公共卫生研究摘要 (2026-05-12)

共收录 50 篇研究文章

1. Interplay between vaccine-related informational milestones, social media discourse, and vaccine administration rates for human papillomavirus and measles/mumps/rubella vaccines in the United States.

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

摘要

The digital age has profoundly transformed public health communication. This study investigated the interplay between vaccine-related informational milestones, social media discourse, and vaccine administration trends for human papillomavirus (HPV) and measles, mumps, and rubella (MMR) vaccines from 2011 to 2019. The goal was to understand how vaccine-related public health and policy events align with online discourse and vaccination behaviors. This retrospective study utilized sentiment analysis of Reddit, X, and YouTube posts categorized as positive, neutral, or negative. Medical claims data from the Merative MarketScan Commercial Database were analyzed to track HPV and MMR vaccine administration rates. Vaccine-related informational milestones were compiled from the Immunization Action Coalition, Centers for Disease Control and Prevention, Food and Drug Administration, and Advisory Committee on Immunization Practices. A total of 110 informational milestones were identified. Social media discussions were primarily neutral (59%), with positive sentiments declining from 35% to 24% between 2011 and 2019. HPV vaccine discussions demonstrated a stable positive-to-negative sentiment ratio (2.75:1 by 2019), while MMR discussions surged during specific events, notably the 2015 Disneyland measles outbreak. Informational milestones often coincided with increased social media activity. HPV vaccination rates peaked in August, and MMR rates showed gradual increases with consistent seasonal peaks. Although increased online discussions rarely correlated with immediate behavioral changes, our analysis reveals intricate relationships between informational milestones, social media sentiment, and vaccine administration rates. Public health communication strategies should consider the nature of these events and the timing of announcements to effectively engage the public and promote vaccination.

2. Mothers' understanding of and attitudes towards providing support for paternal post-partum depression.

期刊: Infant mental health journal 发表日期: 2026-Jul 链接: PubMed

摘要

Although paternal post-partum depression (PPD) significantly impacts the mental wellbeing of fathers and their families, there are many barriers to fathers being assessed and supported for PPD. Given mothers are positioned both close to fathers and healthcare services, we employed mixed-methods to investigate mothers’ potential role in facilitating fathers’ recognition of and help-seeking for PPD. In Study 1, 189 mothers in Australia (M age = 35.0, 78.9% Australian-European) completed an online survey assessing mothers’ levels of mental health literacy regarding paternal PPD. Results showed that 86.8% of mothers correctly recognized paternal PPD, 84.7% recommended professional help options, and almost all mothers were either likely or very likely to recommend professional help-seeking. In Study 2, 15 Australian mothers (M age = 37.4, 93.3% Australian-European) participated in qualitative interviews to explore mothers’ willingness and capacity to facilitate fathers’ recognition of and support for paternal PPD. Findings suggested that mothers’ capacity and willingness to adopt this facilitative role may be undermined by poor-quality partner relationships, the all-encompassing experience of early motherhood, and stigma regarding men’s mental health; however, certain health care practices could target such barriers. Together, these findings have important implications for policy and practice regarding paternal PPD and family support.

3. Association of Military Sexual Trauma With Migraine and Migraine-Related Health Care Utilization Among Post-9/11 US Veterans.

期刊: Neurology. Clinical practice 发表日期: 2026-Jun 链接: PubMed

摘要

Military sexual trauma (MST) is increasingly recognized in US veterans. MST is associated with psychiatric disease, substance abuse, and pain conditions, including headache. Little is known about the relationship between MST and specific headache disorders. This retrospective cross-sectional study analyzed administrative data from the Women Veterans Cohort Study, a sample of post-9/11 US veterans enrolled for Veterans Health Administration care. A positive MST screen in the electronic medical record defined exposure. We extracted demographic and clinical data from administrative coding for migraine and relevant confounders, comparing between subgroups with χ2 tests. Health care utilization variables included designated sites of care and prescribed acute and preventive treatments and were evaluated with multivariable logit, negative binomial (nb), and zero-inflated nb models. Of 846,435 veterans screened for MST, 4.4% of veterans had a positive screen, whereas 9.5% had migraines. Veterans with migraine and a positive MST screen (21.7%) were more often non-White (45.3% vs 38.6%, p < 0.001), and 33 or less years old (55% vs 53%, p < 0.001) than veterans with migraine and a negative MST screen (9.0%). Adjusting for sex, the odds of migraine were greater for veterans with a positive MST screen (OR 1.62, 95% CI 1.57-1.67). Veterans with migraine and a positive MST screen were no more likely to receive triptan medications than veterans with migraine (46.2% vs 45.7%, p = 0.47) although were more likely to be prescribed opioids (36.1% vs 33.4%, p ≤ 0.001), compared with those with migraine and a negative MST screen. After controlling for sex, comorbidities (including chronic pain conditions), treatments, and other health care use, health care utilization was increased among migraine veterans with a positive MST screen, compared with migraine veterans without a positive MST screen for primary care (IRR 1.06, 95% CI 1.04-1.08, p < 0.001) and emergency department care (IRR 1.14, (95% CI 1.07-1.22), whereas neurology visits were not increased (IRR 0.97, 95% CI 0.92-1.02). Veterans with a positive MST screen constitute a vulnerable population more likely to have migraine, take opioid medications, and use emergency departments for migraine care.

4. Bridging the Funding Gap in Drug Development for Amyotrophic Lateral Sclerosis.

期刊: Neurology. Clinical practice 发表日期: 2026-Jun 链接: PubMed

摘要

Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disease with few effective treatments and high clinical trial failure rates. Since 1995, only 3 drugs riluzole, edaravone, and tofersen have gained approval from the Food and Drug Administration, all offering modest benefits. Challenges in ALS drug development include poor translational preclinical models, underpowered early-phase trials, and the high cost of late-stage development. Despite federal initiatives such as the Accelerating Access to Critical Therapies for ALS Act and the ALL ALS Consortium, critical gaps remain in funding large multisite trials and sustaining research networks. Accelerating progress requires strengthening national registries, expanding adaptive trial platforms, integrating existing networks, and adopting innovative funding models such as milestone-based public-private partnerships and reinvestment of licensing revenues. A coordinated, sustainable research and funding ecosystem could transform ALS therapy development and serve as a model for advancing treatments for other rare neurodegenerative and neurogenetic disorders.

5. Uncoupling Relapse Reduction and Disability Progression: Evidence From Tolebrutinib Studies.

期刊: Neurology. Clinical practice 发表日期: 2026-Jun 链接: PubMed

摘要

The aim of this study was to evaluate whether the treatment effects of tolebrutinib on confirmed disability worsening (CDW) diverge from its effects on relapse prevention compared with other disease-modifying therapies (DMTs) for relapsing multiple sclerosis (MS). We extracted published effect estimates for annualized relapse rate (ARR) and CDW confirmed at 24 weeks from all phase 3 trials with teriflunomide as the active comparator: ASCLEPIOS (ofatumumab), OPTIMUM (ponesimod), ULTIMATE (ublituximab), EVOLUTION (evobrutinib), and GEMINI (tolebrutinib). When duplicate trials were available, pooled estimates were derived. Log-transformed estimates were used in a weighted linear regression of CDW vs ARR, with bubble size reflecting statistical precision. Tolebrutinib was excluded from the regression fit but displayed for comparison. Across 4 DMTs other than tolebrutinib, a strong linear association was observed between treatment effects on ARR and CDW (R2 = 0.997), indicating that disability benefit was generally proportional to relapse reduction. By contrast, tolebrutinib deviated from this relationship, with a hazard ratio for CDW of 0.71 (95% CI 0.53-0.95) despite a relapse rate ratio of 1.03 (95% CI 0.85-1.25). Tolebrutinib was the only therapy to show a benefit on CDW without a measurable effect on relapses, highlighting a dissociation between disability worsening and relapse suppression not observed with other DMTs.

6. Health Care Utilization in Refractory Migraine: A Cross-Sectional Analysis of a Cross-Institutional Electronic Health Care Records Database.

期刊: Neurology. Clinical practice 发表日期: 2026-Jun 链接: PubMed

摘要

Refractory migraine (RM) is associated with substantial disability, yet its clinical and health care utilization patterns remain poorly characterized in large, real-world populations. Understanding how preventive treatment progression relates to health care use and patient characteristics may inform earlier identification and care strategies. We sought to evaluate demographic, clinical, and health care utilization patterns in chronic migraine according to the number of preventive medication trials using a large cross-institutional electronic health record (EHR) database. We conducted a retrospective observational study using the Epic Cosmos Cross-institutional EHR Database from January 1, 2016, to December 31, 2024. Adults with chronic migraine (International Classification of Diseases, Tenth Edition code G43.7) were included. Preventive medication trials were categorized into 5 classes: antihypertensives, antidepressants, antiseizure agents, calcitonin gene-related peptide-targeted therapies, and onabotulinumtoxinA. We evaluated demographics, comorbidities, and health care utilization metrics, including inpatient or outpatient dihydroergotamine (DHE) infusions, emergency department (ED) visits for headache, MRI brain orders, and patient EHR portal recency (MyChart). Marginal changes were defined as the percentage point change in outcomes between medication classes. Chi-squared tests and analysis of variance were used with significance set at p < 0.05. A total of 1,572,698 patients were identified by our search criteria; 21.2% were prescribed no preventive medications and 2.5% were prescribed all 5 classes, meeting the study’s definition of RM. Health care utilization increased significantly with each additional medication class. The greatest marginal increases occurred between zero to 1 classes for MyChart access (43-day decrease), 1 to 2 classes for ED visits (+9.2%), and 4 to 5 classes for DHE administration (+6.1%) and MRI brain orders (+4.9%). Patients prescribed more preventive classes were older, a higher percentage female sex, White race, with public insurance, residence in the Northeast United States, and live in less socially vulnerable areas. Comorbidity burden increased progressively, with 94.6% of refractory patients having at least 1 comorbidity, most commonly anxiety (78.1%), depression (71.5%), hypertension (56.0%), and asthma (36.3%). All differences were statistically significant (p < 0.001). Higher health care utilization, greater comorbidity burden, and distinct geographic patterns are observed with increasing numbers of preventive medication trials in chronic migraine. These findings highlight the complexity of RM and underscore the need for earlier identification and more equitable access to comprehensive migraine care.

7. Synovial fibroblasts modulate endothelial activation in an acute injury-on-a-chip model.

期刊: Proceedings of the National Academy of Sciences of the United States of America 发表日期: 2026-May-19 链接: PubMed

摘要

Most patients who sustain an acute joint injury develop degenerative joint disease or osteoarthritis (OA). Animal models have informed the design of OA therapeutics; however, no disease-modifying therapy has successfully translated to human patients. Thus, there is a strong motivation to develop humanized in vitro platforms to fill a critical gap in knowledge of disease progression postinjury. Here, we develop an acute injury-on-a-chip model of the synovium, a vascularized, joint-lining tissue that has been implicated in OA progression and as a key driver of joint disease. We apply this chip-based system to investigate the crosstalk between endothelial cells, lining an engineered vessel, and synovial fibroblasts, embedded within an extracellular matrix hydrogel. Our data indicate that synovial fibroblasts, rather than initiating disease, attempt to support and maintain vascular function in the presence of acute inflammation (i.e., interleukin-1β). Such knowledge may provide new targets for OA therapeutics, preventing the progression from joint injury to disease in patients.

8. Swartkrans Paranthropus and Sterkfontein Australopithecus from southern Africa had different locomotor repertoires.

期刊: Proceedings of the National Academy of Sciences of the United States of America 发表日期: 2026-May-19 链接: PubMed

摘要

Southern African hominin fossils traditionally attributed to Paranthropus robustus and Australopithecus africanus are differentiated from each other by their dentition and cranial architecture, but their postcranial anatomy has typically been regarded functionally as broadly similar (i.e., terrestrial bipedalism with some degree of arboreal locomotion). Testing the hypothesis of a similar locomotor repertoire between these two taxa has been complicated by a lack of postcranial fossils attributable to P. robustus. Here, we detail our comparative examination of the internal bone anatomy of a recently described c. 1.8 Ma P. robustus articulating femur and tibia, which suggests distinct patterns of joint loading and locomotor behavior. Our analysis of cortical bone in the hip and trabecular bone in the ankle, knee, and hip joints suggests that P. robustus habitually adopted a high frequency of ankle, knee, and hip flexion, as required for climbing, while Australopithecus from a c. 3.4 Ma level at the site of Sterkfontein displays a more modern human-like structural pattern across the lower limb joints consistent with comparatively more frequent terrestrial bipedalism. These results reveal that geologically younger P. robustus likely used arboreality more frequently than older Sterkfontein Australopithecus. Together with differences in masticatory behavior, this line of evidence indicates that these two hominin taxa occupied distinct ecological niches.

9. Integrating Planetary Health in Health Guidelines (GRADE Guidance 46).

期刊: Annals of internal medicine 发表日期: 2026-May-12 链接: PubMed

摘要

Human health and natural systems are intrinsically linked-stable natural systems enable healthy human life. Health systems aim to promote, restore, and maintain health. Health systems may promote human health while having detrimental effects on natural systems, contributing to the transgression of planetary boundaries, such as biosphere integrity, climate change, and the introduction of new entities like microplastics. To date, the health guideline field lacks methods to assess the impacts of health interventions on planetary boundaries. The GRADE (Grading of Recommendations Assessment, Development and Evaluation) Working Group established the Planetary Health Project Group in 2023 to develop formal GRADE guidance for integrating planetary health into guideline recommendations to address this gap. Guided by the concepts of planetary health and planetary boundaries and following established methods for GRADE guidance development, the project group conducted iterative case study analyses, expert workshops, and a 2-round global Delphi consensus process. Four case studies were selected for application of this guidance before recommendations were finalized. The GRADE Working Group approved the official guidance. The Planetary Health Project Group presents 7 domains of guidance for incorporating planetary health aspects into the guideline development process, including highly desirable items and optional items. Highly desirable items include formally addressing planetary health in public health and health system guidelines and explicitly justifying its exclusion where it is not addressed. Judgments within the evidence-to-decision (EtD) framework should systematically integrate included evidence across the prioritized planetary boundaries and equity. This guidance aims to support guideline developers and policymakers in making evidence-based, trustworthy recommendations to protect individual and planetary health, while maintaining thoroughness and feasibility for guideline developers within the GRADE approach.

10. Telemedicine Policy and Practice: A Position Paper From the American College of Physicians.

期刊: Annals of internal medicine 发表日期: 2026-May-12 链接: PubMed

摘要

In response to the COVID-19 pandemic, federal policymakers temporarily lifted long-standing restrictions on telemedicine, resulting in an unprecedented and rapid expansion of virtual care across video, audio, and asynchronous modalities. When integrated into longitudinal care relationships, telemedicine can increase access, reduce patient burden, and support continuity for people facing geographic, mobility, or socioeconomic barriers. However, telemedicine also introduces new clinical, regulatory, equity, and safety challenges that require deliberate policy design. Beyond its clinical considerations, telehealth offers environmental and logistical benefits, including reduced travel time and cost, decreased fuel consumption, lower transportation expenses, and lower greenhouse gas emissions. In this position paper, the American College of Physicians updates its previous policy paper on telemedicine to reflect changes in payment policy, licensure, prescribing authority, and utilization patterns that have occurred over the past decade and accelerated during the COVID-19 public health emergency. This paper focuses on access, payment policy, licensure, prescribing practices, equity, and patient safety across federal and state programs and private payers and emphasizes the conditions under which telemedicine should be integrated into clinical practice. Key developments addressed include the expansion and partial lapse of Medicare telemedicine waivers, evolving U.S. Drug Enforcement Administration rules governing prescribing, increased reliance on interstate practice, and normalization of telemedicine by private payers.

11. Giant Cell Arteritis.

期刊: Annals of internal medicine 发表日期: 2026-May-12 链接: PubMed

摘要

Giant cell arteritis is a relapsing large-vessel vasculitis affecting the aorta and its branches. It is the most common vasculitis in persons 50 years of age and older. Vision loss occurs in 18% of patients and is preventable with prompt recognition, evaluation, and treatment. Large-artery complications include stenosis, aortic aneurysms, or dissections. Glucocorticoid therapy is effective, but nearly 50% of patients experience relapse. Tocilizumab and upadacitinib are efficacious glucocorticoid-sparing therapies. Patients require long-term monitoring for aortic aneurysms, a late disease complication, even after therapy is discontinued.

12. Early Versus Late Initiation of Evolocumab and Arterial Aneurysm Events: An Analysis of FOURIER and FOURIER-OLE.

期刊: Circulation 发表日期: 2026-May-12 链接: PubMed

摘要

13. AI-Based Automation for Medication Reconciliation: Scoping Review.

期刊: Journal of medical Internet research 发表日期: 2026-May-11 链接: PubMed

摘要

Medication reconciliation (MedRec) has the potential to improve patient safety by enhancing the continuity of medication information across settings. MedRec involves 3 core tasks: the creation of a best possible medication history, the identification of medication discrepancies among medication lists, and the resolution of medication discrepancies. While artificial intelligence (AI) has the potential to improve MedRec, existing reviews have not identified the ways in which researchers have used AI to facilitate MedRec tasks and their constituent subtasks or the level of automation achieved. This scoping review aimed to map how previous research has applied AI to MedRec tasks and subtasks and assess the extent of automation achieved. We searched MEDLINE, Embase, Web of Science, IEEE Xplore, and Compendex in June 2024 for studies that used AI to support a MedRec task or subtask, excluding entirely rule-based tools or studies focused on other aspects of medication management. After screening 2345 unique records, we conducted backward citation searching of studies included at the full-text stage, identifying an additional 795 unique records. We used a 4-stage model of human information processing as a structural lens to guide our considerations of automation, mapping the core tasks of MedRec onto this model. A total of 94 studies met the inclusion criteria. All studies addressed subtasks related to the creation of a best possible medication history. Only 2.1% (n=2) of the studies also addressed the identification of discrepancies. Thus, the highest stage of automated information processing achieved was information analysis, although most studies (92/94, 97.9%) only automated information acquisition steps. Most studies (67/94, 71.3%) used free-text clinical notes from the electronic health record, although a significant proportion (21/94, 22.3%) used images of pills or images of other medication-related items. Studies using text-based data used a variety of machine learning methods (eg, recurrent neural networks, conditional random fields, support vector machines, and transformers), whereas those that leveraged images typically used convolutional neural networks. Most studies (61/94, 64.9%) used publicly available data from benchmarking datasets (eg, n2c2 2022) and were strictly model development studies, with only 1.1% (n=1) being usability studies. This is the first review to consider the role of AI in the automation of MedRec tasks, offering a basis for prioritizing future development efforts. Current applications of AI to automate MedRec tasks are preliminary, with most work focusing on the extraction of medication information and limited to proof-of-concept model development. Future work should consider addressing infrastructural barriers to the AI-based automation of MedRec tasks (eg, data incompleteness in sources of medication information) and exploring approaches to automate discrepancy resolution. Beyond developing models, there is also a need to implement them in tools and evaluate them in real-world contexts.

14. Natural history of NGLY1 deficiency: motor function & clinical features.

期刊: Human molecular genetics 发表日期: 2026-May-11 链接: PubMed

摘要

N-glycanase 1 (NGLY1) Deficiency is an ultra-rare neurodevelopmental disorder caused by biallelic loss-of-function mutations in the NGLY1 gene, leading to severe impairments in neurocognitive and motor function abilities in the affected patient population. Its core clinical features include global developmental delay, hyperkinetic movement disorders, elevation of liver transaminases, (hypo)alacrima, and progressive sensorimotor neuropathy. Due to the range of phenotypes and severity within the confirmed patient population, ongoing characterization of the disease is critical. A prospective natural history study (NHS) was conducted to further elucidate disease phenotypes and examine any changes in neurocognitive or motor function over a one-year period. Fifteen participants, representing roughly 10% of the total identified patient population, were enrolled to complete three onsite visits. Participants in this study exhibited phenotypes previously reported, including core disease phenotypes, hypotonia, scoliosis, musculoskeletal abnormalities, abnormal electroencephalogram (EEG) results, and visual and genitourinary abnormalities. Results from validated neurocognitive and motor function assessments revealed profound global developmental delays in all participants, including communication, gross and fine motor function, and cognitive domains. Age-equivalent scores identified a widening developmental gap between participants and neurotypical peers over time, indicating delayed milestone achievement and/or regression. Although fluctuations were observed, measurements for individual participants were mostly stable over the course of the NHS. Liver transaminase and biomarker N-acetylglucosamine-asparagine (GlcNAc-Asn; GNA) levels were elevated in all participants. Results build on previous studies and inform the selection of potential endpoints for emerging interventional clinical trials, including laboratory values, neurocognitive and motor function assessments, and caregiver reported outcomes.

15. Stakeholder Perspectives on Cancer Survivors' Return to Work and Well-Being: Qualitative Interview Study.

期刊: JMIR cancer 发表日期: 2026-May-11 链接: PubMed

摘要

About 4 in 10 people in Sweden get cancer during their lifetime, and approximately half of them will be diagnosed during their working life. As cancer survival rates improve, a growing number of individuals face challenges in returning to work following treatment. This increases the demand for effective return-to-work (RTW) strategies. Despite existing rehabilitation frameworks, cancer survivors often encounter barriers to sustainable work reintegration. This study aimed to investigate stakeholders’ perceptions of facilitators and barriers to RTW among cancer survivors, including factors promoting work-related well-being during the RTW process. During the development phase of a work-oriented rehabilitation intervention, semistructured interviews were conducted, with 25 stakeholders involved in the RTW process: health care professionals (n=12), social insurance officers (n=7), employers (n=5), and an employment service agency officer (n=1). Data were analyzed using qualitative content analysis. Five overarching themes were identified that influenced RTW: collaboration and clear division of responsibilities, balancing individual adaptations, reducing structural barriers through support, views and expectations of the individual regarding RTW, and the emotional significance of work. Key facilitators included flexible work arrangements, individualized adaptations, a strong desire to work, and the emotional value of work. Barriers comprised lack of collaboration among stakeholders, particularly the absence of a clear division of responsibilities, as well as structural barriers, such as sick leave bureaucracy and financial obstacles. The role of rehabilitation coordinators was highlighted as pivotal in bridging gaps between stakeholders and ensuring continuity in care. RTW for cancer survivors is a complex, multifactorial process requiring coordinated efforts across health care, insurance, and employment sectors. Enhancing collaboration, clarifying stakeholder responsibilities, and implementing flexible, individualized support structures are essential to facilitating cancer survivors’ RTW. Additionally, including a designated coordinator in the process is proposed. More support during the early phase of RTW is necessary to reduce the risk of long-term labor market exclusion. To help cancer survivors’ RTW, clear role definitions and shared responsibilities among stakeholders are essential. Flexibility in the RTW process helps individuals reintegrate at their own pace, reduces isolation, and promotes social connection. These are key considerations for future policies and support measures.

16. Predictive correlates of arthritis and joint damage in systemic lupus erythematosus: a multinational prospective cohort study.

期刊: Rheumatology (Oxford, England) 发表日期: 2026-May-11 链接: PubMed

摘要

To determine the prevalence and predictive correlates of arthritis and joint damage in systemic lupus erythematosus (SLE) patients in the Asia-Pacific Lupus Collaboration (APLC) cohort, and to determine their impact on health-related quality of life (HRQoL). SLE patient data (2013-2020) were collected from the prospective multinational APLC cohort. We defined arthritis according to SLE Disease Assessment Index (SLEDAI-2K) definition, persistent arthritis as arthritis in ≥ 2 consecutive visits, and joint damage according to the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI) definition (deforming or erosive arthritis). HRQoL was measured by Short Form Survey (SF36). Descriptive statistics, univariable and multivariable Cox hazard models, and Kaplan-Meier analyses were performed. During median 2.5(1.0-5.1) years of follow-up, 803/4106(19.6%) patients had arthritis at least once, and 18/3383(0.53%) accrued joint damage. Patients with arthritis were more likely to be female, Caucasian, current smokers at enrolment, and less like to have tertiary education; they also had higher overall disease activity, and lower physical and mental HRQoL. Kaplan-Meier analysis demonstrated that joint damage was more likely in patients with arthritis. Persistent arthritis and longer follow-up were risk factors for joint damage accrual; being from high-income countries was protective. Patients with joint damage also had worse physical HRQoL. Arthritis in the APLC cohort was infrequent compared with other cohorts and was associated with smoking, higher overall disease activity, and damage accrual across multiple domains. Presence of arthritis significantly impacted physical and mental HRQoL. Joint damage was strongly predicted by persistent arthritis.

17. Ventricular conduction is a marker for arrhythmic risk in SCN5A-E1784K overlap sodium channel disease.

期刊: Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology 发表日期: 2026-May-11 链接: PubMed

摘要

SCN5A-E1784K (c.5350G>A) is the most common variant associated with the long QT (LQTS) and Brugada syndromes (BrS). It can manifest variably as LQTS, BrS and/or conduction disorders. This presents a challenge for risk stratification. We aimed to describe clinical and ECG characteristics and identify risk markers that associate with arrhythmic events. We undertook a retrospective observational multicentre study of a large cohort of 231 subjects with SCN5A-E1784K from Europe, USA and Japan. Comprehensive demographic and clinical data, including initial presentation ECG and follow-up, were collected. ‘Lethal events’ were defined as sudden death, non-fatal cardiac arrest, and documented sustained VT or VF. ‘Cardiac events’ were defined as arrhythmic syncope plus any lethal events. Clinical characteristics and ECG parameters corrected for age were investigated for association with lethal and/or cardiac events. Fourteen (6%) subjects experienced a lethal event and 45 (19%) a cardiac event. PR interval and QRS duration were associated with lethal and cardiac events. In multivariable models, both PR interval and QRS duration were associated with lethal events but only QRS duration was associated with cardiac events. Only age-corrected QRS (rQRS) was associated with lethal and cardiac event-free survival from birth after correction for multiple testing. Ventricular myocardial conduction appears likely to play a role in the risk of arrhythmic events in patients with SCN5A-E1784K. This provides an important opportunity for the personalisation of management and has the potential to guide preventative therapies.

18. Age and Seasonal Variation in Pediatric Fractures: An Epidemiological Study Based on 90,000 Fractures From the Swedish Fracture Register.

期刊: Journal of pediatric orthopedics 发表日期: 2026-May-11 链接: PubMed

摘要

Fractures among children and adolescents are common; however, comprehensive national studies are limited. A nationwide register-based cohort study was undertaken using data from the Swedish Fracture Register (SFR) to analyze the epidemiology of long bone fractures in children and adolescents in Sweden, including seasonal and age-related variations. This observational study used data from the SFR. All patients aged 16 or younger with a fracture in any segment of a long bone (humerus, forearm, femur, and tibia) from May 1, 2015 to April 31, 2023 were included. Epidemiological data, including age, month of injury, sex, affected side, open or closed physis, injury type, fracture classification according to the AO Paediatric Comprehensive Classification of Long Bone Fractures (PCCF), and treatment type, were retrieved and analyzed. During the 8-year study period, 87,004 children with 94,347 fractures to any part of a long bone were registered in the SFR. In 2021, the overall annual incidence of long bone fractures was 133 per 10,000 children. Distal forearm fractures accounted for almost half of all fractures (n=45,355, 48%). There was a continuously increasing number of fractures with increasing age until a peak between ages 10 and 12. Fractures were most common in May to June and August to September. This study presents the epidemiology of pediatric fractures based on over 90,000 cases from the SFR. Distal forearm fractures were the most common, accounting for half of long-bone fractures in children (0-16 y). A general peak in fracture incidence was observed around the onset of puberty, with variation across fracture locations. The study also reveals a distinct seasonal variation in pediatric fractures. May to June and August to September appear to be the most common months for children and adolescents to sustain fractures in Sweden. Level II-retrospective study.

19. Theorizing How Context Influences School-Based Interventions That Support Children's Weight Management: Co-Producing a Refined Logic Model.

期刊: Journal of participatory medicine 发表日期: 2026-May-11 链接: PubMed

摘要

Schools can play an important role in supporting child weight management, with evidence suggesting that school-based interventions can be effective, albeit with substantial variation. Part of this variation could reflect the different contexts in which interventions are implemented. Our previous work found that co-production of research and adopting a complex systems model of evidence can be transformative for understanding this context. However, less is known about how co-production helps prioritize elements for exploration or how we should assess the value of co-production in research development. This study addresses these gaps by co-producing a refined logic model (a graphical representation of a theory) of the contextual influencers on school-based weight management to support public health research and policymaking. This study aimed to (1) identify critical contextual features to consider when planning school-based weight management interventions targeting the intersection of physical activity, healthy eating, and mental well-being; (2) understand the difference that we, as co-producers, make when working together; and (3) identify learning about the process of producing and refining a logic model. Through collaborative workshops, we refined an existing theoretical framework identifying contextual influences. We critically reviewed existing frameworks for evaluating co-production, creating a new evaluation approach for our collaborative practices, complemented by surveys and workshop feedback. Six criteria were identified and applied to refine the original logic model, significantly reducing complexity. The revised model prioritized systemic and policy factors, emphasizing environmental structuring rather than individual behaviors, and incorporated a stronger emphasis on life course factors. We used a tool and process developed specifically for this project, which may have broader utility for other research projects, to understand the value of working together. Many of us recognized that the impacts of the project and working together were unexpected and, for some of us, transformational. Nevertheless, we did identify some factors that could support co-production in future. These included the need for clearer initial discussions on positionalities, role expectations, and autonomy. Our refined model aligns with broader calls to shift away from narratives centered on personal responsibility in children’s health. This research further demonstrates the practical value and feasibility of co-produced theoretical frameworks, effectively reshaping the focus of research from the outset and challenging established assumptions.

20. Unlocking the Full Potential of Health Care Teams: How Artificial Intelligence Can Help.

期刊: JMIR AI 发表日期: 2026-May-11 链接: PubMed

摘要

Developing effective health care teams is critical to meet the rising complexity in patient care. However, optimizing team composition, interpersonal dynamics, and care processes in complex health care systems requires processing vast amounts of data that capture fluid interactions among professionals-a task that has been cumbersome, costly, and avoided by most organizations. Well-designed artificial intelligence (AI) tools can meaningfully advance the frontier of health care teamwork, but the application of AI in this regard has been lagging. To support this development, we outline the potential for AI to help optimize team composition, strengthen norms and relationships among professionals, and standardize team-based clinical care processes. These applications can improve the integration of health care teams. Given the importance of relevant data for realizing such advances, we describe the potential types and sources of data that can support AI development. Furthermore, we highlight enabling strategies, including data-sharing alliances and leadership engagement to address privacy, interoperability, and ethical considerations. We propose a sequenced roadmap for piloting these applications based on technological readiness and clinical feasibility, ensuring that human oversight remains central as AI tools are introduced into complex care environments.

21. Professionalism in Emergency Medical Services: A People-Centered Approach to Prehospital Care-A Position Statement and Resource Document.

期刊: Prehospital emergency care 发表日期: 2026-May-11 链接: PubMed

摘要

Professionalism is an important construct in emergency medical services (EMS) clinical practice. It encompasses a broad range of characteristics in the affective domain and is critical to the creation of effective EMS clinical and administrative teams. Prehospital clinicians play a unique role on the health care team. They are called to a variety of locations for serious illness or injury at a time a patient or a family member is experiencing a crisis in their lives. Patients trust EMS professionals to enter their home, to respect their autonomy, to provide expert medical care, and to transport them to the right place at the right time.Patient-centered care is the ‘north star’ for EMS clinicians and maintaining professionalism is the core value that allows for quality care of all patients 24/7/365. Under stressful conditions, EMS personnel must manage their attitudes, skills, and abilities to advocate for patients and provide the right interventions. Professional behavior at all levels of the EMS organizational structure leads to confidence in the system, support of the professionals providing care, promotion of teamwork within the health care continuum, public trust, a capable and sustainable workforce, and delivery of excellent patient care.The National Association of EMS Physicians (NAEMSP) recommends:Professionalism should be a core competency of EMS practice for EMS clinicians, educators, medical directors, administrators, and support staff (“EMS personnel”).Professionalism should provide the framework for prehospital clinical care and builds public trust in EMS systems.Professionalism should be incorporated in initial training and in continuing education for all levels of EMS professionals.Professional behaviors should be modeled by EMS administrative staff, educators, and medical directors.Professionalism should be incorporated into daily interactions of the EMS workforce with staff, colleagues, patients and families.Professionalism should be measured and incorporated into quality and performance improvement plans within EMS systems.

22. Injury Rates and Costs for Direct and Non-direct Care Employees in Four Public Sector Healthcare Facilities.

期刊: Journal of occupational and environmental medicine 发表日期: 2026-May-11 链接: PubMed

摘要

This study examines injuries among clinical personnel and understudied staff roles (i.e., dietary, cleaning, security). Workers’ compensation claims from 2017-2019 were analyzed for two state Department of Mental Health Services (DMHS) and two Veteran Care (VC) facilities, including workforce size and demographics, injury/illness claims, and costs. Incident rates and costs were compared by job category and facility type. At DMHS, the highest claim rates were from mental health workers (71/100 full-time equivalents (FTEs)), with assaults, surface wounds, and person-related injuries most common. At VCs, nursing aides had the highest rates (45/100 FTEs), primarily due to patient handling injuries, musculoskeletal disorders, and bodily motion. Some non-direct care workers (e.g., dietary) had similar rates to nurses. These findings suggest that targeted prevention interventions should address injury risks and include non-clinical workers.

23. Prevalence and Treatment of Anxiety and Depression Among US Healthcare Workers, 2021-2024.

期刊: Journal of general internal medicine 发表日期: 2026-May-11 链接: PubMed

摘要

Healthcare workers (HCWs) face high levels of psychological distress due to workplace stressors, but there is a paucity of evidence on the prevalence and treatment of anxiety and depression among HCWs. To examine the prevalence and treatment of self-reported anxiety and depression among HCWs. Retrospective cross-sectional study using nationally representative data from the 2021-2024 National Health Interview Survey (NHIS). 76,800 adults aged 18-64 years old. The primary exposure was HCW status, categorized by self-report. The primary outcomes were self-reported anxiety and depression. The secondary outcome was self-reported untreated anxiety or depression. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using logistic regression models. Among 76,800 participants (59.0% aged 18-44, 50.4% female, and 58.9% non-Hispanic White), self-reported anxiety (23.3% vs 19.1%, p < 0.001) and depression (22.3% vs 18.9%, p < 0.001) were more common among HCWs than non-HCWs. Among individuals with self-reported anxiety or depression, HCWs were more likely to report untreated anxiety (72.1% vs 64.9%, p < 0.001) and untreated depression (67.2% vs 60.7%, p < 0.001), respectively. Anxiety and depression increased from 2021-2024 for HCWs (both p < 0.001). In multivariate regression, compared with non-HCWs, HCWs had higher odds of self-reported anxiety (OR: 1.21, 95% CI: 1.12-1.31) and depression (OR: 1.20, 95% CI: 1.11-1.29). HCWs had increased odds of self-reported untreated anxiety (OR: 1.28, 95% CI: 1.12-1.46) and depression (OR: 1.25, 95% CI: 1.10-1.42) among adults with self-reported anxiety or depression, respectively. In this study, HCW status was associated with self-reported anxiety and depression, as well as lower rates of treatment. The prevalence of anxiety and depression significantly increased over the study period. These findings underscore the importance of structural interventions in protecting the mental well-being of the healthcare workforce.

24. Faith-based mental health awareness in Lagos: evaluating knowledge, stigma, and referral outcomes from the MeHPriC initiative.

期刊: Social psychiatry and psychiatric epidemiology 发表日期: 2026-May-11 链接: PubMed

摘要

This study evaluated the effectiveness of a faith-based mental health literacy intervention implemented in churches and mosques in Lagos, Nigeria, as part of the Mental Health in Primary Care (MeHPriC) initiative. The primary aim was to assess changes in mental health knowledge, stigma-related attitudes, and referral behaviour, and to examine the moderating effects of education, gender, language match, facilitator-faith congruence, and congregation size. A total of 14,120 adult participants, recruited from 314 religious institutions (233 churches, 81 mosques), received a single 15-minute mental health awareness session delivered in their preferred language by trained facilitators. Validated instruments were used to assess mental health knowledge (Mental Health Knowledge Schedule, MAKS), stigma-related attitudes (Reported and Intended Behaviour Scale, RIBS), and referral behaviour at baseline, 6 weeks, and 3 months. Significant improvements were observed in mental health knowledge (MAKS: from 17.6 to 21.5, p < 0.001, d = 0.55) and stigma-related attitudes (RIBS: from 12.9 to 16.1, p < 0.001, d = 0.68). Referral behaviour increased from 3.5% at baseline to 8.2% at 3 months (p < 0.001). Moderator effects were evident across all outcomes, with stronger improvements among participants who had higher education, preferred language alignment, female gender, faith-congruent facilitators, and attended medium-sized congregations. Faith-based institutions can serve as effective platforms for delivering scalable, culturally adapted mental health interventions. The findings support further integration of religious venues into national mental health promotion strategies in LMICs, with attention to context-sensitive delivery and primary care linkage.

25. Food Fact-Checks and Trust Scores: Countering Mis-Influencers to Safeguard Nutrition, Public Health, and Our Planet.

期刊: American journal of health promotion : AJHP 发表日期: 2026-May-11 链接: PubMed

摘要

26. Life's Essential 8: Cardiovascular Health Assessment Among Brazilian University Workers.

期刊: Workplace health & safety 发表日期: 2026-May-11 链接: PubMed

摘要

The American Heart Association has introduced Life’s Essential 8 (LE8) for primary cardiovascular disease prevention. This study assessed cardiovascular health (CVH) using LE8 among Brazilian adult university workers and identified associated factors. A cross-sectional study with 532 faculty, research, and staff was conducted, collecting sociodemographic, clinical, and LE8 component data alongside additional variables-LDL-chol, triglycerides, insulin, and waist and hip circumferences. Descriptive and inferential analyses, including regression models, were performed. Most workers exhibited moderate CVH (59.6%). Younger and more educated workers had better CVH. Poor CVH correlated with higher waist and hip circumferences, insulin, LDL-chol, and triglycerides. Poisson regression revealed that increases in waist circumference, insulin, LDL-chol, and triglycerides decreased ideal CVH probability by 2.4%, 3.8%, 0.8%, and 0.5%, respectively. LE8 scores inversely correlated with additional variables except LDL-chol. The sample showed a low ideal CVH prevalence. Increased waist circumference, insulin, LDL-cholesterol, and triglycerides reduced ideal CVH probability. The results showed a low prevalence of ideal CVH, highlighting critical areas that require specific interventions. For occupational health nursing, the findings reinforce the importance of systematic monitoring and health education actions, especially those focused on modifiable factors such as diet, physical activity, stress, and blood pressure control. The use of intervention mapping based on person-centered theories is recommended to support nurses in developing more effective programs for health promotion, risk screening, and prevention of cardiovascular diseases in the workplace, contributing to the reduction of morbidity and mortality associated with these conditions.

27. Moving towards Next-Generation Environmental Risk Assessment of Chemicals in China.

期刊: Integrated environmental assessment and management 发表日期: 2026-May-11 链接: PubMed

摘要

The rapid industrial development and its inherent use of chemicals raise environmental concerns in China, and their risk assessment and management remain challenging. Next-Generation Environmental Risk Assessment (environmental NGRA), as an exposure-led, hypothesis-driven approach, is a promising framework to address this challenge and better protect human and environmental health. This Perspective article stems from the recent, first multi-stakeholder workshop on environmental NGRA in China, which brought together regulators, academia and industry. We reviewed current progress and identified challenges for implementation of environmental NGRA in China, focusing on scientific advancements and regulatory application of spatially explicit exposure modelling and new approach methodologies (NAMs). More importantly, we identified future opportunities and key prioritized actions to advance its implementation in China. Four key recommendations identified to accelerate implementation, including: i) create a multipartite discussion forum (e.g., a working group) to support and guide the development and application of environmental NGRA; ii) develop an environmental NGRA framework and roadmap in China; iii) develop case studies integrating human and environmental safety; iv) foster international collaboration for the co-development of best practice in environmental NGRA ensuring global alignment where possible. Overall, we provide a forward-looking perspective on its scientific, regulatory, and technical dimensions, marking a critical milestone for advancing next-generation safety science in China.

28. Evaluating the use of participatory system dynamics group model building for expanding systems thinking capacity among community-based stakeholders.

期刊: Journal of prevention & intervention in the community 发表日期: 2026-May-11 链接: PubMed

摘要

Community-based participatory research (CBPR) methodologies align closely with the field of community psychology. System dynamics group model building (SD GMB) represents a CBPR-grounded approach that is centered on collaborating with stakeholders to develop a shared understanding of the dynamic complexity of a community problem, represented as a system dynamics (SD) model, and identifying potential solutions. Much is still unknown regarding the value of SD GMB for improving systems thinking capacity among community stakeholders. Therefore, this study evaluates systems thinking capacity among 32 stakeholders who participated in SD GMB workshops from two recent studies. Stakeholders completed a baseline survey before the first SD GMB workshop session and a final evaluation survey following the last session. This survey included a validated systems thinking scale (Dolansky et al., 2020) and a “systems thinking knowledge quiz” (only administered during the baseline survey) developed by the research team to assess stakeholder knowledge of key concepts. Among all stakeholders, the average systems thinking quiz score was nearly 45%, and knowledge quiz scores were higher among stakeholders who were older in age, had lived experience, were in healthcare provider or academic researcher/data professional roles, represented the nonprofit or grassroots sectors, reported prior experience with SD GMB, or did not attend the pre-session orientation. Overall, stakeholders’ pretest scores and post-test scores did not demonstrate a statistically significant difference; however, increases in systems thinking mean scores were observed among stakeholders who were younger in age, had lived experience, were in community-based nonprofit staff roles, represented nonprofit or grassroots organizations, did not have prior SD GMB experience, or did not attend orientation. These findings underscore the importance of adopting a more differentiated and context-sensitive approach to evaluating SD GMB interventions. Future research should further explore how participatory modeling fosters systems thinking capacity across different stakeholder groups.

29. Furuncular myiasis by Cordylobia anthropophaga in three Italian children: First case series and implications for non-endemic regions.

期刊: PLoS neglected tropical diseases 发表日期: 2026-May-11 链接: PubMed

摘要

Cordylobia anthropophaga, commonly known as the tumbu fly, is a leading cause of cutaneous myiasis in sub-Saharan Africa. This condition is characterized by a papulopustular lesion that evolves in a painful boil-like nodule with central ulceration. Human infestations typically occur on covered body parts, due to the fly’s habit of laying eggs on damp clothing. This report describes the first cluster of three pediatric cases of furuncular myiasis caused by C. anthropophaga, diagnosed at the Bambino Gesù Children’s Hospital (Rome, Italy) between April 2024 and April 2025. All patients had recent travel history to endemic African regions and presented with cutaneous nodules, some accompanied by systemic signs such as fever or regional lymphadenopathy. Diagnosis was confirmed through clinical evaluation and morphological identification of the extracted larvae. Treatment consisted of occlusive therapy to facilitate larval expulsion or surgical extraction of the maggots and systemic antibiotics. One patient also exhibited a family cluster, with larval extraction from a parent. Laboratory results were largely unremarkable, consistent with localized infection. These cases highlight the growing relevance of imported myiasis in non-endemic countries like Italy, due to increased international travel and potential climate-driven changes in vector distribution. Enhanced awareness among travelers and healthcare providers, together with proactive public health measures, is crucial. By documenting these cases, we hope to contribute to the understanding of emerging parasitic diseases in non-endemic regions and reinforce the need for vigilance in this time of global environmental changes.

30. Smartphone App-Delivered Mindfulness-Based Intervention for Concussion in Adolescents (MBI-4-mTBI): Feasibility Randomized Controlled Trial.

期刊: JMIR rehabilitation and assistive technologies 发表日期: 2026-May-11 链接: PubMed

摘要

Persisting symptoms affect about one-third of youth following concussion. Mental health history, distress, and coping style are key predictors of prolonged recovery. Early and scalable psychological interventions, such as mindfulness-based intervention (MBI) delivered via smartphones, may improve patients’ ability to regulate their emotions and neurophysiologically recover, reducing overall symptom burden. However, no digital therapeutic (DTx) trials in adolescents experiencing concussion exist. This study primarily aimed to assess the feasibility of conducting a larger randomized controlled trial (RCT) evaluating the effectiveness of a DTx-MBI in adolescents with a concussion compared with an attention-matched sham intervention. This was a Health Canada-regulated, parallel-group, blinded, single-crossover feasibility RCT. Adolescents aged 12 to <18 years presenting to a Pediatric Emergency Department or interdisciplinary concussion clinic within 7 days of a physician-diagnosed concussion were approached for participation from November 2022 to June 2024. After providing consent, participants were randomized (1:1), stratified by sex, to either the experimental group (DTx-MBI) or the control group (sham, attention-matched math puzzle game). The DTx-MBI was delivered via the AmDTx platform (Mobio Interactive Pte Ltd, Singapore) as a custom-designed 4-to-8-week program of 8 standardized modules for adolescents with concussion, including audio-recorded guided mindfulness exercises, goal setting, journaling, and psychoeducation. The control intervention, delivered through the same interface, excluded mindfulness content and instead featured the open-source game “2048”. Participants in both groups were encouraged to engage with the app for at least 10 minutes/day, at least 4 days/week. Feasibility criteria to support progression to a full-scale RCT included: eligibility rate >40% of those screened; recruitment rate >50% of eligible participants randomized; intervention credibility >70% scoring above the midpoint on the credibility and expectancy questionnaire (CEQ) at 1 week; retention >75% of randomized participants completing 4-week outcomes; and adherence >70% completing 10 minutes of intervention on at least 4 days/week for 4 weeks. A total of 124 out of 195 (63.6%) screened youth met eligibility criteria. Of these, 99/124 (79.8%) consented and were randomized to either the DTx-MBI group (n=49, median [IQR] age=15.28 [13.66-16.19] years, 30 [61.2%] female) or the Sham group (n=50, median [IQR] age=14.92 [13.32-16.71] years, 30 [60.0%] female). Credibility was high, with 62/83 (74.7%) of participants scoring above the credibility midpoint (DTx-MBI: 75.0%; Sham: 74.4%). Retention was strong, with 89/99 (89.9%) of participants completing the 4-week outcomes (DTx-MBI: 89.8%; control: 90.0%). Overall adherence was moderate (54/99 [54.5%]; DTx-MBI: 59.2%; control: 50.0%), and a little higher among outcome assessment completers (53/89 [59.6%]; DTx-MBI: 63.6%; Sham: 55.6%). Feasibility indicators were similar between groups. This feasibility trial supports the implementation of a larger RCT, with modifications to enhance adherence, to rigorously evaluate the clinical efficacy of the DTx-MBI. By targeting modifiable psychological risk factors through a scalable digital platform, DTx-MBI could be a low-burden, cost-effective adjunct to pediatric concussion care.

31. Observed frequency of increased iron indices and associated factors in welders.

期刊: Archives of environmental & occupational health 发表日期: 2026-May-11 链接: PubMed

摘要

Increased iron indices among welders are underrecognized. This study investigated their frequency and associated factors in an observational cross-sectional study including 55 male welders. Increased iron indices were defined as serum ferritin >400 µg/L and/or TS ≥45%. Standard statistical and regression analyses were used. Increased iron indices were identified in 25.5% of welders. Compared to those with normal indices, affected welders had longer employment duration. Iron parameters were significantly higher in the increased group (serum iron 139.6 vs. 93.3 µg/dL, ferritin 498.9 vs. 142.3 µg/L, TS 47.7% vs. 28.9%; all p<0.001). Liver enzymes were also higher in this group. Pulmonary siderosis was more prevalent (64.3% vs. 31.7%; p=0.032) and associated with increased iron indices (OR 3.88 [1.08-13.89]; p=0.037). Use of respiratory protective equipment was associated with lower frequency. Increased iron indices are common in welders, particularly with longer exposure and pulmonary siderosis, suggesting a need for routine monitoring.

32. Brain Cancer Mortality following Traumatic Brain Injury (TBI): A TBI Model Systems Study.

期刊: Neuroepidemiology 发表日期: 2026-May-11 链接: PubMed

摘要

Growing evidence suggests traumatic brain injury (TBI) may be a risk factor for subsequent brain cancer. We aimed to compare brain cancer mortality rates between persons with TBI and the general population. Retrospective cohort study of 20,211 individuals with TBI admitted for inpatient rehabilitation following acute hospitalization who enrolled in the TBI Model Systems (TBIMS) National Database (1987-2024). Brain cancer cases were identified by underlying or contributing cause of death on death certificate. Standardized mortality ratios (SMRs) compared to an age, sex, race, and calendar-year matched general population were calculated using the National Institute for Occupational Safety and Health LTASR R package. Secondary analyses explored brain cancer risk factors. Of the 4,297 decedents, 18 died of brain cancer, reflecting a higher rate than the general population (SMR=1.75; 95%CI:1.04-2.77). Significantly higher brain cancer mortality was observed among participants with gunshot wound (GSW) related TBI (SMR=14.29; 95%CI:2.95-41.75), mild TBI (mTBI; SMR=3.88; 95%CI:1.06-9.94), but not moderate-to-severe TBI (SMR=1.52; 95%CI:0.83-2.54). Individuals who sustained a TBI had a 1.75-fold higher likelihood of brain cancer death than the general population. Further analyses observed increased brain cancer mortality risk among those with GSW-related TBI and mTBI. Together, these results may inform targets for early prevention and support further investigation of the causal pathophysiology underlying TBI-related brain cancer mortality.

33. Cost Drivers of Workers' Compensation Low Back Injury Claims in an Academic Health System, 2015-2024.

期刊: Journal of occupational and environmental medicine 发表日期: 2026-May-11 链接: PubMed

摘要

Quantify costs, durations, incidence trends, and risk factors for WC lower-back injury claims in an academic health system. Observational review of 797 closed claims (2015-2024) evaluating demographics, occupation, mechanism, tenure, days away from work, and temporal trends. Mean cost $10,973 (median $3,294); mean duration 197 days (median 74). Top 5% of claims averaged $114,548 and 1,819 days, accounting for 52.1% of total costs. Nurses and patient care assistants were most affected; lifting and pushing/pulling were leading mechanisms. Higher costs were associated with longer duration, occupation, male sex, older age, and shorter tenure. Incidence declined 8.4% annually. OEM-managed claims had lower mean costs than externally managed claims ($9,701 vs $19,880). Lower-back WC claims show a substantial but declining burden; integrated OEM management was associated with lower costs.

34. Mailed dose record review of occupational dosimetry records among Japanese medical radiation workers: the OREMS Study.

期刊: Radiation protection dosimetry 发表日期: 2026-May-11 链接: PubMed

摘要

Occupational dose records in Japan are retained by employers, with no national registry, complicating epidemiological exposure assessments. In the Epidemiological Study on Occupational Radiation Exposure in Medical Staff, the feasibility of a mailed dose record review was evaluated among participants who underwent occupational radiation health surveillance (ORHS) at six annual conferences (November 2020-October 2024). Dose information was obtained for 182 individuals (44.9% of eligible participants). The median cumulative effective dose was 2.3 [25th, 75th percentile: 0.3, 11.7] mSv, and median cumulative duration was 8.5 [3.8, 19.8] years. For the fiscal year prior to ORHS, annualized median values were 0.1 mSv for effective dose (E), 0.6 mSv for equivalent dose to the lens of the eye (Heye), and 0.6 mSv for equivalent dose to the skin (Hskin) (values below the detection limit were set to 0.0 mSv), presented descriptively to characterize data properties in this feasibility study. Interventional radiology physicians tended to show higher cumulative and annualized doses than neuro-spine physicians in this descriptive feasibility analysis.

35. Role Perception and Needs of Employers of Small and Medium-Sized Enterprises Regarding the Return-to-Work of Long-Term Sick-Listed Employees.

期刊: Journal of occupational rehabilitation 发表日期: 2026-May-11 链接: PubMed

摘要

Employers can have an important role in optimizing return-to-work (RTW) support during long-term sick leave. The scarce research shows that especially small and medium-sized enterprise (SME) employers experience this as complex and demanding. In the Netherlands, RTW support is even mandatory by law. This study aims to explore the experiences and needs of Dutch SME employers during long-term sick leave and RTW. Semi-structured interviews were conducted with employers in executive positions at SMEs (≤ 250 employees) who had supervised at least one long-term (> 6 weeks) sick-listed employee in the past year. Interviews were transcribed and thematically analysed. Twenty participants (55% male, mean age: 48) from micro (n = 2), small (n = 8), and medium-sized (n = 10) enterprises across different sectors participated. Employers regarded supporting sick-listed employees as one of their many responsibilities, yet burdensome. This perception of their role was either more intrinsically motivated (e.g., taking care of employees as a core value) or more extrinsically motivated (e.g., concern over financial consequences). Their motivation was shaped by factors such as employee attributes (e.g., reason for sick leave) and organization characteristics (e.g., enterprise size). Interviewees expressed a need for relatedness and autonomy in managing sick leave, but felt restricted by rigid and unclear regulations. They acknowledged lack of competence in providing sick-leave and RTW support. In order to support their sick-listed employees, SME employers’ needs for autonomy, competence and relatedness need to addressed while taking into account their role perception and contextual factors of SMEs.

36. Efficacy and safety of simenafil in men with erectile dysfunction: a multicenter, randomized, double-blind, placebo-controlled, fixed dose, parallel group, phase 2 trial.

期刊: The journal of sexual medicine 发表日期: 2026-May-09 链接: PubMed

摘要

Simenafil, a new potent selective phosphodiesterase-5 inhibitor (PDE5i), has been developed for erectile dysfunction (ED) treatment. To evaluate the efficacy and safety of simenafil therapy in patients with ED. A randomized, double-blind, placebo-controlled, multicenter, parallel-group, phase 2 trial was conducted in men aged ≥22 years with a history of ED of 3 months or more. The subjects were randomized in a ratio of 1:1:1:1 to on-demand receive either placebo or simenafil at fixed doses of 5, 10, and 20 mg for 8 weeks. Primary efficacy endpoints were the least square mean (LSM) changes from baseline to week 8 in the erectile function (EF) domain of the International Index of Erectile Function (IIEF), percentages of “yes” responses to Sexual Encounter Profile (SEP) diary Question 2 (SEP Q2: Were you able to insert your penis into your partner’s vagina?) and Question 3 (SEP Q3: Did your erection last long enough for you to have successful intercourse?). A total of 255 patients were randomized. After 8 weeks of treatment, doses of 5, 10, and 20 mg of simenafil exhibited substantial increases than placebo in IIEF-EF score (9.7, 9.2, 9.5 vs. 5.5, P < .001), the percentages of “yes” responses to SEP Q2 (36.11%, 30.79%, 33.12% vs. 19.56%, P < .01), and SEP Q3 (55.96%, 51.14%, 51.05% vs. 31.02%, P < .001). The incidence of adverse drug reactions was 36.5%, 44.3%, 45.9%, and 61.7% for the placebo, 5 mg, 10 mg, and 20 mg simenafil groups, respectively. Overall, the adverse events were generally mild or moderate. Simenafil could effectively improve erectile function and the adverse reaction profile of simenafil was consistent with its pharmacological mechanism, with most adverse reactions being mild to moderate. The results provide a rationale for further evaluation in larger and longer-term phase 3 clinical trials. We did not conduct a head-to-head study comparing the efficacy and safety of simenafil with other PDE5 inhibitors. Meanwhile, we did not further analyze the efficacy and safety of simenafil in specific populations, such as ED patients with diabetes. Simenafil is an effective and well-tolerated treatment for men with ED.

37. Integrin-focal adhesion-cytoskeleton signaling axis variations and genetic susceptibility to SCD-CAD.

期刊: Forensic science international 发表日期: 2026-May-08 链接: PubMed

摘要

Sudden cardiac death (SCD) is a leading cause of global mortality, with coronary artery disease (CAD) being the primary etiology. Vascular smooth muscle cell (VSMC) migration and proliferation, regulated by actin cytoskeletal dynamics, are pivotal to CAD pathogenesis. The integrin-focal adhesion-cytoskeleton signaling axis modulates these processes; however, its genetic contribution to SCD-CAD remains poorly understood. In this case-control study of a southern Chinese Han population (239 SCD-CAD cases; 594 healthy controls), we investigated 10 insertion-deletion (indel) polymorphisms across eight key genes within this axis. Using multiplex fluorescent PCR and capillary electrophoresis (CE), followed by logistic regression and haplotype analyses, we identified three protective variants: rs10599004 (OR = 0.78, p = 0.018), rs143263543 (OR = 0.70, p = 0.024), and rs58213835 (OR = 0.80, p = 0.046). Additionally, a significant risk haplotype was identified in BCAR1 (ins-rs149617239-ins-rs58213835, p = 0.007). Mendelian randomization (MR) analysis further supported the causal roles of genetically predicted BCAR1, CRK, and DOCK1 expression in cardiovascular risk. These findings underscore the involvement of this signaling axis in SCD-CAD susceptibility and suggest these genetic markers as potential tools for cardiovascular risk assessment as well as forensic molecular autopsy. Further validation through large-scale cohort studies and functional assays is essential to fully elucidate the underlying molecular mechanisms.

38. Muscle Oxygenation, Performance, and Perceived Fatigability During Low-Intensity Isometric Exercise: Effects of Anchoring Strategy, Blood Flow Restriction, and Sex.

期刊: Journal of strength and conditioning research 发表日期: 2026-May-08 链接: PubMed

摘要

Kwak, M, Benitez, B, Mitchinson, CJ, Snell, ER, and Bergstrom, HC. Muscle oxygenation, performance, and perceived fatigability during low-intensity isometric exercise: Effects of anchoring strategy, blood flow restriction, and sex. J Strength Cond Res XX(X): 000-000, 2025-This study investigated the effects of low-intensity isometric exercise modality and sex on muscle oxygen saturation (SmO2), rating of perceived exertion (RPE), pain, performance fatigability (PF; change in maximal voluntary isometric contraction), and time to task failure (TTF). Fifteen healthy men (22.7 ± 4.7 years) and 15 women (22.5 ± 4.4 years) completed 3 isometric exercise conditions: (a): RPE-Clamp at RPE = 3, (b) torque-matched blood flow restriction (BFR), and (c) torque-matched NON-BFR. No significant differences in TTF (p = 0.198) were found across conditions or between sexes. SmO2 was generally highest in the RPE-Clamp condition and lowest in BFR. At task failure during BFR, men exhibited significantly lower SmO2 than women (p = 0.001), though no sex differences were found at other time points or in other conditions. Rating of perceived exertion and pain increased significantly over time in both BFR and NON-BFR conditions (p < 0.001), regardless of sex. Performance fatigability was significantly greater in BFR and NON-BFR than in RPE-Clamp (p < 0.01), with no difference between BFR and NON-BFR (p = 1.000). Men demonstrated greater PF than women in BFR (p = 0.001) and NON-BFR (p = 0.011), but not in RPE-Clamp (p = 0.720). These findings suggested that BFR exercise performed with sustained isometric contractions under relatively moderate cuff pressure may not induce greater fatigability than NON-BFR exercise. However, fatigability may be influenced by sex-related differences in absolute target torque. Although the RPE-Clamp condition, characterized by lower muscular stress and fatigability, may represent a viable option for clinical and early-rehabilitation settings, its training efficacy requires further investigation.

39. Inhalable airborne microplastics in urban air: single-particle evidence of diurnal variability and physicochemical characteristics.

期刊: Environment international 发表日期: 2026-May-07 链接: PubMed

摘要

Microplastics (MPs) have emerged as a critical anthropogenic pollutant, increasingly recognized for their persistence and ubiquity in the environment. While extensive research has focused on MPs in aquatic and terrestrial systems, studies of inhalable airborne MPs (AMPs) remain limited. In this study, we investigated the diurnal variability and physicochemical characteristics of AMPs in PM10 aerosols using a novel single-particle analytical approach that integrates fluorescence microscopy, Raman microspectrometry, and SEM/EDX. AMP number concentrations averaged ∼1,300 particles/m3 during the sampling period and were approximately 60% higher at night than during the day, a trend linked to boundary layer dynamics and air mass trajectories. Most AMPs were smaller than 10 μm (95%), with about 40% below 2.5 μm, indicating high inhalation potential. Morphological and spectral evidence showed that many particles were aged, with transformations from angular to rounded or lumpy forms becoming more pronounced as particle size decreased. Overall, these results indicate that AMP abundance is governed largely by meteorological conditions. AMPs resuspended from contaminated environments likely contribute significantly, alongside direct anthropogenic emissions. This study provides new insights into the diurnal variability, sources, and characteristics of inhalable AMPs and underscores the need for further research on their implications for air quality, climate, and human health. ENVIRONMENTAL IMPLICATION: Our findings provide direct evidence that airborne microplastics are not only an urban pollutant but also part of a global transport cycle, with their abundance strongly modulated by meteorology and resuspension from contaminated environments. This highlights the need to consider AMPs in assessments of air quality, climate interactions, and the redistribution of plastic pollution across environmental compartments. By quantifying inhalable fractions and demonstrating their environmental aging, this study offers a foundation for future work linking airborne microplastics to health risks, climate forcing, and feedback with terrestrial and aquatic systems.

40. Variation in stroke survivors' long-term home care use: a South London population-based study.

期刊: European stroke journal 发表日期: 2026-May-06 链接: PubMed

摘要

Policy shifts towards home-based care are reshaping the management of stroke survivors, many of whom require long-term support. Home care, which encompasses social care for personal and household tasks and informal care provided by family and friends, plays a crucial role in post-stroke recovery and community reintegration. This study examined home care use up to 15 years post-stroke and its associated factors, and assessed unmet needs for assistance with activities of daily living (ADLs). Data from 7885 stroke survivors in the South London Stroke Register (1995-2022) were analysed at 3 months, 1, 5 and 15 years post-stroke. Descriptive analyses examined home care patterns and unmet needs. A Heckman selection model assessed factors associated with home care use while accounting for missing data. On average, 75% of stroke survivors used home care across 15 years post-stroke, with 83% of care at 3 months and 87% at 15 years being provided through informal care. Home care use was more likely among those with functional dependency (29%; 95% CI, 22%-35%) and those living with family (24%; 95% CI, 21%-27%). Social care use was higher in people with greater dependency (48%; 95% CI, 42%-56%), those living alone (25%; 95% CI, 21%-29%), those with lower deprivation (10%; 95% CI, 1%-20%) or those with a Black ethnic background (6%; 95% CI, 2%-9%). Informal care use was higher among those living with family (12%; 95% CI, 9%-14%), those with moderate dependency (2%; 95% CI, 0.1%-5%) or females (6%; 95% CI, 3%-9%). Unmet needs in ADLs increased over time (12% at 3 months to 17% at 15 years) and were higher among those with moderate compared with severe functional dependency. Within home care, informal care remains the predominant long-term support for stroke survivors, persisting up to 15 years after stroke. Addressing health-related, socio-economic, ethnic and gender disparities in home care and unmet needs is essential for equitable community-based stroke care, and caution is needed when promoting home-based care models regarding the distributional impact of home care. Accurate measurement of home care is key to improving post-stroke care models and quality of life.

41. Association of glomerular hyperfiltration with mortality in stroke: an analysis using pooled individual patient data.

期刊: European stroke journal 发表日期: 2026-May-06 链接: PubMed

摘要

Glomerular hyperfiltration has previously been associated with cardiovascular events and mortality but has scarcely been investigated in patients with stroke. We used pooled data from an individual patient data meta-analysis of prospective, cohort studies of stroke or TIA populations. For this analysis, we included participants from study sites that collected estimated glomerular filtration rate (eGFR) at stroke presentation. Using Cox proportional hazards regression, we investigated the risk of death, any stroke and vascular death according to glomerular hyperfiltration, defined as having an eGFR greater than the age- and sex-adjusted 95th percentile. We also investigated these outcomes according to eGFR as a continuous variable, modelled using fractional polynomials. A total of 11,175 patients (mean age 70.7 years, 42% female) were included in the analysis, 554 (4.9%) with hyperfiltration. Compared to the normofiltration group (absence of hyperfiltration and eGFR ≥ 60 mL/min/1.73 m2), the hyperfiltration group had a higher rate of all-cause death, 147 per 1000 person-years (95% CI, 119-180) vs 61 (95% CI, 57-66). Compared to normofiltration, hyperfiltration was independently associated with the risk of death from any cause (adjusted hazard ratio [HR] 1.76; 95% CI, 1.46-2.11; P < .001) and the risk of vascular death (adjusted HR 1.68; 95% CI, 1.29-2.17; P < .001). There were non-linear associations of eGFR with risk of death and vascular death, with increasing risk at both low and high eGFR (Pnon-linearity < .001 for both). Glomerular hyperfiltration was associated with a 76% increased risk of death and a 68% increased risk of vascular death in multivariable models adjusted for age, sex and comorbidities. Glomerular hyperfiltration may be associated with adverse health outcomes, specifically in patients with ischaemic stroke. Further research is needed to confirm these findings.

42. Sex-based differences in emergency department treatment times for acute ischaemic stroke: evidence from a large Italian cohort.

期刊: European stroke journal 发表日期: 2026-May-06 链接: PubMed

摘要

Sex-related disparities in acute ischaemic stroke (AIS) care have been widely reported. However, evidence from Italy remains limited. We aimed to evaluate sex differences in access to revascularisation treatments (RTs) and key time performance indicators in a large Italian cohort. We conducted a single-centre, retrospective, observational study including all adults admitted to the emergency department of a comprehensive stroke centre in Rome between January 2015 and December 2022 for suspected stroke. Clinical and demographic characteristics, comorbidities, presenting symptoms, RTs and stroke care time metrics were collected. Multivariable logistic and linear regression models, as well as restricted cubic spline analyses, were used to assess sex-related differences in RTs and time indicators, adjusting for relevant confounders. Within the 9167 patients, 44.4% had AIS, and 48.2% were women. Among patients with AIS, women were older (P < .001), had higher NIHSS scores at onset (P < .001), a greater comorbidity burden (P < .001) and higher in-hospital mortality (P = .010). No significant sex differences were observed in intravenous thrombolysis and endovascular treatment administration rates. However, median door-to-needle time was 4 min longer in women than in men (P = .030). After adjustment, female sex was not significantly associated with RT administration or in-hospital mortality, but remained an independent predictor of longer DNT [adjusted β -8.242; 95% CI (-15.453 to -1.031); P = .025]. Although access to RTs was comparable between sexes, women experienced longer DNT, indicating persistent in-hospital barriers to timely stroke care. These findings highlight the need for targeted interventions to achieve full equity in AIS management.

43. Blood pressure management in patients receiving rescue stenting after failed endovascular treatment in large vessel occlusion acute ischaemic stroke: a multicentre registry.

期刊: European stroke journal 发表日期: 2026-May-06 链接: PubMed

摘要

Rescue stenting (RS) has emerged as a bailout strategy after failed reperfusion during endovascular treatment (EVT). Optimal blood pressure (BP) management after RS remains unclear. Our aim is to evaluate the association of BP levels and blood pressure variability (BPV) during the first 24 h after RS with short-term and long-term patient outcomes. We performed a retrospective analysis of an international registry where data from adult patients who underwent either RS or rescue angioplasty after failed EVT were collected. Patients who received RS with large vessel occlusion and at least 4 BP measurements in the first 24 h were included. RS was performed in 437 patients (40.5% female, mean age 67.1 ± 13 years). Admission median National Institutes of Health Stroke Scale score was 12 (IQR 7-18) and history of hypertension was present in 74.2% of patients. Μean Systolic BP (SBP) in the first 24 h was 137.4 ± 14.6 mmHg. Higher values of BPV (coefficient of variation, standard deviation, average real variability and successive variation) were associated with lower odds for Modified Rankin Scale score 0-2 at 90 days (adjusted odds ratio ranging 0.55 [0.38, 0.79] to 0.99 [0.98, 0.99] per 10 units increase). No associations were found between any SBP measure and death, sICH as well as neurological deterioration at 24 h. In our study, higher BPV was associated with worse clinical outcomes in stroke patients treated with RS as bailout therapy after failed reperfusion. No association was shown between mean, maximum, minimum and delta SBP and clinical outcomes.

44. Harnessing antimicrobial peptides to engineer mosquito immunity against emerging vector-borne diseases.

期刊: Journal of medical entomology 发表日期: 2026-May-05 链接: PubMed

摘要

A variety of emerging and re-emerging mosquito-borne infectious diseases, including malaria, dengue, chikungunya, and Zika are expanding their geographic range and imposing an escalating burden on global public health. Effective vaccines or targeted therapeutics remain unavailable for most of these diseases. Antimicrobial peptides (AMPs), a class of naturally occurring polypeptides, exhibit potent antiparasitic, antiviral, and antibacterial activities. Their unique modes of action, low toxicity, high target specificity, and broad-spectrum activity, make them as promising candidates for therapeutic development. Here, we review AMPs with demonstrated activity against mosquito-borne pathogens and evaluate their translational potential. We further outline next-generation intervention strategies that leverage artificial-intelligence-driven discovery, circular RNA expression platforms, CRISPR-based gene editing, engineered symbionts, and nanotechnology-enabled delivery systems, providing a roadmap for integrating AMP-based approaches into future public-health strategies.

45. Brick-and-mortar food retail implementation of a nutrition incentive program using Electronic Benefit Transfer integration in Southern California.

期刊: Translational behavioral medicine 发表日期: 2026-Jan-07 链接: PubMed

摘要

Nutrition incentive programs (NIPs) that integrate fruit and vegetable (FV) incentives into Supplemental Nutrition Assistance Program (SNAP) Electronic Benefit Transfer (EBT) systems have strong potential for scaling in the United States, yet little is known about implementation from brick-and-mortar food retailers’ perspectives. To examine brick-and-mortar food retailers’ perceptions and experiences with an NIP using SNAP EBT integration for FV incentives at the point of sale. Guided by the Inner Context of the Exploration, Preparation, Implementation, Sustainment (EPIS) framework, an implementation science evaluation was conducted among 79 independent chain grocers implementing the NIP in Southern California. Leadership and staff were invited to complete an online survey (89% response rate) using validated tools (e.g. Implementation Leadership Scale), expert-developed items, and open-ended questions. The analysis included descriptive statistics and inferential tests that assessed response differences between leadership and staff. Of 538 respondents, most were female (76%) and Latino/a (94%). Perceptions and experiences with the NIP were favorable across EPIS Inner Context constructs, with some differences noted. Leadership support for implementation was rated highly overall, though staff scored items on supportive and knowledgeable leadership lower compared to leadership. While highly satisfied with NIP implementation overall, open-ended responses highlighted opportunities to optimize implementation across stores. Nutrition incentive programs integrating FV incentives into SNAP EBT systems appear well-suited to the brick-and-mortar food retail context. Findings can inform the design and testing of implementation strategies to support sustainment and scaling for population-level impact locally and nationally. This study evaluated a program that used Supplemental Nutrition Assistance Program Electronic Benefit Transfer (EBT) cards to provide nutrition incentives in grocery stores. These types of programs have strong potential for scaling, given EBT integration replaces more manual processes for nutrition incentives. This implementation evaluation was the first to explore how store leadership and staff experienced implementing this kind of nutrition incentive program. Retailers responded positively overall and felt the program aligned with their store’s values and business goals. However, there were also some differences in how leadership and staff viewed the program, which could affect its long-term success. There were also some opportunities identified that could improve implementation across stores. Therefore, this study demonstrated strong scaling potential for nutrition incentive programs using EBT integration across brick-and-mortar food retailers in the United States. To fully achieve this goal, this study identified several ways to strengthen and expand the program, such as through sustained funding, enhanced communication, and improved leadership and staff capacity, especially during busy store times. These findings can help shape future policies and tools that make it easier for grocery stores to offer healthy food programs through EBT systems.

46. Unveiling post-vaccination proteomic signatures in SARS-CoV-2 infection-naïve individuals associated with Omicron breakthrough infections.

期刊: PloS one 发表日期: 2026 链接: PubMed

摘要

Given the persistence of the SARS-CoV-2 virus, it is important to understand the proteome associated with breakthrough infections among COVID-19 vaccinated individuals. We conducted a nested case-control study within the frontline worker HEROES-RECOVER cohorts to specify a study population of SARS-CoV-2 infection-naïve participants who had a third dose of COVID-19 origin strain WA-1 monovalent mRNA vaccine from August 2021 to January 2022. We compared serum proteomic profiles for those who subsequently experienced Omicron breakthrough infections with those of matched controls without infections. Our study leveraged proteomics data generated from the SomaScan Platform and adopted a robust feature selection method, elastic net regularized conditional logistic regression with bootstrapping, to identify key proteins. Enrichment analyses were performed to investigate biological pathways. We identified 28 significant proteins out of over 7,000 candidate proteins. Key findings included downregulated chemokines (CXCL2, CXCL3, CCL19, CCL23) and elevated cytokine IL-7 levels in breakthrough cases, with pathway analysis revealing enrichment in chemokine signaling and cytokine-cytokine interaction pathways. Other key proteins, such as LGALS1, HAVCR2, and SELE were upregulated in breakthrough cases. These results reveal potential immune response mechanisms in breakthrough infections, characterized by viral immune evasion and compensatory T-cell regeneration. The identified biomarkers may provide valuable insights for future predictive profiles and therapeutic strategies.

47. Assessing compliance with smoke-free laws in Purbakhola Rural Municipality, Nepal: A cross-sectional observational study.

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

摘要

Despite Nepal’s comprehensive tobacco control legislation, evidence on its implementation at the local level, particularly in rural areas, remains limited. This study assessed compliance with smoke-free laws in public places of Purbakhola Rural Municipality, Palpa, Nepal. A cross-sectional observational survey was conducted from May 7 to May 16, 2025, across all six wards of the municipality. We assessed 219 public places from 11 categories. Compliance with smoke-free provisions was measured using an adapted observational checklist covering six indicators: active smoking, no-smoking signage, designated smoking areas, ashtrays, cigarette butt litter and tobacco advertisement. Descriptive statistics estimated compliance and exploratory logistic regression examined associations between observed active smoking and environmental factors, including the presence of ashtrays and no-smoking signage. Compliance with smoke-free provisions was high in public institutional settings, including health facilities (100.0%), educational institutions (100.0%), and government offices (88.8-100.0%). In contrast, substantial non-compliance was observed in the hospitality sector, where only 45.0% of restaurants were free from indoor smoking and 37.5% had no visible ashtrays. A critical gap was the lack of systemic compliant no-smoking signage, even in high-compliance settings, with 54.5% of health facilities non-compliant indoors and 100.0% of government offices non-compliant outdoors. The presence of ashtrays was the strongest predictor of smoking, with indoor ashtrays associated with dramatically higher odds of observed smoking. In contrast, no statistically significant association was found for signage, although no smoking was observed in venues with indoor signage. There is a significant implementation gap in smoke-free law compliance particularly in the hospitality sector. The findings underscore the urgent need for strengthening enforcement, ensuring the removal of ashtrays-a major environmental cue for smoking-and promoting the universal installation of standardized no-smoking signage to align practice with policy and protect public from secondhand smoke.

48. The expected benefits of using social robots when working with institutionalised older adults: A qualitative study among healthcare professionals.

期刊: PloS one 发表日期: 2026 链接: PubMed

摘要

The shortage of healthcare professionals increasingly challenges the provision of care for institutionalised older adults. This study investigates healthcare professionals’ expectations regarding the added value of social robots in daily care, as their perspective is adamant for implementation of these robots but not yet fully investigated. Two consecutive focus group sessions were conducted across three nursing homes with 24 healthcare professionals. The first session focused on identifying potential ways in which social robots could add value for both staff and residents. After sharing suggestions across all groups, the second session facilitated cross-validation and in-depth discussion of practical implications. Data were analysed using qualitative thematic analysis. Healthcare professionals expected several benefits from using a social robot, including reduced workload and mental strain, improved work atmosphere, and potentially heightened job satisfaction. For residents, expected benefits included promotion of self-care and self-reliance through reminders and notifications, and provision of companionship during lonely periods. Reported possible barriers included limited technical knowledge and lack of support from residents’ families. Participants expected that social robots could help save time and energy, enabling more focused attention on residents needing support-even those who may not actively seek it. Professionals indicated that this might enhance both residents’ well-being and the quality and satisfaction of their own work. Implementing some of the specific suggestions from professionals merits further investigation.

49. Women waste pickers' perceptions of nursing care and environmentally sustainable practices: action research.

期刊: Revista da Escola de Enfermagem da U S P 发表日期: 2026 链接: PubMed

摘要

To understand the perceptions of women waste pickers regarding nursing care in the promotion of environmentally sustainable practices, from the perspective of social entrepreneurship. An action research study conducted between August 2024 and March 2025 with 26 women from a waste pickers’ association located in southern Brazil, focusing on the promotion of environmentally sustainable practices. This study focused solely on the investigative phase, during which data were collected through individual interviews and examined using reflexive thematic analysis. The women identified nursing care as essential to the organization and safety of the workplace. Their perceptions suggest that the presence of a nurse in the association’s daily activities fostered recognition of the social value of their work and boosted their self-esteem. These findings reinforce the role of nursing care as a form of social entrepreneurship, intrinsically linked to environmental health. The perspectives of women waste pickers reveal that conceiving of nursing care as a driver of sustainability requires a break from the conventional model. From the perspective of social entrepreneurship, care emerges as a systemic and relational phenomenon, in which the nurse serves as the essential link between human health and planetary integrity.

50. Tailoring Bayesian Additive Regression Trees (BART) for environmental mixture studies.

期刊: PloS one 发表日期: 2026 链接: PubMed

摘要

Various methods have been developed to investigate the complex and collective effects of environmental mixtures on human health. Tree ensemble methods, such as Bayesian Additive Regression Trees (BART), are known for their stability and accuracy in variable selection and outcome prediction for high-dimensional correlated data in the statistical literature, but their use has not been well studied for environmental mixtures. We tailored the original BART model for environmental mixtures analysis to achieve both robust identification of toxic agents and accurate prediction of health outcomes. Our modified BART approach allowed for a smooth response surface and incorporated covariate adjustment for both continuous and binary outcomes. It supported both component-wise variable selection and hierarchical variable selection to accommodate scientifically meaningful groupings of chemicals. To facilitate interpretation, we used a Generalized Additive Model (GAM) approximation to quantify the marginal contributions of individual chemicals. The performance of the modified BART was evaluated through simulations and a case study with the National Health and Nutrition Examination Survey (NHANES) 2001-2002 data to examine the effects of persistent organic pollutants (POPs) on leukocyte telomere length. All results were compared with the Bayesian Kernel Machine Regression (BKMR), a widely used method in mixtures analysis. Our simulation studies demonstrated that the modified BART produced results comparable to or superior to BKMR in recovering the true exposure-response surface for both continuous and binary outcomes, with [Formula: see text] consistently above 0.7. Specifically, when chemical groups were considered, modified BART with hierarchical variable selection achieved higher [Formula: see text] (0.82-0.99 for continuous outcomes and 0.73-0.95 for binary outcomes) than BKMR (0.59-0.67 and 0.47-0.59, respectively), on independent test datasets. Modified BART also reduced the computational time by 70% to 99.8% compared to BKMR. Both methods effectively identified relevant chemical groups under hierarchical variable selection, but modified BART more effectively distinguished important components within groups. In the NHANES case study, three chemicals, including 2,3,4,7,8-pncdf, PCB126 and PCB169, were identified by modified BART as having near-linear positive effects on leukocyte telomere length based on GAM approximation plots. Modified BART is a robust and scalable response surface model alternative to BKMR for analyzing environmental mixtures data. It is particularly advantageous for large datasets, binary outcomes, and grouped chemicals. GAM approximation provides practical insights into interpreting individual chemical effect estimated from complex response surface models.