuberculosis (TB) healthcare landscape, with >50% of patients seeking initial care from private providers. Recognizing this critical role, the National Tuberculosis Elimination Program implemented and scaled up an innovative private sector engagement model, Patient Provider Support Agency (PPSA), in over 200 districts of the country in 2023 to improve TB care in the private sector. A cross-sectional study was conducted to assess the role of PPSA in improving TB care services among private-sector patients in 2023. We compared districts with PPSA and without PPSA for their TB notification, treatment timeliness, key quality-of-care indicators and treatment outcomes from the private sector at the national level. Data for private sector notification from Ni-kshay (web-enabled TB patient management system) was analyzed. In 2023, districts supported by PPSA (n = 204) recorded an average private sector TB notification rate of 106 per 100,000 and achieved 99.7% of the set target, compared to 529 districts without PPSA, which reported a rate of 45 per 100,000 and reached only 80% of the target. The pretreatment loss to follow-up (2% vs 4%) and the treatment initiation delay >7 days (5% vs 10%) were lower in districts with PPSA. They also reported improved TB care services- comorbidity testing (HIV and diabetes), bank detail linkage for receiving financial support and treatment success with PPSA support. However, districts with PPSA showed lower coverage of upfront nucleic acid amplification testing (17% vs 22%), drug susceptibility testing (21% vs 25%) and uptake of government-supplied drugs (22% vs 33%) compared with districts without PPSA. The PPSA model improved private sector TB notification and reduced treatment delays nationally; however, strategic expansion by focusing on quality-oriented TB care services and their link to results-based financing is essential to maximize its efficiency and overall impact on private sector TB care.

50. Differences in the long-term course of post-COVID-19 symptoms in adults and children across epidemic periods: A retrospective cohort study in Japan, 2020-2024.

期刊: PloS one 发表日期: 2026 链接: PubMed

摘要

The prevalence of post-COVID-19 symptoms has been reported to decline since the Omicron variant became predominant. However, differences in their long-term course across epidemic periods and between adults and children, including recent Omicron sublineages, remain insufficiently understood. We extended a previously reported retrospective cohort by conducting follow-up and an additional survey in Hiroshima, Japan. The study included 2,689 individuals diagnosed with COVID-19 between March 2020 and June 2024 (1,524 adults and 1,165 children). A self-administered questionnaire captured the presence and duration of 13 symptoms. Interval-censored survival analysis estimated prevalence over time, and proportional hazards models evaluated factors associated with symptom resolution. At six months, the estimated prevalence in adults was highest during the Delta period (47%) and lower during Omicron-2022 (23%) and Omicron-2024 (21%). In children, prevalence remained about one-quarter to one-third that of adults, with no notable differences between Omicron sublineages. At two years, persistent symptoms were reported by about 20% of adults infected before Omicron and 10% during Omicron periods, compared with 4.1% and 1.9% of children infected during the Delta and Omicron-2022 periods. Symptoms persisting beyond two years showed little further resolution, though in children they did not interfere with daily activities. In the Cox model, resolution was slower during the Delta period (HR 0.79) and faster during Omicron-2022 (HR 1.24) and Omicron-2024 (HR 1.30). Younger age, particularly ≤12 years, was strongly associated with faster recovery. The long-term course of post-COVID-19 symptoms differed across epidemic periods and age groups. The risk was highest during Delta and lower among children and those infected during Omicron waves, yet some individuals experienced symptoms for over two years. Long-term follow-up and social support remain crucial to mitigate the burden of post-COVID-19 condition.

51. Gender-specific sociodemographic and lifestyle factors associated with frailty status among Korean older adults.

期刊: PloS one 发表日期: 2026 链接: PubMed

摘要

This study aimed to identify gender-specific sociodemographic and lifestyle factors associated with frailty among Korean older adults. We conducted a cross-sectional analysis using data from the 2014-2019 Korean National Health and Nutrition Examination Survey, including 6,556 participants aged 65 years and older. Frailty was defined by the Fried phenotype. Multivariable logistic regression models were used to examine gender-specific associations between frailty and sociodemographic factors (age, education, marital status, household income, household type, and body mass index) as well as lifestyle factors (smoking, alcohol consumption, meals with family in the past year, energy intake, number of chronic diseases, and self-rated health status), with mutual adjustment for all listed covariates in a single fully adjusted model. The prevalence of frailty was 20.6% in women and 11.5% in men. Among women, current smoking [odds ratio (95% confidence interval), 2.22 (1.16-4.26)] and sharing meals with family in the morning [1.42 (1.05-1.93)] were associated with an increased risk of frailty. For men, high household income [0.51 (0.27-0.99)] and higher energy intake [>2,120 kcal; 0.49 (0.34-0.71)] were associated with a reduced risk of frailty. In both men and women, multiple chronic diseases and poor self-rated health were significantly associated with an increased risk of frailty. Frailty was associated with various sociodemographic and lifestyle characteristics in both men and women. The associations with several factors, such as smoking, meal patterns, and household income, differed by gender. This study highlights distinct gender-specific predictors of frailty among older Korean adults, emphasizing the need for tailored and integrated public health prevention strategies.

52. Significance of RGS13 expression in lupus B cells.

期刊: PloS one 发表日期: 2026 链接: PubMed

摘要

B cells play important roles in systemic lupus erythematosus (SLE) pathogenesis. In this study, we explored the proteins preferentially expressed in SLE B cells, especially double-negative 2 B (DN2B) and age-associated B cells (ABCs), and analysed their functions. We used our previously reported dataset to identify the mRNAs preferentially expressed in SLE B cells and confirmed their expression in each B cell subset via flow cytometry. Additionally, we also used knockout mice of the identified gene to investigate its roles. Of the 525 mRNAs exclusively upregulated in SLE B cells, regulator of G protein signalling (RGS)-13 was identified as a top-ten gene of interest. Its expression levels were determined via quantitative polymerase chain reaction and correlated with the anti-dsDNA antibody levels. Flow cytometry revealed that RGS13 levels were particularly high in DN2B cells. Among the DN2B cell differentiation-inducing factors, B cell receptor stimulation induced RGS13 expression. Total B cell, follicular B cell, and ABC numbers were reduced in the spleen, whereas the number of germinal centre B cells, which also highly express Rgs13, was unaffected in Rgs13-/- mice. Moreover, total B cell number increased in the bone marrow but remained unchanged in the peripheral blood in Rgs13-/- mice. No difference in responsiveness to ABC-inducing stimuli was observed between the Rgs13-/- and wild-type mice. Overall, RGS13 was highly expressed in lupus DN2B cells and mouse ABCs, induced by B cell receptor stimulation, and indirectly associated with the differentiation and maintenance of ABCs relevant to autoimmunity.