公共卫生研究摘要 (2026-05-10)

共收录 62 篇研究文章

1. Examining Staff Perceptions of a Proactive, Telephonic Transition-of-Care Program for Pregnant People With Emergency Department Utilization.

期刊: Health services research 发表日期: 2026-Jun 链接: PubMed

摘要

To examine staff perceptions of a proactive, telephonic transition-of-care pilot model that connects pregnant people with recent emergency department (ED) utilization to early pregnancy-related care (e.g., prenatal care, abortion care, miscarriage support) and community resources. Although pregnant individuals disproportionately seek care in the ED, post-ED discharge models for care navigation remain understudied. Between August 2021 and June 2023, six sites (three health systems, two federally qualified health centers, and one community-based organization) implemented the transition-of-care model with ongoing support from an external organization (‘external facilitator’). We conducted a qualitative descriptive study to explore pilot-engaged staff and leader perspectives regarding intervention fit and contextual factors influencing implementation and sustainability. From February to March 2024, we conducted interviews with 13 individuals (six outreach champions; four administrative champions; three senior leaders) representing all six pilot sites. Guided by the integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework, we employed codebook thematic analysis to identify key themes regarding the extent to which intervention characteristics met patients’ perceived needs and factors influencing pilot site implementation and sustainability. Pilot site champions and leaders described the transition-of-care model as acceptable and feasible. Key strengths included the pilot model’s patient-centered design (e.g., timely, proactive outreach and individualized support), health information exchange (HIE)-driven ED data infrastructure, and role of the external facilitator. Receipt of coaching and training on sensitive, respectful communication in the early pregnancy period also facilitated program implementation. Adequate outreach staffing acted as a barrier and potential determinant of sustainability. Our findings provide preliminary evidence in support of an outreach model to promote initiation of early pregnancy-related care following ED utilization and offer a flexible blueprint for adaptation across clinical settings. Our work meaningfully contributes to the limited literature base on early pregnancy care innovation.

2. The Geography of Disconnection: Rural and Urban Gaps in Post-Pandemic Telehealth Use.

期刊: Health services research 发表日期: 2026-Jun 链接: PubMed

摘要

To examine rural-urban disparities in telehealth utilization during the post-pandemic period and assess whether these disparities persist after adjusting for individual-level characteristics. We used multivariable logistic regression and propensity score matching to estimate differences in telehealth use by rurality and examined self-reported reasons for non-use. We analyzed 2022 and 2024 Health Information National Trends Survey (HINTS) data, a nationally representative survey of noninstitutionalized US adults. The analytic sample included 11,106 respondents after excluding missing observations. Overall, 38.7% of adults reported telehealth use in the past 12 months. After adjusting for covariates, rural residents were significantly less likely to use telehealth than urban core residents; remote rural residence was associated with a 10-percentage point lower probability (95% CI, -16.2 to -2.8; p < 0.01). Propensity score analyses yielded similar results (-7.7% points; 95% CI, -16.2 to -2.8; p < 0.01). Among non-users, rural respondents were more likely to report not being offered telehealth. We observed significant rural-urban disparities in telehealth use in the post-pandemic period. Rural non-users were more likely to report not being offered telehealth, indicating delivery-side barriers.

3. Factors associated with immunological non-response in HIV patients receiving antiretroviral therapy in Southeast Asia: A systematic review.

期刊: Antiviral therapy 发表日期: 2026-Jun 链接: PubMed

摘要

ObjectiveThis systematic review summarizes factors associated with immunological non-response (INR) among people with HIV on antiretroviral therapy (ART) in Southeast Asia.MethodsWe conducted a systematic search of PubMed, ScienceDirect, DOAJ, and Lens.org for studies published between 2010 and 2025. Observational studies examining immunological outcomes following ART initiation and related factors were included. Study quality was assessed using the Newcastle-Ottawa Scale, and results were synthesized using a harvest plot.ResultTen eligible studies were included in the synthesis, comprising a total of 6,988 participants with substantial heterogeneity observed across studies. Factors associated with INR included age, sex, baseline CD4 cell count, HIV RNA levels, and co-infections. Among these factors, baseline CD4 cell count at the initiation of ART emerged as the most consistently associated determinant; lower baseline CD4 levels were linked to a higher risk of INR even with virological suppression.ConclusionThis review highlights baseline immunological status at ART initiation as a key predictor of immunological non-response in Southeast Asia. These findings underscore the critical importance of early HIV diagnosis and timely initiation of ART to prevent advanced immune damage and optimize immunological recovery.

4. Correction to "Midwifery Should Not Be Rendered Secondary in Health Policy: A Philippine Perspective".

期刊: International nursing review 发表日期: 2026-Jun 链接: PubMed

摘要

5. Maternal Dyslipidaemia Aggravates Offspring Metabolic Dysfunction-Associated Steatotic Liver Disease.

期刊: Basic & clinical pharmacology & toxicology 发表日期: 2026-Jun 链接: PubMed

摘要

Paediatric metabolic dysfunction-associated steatotic liver disease (MASLD) and steatohepatitis (MASH) display a distinct and severe histopathology. Maternal metabolic status may program offspring susceptibility to MASLD. This study investigated if maternal dyslipidaemia and low vitamin C (VitC) status influence offspring MASLD using a validated guinea pig model. Thirty female guinea pigs received a low-fat (LF) diet until pregnancy was confirmed, then remained on LF or switched to a high-fat (HF) diet with or without reduced VitC. Offspring were evaluated at birth and after 10 weeks on postweaning HF or LF diets. In dams, HF diet induced dyslipidaemia and elevated hepatic triglycerides and alanine aminotransferase (ALT) compared to LF dams, without causing obesity. Newborns exposed to maternal HF diet showed increased hepatic triglycerides, liver-to-body weight ratio and ALT. By 10 weeks, liver fibrosis and MASLD activity scores were higher in offspring maintained on a postnatal HF diet compared to LF. Notably, offspring viability was markedly reduced on maternal HF diet with low VitC. These findings demonstrate that even short exposure to maternal HF diet, independent of obesity, can adversely affect offspring MASLD risk and highlight the need for early prevention. Additionally, findings support the need to investigate interactions between maternal diet, VitC status and offspring survival. This study investigated if a mother’s diet during pregnancy affects her offspring’s risk of developing fatty liver disease. Using guinea pigs, which develop fatty liver disease in ways very similar to humans, we showed that a maternal high‐fat diet for the second half of pregnancy led to increased liver fat and injury in newborns. When these offspring continued on a high‐fat diet after weaning, they developed worse liver disease than those not exposed during pregnancy. Our results suggest that even without maternal obesity, an unhealthy diet during pregnancy may increase the risk of liver disease in offspring.

6. Psychosocial care and experiences in young adults living with early-onset type 2 diabetes: A narrative review.

期刊: Diabetic medicine : a journal of the British Diabetic Association 发表日期: 2026-May-09 链接: PubMed

摘要

To review the literature on psychosocial care and experiences of young adults with early-onset type 2 diabetes (EOT2D), to identify what is known, current gaps and to develop recommendations to help advance psychosocial care and support for the population. We searched Medline (Ovid), Google Scholar and diabetes-specific journals for English-language articles focused on psychosocial aspects in young adults (aged 18-45 years) with EOT2D. Two people with lived experience reviewed and commented on the review findings. Growing evidence indicates that a diagnosis of EOT2D is associated with an increased risk of developing diabetes-related psychological comorbidities. Experiences of diabetes-related stigma, compounded by age-related negative preconceptions, contribute to heightening the psychosocial impact of EOT2D. Some population sub-groups appear to be more likely to experience adverse psychological effects. However, the evidence base is limited by a dearth of diverse research specifically focused on the psychosocial experiences and needs of this population (e.g., longitudinal and qualitative studies). Adults with EOT2D also experience unmet education, care and support needs relevant to optimising their psychosocial well-being and diabetes management. Overall, they require enhanced, tailored care and support that is age-appropriate, person-centred and responsive to their psychosocial needs. Digital technology and support-based strategies may help to address current gaps and improve the psychological well-being of this group, but these require further exploration. Despite the importance of psychosocial factors in young adults’ diabetes management and outcomes, there remain gaps in research and practice and the need for further research, alongside changes in practice.

7. Mothers' and Health Care Professionals' Experiences of Remote Provision of One-to-One Synchronous Breastfeeding Support: A Qualitative Systematic Review.

期刊: Asia-Pacific journal of public health 发表日期: 2026-May-09 链接: PubMed

摘要

Breastfeeding has been shown to provide numerous benefits for mothers and babies in the short and long term. During the COVID-19 pandemic, breastfeeding support, which was traditionally provided offline, shifted to online platforms. Although these remote services were available before the pandemic began, online interventions emerged as an alternative and proved effective in helping mothers breastfeed during that period. We aimed to explore the existing literature on the experiences of mothers and health care professionals with remote one-to-one synchronous breastfeeding support and to identify the unmet support needs of mothers regarding this type of support. We systematically searched seven literature databases: MEDLINE, CINAHL Plus, MIDIRS, Web of Science, ASSIA, WHO Global Index, and Google Search. Articles published before 2010 and in languages other than English and Bahasa were excluded. A thematic approach was used to synthesise the data. Twenty-one studies were included in this review. Three themes generated from the synthesis: (1) mothers’ acceptance of one-to-one synchronous telelactation, (2) benefit of one-to-one synchronous telelactation, and (3) challenges faced in one-to-one synchronous telelactation. In conclusion, mothers generally accepted one-to-one synchronous breastfeeding support as an alternative to in-person sessions, although some challenges remain. Further improvements are needed to address accessibility and scheduling issues.

8. Alcohol Use and Risky Drinking Among Orang Asli in Malaysia: Evidence From the Orang Asli Health Survey 2022.

期刊: Asia-Pacific journal of public health 发表日期: 2026-May-09 链接: PubMed

摘要

Alcohol consumption profiles among the Orang Asli (OA) remain tribe specific. This study presents the first nationwide analysis of consumption patterns among 9225 OA adults across various tribes, based on the 2022 Orang Asli Health Survey. Alcohol consumption was assessed using the validated Alcohol Use Disorder Identification Test (AUDIT-M) questionnaire; subsequently, multinomial logistic regression was performed using Stata 16 to identify sociodemographic factors associated with non-drinkers, low-risk drinkers, and risky drinkers. Current drinker prevalence was 9.1% (95% confidence interval [6.4, 12.8]), and 88.1% preferred beer. Among drinkers, 59.5% were risky drinkers, 36.3% were binge drinkers, and 8.0% were heavy episodic drinkers. Risky drinking was significantly associated with males (P < .001), younger adults (P = .001), smokers (P < .001), the Senoi (P < .001) and Proto-Malay tribes (P = .014), and those residing in fringe (P < .001) or urban (P = .009) areas. Integrating targeted alcohol screening into community health campaigns is essential to mitigate risky drinking behaviors within these vulnerable populations.

9. Changing patterns of domestic and sexual gender-based violence among survivors attending a referral center in north-east Nigeria: A 5-year retrospective review.

期刊: International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 发表日期: 2026-May-09 链接: PubMed

摘要

This study assesses the changing patterns of domestic, sexual, and gender-based violence (DSGBV) among survivors managed at a dedicated referral center in North-East Nigeria over a 5-year period (2021-2025). A retrospective descriptive study was conducted at the Gender-Based Violence Unit of the Specialist Hospital Gombe. Records of all survivors of DSGBV managed between January 1, 2021, and December 31, 2025, were reviewed. Data on year of presentation, age, sex, type of violence, place of residence, and time of reporting were extracted. Descriptive statistics were used to summarize trends and distributions. Inferential analysis was performed using IBM SPSS version 26 (IBMCorporation, Armonk, NY, USA). This study was reported in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. A total of 675 survivors were recorded, with a progressive increase from 79 cases in 2021 to 171 in 2025. Adolescents aged 10-14 years consistently accounted for the highest proportion of cases (196/675; 29%). Females constituted 81.6% (551/675) of survivors. Sexual violence was the predominant form of abuse (556/675; 82.3%). Most survivors (601/675; 89.0%) resided in rural areas. Delayed reporting beyond 72 h was the most common pattern across all years. Reported cases of DSGBV increased progressively over 5 years, with children and adolescents bearing a disproportionate burden and sexual violence predominating. These findings highlight the need for strengthened routine screening, provider training, and equitable access to survivor-centered services, particularly for rural and adolescent populations in conflict-affected settings.

10. The current landscape and opportunities in gastrostomy care quality improvement in low- and middle-income countries: a scoping review.

期刊: International health 发表日期: 2026-May-09 链接: PubMed

摘要

This scoping review examined gastrostomy tube use and care practices in low- and middle-income countries (LMICs) to identify complications, barriers and strategies to improve patient outcomes. Guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Reviews framework, six electronic databases were searched for studies published between 2000 and 2024. Of 1805 identified articles, 18 met the inclusion criteria and were classified into two themes: gastrostomy tube indications, techniques and outcomes; and care quality assessments and interventions. Patient outcome studies reported that adult complication rates ranged from 10% to 25%, with overall mortality from 0% to 48%, while paediatric complication rates ranged from 10% to 55%. Care quality studies identified gaps in nursing practices, protocol adherence and caregiver training. Interventions proposed included multidisciplinary care models and structured training programs for providers and caregivers. These findings highlight opportunities to improve gastrostomy outcomes in LMICs through establishing culturally sensitive and well-trained multidisciplinary care teams, implementing standardized protocols and caregiver engagement.

11. Echoes of crisis: HIV risk behaviour and responses in the aftermath of multiple crises among South African vulnerable youth in an exploratory longitudinal study.

期刊: AIDS care 发表日期: 2026-May-09 链接: PubMed

摘要

The COVID-19 pandemic caused 10.5 million children and adolescents worldwide to lose a caregiver, with South Africa facing this crisis alongside the world’s largest HIV epidemic. This study examines how overlapping crises shape HIV-related risk behaviours and mental health among affected young people. Using longitudinal data from 389 participants aged 9-18; researchers assessed HIV risk behaviours, mental health symptoms and social risks at two time points. Half the sample (50.4%) experienced COVID-19-associated orphanhood. Overall, HIV risk behaviours were common, reported by 78.9% at baseline and 73.5% at follow-up. However, reductions occurred only among non-orphaned children; those experiencing COVID-19 orphanhood showed a slight increase in risk behaviours over time. Orphanhood, older age, bullying, domestic violence and community violence were associated with higher HIV risk, while female sex and larger households were protective. Mental health symptoms were significantly worse among children living in HIV-affected households who also experienced COVID-19 orphanhood (66.7% at baseline), a pattern that persisted at follow-up. These findings highlight the heightened vulnerability of children facing multiple, overlapping crises. Effective HIV prevention and support strategies must account for the compounded impacts of pandemic-related loss, violence and pre-existing HIV burdens to protect long-term wellbeing.

12. Fall research funding in the US from 2018-2022 relative to fall-related mortality, disability-adjusted life years, and healthcare expenditures.

期刊: American journal of health promotion : AJHP 发表日期: 2026-May-09 链接: PubMed

摘要

PurposeTo examine the relationship between fall-related mortality, disability-adjusted life years (DALY), healthcare expenditures, and research funding and determine whether fall prevention funding is proportional to fall-related public health impact.DesignCross-sectional.SettingUnited States.SampleNot applicable.MeasuresMortality rates (2018-2022) for leading causes of death were obtained from CDC WONDER. Disability-adjusted life-year (DALY) rates (2021) were obtained from the World Health Organization. Healthcare expenditures (2016) were obtained from the Institute for Health Metrics and Evaluation. Research funding data (2018-2022) were obtained from NIH ExPORTER and linked to causes of death using MeSH term searches.AnalysisLinear regression models were used with log-transformed research funding as the dependent variable and log-transformed mortality rates, DALY rates, and healthcare expenditures as predictors.ResultsFall mortality rate was 13.1 deaths per 100 000 individuals, fall-related DALY rate was 713.2 per 100 000, and fall-related healthcare expenditures were $106.6 billion. Falls ranked 12th in mortality, 8th in DALY, and 5th in healthcare costs but 20th in research funding, receiving $489 million over 5 years. Falls received significantly less funding than expected based on mortality rates (predicted $1.95 billion), DALY rates (predicted $3.27 billion) and healthcare expenditures (predicted $5.63 billion).ConclusionAlthough falls have a significant impact on older adults’ health and mortality, fall research funding is disproportionately low. To reduce mortality and mitigate rising healthcare costs associated with falls, federal investment in fall prevention research should be a higher priority.

13. Integration of exercise and sports medicine curriculum in China: a structured pilot course evaluation conducted among medical students.

期刊: BMC medical education 发表日期: 2026-May-09 链接: PubMed

摘要

The integration of sports and exercise medicine curriculum (SEMc) including physical activity promotion and exercise prescription competencies into medical curricula is increasingly recognised within health profession education (HPE), yet evidence of its educational impact remains limited. This study evaluated the effects of a structured SEMc on medical students’ knowledge, skills, confidence, and attitudes in exercise prescription. Medical students (n = 10) completed a 4-week SEMc on the basis of international frameworks and China’s national guidelines; controls (n = 14) received no training. All participants completed baseline and post-course knowledge tests and a course-developed questionnaire with high internal consistency.The outcomes were analysed via repeated-measures ANOVA and t tests. Participation in the SEMc significantly enhanced medical students’ competency in exercise prescription. Students who received training demonstrated substantial gains in knowledge, with scores improving from baseline and exceeding those of controls at post-assessment (95.2 ± 3.3 vs. 66.6 ± 17.1; p < 0.001). Improvements were sustained at the one-month follow-up, despite a slight decline from the immediate post-test (p = 0.041). The questionnaire data supported these findings, showing significant increases in skills (3.43 ± 0.67 to 4.18 ± 0.54; p = 0.030) and confidence (3.52 ± 0.55 to 4.07 ± 0.58; p = 0.046). Motivation remained consistently high (p = 0.290), and self-perceived knowledge did not change significantly (p = 0.170). Students not participating in the SEMc showed no notable changes (p > 0.10). At post-intervention, the SEMc group scored higher than controls in knowledge (p = 0.020), skills (p < 0.001), and confidence (p = 0.002). In this quasi-experimental pilot study, a brief, structured SEMc was associated with improvements in medical students’ exercise prescription-related knowledge, skills, and confidence. Embedding SEMc into mainstream curricula may equip future physicians with essential capacities for chronic disease prevention, aligning with the WHO’s Global Action Plan on Physical Activity.

14. Antibody response following rabies vaccination: a retrospective cohort study from a tertiary centre in Kerala, India.

期刊: Transactions of the Royal Society of Tropical Medicine and Hygiene 发表日期: 2026-May-09 链接: PubMed

摘要

Globally accelerated efforts are underway to eliminate dog-mediated rabies, underscoring the importance of effective anti-rabies prophylaxis. This study aims to assess the antibody response and its long-term persistence following rabies vaccination, their determinants, and suggest the optimal timing for a booster dose. We performed a retrospective cohort study among 150 participants, at the preventive clinic of Government Medical College, Thiruvananthapuram. Anti-rabies antibody titer in serum samples was estimated with the Rapid Fluorescent Foci Inhibition Test. To estimate the optimal timing for booster doses, the receiver operating characteristic (ROC) curve was plotted. Protective antibody titers (0.5 IU/ml) were observed in 92.7% of participants, with a mean titer of 3.81 (3.31) IU/ml. ROC analysis identified 5 years as a cut-off for booster dose. Regression analysis indicated a shorter time duration since last vaccination (P = .003) and intramuscular route (P = .005) as predictors of high antibody titers. However, the achievement of protective antibody titer was comparable for intramuscular and intradermal schedules. Achievement of protective antibody titers is universal and long-lasting following anti-rabies vaccination, irrespective of the route of vaccination. Five years since the last dose could be used as an optimal cut-off for booster dose.

15. P-CAB vs. PPI for Upper Gastrointestinal Bleeding Prevention in Patients With Atherothrombotic Disease on Antithrombotic Therapy: A CDM Cohort Study.

期刊: Alimentary pharmacology & therapeutics 发表日期: 2026-May-09 链接: PubMed

摘要

Randomised trials have suggested the benefit of potassium-competitive acid blockers (P-CABs) is superior to proton pump inhibitors (PPIs) for ulcer recurrence in high-risk aspirin users. However, real-world comparative effectiveness across diverse antithrombotic regimens remains poorly defined. We evaluated P-CABs versus PPIs for preventing upper gastrointestinal (GI) bleeding in patients with acute atherothrombotic disease and using antithrombotic therapy. This retrospective cohort study utilised hospital-based Common Data Model data (2018-2024). Patients with acute cardiovascular or cerebrovascular disease receiving antithrombotic therapy who initiated a PPI or P-CAB were included. Drug exposure was modelled as a time-varying variable to mitigate immortal-time bias. The primary outcome was upper GI bleeding, analysed via time-dependent Cox regression adjusted for age, sex, comorbidities, and concomitant medications. Among 2255 patients (PPI: 1726; P-CAB: 529) in which 53 upper GI bleeding events occurred during a median follow-up of 637 days. P-CAB use was associated with a significantly lower risk of upper GI bleeding than PPIs (incidence rate 5.7 vs. 25.8 per 1000 person-year; adjusted hazard ratio [HR] 0.22, 95% CI 0.06-0.75, p = 0.016). P-CABs showed a profound reduction in moderate-to-severe upper GI bleeding (HR 0.11, 95% CI 0.02-0.60; p = 0.011). Notably, no bleeding events occurred in P-CAB users with high antithrombotic burden (≥ 2 agents). In patients receiving antithrombotic therapy, P-CABs are associated with a significantly lower risk of clinically significant GI bleeding compared to PPIs. These findings support P-CABs as a potent acid-suppressive strategy for gastroprotection in high-risk populations.

16. The contribution of rare germline variants to the immune landscape of breast cancer.

期刊: Genome medicine 发表日期: 2026-May-09 链接: PubMed

摘要

Many breast cancer predisposition genes are involved in DNA damage repair, leading to genome instability that can impact immunosurveillance, neoantigen formation, and the composition of the tumor immune microenvironment. Here, we explored associations between germline protein truncating variants (PTVs) in 34 (putative) breast cancer predisposition genes, of which 26 involved in DNA damage repair, with the abundance of four immune cell markers, i.e., CD8 + , FOXP3 + , CD20 + and CD163 + , across 7,969 invasive breast tumors of women of European ancestry. The most apparent associations were those of CD163, a marker of M2-like tumor-associated macrophages, with genes involved in double- and single-strand break DNA repair, and with the 12 known breast cancer predisposition genes combined. Specifically, DNA damage repair genes, BRCA1, BRCA2, PALB2, RAD51D, and MSH6 were associated with a 1.3 to twofold abundance of CD163-positive cells. Estrogen receptor status was found to mediate associations to a limited extent. Our findings support a role of rare pathogenic germline variants involved in DNA damage repair, and particularly those predisposing to breast cancer, in the immune landscape of breast tumors. These insights may help guide the development of immunomodulatory strategies for breast cancer prevention and treatment.

17. The relationship between aging anxiety, job stress and psychological resilience in oncology nurses: a cross-sectional study.

期刊: BMC psychology 发表日期: 2026-May-09 链接: PubMed

摘要

Cancer is one of the leading causes of death worldwide. Oncology nurses play an essential role in the care of oncology patients. Providing care for cancer patients and managing complex treatment processes can be challenging for oncology nurses. The psychological effects of caring for cancer patients and facing their illness and death are often overlooked. The relationships between aging anxiety, job stress, and psychological resilience remain unclear. The aim of this study was to determine the relationship between aging anxiety, job stress, and psychological resilience in oncology nurses. This cross-sectional, correlational and descriptive study was conducted with 220 nurses working in an oncology hospital from December 2023 to February 2024. The Personal Information Form, Relational Aging Anxiety Scale (RASS), Nurse Stress Scale (NSS), and Resilience Scale for Nurses (RSN) were used to collect the data. Descriptive analyses, correlation analysis, and Structural Equation Modeling (SEM) were performed. Correlation analyses revealed a statistically significant low positive correlation between the relational aging anxiety subscale and NSS scores (r = 0.240, p < 0.05), and a low negative correlation with RSN scores (r = - 0.182, p < 0.05). SEM indicated that RAAS scores were a significant negative predictor of RSN scores (β = -0.214, p < 0.05) and a significant positive predictor of NSS scores (β = 0.608, p < 0.05). No significant direct effect between RSN and NSS scores (β = -0.007, p > 0.05). These findings suggest that higher aging anxiety among nurses is associated with greater stress and lower psychological resilience, highlighting the need for comprehensive training programs to reduce aging anxiety and job stress, and to enhance psychological resilience among oncology nurses. Interventions focusing on stress management, emotional regulation, and self-care are recommended. Experimental studies to evaluate the effectiveness of these interventions are encouraged.

18. Self-rated health and mental health before and during the early phase of the COVID-19 pandemic in Germany: the population-based German National Cohort (NAKO) study.

期刊: BMC public health 发表日期: 2026-May-09 链接: PubMed

摘要

The COVID-19 pandemic and accompanying social distancing measures might have caused adverse health consequences. We aimed to describe changes in participants’ self-rated health and mental health (depression, anxiety, and stress), and investigate factors associated with them. We collected data from the German National Cohort (NAKO). We first described changes in participants’ self-rated health and mental health from the baseline examination (1 to 6 years earlier) to the early phase of the COVID-19 pandemic. We then applied the multinomial logistic regression model (self-rated health) and the quantile regression model (mental health) to investigate the potential factors associated with the health status and changes. After a median of 3.1 [2.1, 4.1] years from baseline to the early pandemic phase (N = 91,809), 39.3% of participants with good health and 69.7% with less good health status at baseline reported better health. However, the percentage of participants with high depression, anxiety, and stress scores (≥ 10) increased from 6.2%, 4.1%, and 4.3% to 8.6%, 5.6%, and 10.1%, respectively. In the multivariable models, we found that being younger, being male, highly educated, being employed, having higher life satisfaction at baseline, being more physically active, drinking heavily, and experiencing improved anxiety symptoms were associated with improved self-rated health. In contrast, smoking and having mental health disorders were all associated with worse self-rated health. Our results showed that being younger, being female, smoking, drinking heavily, and drinking more since baseline were associated with higher depression scores. Having had a coronavirus test was associated with worse self-rated health and more severe anxiety and stress. During the early COVID-19 pandemic, many participants experienced improvements in self-rated health but suffered deterioration in mental health and physical activity engagement. Female participants, those who were physically inactive, and those with pre-existing mental disorders were more likely to report poorer health.

19. The Indian Medical Association's Role in Federal and State Policy Processes in India: A Scoping Review.

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

摘要

Physician associations play a significant role in shaping health policy at national and sub-national levels. However, the influence of such associations in low- and middle-income countries has not been synthesized or assessed. The Indian Medical Association (IMA), one of the largest physician associations in the world, has a long history of policy engagement at national and state levels across multiple issues. This review aims to assess - for the first time - the empirical literature available on the IMA as a political actor. Adopting a scoping review methodology, the paper sought to identify the policy stances, strategies and influence of the IMA over India’s health policy. Nine health, social science, and policy research databases were searched for English-language studies published between 1974 and 2024. Reviewing 37 papers, it finds that the IMA has been active in seven main policy domains: violence against doctors; regulation of the private healthcare sector; restriction of traditional medicine; professional authority or autonomy for physicians; publicly funded health insurance; medical ethics; and partnership in public health programs. It has been reactive against new legislation, reform or regulation in all domains except for violence against doctors. Through interrelated interior and exterior strategies, the organization has been successful in influencing, stalling or limiting legislation. While the IMA holds influence through the size of its membership and its embeddedness in health administration and corporate interests, the tactics of the organization often lack coherence and consistency. Situating these findings in the broader landscape of health governance, our review contributes further evidence for the need to develop more inclusive and transparent pathways for participation in decision-making.

20. American Medical Women's Association Position Statement on Period Poverty: Advancing Menstrual Equity Through Health Coverage Reform.

期刊: Journal of women’s health (2002) 发表日期: 2026-May-08 链接: PubMed

摘要

One in four persons with a uterus is unable to afford menstrual products, with even higher prevalence among low-income populations, an unmet need that contributes to preventable infections, missed school and work, and persistent health inequities. Despite the essential role of menstrual products in basic health and hygiene, many public health coverage programs across the United States, including Medicaid and other assistance programs, continue to exclude items such as pads and tampons. This gap disproportionately harms individuals who already face significant economic and health disparities. Although Flexible Spending Accounts and Health Savings Accounts now permit the use of funds for menstrual products, these mechanisms primarily benefit individuals with stable employment and disposable income, leaving the most vulnerable populations unprotected. Continued exclusion by insurance and assistance programs imposes an unnecessary financial and health burden and undermines dignity and well-being. Federal and state policymakers, including Congress, the Centers for Medicare & Medicaid Services, and state Medicaid agencies, have clear authority to address this inequity by expanding definitions of “durable medical equipment” and “hygiene supplies” to explicitly include menstrual products and by removing administrative barriers to coverage. The American Medical Women’s Association calls for federal action to classify menstrual products as essential health services under Medicaid and other public assistance programs.

21. Body Politic: The Political Divide in Vaccine Uptake. A County-Level Analysis of COVID-19 and Flu Vaccination Rates Across the United States.

期刊: American journal of health promotion : AJHP 发表日期: 2026-May-08 链接: PubMed

摘要

PurposeTo examine the relationship between political county-level partisanship and COVID-19 and flu vaccination uptake in the United States following the 2020 and 2024 presidential elections.DesignEcological, cross-sectional analysis utilizing public datasets.SettingAll 3224 US counties and county equivalents.SampleData includes 3224 counties; 3192 had complete COVID-19 vaccination data, and 3125 had complete flu vaccination data.MeasuresDependent variables were county-level flu and full COVID-19 vaccination rates. Independent variables included 2020 and 2024 GOP vote share, median household income, education, healthcare access, and county-level health indicators.AnalysisSpearman correlation, independent t-tests, and multivariate linear regressions.ResultsGOP vote share is strongly negatively correlated with COVID-19 vaccination (r = -.699, P < .001) and moderately with flu vaccination (r = -.427, P < .001). Counties in the highest GOP quartile had significantly lower vaccination rates than Democratic quartile counties (COVID-19: 45% vs 60%, t = -39.64, P < .001; flu: 35% vs 46%, t = -23.10, P < .001). Each percentage-point increase in GOP vote share is associated with a 0.45% decrease in COVID-19 uptake in 2024 (β = -.449, P < .001) and a 0.13% decrease in flu uptake (β = -.128, P < .001), independent of socioeconomic controls.ConclusionsPartisan alignment has become a significant determinant of vaccination, with the divide persisting between 2020 and 2024. Findings underscore the need for localized, depoliticized public health strategies.

22. SLC26A2 as a key regulator and therapeutic target in hepatocellular carcinoma: evidence from pan-cancer and mechanistic studies.

期刊: Human genomics 发表日期: 2026-May-08 链接: PubMed

摘要

Hepatocellular carcinoma (HCC) faces a critical shortage of prognostic biomarkers and therapeutic targets. While solute carrier family 26 member 2 (SLC26A2) is known to be involved in skeletal disorders and even tumors, its specific role in HCC pathogenesis remains undefined. We utilized public databases to conduct a comprehensive analysis of SLC26A2 across 33 different cancer types. Additionally, we performed in vitro and in vivo experiments to investigate the functional role of SLC26A2 in the biological behavior of HCC and to explore its mechanistic pathways. A pan‑cancer analysis revealed significant variability in SLC26A2 mRNA and protein levels, with prognostic implications across cancers. In HCC, SLC26A2 was identified as an independent risk factor for poor overall survival (HR = 1.539, 95% CI 1.084-2.186, p = 0.016) and correlated with higher pathological grade. Functional assays showed that silencing SLC26A2 inhibited HCC cell proliferation, migration, and invasion, while promoting apoptosis; conversely, overexpression led to opposite outcomes. Notably, silencing SLC26A2 significantly increased intracellular ROS, which was linked to subsequent modulation of the JNK/ERK/p38 MAPK signaling pathway-an effect suggested to be reversible by the antioxidant N‑acetylcysteine. In vivo studies demonstrated that silencing SLC26A2 suppressed subcutaneous tumor growth in an HCC xenograft model. Additionally, bioinformatics analysis predicted a competing endogenous RNA regulatory axis comprising the SNHG3/LINC00662-hsa-miR‑122‑5p-SLC26A2. Our study identifies SLC26A2 as a clinically relevant biomarker and candidate therapeutic target in HCC. Mechanistically, SLC26A2 modulates JNK/ERK/p38 MAPK activity in a manner involving ROS signaling. While its biological roles extend beyond HCC, the clinical implications are most pronounced in this malignancy.

23. Diversity and perceptions about side effects of medicinal plants used by herbalists to treat gastrointestinal diseases in Sironko District, Eastern Uganda.

期刊: Tropical medicine and health 发表日期: 2026-May-08 链接: PubMed

摘要

The escalation of gastrointestinal tract (GIT) illnesses is now a major global threat, with countries like Uganda having a prevalence of over 31 %. Herbal medicines (HM) are widely used to treat GIT illnesses in many low-resource settings including Sironko District in Eastern Uganda, but their safety remains a grave concern because they often contain bioactive phytochemicals that may cause harmful side effects. In Sironko, herbalists commonly rely on indigenous knowledge rather than formal pharmacological training when prescribing HM hence the potential for adverse reactions linked to toxic phytocompounds is substantial, warranting comprehensive scientific investigation. To explore plant species used to treat GIT illnesses and perceptions of their adverse effects in Sironko District, to inform safer herbal medicine use. A sample of 70 herbalists was subjected to an ethnobotanical survey using pre-validated semi-structured questionnaires to profile plant species primarily used against GIT illnesses plus awareness and perceptions about the associated side effects. Data were analyzed with descriptive and inferential statistics using STATA version-15.0. Graphs were plotted with GraphPad Prism® version 9.0.0. A total of 80 plants species used against GIT infections were documented, mainly in families; Asteraceae and Euphorbiaceae, indicated for treatment and prevention of 24 gastrointestinal illnesses, mostly diarrhea (18.94%), ulcers (11.81%), and stomachaches (8.52%), plus 39 ailments affecting other body systems. Informant consensus factors were high for all disease categories (≥ 0.630), showing homogeneity of ethnomedicinal knowledge. Chenopodium opulifolium, Tithonia diversifolia and Senna didymobotrya were reported to pose the greatest number of side effects, including headache and insomnia. The 70% of participants were unaware that HM can be toxic, 57% were certain that HM do not have side effects, yet those that opposed the need for urgent action against HM adversity were significantly more than participants who perceived it as vital (χ2, p < 0.0001). There is a high diversity of plant species used to treat primarily GIT illnesses in Sironko, but many potentially stimulate life-threatening adverse effects such as severe headache and vomiting. These results highlight a need for considerable investment in herbal medicine safety to leverage its optimal use in health promotion and economic development.

24. Sex-biased transcriptomic landscapes in bipolar disorder: integrating neurobiology and clinical heterogeneity through cross-study meta-analysis.

期刊: Biology of sex differences 发表日期: 2026-May-08 链接: PubMed

摘要

Bipolar disorder (BD) exhibits significant sex differences in its frequency, symptom presentation, and treatment response, suggesting distinct underlying neurobiological mechanisms. However, transcriptomic studies investigating these sex-specific pathways have been fragmented and underpowered. We conducted the first meta-analysis of post-mortem brain RNA-seq data to delineate sex-related transcriptomic landscapes in BD. We integrated data from four public datasets (GSE80336, GSE80655, GSE202537, GSE42546) from GEO and Array Express, comprising an aggregate of 173 individuals (66 BD cases and 117 controls). After preprocessing and correcting for batch effects, sex-stratified expression analysis was performed using DESeq2. A meta-analysis was conducted with the metafor package to identify differentially expressed genes (DEGs) at an FDR < 0.05. We also performed functional enrichment, protein-protein interaction (PPI) network analysis, hub gene identification, regulatory network reconstruction, and supplementary quantitative analyses of sex-specific interaction effects. Our results reveal striking differences in transcriptomic signatures between men and women with bipolar disorder, with the most pronounced changes occurring in the brain. A meta-analysis across brain regions identified 34 significantly dysregulated genes. In females, upregulated genes were enriched for hormonal signaling (FSHR pathway, G-protein signaling) and transcriptional/epigenetic regulation (GLIS1, neural plasticity). In males, upregulated genes were involved in synaptic calcium signaling (PDLIM5, dendritic spine regulation) and DNA mismatch repair pathways (PMS1). Analysis of the striatum identified 289 differentially expressed genes. The most significantly upregulated genes in females were implicated in immunity and synaptic plasticity, while the male-specific pattern pointed to alterations in basic cellular functions like structure, internal communication, and genetic regulation. A quantitative interaction analysis revealed a negligible correlation (r = -0.122) between disease effect sizes in females and males and identified one gene with opposing, sex-dependent dysregulation (MEF2C). This study provides robust evidence that bipolar disorder engages fundamentally distinct molecular pathways in males and females, underscoring the necessity of integrating sex as a biological variable in psychiatric research and advancing toward personalized therapeutic strategies. Bipolar disorder is a mental health condition that affects mood, energy, and activity levels. It is well known that the disorder affects men and women differently. However, the biological reasons for these differences are not well understood.In this study, we investigated these differences by analyzing gene activity in brain tissue from people with and without bipolar disorder. By combining data from several existing studies, we created a large dataset to see how the disorder’s biology differs between sexes.We found that the biological basis of bipolar disorder is fundamentally different in men and women. The most striking differences were in a brain region called the striatum, which is involved in reward and motivation. In men, gene changes were related to basic cell functions like energy production. In women, the changes involved genes for brain cell communication and immune response.This means the illness process differs between males and females. These findings help explain why symptoms vary by sex. Ultimately, this research suggests that doctors should consider sex as a crucial factor. Understanding these separate biological pathways could lead to better, more personalized treatments for everyone living with bipolar disorder.

25. Health literacy and its association with sustainable healthcare attitudes among nursing students.

期刊: BMC medical education 发表日期: 2026-May-08 链接: PubMed

摘要

Health literacy is a core competency in nursing education and an essential component of person-centered care. Its association extends beyond clinical communication to shaping attitudes that support sustainable, ethical, and environmentally responsible healthcare. However, this relationship remains under examined among nursing students in Middle Eastern settings. To investigate the relationship between health literacy dimensions and sustainable healthcare attitudes among Saudi nursing students and to determine whether health literacy predicts sustainability-related awareness, values, and behavioral intentions. A cross-sectional design was conducted using three independent samples: exploratory factor analysis (n = 385), confirmatory factor analysis (n = 514), and hypothesis-testing correlational analysis (n = 652). This multi-sample validation design represents a key methodological strength ensuring robust psychometric evaluation. Participants completed validated Arabic measures assessing health literacy (information literacy, communication and navigation, self-management and promotion) and sustainable healthcare attitudes (awareness/knowledge, attitudes/values, behavior/action). Correlation analysis, multiple regression, and two-way ANOVA were performed. Ethical approval and informed consent were obtained. Strong positive correlations were observed between all health literacy and sustainable healthcare dimensions (r = .776, p < .001). Regression analysis showed that health literacy collectively predicted 60.3% of the variance in sustainable healthcare attitudes (F(3,648) = 328.147, p < .001), with information literacy representing the strongest predictor (β = 0.349). Residence demonstrated a significant effect favoring urban students (p < .001), while gender showed no significant influence. Findings highlight that students with stronger meaning-making capacities, reflective awareness, and ability to interpret information demonstrated more developed sustainability attitudes and intentions, with the behavioral dimension reflecting self-reported intentions rather than observed behaviors. Health literacy is strongly associated with sustainability attitudes among future nurses. Integrating literacy-enhancing pedagogies may strengthen environmental stewardship, ethical responsibility, and holistic care orientations within nursing curricula.

26. The geographic digital divide among dementia caregivers in the U.S.: a cross-sectional study.

期刊: BMC health services research 发表日期: 2026-May-08 链接: PubMed

摘要

Digital health tools, particularly patient portals, can support caregiving, but there is limited understanding of how sociodemographic and geographic factors influence digital health engagement among U.S. caregivers, especially dementia caregivers. Dementia caregiving involves complex coordination, medication management, and frequent healthcare interactions. Therefore, access to online medical records is particularly valuable. Moreover, most previous research focuses on general digital health adoption or patient portal use among patients, not caregivers, particularly among dementia caregivers, and rarely considers geographic differences or the interaction effects between age and caregivers’ self-rated health. Comparing dementia caregivers to those without is essential because dementia caregiving entails more extensive care, longer duration, behavioral challenges, and emotional strain. These factors may increase reliance on digital health tools like online medical records. However, national studies often do not distinguish between dementia and non-dementia caregiving in digital health analyses. This study explored how sociodemographic and geographic factors are associated with caregivers’ frequency of accessing care recipients’ online medical records, especially for caregivers of individuals living with dementia compared to those caregivers of individuals without dementia. We also evaluated the interaction effect between age and health condition, motivated by the hypothesis that digital engagement is influenced not only by age but also by functional health status. This study examined caregivers’ portal access frequency using data from the 2022 National Health Interview Survey, collected between March 7th and November 8th, 2022. Descriptive statistics captured differences in access frequency and sociodemographic characteristics between dementia caregivers and non-dementia caregivers. Three ordered logistic regression models examined predictors of accessing online medical records for dementia caregivers, non-dementia caregivers, and all caregivers, followed by an all-caregiver model with interaction terms to assess moderation effects between caregiver age and self-reported health. ArcGIS Pro was adopted to visually capture the geographic regional divide in portal access frequency across the U.S. Of the 6,252 total responses, 916 caregivers provided data on portal access frequency. More than half of dementia caregivers (60.25%) and non-dementia caregivers (51.11%) did not access online medical records in the past 12 months. Frequent access (≥ 10 times/year) was low across both groups (dementia caregivers (7.03%) vs. non-dementia caregivers (12.66%)). Survey-weighted ordered logistic regression models identified significant sociodemographic and geographic disparities in portal access frequency. Being female (OR = 1.931, SE: 0.074), having a bachelor’s degree (OR = 1.769, SE: 0.168), and being married (OR = 1.749, SE: 0.068) were associated with higher portal access frequency in the all-caregivers model, and similar results were found in dementia caregivers and non-dementia caregivers. Regarding geographic disparities, dementia caregivers residing in micropolitan areas had substantially lower odds of frequent portal access than those in metropolitan areas (OR = 0.633, SE: 0.071); a similar trend was observed among dementia and non-dementia caregivers. Rural residence was also associated with lower portal access among dementia caregivers (OR = 0.529, SE: 0.152) and non-dementia caregivers (OR = 0.654, SE: 0.097). In the all-caregiver sample, caregivers in small-town areas (OR = 0.522, SE: 0.071) had lower odds of portal access compared to metropolitan caregivers. Health status showed differential patterns across caregiving groups. Among dementia caregivers, reporting very good health (vs. excellent) was associated with lower odds of portal access (OR = 0.268, SE: 0.023), whereas among non-dementia caregivers, very good health was associated with higher portal access (OR = 1.246, SE: 0.062). Good or fair health was associated with lower portal access across all caregiver groups. Interaction analysis revealed that as caregiver age increased, those in poor health had a significantly lower portal access frequency. Accessing online medical records among family caregivers remains limited and varies notably by gender, educational attainment, geographic location, and the interaction between age and health status. These findings highlight the importance of developing tailored digital support strategies that address the intersecting socioeconomic and health-related barriers faced by caregivers, particularly as artificial intelligence-enabled tools become more prevalent in dementia care. Older caregivers in poor health are especially unlikely to adopt digital resources, underscoring the urgent need for targeted outreach and educational initiatives. Additionally, the persistent geographic digital divide among dementia caregivers, especially those in small towns, calls for increased support to promote equitable access to caregiving technologies. This study conducted a secondary data analysis, so trial registration is NOT required because it does not run a prospective randomized trial. And Institutional Review Board approval is also not needed because the dataset is de-identified and public.

27. Effects of short-term resistance training plus whole-body neuromuscular electrical stimulation on blood cardiometabolic biomarkers in sedentary middle-aged women: a parallel-group, randomized trial.

期刊: BMC women’s health 发表日期: 2026-May-08 链接: PubMed

摘要

Middle-aged women are disproportionately affected by cardiometabolic deterioration during the menopausal transition. Resistance training (RT) is an established countermeasure, and whole-body neuromuscular electrical stimulation (WB-NMES) may enhance its physiological effects. However, whether short-term RT combined with WB-NMES further improves blood cardiometabolic biomarkers in this population remains unknown. In this parallel-group, randomized trial, 23 sedentary middle-aged women (47 ± 6 y, 86.3 ± 15.7 kg, 1.61 ± 0.06 m, 33.2 ± 6.0 kg∙m2) were allocated to six weeks of RT combined with WB-NMES (RT + WB-NMES; n = 11) or RT alone (RT; n = 12), performing two supervised sessions per week. Primary outcomes were blood biomarkers related to cardiometabolic risk (total cholesterol, LDL-c, HDL-c, VLDL-c, triglycerides, fasting glucose, liver enzymes, and C-reactive protein). Secondary outcomes comprised anthropometric measures, body composition, and physical fitness. No significant Group × Time interaction was identified for any blood biomarker. A significant main effect of Time was observed for LDL-c (P = 0.002) and total cholesterol (P = 0.001), with post-hoc analyses revealing significant within-group reductions exclusively in the RT + WB-NMES group (LDL-c: P = 0.041, ES = - 1.13; total cholesterol: P = 0.026, ES = - 0.91). No significant Group × Time interaction was found for any anthropometric, body composition, or most physical fitness variables. Lumbar traction strength improved significantly within the RT + WB-NMES group (P = 0.029, ES = 0.99) but not in RT alone (P = 0.569, ES = 0.53). Six weeks of RT combined with WB-NMES accelerated reductions in LDL-c and total cholesterol in sedentary middle-aged women, although statistical superiority over RT alone was not demonstrated. These preliminary findings support the cardiometabolic relevance of short-term RT + WB-NMES, though larger trials are required. U111113186998 https://ensaiosclinicos.gov.br/rg/RBR6zx5zcz. Registered on 10/09/2025.

28. Chronic alcohol consumption compromises gut barrier integrity and promotes endotoxemia: Implications for sepsis susceptibility in immunocompromised hosts.

期刊: Animal models and experimental medicine 发表日期: 2026-May-08 链接: PubMed

摘要

Gut barrier integrity prevents microbial translocation and systemic infection. Chronic alcohol disrupts this barrier, but its role in infection susceptibility among immune-compromised hosts remains unclear. We investigated how chronic alcohol promotes gut barrier dysfunction, endotoxemia, and dysbiosis, predisposing to bacterial translocation and sepsis. Twenty-four-week-old female FcγRIIb-/- and wild-type mice received oral gavage of 35% ethanol (4.2 g/kg/day) or water for 10 weeks. Gut barrier integrity was assessed by serum endotoxin, FITC-dextran permeability, ileal claudin-1, and intestinal IgG/neutrophil infiltration. Systemic inflammation was evaluated by serum TNF-α, IL-1β, and IL-6; gut microbiota by 16S rRNA sequencing. Bone marrow-derived macrophages and hepatocytes from both genotypes were stimulated with LPS or ethanol to assess inflammatory responses, mitochondrial damage, and cGAS-STING activation. Chronic alcohol induced gut barrier dysfunction in both groups, with more severe effects in FcγRIIb-/- mice, which showed marked increases in serum endotoxin and FITC-dextran permeability, reduced claudin-1, and enhanced intestinal IgG deposition with neutrophil accumulation. Serum TNF-α, IL-1β, and IL-6 were significantly elevated, reflecting a sepsis-like profile. Alcohol induced dysbiosis with an increased Firmicutes-to-Bacteroidota ratio, elevated Lachnospiraceae, and reduced Alistipes, Bacteroides, and Odoribacter. In vitro, LPS elicited stronger inflammation than ethanol in both cell types, with FcγRIIb-/- cells producing greater cytokine levels. Both stimuli caused comparable mitochondrial damage and cGAS-STING activation. Alcohol-induced gut barrier dysfunction, endotoxemia, and dysbiosis predispose to bacterial translocation and early sepsis, particularly in hosts with impaired inhibitory Fcγ receptor signaling, supporting gut barrier preservation as a strategy for preventing alcohol-associated infections and sepsis.

29. Critical Evaluation of Analytical Strategies for the Quantification of Procaine and Its Metabolites Across Diverse Matrices.

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

摘要

Procaine (PC) is an ester-type local anesthetic whose rapid enzymatic and chemical hydrolysis to p-aminobenzoic acid (PABA) makes intact-drug quantification exceptionally difficult across plasma, serum, urine, pharmaceutical formulations, and environmental waters, where PC exists only transiently and at ultra-trace levels; this review therefore aims to critically compare chromatographic, electrochemical, and spectroscopic strategies for the selective and sensitive measurement of PC and its metabolites. The evidence shows that physical separation by HPLC is indispensable for resolving PC from PABA and excipients, with fluorescence-enhanced HPLC achieving ng/mL sensitivity, while LC-MS/MS offers demonstrated analytical feasibility molecular selectivity and sub-ng to pg/mL limits enabling simultaneous PC-PABA profiling in ≤5 min; nanostructured and molecularly imprinted electrochemical sensors exploit the electroactive para-aminobenzoate moiety to provide rapid, matrix-tolerant nanomolar to sub-nanomolar detection that may reduce the extent of ex vivo hydrolysis due to rapid analysis and minimal sample handling time. Spectroscopic assays are suitable for high-throughput pharmaceutical and environmental screening, but their applicability is limited by drug instability and cross-reactivity. Given the relative scarcity of chromatographic studies on PC despite its instability-driven analytical complexity, future work should prioritize stabilization-coupled LC-MS/MS and next-generation electrochemical platforms, together with green, miniaturized workflows and AI-assisted optimization, to enable robust, high-confidence quantification of PC in real-world matrices.

30. Association between Long-Term Ambient Air Pollution and Erectile Dysfunction in Taiwan: A Nationwide Cohort Study.

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

摘要

Erectile dysfunction (ED) is a prevalent condition with important vascular and systemic implications. Although air pollution has been linked to multiple chronic diseases, its association with ED remains insufficiently explored. To investigate the association between long-term exposure to multiple ambient air pollutants and the risk of ED among Taiwanese men. We conducted a retrospective nationwide cohort study using the National Health Insurance Research Database from 2000 to 2013. Ten-year cumulative exposures to 11 pollutants-sulfur dioxide (SO2), carbon monoxide (CO), ozone (O3), particulate matter <10 µm (PM10), particulate matter <2.5 µm (PM2.5), nitrogen oxides (NOX), nitrogen monoxide (NO), nitrogen dioxide (NO2), total hydrocarbons (THC), nonmethane hydrocarbons (NMHC), and methane (CH4)-were estimated by linking residential postal codes. The outcome was incident ED (Ninth Revision of the International Classification of Diseases, Clinical Modification 302.72 or 607.84). Cox regression models adjusted for demographics, comorbidities, medications, ambient temperature, season, and short-term pollutant levels were used to estimate hazard ratios (HRs) with 95% confidence intervals (CIs). During follow-up, 4936 participants (1.16%) developed ED. Each 1-SD increase in SO2, CO, O3, PM10, PM2.5, NOX, NO, NO2, THC, NMHC, and CH4 was associated with increased ED risk (adjusted HRs 1.45-2.65; p < 0.001 for all). Conversely, O3 exposure was inversely associated with ED (HR 0.45; 95% CI 0.44-0.46). These associations remained consistent across age strata. Our findings suggest that chronic exposure to most ambient air pollutants may contribute to ED, potentially through vascular, endocrine, and inflammatory pathways, while O3 may exhibit paradoxical protective effects. Long-term exposure to multiple air pollutants is associated with an elevated risk of ED among Taiwanese men, highlighting air pollution as a potential modifiable environmental risk factor for men’s sexual health.

31. Experiencing and navigating occupational stigma as a peer support worker in mental health services: a qualitative exploration.

期刊: International journal of mental health systems 发表日期: 2026-May-08 链接: PubMed

摘要

Peer support workers (PSWs) provide support to others through their personal lived experiences of mental health. However, their work is often undervalued by their colleagues, and they frequently face challenges in the workplace, resulting in occupational stigma. Currently, there are limited insights into how PSWs experience and manage the stigma they face. Therefore, this study examines how PSWs in the UK National Health Service experience and navigate occupational stigma in their roles. Seventy semi-structured interviews were conducted with PSWs and their colleagues. Interviews explored their experiences in the role, workplace interactions, and subsequently perceptions and experiences of stigma, and how they dealt with stigmatising experiences. The data were analysed using thematic analysis to identify how stigma manifested and how they navigated it. PSWs reported experiencing stigma both covertly and explicitly. Covert stigma included subtle devaluation of their knowledge and exclusion from decision-making, while explicit stigma involved direct questioning of competence and disrespectful behaviour from colleagues. In response, PSWs navigated stigma through three main strategies. First, they demonstrated commitment to their role via reliability, dedication, and consistent performance, reinforcing the value of their work. Second, PSWs leveraged experiential knowledge as expertise, emphasising practical skills and lived experience in patient care. Third, they used their roles to create reciprocal benefits, where they supported service-users, which in turn helped their own mental health and recovery. Occupational stigma towards PSWs is pervasive, manifesting in both subtle and overt ways that can undermine their role. PSWs actively counter stigma through commitment, expertise, and reciprocal relationships, highlighting their resilience and adaptability. Addressing stigma in healthcare settings is critical for improving team dynamics and ensuring high-quality care. Going forward to support the role, policymakers and organisations that employ PSWs should focus on improving organisational culture, recognition of the role, and collaborative practices to reduce stigma, strengthen workforce sustainability and recognise the value of lived experience in the workforce.

32. The relationship between caring stress management and quality of working life in Iranian nurses: the mediating role of hope.

期刊: BMC nursing 发表日期: 2026-May-08 链接: PubMed

摘要

Nurses, as central providers of healthcare, face considerable occupational stress that threatens both their well-being and the quality of patient care. This study investigates the relationship between caring stress management and quality of working life (QWL) among Iranian nurses, with a focus on the mediating role of hope. Using a cross-sectional design, 300 nurses from two Tehran hospitals completed validated instruments measuring Caring stress management, QWL, and hope. Data were analyzed with SPSS and AMOS, employing structural equation modeling and bootstrapping methods. Structural equation modeling revealed that caring stress management significantly predicted hope (β = 0.65, p < 0.001), and hope significantly predicted quality of working life (β = 0.45, p < 0.001). The direct effect of caring stress management on quality of working life was significant (β = 0.38, p < 0.001), and the indirect effect through hope was also significant (β = 0.29, 95% CI [0.23, 0.36], p < 0.001), confirming hope’s partial mediating role. The model demonstrated good fit (χ²/df = 1.95, CFI = 0.96, RMSEA = 0.05). Findings highlight that caring stress management is not only directly associated with quality of working life but is also indirectly associated with it through higher levels of hope. These results underscore the importance of implementing caring stress management and hope-promoting strategies to support nurses’ psychological resilience, which is linked to better quality of working life and healthcare outcomes. Not applicable.

33. Prevalence and determinants of compassion fatigue among nurses in a district hospital in Bangladesh.

期刊: BMC nursing 发表日期: 2026-May-08 链接: PubMed

摘要

Compassion fatigue is an occupational hazard among nurses that arises from prolonged exposure to patient suffering and to work-related stress. In resource-limited healthcare settings, such as public district hospitals in Bangladesh, high patient loads, staffing shortages, and limited organizational support may increase nurses’ vulnerability to CF. However, evidence from district-level hospitals in low- and middle-income countries is limited. A cross-sectional study was conducted between January and June 2025 among nurses working at a 250-bedded district hospital in Bangladesh. Using stratified random sampling, 380 nurses from the medicine, surgery, pediatrics, and intensive care/emergency units were recruited. Compassion fatigue was assessed using the Professional Quality of Life Scale (ProQOL-5). Descriptive statistics were used to estimate the prevalence. Chi-square tests and multivariate logistic regression were performed to identify the demographic and occupational predictors of high compassion fatigue. Overall, 44.2% of nurses reported high compassion fatigue, and 37.6% reported moderate levels. The highest prevalence was observed among nurses working in intensive care/emergency units (52%). Multivariate analysis identified lack of organizational support (odds ratio [OR] 2.6, 95% confidence interval [CI] 1.6-4.1), more than 10 years of service (OR 2.3, 95% CI 1.4-3.8), and intensive care/emergency assignment (OR 1.9, 95% CI 1.2-2.9) as significant predictors of high compassion fatigue scores. Subscale analyses indicated higher burnout and secondary traumatic stress among nurses working in high-acuity departments. Compassion fatigue is highly prevalent among nurses in a resource-limited district hospital in Bangladesh, particularly among those working in high-acuity settings and those reporting insufficient organizational support. These findings highlight the need for targeted organizational strategies, including improved support systems, workload management, and mental health interventions, to promote nurses’ well-being and sustain quality patient care in similar healthcare contexts.

34. The physical activity health paradox: what is it, why might it happen, and where to go from here?

期刊: The international journal of behavioral nutrition and physical activity 发表日期: 2026-May-08 链接: PubMed

摘要

The “physical activity health paradox” posits that physical activity done during work (occupational physical activity [OPA]) may not yield the health benefits consistently observed for leisure-time physical activity (LTPA) and, in some cases, may be harmful. Given the broad implications for such a paradox, which contradicts current public health guidelines for physical activity, we conducted a narrative, non-systematic review to discuss the current epidemiological and mechanistic evidence on the topic to inform opportunities for research and practice moving forward. Epidemiological evidence shows that LTPA is reliably protective against mortality and cardiovascular disease, whereas OPA has mixed or adverse associations. Several recent meta-analyses found higher all-cause mortality risk among men with high vs low OPA and found LTPA to potentially mitigate this OPA risk. Studies with device-measured OPA further highlight potential heterogeneity by OPA task and context. These conclusions remain limited by low quality evidence due to heterogeneous OPA exposure measurements, referent group selection, challenges in study design, and varied confounder adjustments. Mechanistically, four interrelated pathways that may explain the observed presence of a paradox have been proposed and preliminarily tested: (1) acute cardiovascular strain catalyzed by long-duration OPA with little recovery; (2) downstream vascular changes such as greater arterial stiffness, blunted baroreflex sensitivity, and maladaptive cardiac remodeling from chronic OPA exposure; (3) systemic inflammation associated with high OPA levels; and (4) modifiers such as low cardiorespiratory fitness and high psychosocial stress amplifying strain, inflammation, and risk. Current evidence is limited by reliance on cross-sectional or between-subject designs, crude OPA classification, and limited mechanistic interventions. Unlike the clear benefits from LTPA, research findings examining the health effects of OPA remain mixed. While uncertainty remains, the balance of evidence suggests that OPA is less beneficial to health than LTPA which should be considered in public health messaging. Advancing the field will require multidimensional OPA exposure assessment, rigorous study designs, and evaluation of mechanism-driven outcomes to clarify causal pathways and identify feasible intervention targets to promote health in workers with physically demanding jobs.

35. An integrated cardiometabolic genetic testing program in a predominantly Hispanic population within a community setting.

期刊: Genetics in medicine : official journal of the American College of Medical Genetics 发表日期: 2026-May-07 链接: PubMed

摘要

This study aimed to apply cardiometabolic genetic testing in a community setting with a predominantly Hispanic population and assess feasibility and perspectives towards genetic testing. A genome sequencing (GS)-based genetic panel for cardiometabolic disorders (177 genes related to monogenic conditions, two LPA risk alleles, two pharmacogenomic (PGx) loci, and ancestry-adjusted polygenic risk scores (PRS) for type 2 diabetes (T2D) and coronary artery disease (CAD)) was deployed in community cardiology and endocrinology clinics in South Texas. A survey on perceptions towards genetic testing was administered after return of results. Testing was completed for 776 patients (18-92 years old, 92% Hispanic). 26 patients (3.4%) were identified with a pathogenic or likely pathogenic variant in a monogenic disease gene, including 17 diagnostic and nine secondary findings. Additionally, 291 (37.5%), 181 (23.3%), and 298 (38.4%) patients were identified with at least one LPA risk allele, PGx finding, or elevated PRS risk, respectively. Participants perceived the testing to be beneficial with few concerns. This study expanded cardiometabolic genetic testing to a predominantly Hispanic population in a community setting, providing actionable guidance for disease diagnosis, intervention, and preventative care with a favorable patient perception.

36. Orobanche cumana KAI2d2 mediates perception of dehydrocostus lactone and strigolactones and is inhibited by triazole ureas.

期刊: Plant communications 发表日期: 2026-May-07 链接: PubMed

摘要

Seed germination of the parasitic plant Orobanche cumana is induced by host-derived strigolactones and dehydrocostus lactone. We show that the KAI2d2 receptor perceives both ligands through distinct modes of interaction. Triazole urea compounds covalently inhibit KAI2d receptors, suppressing germination without affecting sunflower growth.

37. Pheochromocytoma and Paraganglioma: Incidence and Comparative Analysis Between Familial and Sporadic Cases in a Portuguese Single Center.

期刊: Acta medica portuguesa 发表日期: 2026-May-04 链接: PubMed

摘要

Pheochromocytomas and paragangliomas are rare neuroendocrine tumors, with an estimated incidence rate of two to eight cases per million people, and one of the highest heritability rates among neoplasms, with a genetic cause identified in approximately 40% of cases. This study analyzed cases diagnosed within the referral area of Unidade Local de Saúde de Braga between 2004 and 2024, aiming to estimate incidence, characterize the population, and compare sporadic and familial pheochromocytomas and paragangliomas. A total of 85 patients were identified, corresponding to 87 cases, with an average annual incidence of 5.3 cases per million between 2012 and 2024 and a rising trend over the study period. Genetic testing was performed in 61 patients, revealing 43 sporadic and 20 familial cases. The age at diagnosis was significantly lower in familial cases (43.4 ± 12.7 years; p < 0.001). Metastatic disease occurred only in patients with familial pheochromocytomas and paragangliomas, four and six years after diagnosis, while recurrences were observed exclusively in sporadic cases, with a median of seven years after complete remission. These findings highlight the importance of genetic testing and long-term follow-up in patients with pheochromocytoma and paraganglioma, given the risk of metastasis and recurrence even several years after the initial diagnosis.

38. [Value-Based Healthcare in the Treatment of Age-Related Macular Degeneration: Clinical and Patient-Reported Outcomes from a Portuguese Multicenter Study].

期刊: Acta medica portuguesa 发表日期: 2026-May-04 链接: PubMed

摘要

This study aimed to describe and compare patient-reported outcome measures (PROMs) and objective clinical outcome measures (CROMs) in the treatment of age-related macular degeneration (AMD), exploring the concordance between these measures within a value-based healthcare (VBH) framework. This prospective, multicenter, observational, real-world study was conducted at three tertiary referral hospitals specializing in the treatment of neovascular AMD. Clinical outcomes (CROMs) and patient-reported outcomes (PROMs) were analyzed using the National Eye Institute Visual Functioning Questionnaire 25 (NEI VFQ-25) questionnaire as a functional assessment tool. Data were collected at baseline and at three, six, and 12 months following initiation of intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy. Statistical analysis was primarily descriptive. The comparison between baseline and 12 months in the global NEI VFQ-25 score was performed using the Wilcoxon signed-rank test for paired samples. Concordance between CROMs and PROMs was assessed using the intraclass correlation coefficient (ICC). A total of 235 eyes were included, receiving 2338 intravitreal injections. The mean age of participants was 81 years (SD = 8.57), and 55.8% were female. The mean baseline NEI VFQ-25 score was 67.83 (SD = 10.39). The median best-corrected visual acuity was 63 ETDRS letters (interquartile range [P25 - P75]: 41 - 75) at baseline, increasing to 65 letters at three months and remaining stable through 12 months of follow-up. The comparison between baseline and 12 months revealed a statistically significant difference in visual acuity (Wilcoxon signed-rank test, Z = 4.2; p < 0.001). A reduction in the proportion of patients classified as legally blind was observed, together with an increase in the proportion of patients in the reading-vision and driving-vision categories. At 12 months, 58.7% of patients reported stabilization or improvement in visual function on the NEI VFQ-25 questionnaire. Concordance between the variation in visual acuity and the variation in the global NEI VFQ-25 score showed good agreement between CROMs and PROMs (ICC = 0.76; p < 0.001). The integrated analysis of CROMs and PROMs suggests that anti-VEGF treatment for neovascular AMD is associated with stabilization or improvement in visual acuity and patients’ perceived visual function. The implementation of the VBH-AMD model proved feasible in a real-world clinical setting, reinforcing the importance of integrating patient-centered measures into the evaluation of therapeutic outcomes. Introdução: O objetivo deste estudo foi descrever e comparar os resultados reportados pelos doentes (patient-reported outcome measures, PROM) e os resultados clínicos objetivos (clinical-reported outcome measures, CROM) no tratamento da degenerescência macular da idade (DMI), explorando a concordância entre estas medidas no contexto de um modelo de cuidados de saúde baseados em valor (value-based healthcare, VBH). Métodos: Conduziu-se um estudo prospetivo, multicêntrico e observacional, da prática clínica, realizado em três hospitais terciários de referência no tratamento da neovascularização macular secundária à DMI. Foram analisados os resultados clínicos e os resultados reportados pelos doentes, utilizando o questionário National Eye Institute Visual Functioning Questionnaire 25 (NEI VFQ-25) como instrumento de avaliação funcional. Os dados foram recolhidos no início do tratamento e aos três, seis e 12 meses após o início da terapêutica com injeções intra-vítreas de agentes anti-fator de crescimento endotelial vascular (anti-VEGF). A análise estatística baseou-se em estatística descritiva. A comparação entre o baseline e os 12 meses do score global do NEI VFQ- 25 foi realizada através do teste de Wilcoxon para amostras emparelhadas. A concordância entre os CROM e os PROM foi avaliada através do intraclass correlation coefficient (ICC). Resultados: Foram incluídos 235 olhos, tratados com 2338 injeções intravítreas. Na amostra, a idade média dos participantes foi de 81 anos (DP = 8,57), sendo 55,8% do sexo feminino. Relativamente ao questionário, o score médio na avaliação basal foi de 67,83 (DP = 10,39). A mediana da melhor acuidade visual corrigida foi de 63 letras ETDRS (intervalo interquartil [P25 - P75]: 41 - 75) na baseline, aumentando para 65 letras aos três meses e mantendo-se estável até aos 12 meses de seguimento. A comparação entre a baseline e os 12 meses revelou uma diferença estatisticamente significativa na acuidade visual (Wilcoxon signed-rank test, Z = 4,2; p < 0,001). Observou-se uma redução da proporção de doentes classificados como cegueira legal e um aumento das proporções de doentes nas categorias de visão de leitura e visão de condução. Aos 12 meses, 58,7% dos doentes reportaram estabilização ou melhoria da funcionalidade visual no questionário NEI VFQ-25. A concordância entre a variação da acuidade visual e a variação do score global do NEI VFQ-25 revelou boa concordância entre CROM e PROM (ICC = 0,76; p < 0,001). Conclusão: A análise integrada de CROM e PROM sugere que o tratamento da neovascularização macular secundária à DMI com anti-VEGF se associa a uma estabilização ou melhoria da acuidade visual e da perceção funcional da visão. A implementação do modelo VBH-DMI demonstrou ser aplicável em contexto de prática clínica real, reforçando a importância de integrar medidas centradas no doente na avaliação dos resultados terapêuticos.

39. [Immunoglobulin Replacement Therapy in Antibody Production Defects].

期刊: Acta medica portuguesa 发表日期: 2026-May-04 链接: PubMed

摘要

Immunoglobulin replacement therapy is an essential approach for treating patients with inborn errors of immunity that impair humoral response. The main goal of immunoglobulin replacement treatment is to provide antibodies passively, preventing severe or recurrent infections, as well as medium/long-term complications. Currently, there are different administration routes: intravenous, conventional subcutaneous, and facilitated subcutaneous with recombinant hyaluronidase. Therefore, the choice of the administration route should be individualized, with the active participation of the patient and guidance from healthcare professionals regarding the advantages and limitations of each option. This guideline aims to clarify the available immunoglobulin treatment modalities, provide practical guidance for their selection, and thereby promote better treatment adherence and effectiveness, leading to improved clinical stability for patients. A terapêutica substitutiva com imunoglobulina é parte essencial do tratamento dos erros inatos da imunidade que comprometem a resposta humoral. O seu principal objetivo é fornecer anticorpos de forma passiva, prevenindo infeções graves ou recorrentes, bem como as suas complicações a médio e longo prazo. Atualmente, existem diferentes vias de administração: endovenosa, subcutânea convencional, e subcutânea facilitada com hialuronidase recombinante. A escolha da via de administração deve ser feita de forma individualizada, com participação ativa do doente e orientação pelos profissionais de saúde quanto às vantagens e limitações de cada alternativa. Este protocolo pretende esclarecer sobre as modalidades disponíveis de tratamento com imunoglobulina, propor orientações práticas para a sua escolha e, com isso, favorecer uma maior adesão e eficácia terapêutica, promovendo maior estabilidade clínica dos doentes.

40. Portable Home-Use Triglyceride Meter Demonstrates Good Agreement With Plasma Laboratory Measures During Pregnancies Complicated by Metabolic Disease.

期刊: Endocrinology, diabetes & metabolism 发表日期: 2026-May 链接: PubMed

摘要

Fasting and postprandial triglycerides (PPTG) in obese pregnancies may be stronger predictors of fetal overgrowth than glucose, making them a potential novel treatment target. Measurement of TG currently requires venipuncture in a laboratory, a barrier to collecting repeated measures to understand contributions to fetal growth. Our aim was to evaluate agreement between fingerstick capillary TG using an FDA-approved point-of-care (POC) meter and venipuncture plasma TG (vTG) during fasting and controlled fed conditions within pregnant women. Pregnant patients (n = 35) with obesity alone (59%) or GDM (41%) (BMI 33 ± 4 kg/m2) had fasting vTG and POC TG collected, within ≤ 5 min apart at 25 ± 9 weeks’ gestation. A subset (n = 23) had PPTG collected at 1- and 2-h after a controlled breakfast test meal (35 ± 2 weeks). Two-way mixed effects intraclass correlations (ICC) and Bland-Altman plots determined agreement. Paired t-tests were used to compare vTG and POC TG (mean ± SD). Sixty-eight paired fasting TG and 52 paired 1- and 2-h PPTG were collected. Fasting vTG were slightly lower than POC TG (181 ± 66 vs. 192 ± 81 mg/dL), as were 1-h (225 ± 65 vs. 260 ± 76) and 2-h PPTG (227 ± 70 vs. 249 ± 77; p < 0.05 all). The ICC for fasting TG was 0.86 [95% CI: 0.78, 0.91] and 0.84 [95% CI: 0.32, 0.94] for PPTG. The mean % difference (vTG minus POC TG) was -4.6% ± 17.8% for fasting TG and -12.0% ± 12.0% for PPTG. These data suggest good agreement between vTG and POC TG in fasting and PPTG during pregnancies complicated by obesity and GDM. Our findings support the novel approach to utilising a POC TG meter, similar to a glucometer, to conveniently discern the contribution of TG and their potential targets in optimising fetal growth in pregnant patients with obesity and GDM.

41. Effectiveness and cost-effectiveness of text message and financial incentives for weight management in men with obesity: The Game of Stones RCT.

期刊: Public health research (Southampton, England) 发表日期: 2026-May 链接: PubMed

摘要

Men with obesity infrequently engage with weight management services. To determine: (1) percentage weight loss at 12 and 24 months for text messages with or without financial incentives compared to control; (2) secondary outcomes; (3) cost-effectiveness; (4) moderators of effectiveness and (5) participant and stakeholder perspectives. Assessor-blinded randomised controlled trial. United Kingdom National Health Service perspective cost-effectiveness over 24 months and modelled lifetime horizon. Mixed-methods process evaluation. Five hundred and eighty-five men with body mass index ≥ 30 kg/m2 enrolled (July 2021-May 2022) in Belfast, Bristol and Glasgow; final follow-up June 2024. Random allocation to 12 months of behavioural text messages plus financial incentives (N = 196), same texts alone (N = 194) or 12-month waiting list control group offered 3 months of texts between 12 and 15 months (N = 195). A £400 financial incentive was lost if weight loss targets were not met. Weight change as a percentage of baseline weight at 12 and 24 months comparing control with (1) texts with financial incentives and (2) texts alone. Of 585 men (mean age 51 years; mean weight: 119 kg), 227 (39%) lived in lower socioeconomic areas, 146 (25%) reported a mental health condition and 253 (40%) had multiple long-term conditions. Follow-up was completed by 426 (73%) at 12 months and 377 (64%) at 24 months. At 12 months, mean percentage weight changes (standard deviation) were -4.8% (6.1) (-5.7 kg), -2.7% (6.3) (-3.0 kg), and - 1.3% (5.5) (-1.5 kg) for the incentives, text-only, and control groups, respectively. Compared to control, weight loss was significantly greater with incentives [-3.2% (97.5% confidence interval -4.6 to -1.9; p < 0.001)] but not texts alone (-1.4%; confidence interval -2.9 to 0.0; p = 0.053). At 24 months, changes were -3.9% (-4.6 kg), -2.6% (-3.1 kg), and -2.2% (-2.6 kg), no significant between-group differences. Intervention costs were £243 for texts with incentives, £110 for texts alone. There were no significant differences between 24-month costs and quality-adjusted life-years. Long-term modelling found texts with incentives versus control were: quality-adjusted life-year difference (95% confidence interval): 0.02 (0.007 to 0.029); cost difference: £176 (£43; £311); incremental cost-effectiveness ratio: £9748 (£7705 to £11,791). For texts alone versus control: quality-adjusted life-year difference: 0.03 (0.015 to 0.037); cost difference: £16.5 (-£117; £152); incremental cost-effectiveness ratio: £628 (-£5914 to £5384). There were no moderator effects for socioeconomic, health or well-being status for either comparison versus control. The texts with incentives group had a higher engagement in weight goal setting, food changes, self-weighing, confidence, satisfaction and quality of life compared to the control. Generalisability to women, diverse ethnic groups and people with low literacy is uncertain. Not generalisable to people with no mobile phone access. Retention was lowest in the text messages alone group. Texts with financial incentives have a modest but important effect to 12 months with clinically relevant weight loss maintenance to 24 months, are cost-effective and equally effective regardless of socioeconomic or health characteristics. Implementation, adapt for women, other cultures and longer-term follow-up. This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme as award number NIHR129703. The Game of Stones study aimed to help men lose weight and keep it off for at least 2 years. Five hundred and eighty-five men living with obesity across the United Kingdom were split into three groups by chance: supportive text messages for 1 year and opportunity to get money for weight loss the same text messages alone for 1 year neither for 1 year, then text messages for 3 months. The first two groups received the same daily text messages about changing weight-related behaviours. Group 1 was told at the start that £400 had been put aside for them and that money would be lost if weight targets were missed. The targets were 5% weight loss at 3 months, 10% at 6 months and maintaining that 10% loss at 12 months. Money was then paid to the men after being weighed at 12 months. Every man was asked questions about their health, well-being and experiences of being in the study. After 1 year, the men in group 1 lost the most weight (5%, 5.7 kg). The men in group 2 lost some weight (3%, 3.0 kg) but not as much as the first group. The men in group 3 lost the smallest amount of weight (1%, 1.5 kg). On average, men in group 1 received £128 for meeting weight loss targets. One year after the 12-month measures, men in groups 1 and 2 had gained back some weight. Men in group 3 lost a bit more weight between year 1 and 2. Weight loss was similar whether or not men had long-term health conditions, disability, mental health issues or lived in the most deprived areas. This study showed that Game of Stones was a popular, low-cost and modestly effective way of helping men to lose weight.

42. Clinical and cost-effectiveness of negative pressure wound therapy versus usual care for surgical wounds healing by secondary intention: the SWHSI 2 pragmatic RCT.

期刊: Health technology assessment (Winchester, England) 发表日期: 2026-May 链接: PubMed

摘要

Surgical wounds healing by secondary intention occur if a surgical wound is not closed or dehisces following primary closure. Surgical wounds healing by secondary intention are common and adversely affect patients’ quality of life. Treatment is often prolonged, complex and expensive. Negative pressure wound therapy applies a controlled vacuum to the wound and is increasingly used to promote surgical wound healing by secondary intention despite limited rigorous evidence for the clinical and cost-effectiveness of negative pressure wound therapy to augment surgical wound healing by secondary intention. Assess the clinical and cost-effectiveness of negative pressure wound therapy versus usual care (no negative pressure wound therapy) in treating surgical wounds healing by secondary intention. A pragmatic, two-arm, parallel-group, randomised controlled superiority trial. Twenty-eight UK NHS Trusts randomised adult patients with a surgical wounds healing by secondary intention to receive negative pressure wound therapy or usual care (no negative pressure wound therapy). The planned sample size was 696 participants. Participants were followed up for 12 months via weekly telephone contact to collect the primary outcome (time to healing: full cover with no scab in days since randomisation) and clinical secondary outcomes: wound healing, surgical site infection, pain, hospital re-admission, current treatment and reasons for treatment change (if applicable), reoperation, amputation, antibiotic use, death. Patient-reported outcomes (pain, health-related quality of life and resource use) were collected by postal questionnaire at 3, 6 and 12 months. Validation of the Bluebelle Wound Healing Questionnaire, a patient-reported measure of surgical site infection, was also undertaken. A cost-effectiveness decision model considering all available evidence, and a within-trial cost-utility analysis, was also undertaken to evaluate the cost-effectiveness of negative pressure wound therapy against usual care. Neither participants nor the investigators were blind to treatment allocation. Between 15 May 2019 and 13 January 2023, 686 participants were recruited, randomised and included in the analysis (negative pressure wound therapy n = 349; usual care n = 337). Most participants had a single surgical wound healing by secondary intention (n = 622, 90.7%), located on the foot (n = 551, 80.3%) or leg (n = 69, 10.1%) arising following vascular surgery (n = 619, 90.2%). Most participants had comorbidities; diabetes (n = 549, 80.0%), cardiovascular disease (n = 446, 65.0%) and/or peripheral vascular disease (n = 349, 50.9%). Median time to healing was 187 days (negative pressure wound therapy) versus 195 days (usual care), with no evidence that negative pressure wound therapy reduced the time to wound healing compared to usual care (hazard ratio 1.08, 95% CI 0.88 to 1.32; p = 0.47). Odds of re-admission, reoperation, surgical site infection and antibiotic use were slightly higher, and odds of amputation or death slightly lower for negative pressure wound therapy participants. These results were not clinically or statistically significant. Bluebelle Wound Healing Questionnaire, quality of life and wound pain scores were not statistically significantly different at any time point. Serious adverse events were rare (nine negative pressure wound therapy vs. five usual-care participants). Both cost-effectiveness analyses concluded that negative pressure wound therapy generates higher costs and marginally higher quality-adjusted life-years than usual care, although findings were statistically insignificant. The probability of negative pressure wound therapy being cost-effective was under the recommended National Institute for Health and Care Excellence cost-effectiveness thresholds. The Bluebelle Wound Healing Questionnaire was acceptable to participants, had low levels of missing data and demonstrated good levels of sensitivity and specificity in the detection of surgical site infection in surgical wounds healing by secondary intention. The trial included a high proportion of diabetic participants with foot wounds, which may affect study generalisability. Negative pressure wound therapy use for ‘wound management’, common in certain surgical specialties, was not assessed in this study. Negative pressure wound therapy is not clinically or cost-effective in augmenting healing in patients with surgical wounds healing by secondary intention, particularly those with comorbidities. Evaluation of methods to treat or prevent infection of surgical wounds healing by secondary intention and evaluation of negative pressure wound therapy for ‘wound management’ are recommended. This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme as award number 17/42/94. After an operation, most wounds are closed using stitches or staples. Some wounds cannot be closed and are left open. Some closed wounds may reopen. These ‘open’ wounds are usually left to heal slowly from the bottom up. Negative pressure wound therapy is commonly used to treat ‘open’ wounds. Negative pressure wound therapy uses a machine to apply gentle suction to a wound, which removes wound fluid, and may help keep the wound clean and perhaps aid healing. We do not know if negative pressure wound therapy is as good as, better than or worse than standard wound dressings that are also used for healing ‘open’ surgical wounds. We also do not know if negative pressure wound therapy is good value for money. There has not been enough, high quality, independent research to enable doctors and nurses to decide on the best treatment. Between May 2019 and January 2023, 686 patients with an open wound agreed to take part and were equally randomly assigned to standard dressings or negative pressure wound therapy. Most of the wounds were on patient’s feet. Most patients had diabetes, and many patients also had conditions affecting their heart and/or blood vessels. We collected wound healing data, treatment information and health outcomes for each participant for a year. We found no clear evidence that negative pressure wound therapy provided any significant benefits for patients and specifically that negative pressure wound therapy did not reduce the time it took for wounds to heal compared to standard wound care. Negative pressure wound therapy was also more expensive than standard dressings and so was not likely to be a good use of healthcare resources. Patients and doctors will be able to make more informed decisions about which dressing to use to help wounds heal. The National Health Service can save money by recommending the use of standard dressings for open wounds instead of using the more expensive negative pressure wound therapy.

43. Early Carotid Structural and Functional Changes Associated With Elevated Blood Pressure in Children: A Multimodal Ultrasound Study.

期刊: Journal of clinical hypertension (Greenwich, Conn.) 发表日期: 2026-May 链接: PubMed

摘要

Childhood hypertension is closely associated with cardiovascular disease in adulthood, and the carotid artery is one of the principal target organs affected by elevated blood pressure (BP). The purpose of this study is to assess the association between carotid ultrasound-derived indices and elevated BP in children and to identify early vascular changes using multimodal ultrasound imaging. This case-control observational study included 118 children aged 10-11 years, of whom 55 had elevated BP and 63 had normal BP. Carotid ultrasound measurements included carotid diameter, conventional carotid intima-media thickness (CIMT), ultrahigh frequency CIMT (uhf-CIMT), carotid intima thickness, carotid media thickness (CMT), intima-to-media ratio (I/M), and radiofrequency-derived pulse wave velocity (rf-PWV). Associations between ultrasound parameters and BP were evaluated using multivariate linear regression models adjusted for age, sex, and body mass index. Children with elevated BP had higher values of uhf-CIMT, CMT, rf-PWV and lower values of I/M compared with children with normal BP (all p < 0.05). Systolic BP with the strongest association observed for CMT (r = 0.45). After adjustment for potential confounders, elevated BP remained independently associated with CMT, uhf-CIMT, I/M, and rf-PWV (all p < 0.05). Rf-PWV was significantly associated with carotid structural indices, particularly the I/M ratio (p < 0.05). Elevated BP in children is associated with early carotid structural remodeling and increased arterial stiffness. Ultrahigh frequency ultrasound may facilitate the detection of subtle vascular changes in pediatric with elevated BP.

44. Time Windows Used When Identifying Current Drug Use and Polypharmacy.

期刊: Pharmacoepidemiology and drug safety 发表日期: 2026-May 链接: PubMed

摘要

The length of the time window used to assess “current drug use” or “number of medications used” will influence the estimates hereof; however, no consensus exists on the optimal width of such time windows. We aimed to explore how the estimated prevalence of drug use in general, and of polypharmacy in particular, is affected by definitions used. We conducted a drug-utilization study divided into two parts. In the first part, we focused on current drug use. Using population-based registries from Denmark, we identified adults (i.e., individuals aged ≥ 18) during 2020-2022, and among them, current use of different drugs, including those with typically chronic or episodic patterns of use. The second part of the study focused on polypharmacy. We estimated its prevalence, based on different definitions, using population-based registries from Denmark in a cohort of older adults (i.e., individuals aged ≥ 65) in 2022. We also evaluated the accuracy of different criteria for predicting polypharmacy using simulations. Evaluating current drug use, the proportion of individuals classified as exposed increased with the length of the time window for all drugs, reaching a plateau considering a 120-150-day window for statins, glucose-lowering drugs, and selective serotonin reuptake inhibitors, and a 180-300-day window for opioids, whereas no plateau was reached for non-steroidal anti-inflammatory drugs within 360 days. The prevalence of polypharmacy ranged from 21% (10 different 4th level Anatomical Therapeutic Chemical (ATC) groups in 1 year) to 92% (two different 4th level ATC groups in 1 year) depending on the applied definition. In the simulation, the best criterion for identifying polypharmacy required at least two dispensations during the one-year study period for each of at least five drugs, with sensitivity ranging between 0.93 and 1.0, and specificity between 0.72 and 1.0. Time windows up to 120 days are too short to identify baseline drug use in the Danish setting. How polypharmacy is defined significantly influences its estimate, suggesting a need to use multiple definitions in each study. “Current drug use” is estimated in most pharmacoepidemiological studies. However, the impact of using different time window lengths is rarely investigated. The definition of such baseline drug use itself varies substantially—for example it may be based on prescriptions filled within the last 60, 90 or 120 days prior to, for example, cohort entry. In this study, we explored how the length of the time window considered influences the estimated prevalence of “current drug use” using Danish registry data. We observed that such prevalence was considerably underestimated when time windows shorter than 120 days were considered. We also investigated how both the number of different concomitant drugs and the time window considered affected the estimated prevalence of polypharmacy. Our findings show that these factors substantially influence the estimated prevalence, underscoring the need to include multiple definitions of polypharmacy within each study.

45. Dermal Fibroblasts Step Into the Spotlight as Potent Amplifiers of Cutaneous Inflammation.

期刊: Experimental dermatology 发表日期: 2026-May 链接: PubMed

摘要

46. Effects of Rosemary Extract on Methylglyoxal/Glyoxal-Mediated Glycation of Dairy Proteins During Thermal Processing.

期刊: Journal of food science 发表日期: 2026-May 链接: PubMed

摘要

Nonenzymatic glycation of dairy products induced by α-dicarbonyl compounds (α-DCs) occurs during thermal processing, leading to the formation of advanced glycation end products (AGEs) that pose potential health risks to human health. Rosemary extract (RE) is a common food antioxidant additive. In this study, RE was employed to counteract two representative α-DCs, that is, methylglyoxal (MGO, 1 mM) and glyoxal (GO, 1 mM), during simulated thermal processing (75°C for 2 h) of whey protein isolate (WPI, 7 mg/mL). Results showed that RE (0.1, 1, and 2 mg/mL) significantly suppressed MGO/GO-induced formation of fluorescent AGEs and concomitant glycoxidation products in a dose-dependent way. Western blotting analyses confirmed that RE interrupted the binding of MGO/GO to WPI, as evidenced by the reduced immunoreactivity of modified proteins. HPLC analysis revealed near‑complete elimination of MGO and GO at 2 mg/mL RE. Molecular docking simulations further demonstrated that the representative compounds (rosmarinic acid and carnosic acid) exhibited strong binding affinities to the protein and effectively shielded potential glycation sites from MGO/GO. However, phenol-protein interactions may compromise the structural properties of WPI proteins at high RE concentrations, which was manifested by the reductions in surface hydrophobicity and intrinsic fluorescence. Collectively, RE was validated as an effective anti-glycation agent to alleviate α-DC-mediated damage in dairy proteins in this study, which might extend its role from a conventional food antioxidant to a potent glycation inhibitor.

47. The association of burnout with occupational stressors among physicians and medical technicians/nurses in the Federation of Bosnia and Herzegovina: a cross-sectional study.

期刊: Croatian medical journal 发表日期: 2026-Apr-30 链接: PubMed

摘要

To assess the prevalence of burnout syndrome and its association with occupational stressors among physicians and medical technicians/nurses in the Federation of Bosnia and Herzegovina (FBiH). This cross-sectional study was conducted between February 12 and April 12, 2025, using an anonymous online survey. Structured self-administered questionnaire scales were used to assess burnout (Copenhagen Burnout Inventory) and workplace stressors (Occupational Stress Questionnaire). The association of personal, work-related, and patient-related burnout with occupational stressors was assessed. The survey was sent to the members of the Union of Physicians and Dentists in the FBIH, who were asked to forward the link to their medical technicians and nurses. Overall burnout symptoms were reported by more than half of the respondents (53.0%), with 75.7% experiencing at least one form of burnout. Personal burnout was the most prevalent (70.9%), followed by work-related burnout (54.2%) and patient-related burnout (40.1%). In multiple regression analysis, overall burnout was driven by the cumulative impact of multiple stressors rather than by any single factor. All stressors were positively correlated with burnout, but conflicts and communication at work (for personal and work burnout) and public criticism (for patient-related burnout) stood out as the strongest predictors. This study observed a high prevalence of burnout among physicians and medical technicians/nurses in the FBiH. All examined domains of professional stressors were correlated with all burnout dimensions. Given the importance of preventing and alleviating burnout among health care professionals, this research provides insight into key factors contributing to burnout.

48. Enhancing Aging Research in Public Health.

期刊: Biomedical and environmental sciences : BES 发表日期: 2026-Apr-20 链接: PubMed

摘要

49. Sex-specific Associations of Prenatal Exposure to Legacy and Emerging PFAS with Fetal Anogenital Distance: A Study based on the Jiashan Birth Cohort.

期刊: Biomedical and environmental sciences : BES 发表日期: 2026-Apr-20 链接: PubMed

摘要

50. Association of Planetary Health Diet with Decreased Risk of All-cause Mortality and Environmental Benefits: Insights from a Multi-national Prospective Cohort Study.

期刊: Biomedical and environmental sciences : BES 发表日期: 2026-Apr-20 链接: PubMed

摘要

Whether adherence to the Planetary Health Diet (PHD) benefits human and environmental health is less known. We included 131,130 adults from the National Health and Nutrition Examination Survey and UK Biobank. Adherence to the PHD was measured using the Planetary Health Diet Index (PHDI) and mortality was ascertained by linking to national registries. Cox proportional hazards and linear/ordinal logistic regression models were used to analyze the association between PHD and the risk of mortality and environmental impacts, respectively. During a median follow-up of 10.6 years, participants in higher adherence groups (Quartile 2: hazard ratio = 0.88, 95% confidence interval = 0.82-0.95; Quartile 3: 0.87, 0.82-0.93; Quartile 4: 0.70, 0.54-0.92) had a lower risk of mortality, compared to Quartile 1. The relationship between the PHDI and mortality showed linearity in the two cohorts ( P = 0.1877 and 0.5456, respectively), and body mass index mediated 11.88% of the relationship. A higher PHDI was associated with lower greenhouse gas emissions but higher freshwater use. Our findings suggest that greater compliance with the PHD reduces mortality risk; however, its benefits for environmental sustainability are less certain.

51. Heat Wave and Mortality Burden of Chronic Kidney Disease: Current Assessment and Future Projection in China.

期刊: Biomedical and environmental sciences : BES 发表日期: 2026-Apr-20 链接: PubMed

摘要

Although many studies have examined temperature-related non-accidental mortality, the impact of heat waves on the mortality burden of chronic kidney disease (CKD) remains poorly understood. This study aimed to assess the CKD mortality burden associated with heat waves in China under global warming. Mortality data on CKD from 2,790 counties/districts in China from 2004 to 2022 were collected from the Chinese Center for Disease Control and Prevention; meteorological data for the same period were obtained from the fifth-generation European Reanalysis Land dataset. A time-stratified case-crossover design combined with a distributed lag nonlinear model was used to examine the association between heat waves and CKD mortality. Future CKD mortality burdens attributable to heat waves under climate change and future population scenarios were projected. In total, 236,260 CKD deaths were included in this study. Compared to that during non-heat wave days, CKD mortality increased by 3.48% (95% confidence interval [ CI]: 1.67% to 5.33%) during heat waves, and the mortality risk escalated by 2.48% (95% confidence interval [ CI]: 0.12% to 4.91%) for each 1 °C increment during heat wave days. Stratified analyses revealed that CKD mortality risks were greater for women (Excess Risk [ER] = 5.52%, 95% CI: 2.71% to 8.40%), individuals aged 65 years and older (ER = 4.60%, 95% CI: 2.30% to 6.96%), and people in mesic/cold regions (ER = 6.20%, 95% CI: 1.13% to 11.53%). The projections showed that the attributable fraction(AF) of CKD mortality due to heat waves would rise from 0.64% (95% CI: 0.52% to 0.78%) in the 2020s to 2.44% (95% CI: 1.97% to 2.95%) in the 2090s under the SSP5-8.5 scenario, with the highest burden in southeastern China, including Hainan (3.31%, 95% CI: 1.66% to 5.02%), Yunnan (3.05%, 95% CI: 1.46% to 4.75%), and Guangdong Province (2.84%, 95% CI: 1.24% to 4.41%). This nationwide study demonstrated that exposure to heat waves significantly increased the mortality risk of CKD, and that women, older individuals, and people in mesic/cold regions are more susceptible to heat waves. Global warming will significantly increase the future CKD mortality burden attributed to heat waves, particularly in southeastern China. Our findings emphasize the need to address CKD in the context of ongoing climate change.

52. Persistent Negative Symptoms: Characterization of an Unmet Need in a Learning Health System for First-Episode Psychosis.

期刊: Schizophrenia bulletin 发表日期: 2026-Apr-10 链接: PubMed

摘要

Persistent negative symptoms (PNS) often emerge early in the course of schizophrenia spectrum disorders, significantly impair long-term functional outcomes, and remain difficult to treat, with no consistently effective interventions available. The manifestation of PNS in individuals with first-episode psychosis (FEP) engaged in coordinated specialty care (CSC) in the United States remains largely unknown. This study characterizes negative symptoms in routine clinical care using data from the Early Psychosis Intervention Network’s Connection Learning Healthcare System, with a focus on a subcohort of individuals with PNS. Practice-based data were collected every 6 months over a 2-year period from 1289 participants across 23 CSC programs using a Core Assessment Battery (CAB) comprised of clinician-rated and self-report measures. Negative symptoms were quantified across CAB items, allowing for categorization of participants into PNS (n = 79) and non-PNS groups (n = 455). Group comparisons examined outcomes across CAB items, and exploratory mediation analyses focused on the role of engagement in outcomes relative to PNS. Individuals with PNS had higher rates of schizophrenia and lower social and role functioning compared to those in the non-PNS group. Exploratory analyses indicated that service engagement at 6 months mediated the negative relationship between PNS and 12-month social and role functioning. These findings highlight the challenge of PNS in individuals with FEP receiving CSC, the importance of early service engagement, and an opportunity to develop targeted interventions and refine treatment approaches to improve outcomes in this unique subgroup.

53. Characterizing Infectious Disease Mortality in Severe Mental Illness: A Retrospective Matched Cohort Study.

期刊: Schizophrenia bulletin 发表日期: 2026-Apr-10 链接: PubMed

摘要

People with severe mental illness (SMI) are at an increased risk of infection mortality compared to the general population. Little is known about how this risk might differ across infection types, and the potential impact of sociodemographic and clinical factors. We investigated associations between SMI and infection mortality in a population-based cohort, examining variation by infection type and potential moderating factors. This retrospective matched cohort study (January 1, 2000 to December 31, 2019) used national primary care data from the UK Clinical Practice Research Datalink linked with Office of National Statistics mortality data. Competing risks regression and cause-specific hazard models assessed risk of infection mortality in people with SMI versus non-SMI controls. We examined risk across different infection types and assessed the impact of sociodemographic and clinical factors. Our cohort comprised 84 494 people with SMI matched on age, gender, and GP practice with 84 494 non-SMI controls. Fully adjusted models showed that people with SMI were more likely to die from any infection compared to non-SMI controls (adjusted hazards ratio (aHR) = 1.58, 95% CI, 1.44-1.74). Infection-specific analyses revealed increased risk of death from respiratory (aHR = 1.69, 95% CI, 1.51-1.89), gastrointestinal (aHR = 2.01, 95% CI, 1.16-3.48), and renal/urinary (aHR = 1.70, 95% CI, 1.32-2.19) infections in the SMI group. People with SMI are at increased risk of infection mortality, especially from respiratory, gastrointestinal, and renal/urinary infections. We recommend prioritizing this group for preventative measures including influenza and pneumococcal vaccines.

54. Persistent Psychosis During 4 Years after First Hospitalization for a Psychotic Disorder in the Suffolk County Mental Health Project: Prevalence, Risk Factors, and Relationship to 25-Year Outcomes.

期刊: Schizophrenia bulletin 发表日期: 2026-Apr-10 链接: PubMed

摘要

The early phase of psychosis is critical for interventions to modify long-term outcomes. It is unclear what proportion of individuals’ exhibit early persistent psychosis and the long-term implications. An epidemiologic sample of individuals with acute psychosis was recruited at first admission and followed for 25 years. Early persistent psychosis was defined as presence of active psychosis for ≥90% of the days of the 4 years after first hospitalization for psychosis. Multivariable regression analyses were conducted, testing the association between baseline predictors and persistent psychosis, and between persistent psychosis and 25-year outcomes. Out of 526 individuals (age = 27.4 ± 9.4 years, males = 56.8%, baseline schizophrenia/schizoaffective disorder = 30.0%), 101 (19.2%) had early persistent psychosis. At baseline, low premorbid cognitive performance (odds ratio (OR) = 2.08, 95% CI, 1.05-4.12), lower Global Assessment of Functioning (OR = 1.59, 95% CI, 1.16-2.13), low role function (OR = 1.49, 95% CI, 1.03-2.16) and worse social function (OR = 1.52, 95% CI, 1.03-2.22) were predictive of persistent psychosis. At 25-year follow-up (n = 307, 58.9%), early persistent psychosis was associated with worse avolition ($\beta$=0.25, 95% CI, 0.14-0.35), more severe reality distortion ($\beta$=0.19, 95% CI, 0.07-0.31), disorganization ($\beta$=0.21, 95% CI, 0.09-0.32), worse social ($\beta$=-0.18, 95% CI, -0.06 to -0.30), role ($\beta$=-0.22, 95% CI, -0.09 to -0.34), and global function ($\beta$=-0.28, 95% CI, -0.17 to -0.38), greater odds of being on public assistance (OR = 2.13, 95% CI, 1.15-3.95), lower odds of living independently (OR = 0.43, 95% CI, 0.23-0.80) or recovery (OR = 0.09, 95% CI, 0.02-0.38). One in 5 individuals with first-episode psychosis had early persistent psychosis without clearly modifiable premorbid factors, and with strong associations with adverse long-term outcomes. Individuals experiencing early persistent psychosis require focused long-term interventions.

55. Psychotropic Prescribing in Young People with Schizophrenia: Trends, Sex Differences, and COVID-19 Effects.

期刊: Schizophrenia bulletin 发表日期: 2026-Apr-10 链接: PubMed

摘要

Schizophrenia treatment in young people involves complex pharmacological decisions, yet sex-specific prescribing patterns and pandemic impacts remain poorly understood. We hypothesized that prescribing trends would differ systematically by sex and show pandemic-related disruptions. This population-based cohort study analyzed 8092 individuals aged 15-29 years with schizophrenia-spectrum disorders in Hong Kong (2011-2023) using electronic health records from the Hospital Authority system. We examined temporal trends in 11 medication subclasses using generalized least squares models with autoregressive correlation structures, sex differences using interaction terms, and COVID-19 impacts using interrupted time series (ITS) analysis with adjustment for age and comorbidity. After covariate adjustment, all medication subclasses increased over time (0.05-3.71 percentage points annually), indicating universal treatment intensification. Males showed steeper increases than females in 5 subclasses after adjustment, with 18 of 21 specific agents increasing significantly more in males. Period-level pandemic comparisons showed minimal effects, but ITS analysis revealed substantial COVID disruptions in 5 medication subclasses namely oral first-generation antipsychotics, injectable second-generation antipsychotics, serotonin and norepinephrine reuptake inhibitor, Z-hypnotics, and benzodiazepines. Young people with schizophrenia experienced universal treatment intensification with males receiving more intensive pharmacotherapy after controlling for confounders. The pandemic produced complex sex-specific disruptions masked by aggregate analyses. Whether these prescribing patterns represent appropriate individualization or systematic care variation remains unknown, highlighting the critical need for studies linking prescribing patterns to functional outcomes and quality of life.

56. Dopamine Receptor D1 Activation Alleviates Repeated Ketamine Exposure-Induced Cognitive Dysfunction in Mice by Inhibiting NLRP3/Caspase-1-Dependent Pyroptosis.

期刊: Schizophrenia bulletin 发表日期: 2026-Apr-10 链接: PubMed

摘要

Ketamine triggers cellular pyroptosis through an NOD-like receptor protein 3 (NLRP3)/caspase-1 pathway, leading to neurotoxicity and cognitive deficits. Dopamine receptor D1 (DRD1) activation, however, suppresses NLRP3 inflammasome activation, thereby curbing inflammation. We hypothesized that ketamine induces pyroptosis through the NLRP3/caspase-1 pathway, resulting in neurotoxicity and cognitive dysfunction, and that DRD1 activation could counteract these effects. To investigate the relationship between DRD1 and ketamine-induced pyroptosis and behavioral changes in mice, we conducted both in vivo and in vitro experiments. Our findings reveal that ketamine induces dose-dependent pyroptosis in HT22 cells, which is alleviated by NLRP3 and caspase-1 antagonists. Furthermore, a DRD1 agonist effectively reduces ketamine-induced pyroptosis in these cells. In vivo, DRD1 activation decreases ketamine-induced NLRP3/caspase-1-dependent neuronal pyroptosis and ameliorates cognitive impairment in mice by inhibiting NLRP3. Conversely, a DRD1 antagonist enhances NLRP3/caspase-1-mediated pyroptosis, replicating the behavioral deficits seen with ketamine exposure. Moreover, DRD1-specific knockdown in neuronal cells prevents ketamine-induced cognitive dysfunction and reduces pyroptosis. Dopamine receptor D1 activation mitigates ketamine-induced cognitive dysfunction in mice by inhibiting NLRP3/caspase-1-dependent pyroptosis. These findings offer new insights into the psychobehavioral disorders and cytotoxicity associated with ketamine.

57. Genetically Predicted Gut Microbiota and Bladder Cancer Risk: A Mendelian Randomisation Analysis.

期刊: Archivos espanoles de urologia 发表日期: 2026-Apr 链接: PubMed

摘要

Gut microbiota (GM) has been increasingly implicated in cancer development through immune modulation, metabolic regulation, and systemic inflammatory pathways. Although observational studies have suggested a potential link between GM dysbiosis and bladder cancer (BC), these findings remain susceptible to confounding and reverse causation. To our knowledge, few studies have applied a Mendelian randomisation (MR) framework to systematically evaluate the gut-bladder axis from a genetic perspective. We performed a two-sample MR analysis to examine associations between genetically predicted GM composition and BC risk. Genetic instruments for 119 GM taxa were obtained from the MiBioGen consortium. Summary-level genetic association data for BC were derived from the UK Biobank. The inverse variance weighted (IVW) method was used as the primary analytical approach, complemented by Mendelian randomisation-Egger regression (MR-Egger) and weighted median methods. Sensitivity analyses were conducted to assess heterogeneity and horizontal pleiotropy. Instrumental variants were further mapped to host genes to perform exploratory functional annotation and pathway enrichment analyses. In the primary IVW analysis, five GM taxa demonstrated nominal associations with BC risk. Higher genetically predicted abundance of Oscillibacter (OR = 0.706, 95% CI: 0.564-0.883) and Oscillospira (OR = 0.668, 95% CI: 0.490-0.910) was associated with lower risk, whereas Lachnospiraceae (FCS020 group) was associated with increased risk (OR = 1.406, 95% CI: 1.070-1.847). However, none of the associations remained statistically significant after Bonferroni correction for multiple testing. Sensitivity analyses revealed no evidence of significant heterogeneity or directional pleiotropy, and estimates were broadly consistent across MR methods. In this MR study, we identified nominal associations between genetically predicted GM composition and BC risk. As none of the findings remained statistically significant after correction for multiple testing, these results should be interpreted with caution. Further replication in independent cohorts and mechanistic investigations into the role of candidate taxa are warranted to clarify the potential involvement of the gut-bladder axis in bladder carcinogenesis.

58. Dynamic changes in mean corpuscular volume could be integrated into longitudinal prediction frameworks for individualized risk assessment in the ICU setting: A retrospective study.

期刊: Science progress 发表日期: 2026 链接: PubMed

摘要

ObjectiveTo evaluate whether early variability in mean corpuscular volume (MCV) during the first five days of intensive care unit stay is associated with in-hospital mortality in critically ill patients.MethodsWe retrospectively studied all adult patients treated on intensive care units (ICU) at the University Medical Center Mannheim between 2018 and 2022 with more than one MCV measurement within the first five days, including at least one on the day of admission. The primary endpoint was in-hospital mortality. MCV variation, expressed as the coefficient of variation (CV), was analyzed using generalized additive models, multivariable logistic and Cox regression.ResultsAmong 5,327 patients (median age 66 years, 38.9% female, mortality 28.3%), median MCV variation was 1.86% (IQR 1.15-2.74%). Patients with high variation (CV >2.5%) showed higher mortality rates (34.7% vs. 20.1%, p<0.0001). In a baseline-adjusted model, this association remained significant (OR 1.65, 95% CI 1.46-1.87, p<0.001). By contrast, baseline MCV at admission showed a univariat association with mortality but was not independently associated with mortality after multivariate adjustment (OR 1.02, 95% CI 0.98-1.06, p=0.31). Determinants of high variation (>2.5%) included elevated CRP, transfusion volume, respiratory disease, and fluid balance disturbances. In a second, severity-adjusted model including lactate, mean arterial pressure, and fluid balance, the previously observed association between high MCV variation and mortality was no longer significant (adjusted OR 1.16, p = 0.57, CI: 0.84-1.59).ConclusionsEarly variation in MCV during the initial five days after ICU admission is associated with in-hospital mortality in unadjusted analyses. However, this relationship is not independent of established clinical severity markers, suggesting that MCV variability reflects disease severity. Nonetheless, MCV variation may serve as a readily accessible adjunctive marker of physiological instability in critically ill patients, meriting further investigation.

59. Trastuzumab Deruxtecan-Induced Interstitial Lung Disease: A Systematic Review and Meta-Analysis of Clinical Trials and Real-World Evidence.

期刊: Cancer control : journal of the Moffitt Cancer Center 发表日期: 2026 链接: PubMed

摘要

IntroductionTrastuzumab deruxtecan (T-DXd)-induced interstitial lung disease/pneumonitis (ILD) represents a clinically significant and potentially fatal toxicity. Discrepancies exist regarding its reported frequency and severity between clinical trials (CTs) and real-world data (RWD). This meta-analysis aims to evaluate the incidence of T-DXd-related ILD and investigate its differences between CTs and RWD.MethodsA systematic review and meta-analysis was conducted in accordance with the PRISMA guidelines. Databases were searched from their inception through January 2026. CTs and real-world studies reporting T-DXd-related ILD were included in the analysis. Pooled incidences for all-grade, grade ≥3, and fatal ILD were calculated using random-effects models. Subgroup analyses comparing CTs and RWD, and meta-regression analyses for relevant outcomes were performed.ResultsThirty-five studies (19 CTs, 16 RWD) including 6840 patients were analyzed. The pooled incidence was 8.8% for all-grade ILD, 1.6% for grade ≥3 ILD, and 0.26% for fatal ILD. RWD was independently associated with lower reported rates of all-grade and fatal ILD, while prior lines of therapy were the main predictor of grade ≥3 ILD.ConclusionILD risk with T-DXd differs by severity and data source. Vigilant monitoring is essential, particularly in heavily pretreated patients.

60. Medicaid CGM Barriers in Blind/Low Vision and Deaf/Hard of Hearing Populations.

期刊: Journal of diabetes research 发表日期: 2026 链接: PubMed

摘要

Continuous glucose monitors (CGMs) are essential tools for diabetes management; however, many state Medicaid programs do not have standardized, inclusive policies that ensure equitable access to CGMs for blind/low vision (BLV) and deaf/hard of hearing (DHH) populations, driving disparities across the United States and its territories. This policy analysis examines the barriers and facilitators to Medicaid CGM coverage for BLV and DHH populations, specifically in Medicaid and non-Medicaid expansion states, and patient choice in CGM device selection. CGM barrier language existed in 9.6% of states and U.S. territories, preventing BLV and DHH populations from accessing CGM. Facilitator language was present in 5.8% of states and U.S. territories, advocating for equitable access to CGMs for BLV individuals but not DHH individuals. Given the limitations of CGM alarms, this paper also emphasizes the need for Medicaid to cover secondary devices that provide needed haptic, visual, and audible alarms as necessary accessibility tools rather than optional add-ons. These devices are integral to ensuring a safe and independent CGM use for BLV and DHH individuals. Policy changes that prioritize health equity, framing CGM access as both a usability issue and a matter of eligibility for all Medicaid beneficiaries, is crucial.

61. Can Technology Use Alleviate Workforce Needs in Finnish Assisted Living Services? A Convergent Mixed-Methods Study of Automatic Medicine Dispensers and Night-Time Monitoring.

期刊: Journal of nursing management 发表日期: 2026 链接: PubMed

摘要

Workforce needs are growing in older people care, exacerbated by the aging population. Technological solutions offer potential means to address this challenge. However, their effects on work and worktime management remain unclear, especially in the setting of assisted living services. Our aim was to assess the potential of two established technologies, automatic medicine dispensing and night-time monitoring, in alleviating workforce needs in Finnish assisted living facilities. The effects of the two technologies on workforce needs were studied using a convergent mixed-methods design, incorporating quantitative time and motion analysis and qualitative analysis of two open-ended survey questions. Linear regression analysis and data-driven thematic analysis were employed. The quantitative and qualitative results were integrated and compared afterward. Our quantitative results indicated that medicine dispensing technology can streamline medicine management and administration, but effects on direct care time were not found. Use of night-time monitoring technology was associated with more direct care during nights and reduced nightly staffing. The qualitative analysis highlighted medicine dispensers freeing up time for other work and night-time monitoring reducing the need for nightly rounds. However, several technology-related problems and a loss of medication competencies were perceived. Our results converged on several positive workforce effects, notably optimizing medication management and promoting individualized care during nights. Technology use could be promoted in assisted living services, when it demonstrably streamlines care work, increases work efficiency, allows for reduced staffing, or promotes individualized and patient-centered care. National care policy can incentivize the use of similar technologies, for example, through staffing level legislation. However, care unit management should prepare for potential technology-related errors and acute emergencies by upkeeping both technology and medication competencies of nurses and ensuring the presence of sufficient staff. Importantly, the potential efficiency gains must not come at the expense of quality or safety of care.

62. Migraine Features and Nociceptive Profile Do Not Influence Conditioned Pain Modulation in Women With Episodic and Chronic Migraine.

期刊: Pain research & management 发表日期: 2026 链接: PubMed

摘要

To determine the influence of sensitization-associated and neuropathic-like symptoms and clinical features in conditioned pain modulation (CPM) activity in women with episodic or chronic migraine. A cross-sectional study including 70 women with chronic migraine and 70 with episodic migraine was performed. Clinical migraine features (related disability, pain intensity, frequency, and duration) and pain processing variables (sensitization-associated or neuropathic-like symptoms) were evaluated with self-reported outcomes. Pressure pain thresholds (PPTs) at the temporalis muscle, lateral epicondyle, and tibialis anterior were bilaterally assessed. Heat (HPT) and cold (CPT) pain thresholds at the frontalis (V1 area) muscle were also assessed. Subsequently, CPM was evaluated immediately after a 1-min cold-pressor test paradigm on changes obtained in PPTs, HPT, and CPT. No significant group ∗ time interactions after controlling for migraine features, related disability (MIDAS, HIT-6), sensitization-associated (CSI), or neuropathic-like symptoms (S-LANSS) were found for PPTs at the temporalis muscle (Wilk’s λ = 0.996, F[1128] = 0.500, p = 0.481, n2p = 0.004, 1 - β = 0.108), lateral epicondyle (Wilk’s λ = 0.997, F[1128] = 0.369, p = 0.545, n2p = 0.003, 1 - β = 0.093), and tibialis anterior (Wilk’s λ = 0.999, F[1128] = 0.070, p = 0.792, n2p = 0.001, 1 - β = 0.058) as well as CPT (Wilk’s λ = 0.991, F[1128] = 1.136, p = 0.288, n2p = 0.009, 1 - β = 0.185) or HPT (Wilk’s λ = 0.992, F[1128] = 0.992, p = 0.315, n2p = 0.008, 1 - β = 0.170): no significant changes in PPTs, CPTs, or HPTs were seen after the conditioned stimulus in women with either episodic or chronic migraine. No significant effect of clinical or pain processing outcomes on CPM was seen. This study showed similar CPM activation (lack of) in women with episodic and chronic migraine. Thus, clinical features and the presence of sensitization-associated or neuropathic-like symptoms did not modulate CPM activity in women with migraine.