公共卫生研究摘要 (2026-05-13)

共收录 57 篇研究文章

1. Reply to: Sex for the purposes of MELD 3.0 calculation: When this differs from birth sex and implications for policy.

期刊: Hepatology communications 发表日期: 2026-Jun-01 链接: PubMed

摘要

2. Empirical validation of race-neutral normative brain morphometry models across ethnoracially diverse populations.

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

Normative models of brain morphometry quantify individual deviations from typical anatomical patterns and hold promise for enhancing clinical decision-making. However, their clinical utility depends critically on demonstrating generalizability across diverse ethnoracial populations. We previously developed sex-specific, race-neutral normative models for cortical thickness, surface area, and subcortical volumes using brain scans from a large international sample of healthy individuals, as part of the CentileBrain Project, a global initiative to provide open-access, neuroimaging reference models. The primary aim of the present study was to empirically evaluate the generalizability and accuracy of these pretrained models across multiple ethnoracial groups. To this end, we tested model performance in independent samples of healthy individuals from Africa, Asia, Europe, and the Americas, with ethnoracial classification defined either by self-identification or genetic ancestry (N = 4,862). We further compared performance against normative models developed exclusively from a single-population Chinese cohort. Across all groups, as well as in the pooled sample, the pretrained CentileBrain models demonstrated consistently high accuracy, with relative mean absolute error values below 10% for subcortical volume and surface area and below 5% for cortical thickness. Model performance was highly concordant across self-identified and ancestry-defined groups. In a separate analysis, the CentileBrain models performed comparably to a population-specific model when applied to an independent ancestry-matched sample. These findings provide empirical support for the generalizability of race-neutral normative models developed on large and diverse samples and underscore their potential utility for individualized neuroimaging assessment across ethnoracially diverse populations.

3. Diabetes and cancer incidence among adults in the Hispanic Community Health Study/Study of Latinos.

期刊: Cancer 发表日期: 2026-May-15 链接: PubMed

摘要

Diabetes is associated with an increased risk of cancer; however, few epidemiological studies of diabetes and cancer risk have focused on Hispanic/Latino adults. This study examined the associations between three time-varying measures of diabetes and cancer incidence among participants from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). HCHS/SOL is a multi-site prospective cohort study of 16,415 Hispanic/Latino adults. Time-varying diabetes measures (assessed at visit 1: 2008-2011 and visit 2: 2014-2017) included diabetes status (no diabetes, pre-diabetes, and diabetes), glycemic control (no diabetes, pre-diabetes, controlled diabetes [hemoglobin A1c (HbA1c) <7.0%], and uncontrolled diabetes [HbA1c ≥7.0%]), and insulin resistance (no diabetes, pre-diabetes + Homeostatic Model Assessment of Insulin Resistance [HOMA-IR] <3.0, pre-diabetes + HOMA-IR ≥3.0, diabetes + HOMA-IR <3.0, and diabetes + HOMA-IR ≥3.0). Incident cancers diagnosed from visit 1 through 2021 were identified through state cancer registry linkages; 715 cancers including 330 obesity-related cancers (ORCs) were diagnosed over a mean follow-up of 10.7 years. The authors used survey-weighted marginal structural Cox regression models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for each time-varying diabetes measure and overall cancer and ORC risk, adjusting for demographic, social, and behavioral characteristics. Time-varying pre-diabetes and diabetes (vs. no diabetes) status were associated with cancer HRs of 1.82 (95% CI, 1.27-2.61) and 2.49 (95% CI, 1.65-3.74), respectively. HRs were further elevated among those with diabetes + HbA1c ≥7.0% (HR, 3.12; 95% CI, 1.44-6.79) and those with diabetes + HOMA-IR ≥3.0 (HR, 2.78; 95% CI, 1.69-4.56). Associations were stronger for ORC risk; however, estimates were less precise. Diabetes is associated with increased risk of cancer and ORC. Diabetes prevention and control may be additionally important for cancer prevention among Hispanic/Latino adults.

4. Prevalence of poor functional capacity in patients undergoing prehabilitation before major surgery: A systematic review and meta-analysis.

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

摘要

Prehabilitation aims to enhance physiological reserve prior to major surgery; however, the proportion of patients with impaired functional capacity who actually receive these interventions remains unclear. Identifying this subgroup is crucial, as patients with reduced functional capacity are those most likely to benefit from prehabilitation. This systematic review and meta-analysis aimed to estimate the prevalence of poor functional capacity among adult patients undergoing prehabilitation before major surgery. A systematic review was conducted according to PRISMA 2020 guidelines and was prospectively registered in PROSPERO (CRD420251026613). MEDLINE, Embase, Scopus, Web of Science, SciELO, and Biblioteca Virtual de Salud were searched from inception to September 2025. Studies including adults undergoing prehabilitation prior to major surgery with reported functional capacity data were eligible. Risk of bias was assessed using the Joanna Briggs Institute checklist for prevalence studies. A random-effects meta-analysis was performed to estimate pooled prevalence, with heterogeneity explored through subgroup, sensitivity, and meta-regression analyses. Seven studies comprising 306 participants were included. Functional capacity was assessed with cardiopulmonary exercise testing in four studies and the six-minute walk test in three. The pooled prevalence of poor functional capacity among patients undergoing prehabilitation was 36% (95% CI: 27-46%), with substantial heterogeneity (I2=63%). A higher prevalence was observed in patients undergoing oncological surgery (41%; 95% CI: 30-53%) than in those undergoing non-oncological surgery (23%; 95% CI: 13-35%). Sensitivity analyses confirmed the robustness of the findings. More than one-third of patients receiving prehabilitation before major surgery have poor functional capacity, though considerable variability exists across studies. Standardized, systematic assessment of functional capacity may improve identification of high-risk patients and optimize the targeting and effectiveness of prehabilitation programs in perioperative care.

5. Comparison of cardiorespiratory responses between the incremental step test and the cardiopulmonary exercise test in people with chronic obstructive pulmonary disease.

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

摘要

The incremental step test (IST) is designed for people with COPD, but its cardiorespiratory response remains unknown. This study aimed to assess the cardiorespiratory response of the IST and compare it to CPET in people with COPD. This cross-sectional study was conducted at a pulmonary rehabilitation centre in a general hospital. Participants completed the CPET (cycle ergometer) followed by the IST. Gas exchange, HR, %SpO2, dyspnea and leg fatigue (modified Borg scale) were collected. Twenty adults (67.8±8.62 years; 60% men) with stable COPD were included. At peak effort, VO2 was similar between IST (15.6±3.4ml/kg/min) and CPET (14.7±3.3ml/kg/min), p>0.05. Similar results were observed in VE (IST: 41.3±11.6ml/min; CPET: 44.2±12.7ml/min), HR (IST: 122±21bpm; CPET: 124±22bpm), and Δdyspnea (IST: 3.5 [2-4]; CPET: 3 [3,4]), p>0.05. VCO2 (IST: 14.9±3.6ml/kg/min; CPET: 15.9±3.7ml/kg/min), RER (IST: 0.94±0.09; CPET: 1.07±0.11), Δ%SpO2 (IST: -2.50 [-7; -0.25]%; CPET: 0.5 [-2; 1]%) and Δleg fatigue (IST: 3.75 [0.125; 5.0]; CPET: 4 [3.0; 7.0]) were significantly lower on the IST, p<0.05. Median VE/MVV percentage was greater than 80% during both the IST (91.4 [73.4; 101.1]%) and the CPET (100.8 [78.4; 110.5]%). IST showed a cardiorespiratory response similar to the response observed during CPET, in terms of VO2, VE, HR and dyspnea. The ventilatory limitation can be a limiting factor in IST performance, which showed that this test can be considered a symptom-limited option to assess exercise capacity.

6. "Nothing is the same. We are all changed": European families' perspectives on adaptation and the nurse's role in supporting them.

期刊: Journal of pediatric nursing 发表日期: 2026-May-12 链接: PubMed

摘要

Caring for a child with a chronic condition places enduring emotional, relational, and practical demands on families. A deeper understanding of how families adapt, and how nursing care supports this process, is essential to strengthen family-centered pediatric nursing practice. This study explored parents’ perceptions of their family’s adaptation to a child’s chronic condition and examined how they viewed the role of nurses in this process across diverse European healthcare contexts. This qualitative sub-study was part of a multinational comparative project. Data comprised responses to three open-ended survey questions from parents of children (0-18 years) living with chronic conditions. Thematic analysis was conducted following Braun and Clarke’s six-phase framework. Two overarching themes were identified. Meaning-Making in the Context of Family Vulnerability and Growth described families’ experiences of psychological and relational burden, unmet support needs, and gradual adaptive growth. Relational Care and Strengthening Family Agency captured how trust in professional competence, nurses’ empathetic presence, and tailored guidance empowered families to manage care at home. Parents reported ongoing strain and uncertainty but also described resilience and a sense of shared purpose when supported by relational and continuous nursing care. Family adaptation to a child’s chronic condition is a dynamic relational process shaped by both vulnerability and opportunities for growth. Nurses play a pivotal role in fostering trust, strengthening family agency, and alleviating emotional and practical burdens. Healthcare systems should prioritize continuity, relational depth, and accessible psychosocial and educational resources for families.

7. Corrigendum to "Follow-up of cancer incidence associated with smoke-related PM2.5 exposure due to a coal mine fire" [J Epidemiol Popul Health 2025;73(6):203148].

期刊: Journal of epidemiology and population health 发表日期: 2026-May-12 链接: PubMed

摘要

8. Population-based prevalence and pharmacotherapy sequences of treatment resistant depression in Germany.

期刊: European neuropsychopharmacology : the journal of the European College of Neuropsychopharmacology 发表日期: 2026-May-12 链接: PubMed

摘要

Treatment-resistant depression (TRD) represents a significant clinical challenge, yet data on its epidemiology and real-world therapy patterns remain limited. This study aimed to estimate TRD prevalence and analyze treatment patterns using claims data. This retrospective analysis used the German Analysis Database for Evaluation and Health Services Research (DADB), encompassing 2.47 million statutory health insurance beneficiaries in 2019. TRD was operationally defined as a claims-based proxy for patients with moderate-to-severe depression receiving at least three consecutive antidepressant prescriptions involving two or more changes of therapeutic strategy (switch, combination, augmentation, or ECT) using claims data. Among 360,344 individuals diagnosed with depressive episodes, 98,577 (27.36%) had moderate-to-severe depression and received pharmacological treatment. Of these, 12,054 patients met our operational TRD definition, representing 6.46% of all moderate/severe depression cases and 17.49% of those receiving continuous pharmacological treatment. Treatment patterns revealed suboptimal guideline adherence: only 27.20% of patients received combination or augmentation therapy after failure of first-line therapies, and 38.35% in third-line treatment. SSRIs dominated across all therapy lines, with frequent class-level cycling back to previously failed medication groups. ECT remained critically underused. This study provides the first large-scale, real-world evidence on epidemiology and treatment patterns of TRD in Germany. TRD affects a substantial proportion of patients with moderate-to-severe depression. As first large-scale, real-world evidence on TRD in Germany, these findings highlight urgent needs for improved clinical decision-making and better access to specialized care to address the substantial burden and suboptimal treatment trajectories of TRD in Germany.

9. The impact of contact lenses on binocular vision in patients with Keratoconus.

期刊: Journal of optometry 发表日期: 2026-May-12 链接: PubMed

摘要

To compare the effect of corneal rigid and scleral contact lenses (CRCL & SCL) on binocular vision and accommodative function in keratoconus (KCN) patients. In this prospective non- randomized comparative interventional study, patients aged 20 to 40 years with a definitive diagnosis of KCN were participated. Only patients with the best-corrected visual acuity (BCVA) of 0.40 LogMAR or better were included. A comprehensive examination including assessment of BCVA, refractive error, and stereopsis were performed. Furthermore, all participants underwent the complementary binocular vision and accommodation testing. All examinations were performed by spectacle and then repeated after contact lens fitting in both groups. In total, 31 patients were recruited (12 in the CRCL group and 19 in the SCL group). Both groups demonstrated significant improvements in BCVA after lens fitting in both eyes, with the SCL group showing an average gain of approximately 1-3 lines. Additionally, a higher proportion of patients in the SCL group achieved central stereopsis (<100 sec/arc) following lens fitting (p = 0.011). While both SCL and CRCL contributed to improved visual acuity in patients with KCN compared with spectacle, SCL exhibited more advantages over CRCL, particularly in enhancing stereopsis and fusional vergence performance.

10. Prenatal and childhood exposure to common plasticizers in relation to emotional and behavioral development through adolescence.

期刊: The Science of the total environment 发表日期: 2026-May-12 链接: PubMed

摘要

Individuals are ubiquitously exposed to bisphenols and phthalates, common plasticizers that may affect neurodevelopment. We examined associations of prenatal and childhood bisphenol and phthalate exposure with internalizing and externalizing problems from early childhood through adolescence. Within the Generation R study, prenatal urinary concentrations of bisphenol A (BPA) and phthalate metabolites were assessed in early, mid- and late pregnancy and in childhood at age 6 years. Pregnancy levels were averaged and used in analyses. Internalizing and externalizing problems were reported by parents at child age 3, 6, 10 and 14 years and by children at ages 10 and 14 years. Mother-child dyads with at least one prenatal exposure measure and one internalizing or externalizing problem score during follow-up were included (n = 1361). Among children with childhood exposure measures, n = 651 had at least one internalizing or externalizing problem score. Associations were examined using linear mixed models. Mixture analysis was performed for self-reported scores at age 14 with G-computation. Associations between phthalate/bisphenol levels and child outcomes were largely null. Except, prenatal mono-n-butylphthalate and mono-(2-ethyl-5-hydroxyhexyl)phthalate were associated with higher self-reported internalizing problem scores in girls (BmBP = 0.16, 95%CI: 0.03, 0.28 and BmEHHP = 0.11, 95%CI: 0.03,0.19, respectively). Prenatal mono-isobutyl phthalate, mono-(2-ethyl-5-carboxypentyl)phthalate and mono-(4-carboxymethyl-hexyl)phthalate were associated with higher self-reported externalizing problem scores in boys (BmIBP = 0.12, 95%CI: 0.03, 0.20, BmECPP = 0.17, 95%CI: 0.07, 0.28 and BmCMHP = 0.19, 95%CI: 0.08, 0.30, respectively). Childhood mono-methyl was associated with lower parent-reported externalizing problem scores in boys (BmMP = -0.12, 95%CI: -0.22, -0.03). Childhood mono-Benzyl phthalate was associated with higher self-reported externalizing problem scores in boys (BmBzP = 0.12, 95%CI: 0.04, 0.20). No associations with BPA were found. G-computation showed positive, but non-significant, associations for the same metabolites as in single chemical analyses. Associations of BPA and phthalate exposure with internalizing and externalizing problem scores in adolescents were largely null, associations with childhood phthalate exposure were less consistent and harder to interpret.

11. Plasma soluble TREM-1 and risk of cardiovascular disease in the population. Results from the Paris Prospective Study III and the CoLaus|PsyCoLaus.

期刊: European journal of preventive cardiology 发表日期: 2026-May-12 链接: PubMed

摘要

We examined the predictive value of soluble levels of triggering receptor expressed on myeloid cells 1 (sTREM-1) for incident cardiovascular disease (CVD). The main analysis was conducted in an observational prospective cohort. Adjudicated CVD events included coronary heart disease, stroke, heart failure and peripheral artery disease. sTREM-1 measures were centralized using a protocol optimized for Meso Scale Discovery technology. Among 9097 CVD-free participants (39% females, mean age 59.6±6.3 years), median sTREM-1 concentration was 193.41 pg/mL (IQR= 158.13 to 241.54) at baseline (2008 to 2012). Over 10.1 years of median follow-up (IQR= 9.2 to 12.0), 444 participants experienced 479 CVD events. Higher sTREM-1 concentrations were associated with higher risk of CVD in multivariable Cox proportional hazard model (HR 200-290 vs. <200pg/ml= 4.25;95% CI:3.20 to 5.63 and HR >290 vs. <200pg/ml=10.40;95% CI:7.72 to 14.02). Results were consistent across CVD subtypes. Adding sTREM-1 to SCORE2-SCORE2 OP improved the Harell-C index (C-index 0.79 vs. 0.71; bootstrapped C index difference: 0.084; 95% CI: 0.083 to 0.085) overall including among individuals at low to moderate 10-year risk of CHD or stroke, and reclassification: categorical NRI: 0.34; 95% CI: 0.28 to 0.40. Findings were similar with other recommended risk scores. In this prospective study, higher circulating sTREM-1 levels were independently associated with incident CVD. Addition of sTREM-1 to established risk scores was associated with improvements in discrimination and reclassification metrics, supporting its potential relevance as a candidate biomarker for further evaluation in primary prevention. in people without personal history of cardiovascular disease (CVD), higher concentration of triggering receptor expressed on myeloid cells 1 (TREM-1) was associated with a higher risk for CVD occurrence beyond established CVD risk factors. Key Findings:In multivariable analysis, higher sTREM-1 concentrations were associated with higher risk of CVD (HR 200-290 vs. <200pg/ml= 4.25;95% CI:3.20 to 5.63 and HR >290 vs. <200pg/ml=10.40;95% CI:7.72 to 14.02).Adding sTREM-1 to SCORE2-SCORE2 OP improved the Harell-C index (C-index 0.79 vs. 0.71; bootstrapped C index difference: 0.084; 95% CI: 0.083 to 0.085) overall including among individuals at low to moderate 10-year risk of CHD or stroke (5 to 10% and 7.5% to 15%), with similar results for other recommended risk prediction scores.

12. Molecular mechanism leading to human coronary atherosclerosis assessed by proteomic analysis and RNA sequences.

期刊: European heart journal 发表日期: 2026-May-12 链接: PubMed

摘要

Atherosclerosis results from cellular and extracellular changes in the arterial wall, preceded by molecular shifts that initiate disease and drive tissue conversion, yet these changes are not yet fully described. More data are needed concerning these early changes in the coronary artery molecular landscape that signify the initiation of atherosclerosis and the subsequent tissue pheno-conversion to atherosclerotic plaque. This report summarizes results from a large biorepository of human coronary artery tissue, applying state-of-the-art omics technology, advanced data analytic methods, and an arterial organoid model system to predict molecular dynamics and identify potential regulatory mechanisms that could interrupt molecular changes that contribute to the earliest stages of disease pathogenesis. The long-term goal of this effort is to identify and develop new therapies to further mitigate the persistently high burden of clinical coronary disease. Mass spectrometry-based proteomic analysis and RNA sequencing (RNASeq) were used to analyse proximal coronary arterial samples from young adults who died of trauma with no ante mortem suspicion of coronary disease [n = 322, mean age (range): 34.1 years (15-59); sex: M-239, F-83; race: W-218, B-88, other-16]. Despite the absence of clinical disease, 56% of samples had morphologic evidence of pre-clinical atherosclerosis. Analyses of the proteomic data (n = 1900 proteins) using state-of-the-art dimensionality reduction and deconvolution techniques generated an estimate of molecular disease progression (e.g. pseudo-time) and identified selected proteomic latent features (LFs) (i.e. large groups of co-ordinated proteins) associated with its initiation and progression. Computational genomics, machine learning models, and multi-omic network mapping of these proteomic LFs and associated mRNA gene transcripts suggested potential transcriptional regulators which were subsequently confirmed in publicly available single-cell coronary artery data. The effects of one of the leading regulatory transcription factors (TFs), MLXIPL, predicted to regulate two LFs, were further validated in a human arterial cell organoid model system. Four proteomic LFs, composed of n = 100 signature proteins/LF, exhibited distinct patterns with respect to disease progression [false discovery rate (FDR) P < .01]. These LFs illuminate the earliest changes in the arterial proteome during tissue pheno-conversion from normal coronary artery to atherosclerotic plaque, including dramatic declines in mitochondrial energy biosynthesis proteins, evidence of vascular unit activation (including pericytes), and neurovascular and neuroimmune modulation (all FDR P < .01). These early changes preceded the expected immune cell recruitment and innate immune response characteristic of atherosclerotic plaque formation. Analysis of transcriptional regulatory networks identified from RNASeq data highlighted both known and novel TFs and master regulators of LF proteins that may drive the initial and early stages of disease progression. Publicly available single-cell RNASeq data from normal and atherosclerotic coronary arteries validated the LFs and several of their likely master transcriptional regulators (all P < .01); and manipulation of the levels of one of top regulatory TFs, MLXIPL, in human arterial cell organoids resulted in the expected changes in expression of the proteins associated with its two targeted LFs (P = .0003 and P < .00001, respectively). The unique nature of this human coronary biorepository with samples ranging from entirely normal to mature pre-clinical atherosclerotic plaque facilitated prediction of molecular disease progression and identification of several potential transcriptional regulators for further evaluation as potential novel targets to interrupt early initiation and progression of atherosclerotic coronary disease.

13. Rural livelihood vulnerability to climate variability: a district-level assessment in Ethiopia.

期刊: The Science of the total environment 发表日期: 2026-May-12 链接: PubMed

摘要

Climate variability poses significant risks to Ethiopia’s rainfall-dependent smallholder farming systems. Since meteorological patterns can vary widely across agro-ecological zones, understanding differences in vulnerability across these zones is essential for targeted adaptation. However, many existing vulnerability studies rely on basin-, zonal-, or inter-district analyses and apply composite indices without robustness testing, which can obscure within-district heterogeneity and limit policy relevance at the scale where adaptation decisions are implemented. This study assesses smallholder farmers’ vulnerability to climate variability across three agro-ecological zones (midland, highland, and cold highland) in Legambo District, north-central Ethiopia. It examines spatial differences in vulnerability levels, identifies key biophysical and socio-economic drivers, and generates evidence to inform locally differentiated adaptation and development interventions. A mixed-methods approach was employed, combining household survey data from 347 randomly selected households with focus group discussions, key informant interviews, and long-term climate data. Forty-eight indicators were grouped into twelve major components and analyses using the Livelihood Vulnerability Index (LVI) and the LVI-IPCC framework, which conceptualise vulnerability in terms of exposure, sensitivity, and adaptive capacity. The robustness of the composite indices was assessed using a PCA-based sensitivity analysis, and household-level vulnerability distributions were examined to capture within-zone heterogeneity. The results reveal modest but consistent differences in vulnerability across agro-ecological zones. The cold highland zone was the most vulnerable (LVI = 0.370), driven by high exposure to climatic hazards, limited infrastructure, weak social networks, low innovation uptake, and constrained adaptive capacity. The highland zone exhibited moderate vulnerability, largely associated with inadequate water and health services and limited soil and water conservation practices. In contrast, the midland zone was the least vulnerable (LVI = 0.285), benefiting from greater livelihood diversification, better access to assets, and stronger adaptive capacity. The LVI-IPCC analysis confirmed these patterns, indicating higher exposure and sensitivity in the cold highlands and comparatively stronger adaptive capacity in the midlands. These findings indicate the interest of differentiated policy responses to strengthen resilience among smallholder farmers. In particular, the results indicate that improved rural roads, water supply, and health services, together with agro-ecological-zone-specific extension support and improved access to climate-resilient inputs, should strengthen adaptation planning and rural development program.

14. Correction to: Assessing the costs of antenatal care in Eastern Ethiopia: implications for improving the free maternity services policy.

期刊: Health policy and planning 发表日期: 2026-May-12 链接: PubMed

摘要

15. Mental Health Care for Refugees, Immigrants, and Migrants in the United States.

期刊: Psychiatric services (Washington, D.C.) 发表日期: 2026-May-12 链接: PubMed

摘要

Diverse refugee, immigrant, and migrant (RIM) populations in the United States face complex mental health needs that are shaped by migration experiences, cultural transitions, and structural barriers to accessing care. Although RIM populations have different legal statuses, cultural backgrounds, and lengths of U.S. residence, many encounter common stressors related to uncertain immigration policies, economic instability, and limited access to culturally responsive services. Recent federal actions-including suspension of the U.S. Refugee Admissions Program and revocation of “protected areas” policies-have intensified fears and mental health vulnerabilities among these populations. Using a multilevel, biopsychosocial approach, the authors aimed to provide clinical guidance on the biological, structural, sociocultural, and health care system factors that affect mental health care delivery for RIM populations. This article provides evidence-based clinical guidance and actionable recommendations that allow clinicians to selectively apply interventions (e.g., trauma-informed practices, low-barrier care models, medical-legal partnerships, and culturally responsive approaches that respect alternative healing frameworks) on the basis of individual patient circumstances. Key recommendations pertain to working with professional interpreters, navigating diagnostic ambiguity, and interfacing with immigration enforcement.

16. Modality of Behavioral Health Care Delivery in Commercial Claims: Implications for Telehealth Policy.

期刊: Psychiatric services (Washington, D.C.) 发表日期: 2026-May-12 链接: PubMed

摘要

The authors examined the distribution of behavioral health episodes of care (EOCs) by modality-telehealth only, in-person only, and both (hybrid)-to identify factors associated with telehealth use. Using 2021-2022 MarketScan Commercial Database claims, the authors categorized EOCs by modality. Descriptive analyses were followed by logistic regression to identify independent associations of patient and provider characteristics with telehealth use. Among 937,711 EOCs, 41.1% were in-person only, 32.9% telehealth only, and 26.0% hybrid. Compared with individuals <18 years, all adult age groups had higher odds of telehealth-only care. Female sex and urban residence were also associated with greater telehealth use, whereas residence outside the Northeast and nonpsychiatrist providers were associated with lower use. Among hybrid EOCs, telehealth initiation was more likely among adults ages 36-55, urban residents, and those treated by nonpsychiatrists. Telehealth constituted a substantial proportion of behavioral health care, highlighting the importance of maintaining flexible telehealth policies.

17. Extensive diversity and impact of drug-resistant HIV-1 variants in individuals with prior virologic failure.

期刊: PLoS pathogens 发表日期: 2026-May-12 链接: PubMed

摘要

HIV-1 drug resistance remains a major challenge to treatment and control efforts, particularly in sub-Saharan Africa (sSA). However, standard resistance genotyping does not adequately capture linked drug resistance mutations within the viral quasispecies that may influence virologic failure (VF). We used a next-generation sequencing primer ID (NGS-Primer ID) assay to characterize linked HIV-1 drug resistance mutations in plasma from participants in the Resistance Testing to Improve Management of Virologic Failure (REVAMP) study who had detectable viremia on first-line non-nucleoside reverse transcriptase inhibitor (NNRTI)-based antiretroviral therapy (ART) and were maintained on NNRTI-based regimens. For each participant, we calculated a weighted genotypic susceptibility score (wGSS) based on the GSS of each reported pattern and its sequence-supported frequency within the sample. Plasma specimens from 108 participants were sequenced. Sanger sequencing showed a median GSS of 1.0 (IQR, 1.0-2.0), whereas NGS-Primer ID identified a median of 10 distinct resistance patterns per participant (IQR, 5-17), with 67% (IQR, 8-92) of reported DRM-pattern frequency within participants corresponding to linked dual-class mutations. A broad spectrum of drug-susceptible and resistant- DRM patterns were observed, with the median difference between the highest and lowest pattern-specific GSS being 2.0 (2.0-2.75). Within each participant, a median of 10% of reported patterns showed less resistance, while 19% showed more resistance compared to that predicted by Sanger sequencing. Individuals with persistent VF had significantly lower wGSS at study entry than those who later achieved virologic re-suppression (median, 1.3 vs 2.1; p < 0.001). NGS-Primer ID revealed substantial intra-host diversity in linked HIV-1 drug resistance patterns that was not captured by conventional Sanger sequencing. Incorporating linked resistance patterns into susceptibility assessment may improve prediction of subsequent virologic failure.

18. Moving toward integrated care for perinatal opioid use disorder and mental health in an urban safety-net hospital: A formative implementation evaluation.

期刊: Journal of health services research & policy 发表日期: 2026-May-12 链接: PubMed

摘要

BackgroundOpioid use disorder (OUD) among pregnant and parenting individuals in the U.S. is a major public health concern. Current policies and procedures are not conducive to effective management of OUD in perinatal patients, who require multidisciplinary approaches. These approaches can challenge rigid healthcare structures, protocols, and staff beliefs. A formative evaluation was conducted of an integrated model of care, introduced as a first step in a system change process to provide comprehensive care to patients with perinatal OUD.MethodsRapid qualitative analysis was conducted of interviews with hospital staff (n = 19), staff at local organizations serving the population (n = 15), and patients (n = 5). Using the PRISM implementation framework, we evaluated current resources, gaps in care, treatment priorities, and feasibility, acceptability, and appropriateness of proposed changes.ResultsThere is a need for a centralized, long-term, healthcare system-linked space where pregnant and parenting women can obtain evidence-based, culturally- and life-stage-competent OUD treatment. Changing governmental policies is not enough to effect change; champions within the system are needed to advocate for changes in organizational policies and staff training. System-level changes must reduce departmental silos, improve integration with community and public health resources, and address the culture of stigma to create psychological safety for patients. Patients need to feel safe and supported throughout the healthcare system.ConclusionThe proposed integrated model of care was acceptable and appropriate; hospital employees provided clear guidance to ensure feasibility. Developing a multidisciplinary care team with coordinated care pathways, data reporting infrastructure, and staff education to reduce stigma are next steps.

19. The Neuroprotective Effect of a Waste Byproduct Obtained From Pomegranate (Punica granatum).

期刊: Phytotherapy research : PTR 发表日期: 2026-May-12 链接: PubMed

摘要

Pomegranate is an exceptional fruit that can have several beneficial effects on human health. The peel of pomegranate, a waste product, should be recovered as it still contains valuable constituents, including phenolic compounds, minerals and fibre. The recovery of bioactive compounds occurs through eco-sustainable extraction techniques that reduce costs and promote environmental sustainability and public health. Neurodegeneration is a pathological process causing progressive neuronal damage, potentially leading to cell death. Currently, no drug is known to cure neurodegenerative diseases definitively. A balanced diet rich in fruits and vegetables is associated with a lower risk of certain neurodegenerative conditions. The phytochemicals of plants and their beneficial bioactive compounds demonstrate promising therapeutic potential for human neurological diseases, exhibiting antioxidant and anti-inflammatory properties in the brain. This review aims to highlight the currently existing knowledge on the effects of pomegranate peel against neurodegenerative diseases and their mechanisms of action. The manuscript is intended for those who explore strategies for recovering waste materials and for those who investigate the effects of natural products on neurodegeneration. Prospects could include clinical trials in which pomegranate peel is used in the management of human neurodegenerative diseases.

20. Theoretical Framework and Key Considerations for Time-to-Onset Analysis in Spontaneous Reporting Systems.

期刊: Drug safety 发表日期: 2026-May-12 链接: PubMed

摘要

Spontaneous reporting databases play a central role in pharmacovigilance for monitoring the safety of drugs and vaccines. Conventional statistical signal detection has relied primarily on disproportionality analyses based on reporting frequencies, whereas information on the timing of adverse event onset has not been fully exploited. Time to onset (TTO), defined as the interval between the initiation of drug administration and the occurrence of an adverse event, provides complementary information that captures temporal patterns of event manifestation beyond simple occurrence counts. This review summarizes the definition, calculation, characteristics, and limitations of TTO analyses in spontaneous reporting databases and provides an overview of statistical signal detection methods incorporating TTO information. In particular, nonparametric distribution-comparison approaches, such as the Kolmogorov-Smirnov and Anderson-Darling tests, are well suited to spontaneous reporting data, in which the underlying population and exposure size are unknown. These methods enable the detection of abnormalities in the temporal structure of adverse event onset that may not be identifiable through frequency-based analyses alone. Furthermore, disproportionality analysis and TTO-based approaches are not competing methods but complementary strategies that capture different dimensions of safety signals-reporting frequency and temporal patterns-and their combined use may improve both sensitivity and interpretability of signal detection. The review also discusses survival analysis-based methods and Weibull modeling for TTO data, outlining their theoretical background and applications while emphasizing their inherent limitations when applied to spontaneous reporting systems. Because of reporting bias, incomplete time information, and the absence of non-event cases, such methods should not be used to estimate population-level risks or to infer causality. In conclusion, TTO analyses using spontaneous reporting databases should be positioned as exploratory tools for characterizing onset patterns, generating hypotheses, and informing the design of subsequent epidemiological and safety studies, rather than as a direct basis for clinical or regulatory decision making.

21. Antibiotic resistance among Gram-negative bacteria in bloodstream infections in Shiraz, Iran (2012-2023).

期刊: AMB Express 发表日期: 2026-May-12 链接: PubMed

摘要

Regular monitoring and conducting surveillance studies are necessary to control and treat antibiotic-resistant infections on a global scale. The present study aimed to perform a time-trend analysis of the distribution and antibiotic resistance of Gram-negative bacteria (GNB) isolated from bloodstream infections over 12 years in Iran. Throughout a 12-year duration, from January 2012 until the end of December 2023, data from the blood specimens of patients were obtained from three university teaching hospitals in Shiraz, Iran. Antimicrobial susceptibility profiles of GNB were determined using the Kirby-Bauer disk diffusion method (DDM) on Mueller-Hinton agar (MHA) media. A total of 391,762 blood samples were obtained from patients. Among these, 40,397 (10.31%) were confirmed to be positive for GNB. The frequency of GNB was higher among patients aged over 50 years. The highest number of GNB was isolated from the emergency (50.54%) ward. Escherichia coli with 42.65%, and Klebsiella spp. with 17.02% frequently isolated from blood specimens. CAZ was the most effective antimicrobial agent against Pseudomonas aeruginosa (7.16%), Acinetobacter spp. (1.18%), E. coli and Klebsiella spp. (1.17%). The trends observed in antibiotic resistance among GNB from 2012 to 2023 indicate a reduction in resistance levels for certain antibiotics: SXT decreased from 75.41 to 58.85%, TET from 82.39 to 25%, CAZ from 85.21 to 42.86%, AMP from 92.14 to 62.5%, and FEP from 100 to 67.96%. Results demonstrate a general downward trend in antibiotic resistance among GNB. However, variation in antibiotic resistance profile among GNB suggested that follow-up antimicrobial resistance (AMR) programs, along with constant screening and developing antimicrobial stewardship programs in Shiraz, are necessary.

22. Diagnostic accuracy and clinical impact of internist-performed point-of-care ultrasound in atrial fibrillation: a multicenter study.

期刊: Internal and emergency medicine 发表日期: 2026-May-12 链接: PubMed

摘要

Atrial fibrillation (AF) is highly prevalent in internal medicine and often requires timely echocardiographic assessment. Limited availability of standard studies may delay management, particularly in acute or resource-limited settings. We conducted a multicenter, cross-sectional study across 35 Spanish hospitals, enrolling adults with new-onset or chronic AF without echocardiography in the previous 12 months, comparing internist-performed point-of-care ultrasound (POCUS) with blinded cardiologist-performed transthoracic or transesophageal echocardiography (TTE/TEE) as the reference standard. The primary outcome was diagnostic accuracy for structural abnormalities. Secondary outcomes included comparison with auscultation and the clinical impact of POCUS findings. Among 441 patients (mean age 80.4 ± 9.9 years; 51% women), POCUS showed good diagnostic accuracy for left ventricular (LV) dilation (sensitivity 83%, specificity 94%) and LV systolic dysfunction (sensitivity 81%, specificity 94%), and moderate accuracy for left atrial (LA) enlargement (sensitivity 91%, specificity 64%). Compared with auscultation, POCUS was significantly more accurate for detecting mitral and tricuspid disease. POCUS findings frequently prompted therapeutic adjustments, including anticoagulation in mitral stenosis, individualized rate-control strategies in LV dysfunction, diuretic titration in congestion, and referral for significant valvular disease. Pericardial effusion, though less common, strongly influenced management. Internist-performed POCUS demonstrated robust diagnostic performance in AF and directly informed bedside therapeutic decisions. Although it does not replace comprehensive echocardiography, particularly for detailed valvular assessment, it represents a valuable extension of the physical examination and may improve timely and equitable cardiac evaluation.

23. Occupational mechanical exposures and upper-body musculoskeletal disorders: an overview of systematic reviews.

期刊: Annals of work exposures and health 发表日期: 2026-May-12 链接: PubMed

摘要

The aim was to provide a comprehensive overview of systematic reviews with meta-analyses of the association between occupational mechanical exposures and upper-body musculoskeletal disorders. A systematic literature search was conducted in PubMed, Web of Science, Embase, and CINAHL. Systematic reviews were considered eligible if they included occupational mechanical exposures and provided weighted measures of association in relation to specific musculoskeletal disorders. From each systematic review, data on eg databases searched, exposure, outcome, effect estimates, and quality of evidence of the association were extracted. The methodological quality of each systematic review was assessed using AMSTAR 2. The screening of 1,756 articles resulted in the inclusion of 17 systematic reviews with meta-analysis covering 6 musculoskeletal disorders: subacromial pain syndrome (n = 3), lateral epicondylitis (n = 2), carpal tunnel syndrome (n = 7), Dupuytren’s disease (n = 4), hand-arm vibration syndrome (n = 1), and hand osteoarthritis (n = 1). The weighted odds ratios from the meta-analyses generally ranged between 1.5 and 3.0. Approximately 35% of the included systematic reviews assessed the quality of evidence of the association, and among these, 48% graded the evidence as being low to very low. In general, this overview found an increased risk associated with most mechanical exposures in relation to specific upper-body musculoskeletal disorders. However, grading of evidence quality was rarely applied, and when present, showed substantial variability. Future research related to primary studies should prioritise high-quality prospective studies and objective exposure assessments, and systematic reviews would benefit from standardised methodologies and improved reporting transparency to further strengthen the evidence quality.

24. Key Features of Engagement Strategies in Nutrition Apps for Adults: Scoping Review.

期刊: JMIR mHealth and uHealth 发表日期: 2026-May-12 链接: PubMed

摘要

Nutrition apps offer scalable opportunities to support dietary behavior change and prevent chronic diseases. Their success depends on sustained user engagement, which is essential yet challenging to achieve and, consequently impacts the long-term effectiveness of these digital tools. Engagement strategies have been widely explored in digital health, but a comprehensive synthesis focusing on nutrition apps for adults is lacking. This scoping review aimed to map the current engagement approaches and metrics implemented in nutrition apps targeting adults and to identify how user engagement is defined across studies. We conducted a search of the PubMed, Scopus, Cochrane, and Web of Science databases for relevant studies published from January 1, 2013, to June 30, 2024. The inclusion criteria included original adult interventional or observational studies that evaluated nutrition apps and reported user‑engagement strategies or metrics. Two reviewers independently screened records in Covidence, with discrepancies resolved by a third reviewer. Data were charted across study characteristics, engagement strategies, and engagement metrics and then synthesized narratively. A total of 59 studies that used apps to improve dietary behaviors were included in our analysis, including randomized controlled trials, observational trials, and mixed methods studies. Most of these apps were designed for adults who were overweight and obese. The studies were primarily conducted in North America and Europe and were randomized controlled trials or nonrandomized intervention studies, with varying durations and sample sizes. Engagement strategies varied widely, and engagement was typically measured by frequency of specific function use and frequency of app use, followed by retention rate. The most common engagement strategies reported in studies were push notifications (n=29, 49%), behavioral theory integration (n=24, 41%), personalization and customization (n=19, 32%), and goal‑setting features (n=18, 31%). Only 31% (n=18) of studies provided an explicit definition of “user engagement,” and definitions were highly heterogeneous. Engagement measurement was dominated by quantitative system‑recorded metrics, including time and frequency of using specific functions (n=38, 64%), app use frequency (n=34, 58%), and retention (n=17, 29%). Few studies assessed qualitative or long‑term engagement dimensions, and long‑duration studies rarely integrated adaptive or contextualized engagement mechanisms. Research apps more frequently used theory‑driven strategies compared with commercial apps, which tended to emphasize streamlined user experience. Although several engagement strategies are commonly used, their implementation is inconsistent and often lacks grounding in conceptual frameworks. Research in the future needs to prioritize the use of common definitions for user engagement and measurement criteria while implementing user-centered design methods and using multiple research approaches to study the complex patterns of user engagement. The evidence base for engagement strategies needs strengthening because it will support the development of sustainable nutrition mobile health interventions.

25. Structural and Pharmacological Basis for the State-Dependent Activation of the Autoinhibited P. aeruginosa ClpP2 Protease.

期刊: ACS chemical biology 发表日期: 2026-May-12 链接: PubMed

摘要

Ubiquitous in biological systems, caseinolytic protease P (ClpP) represents a premier target for antimicrobial and antitumor therapies due to its central role in proteostasis. In Pseudomonas aeruginosa, PaClpP1 and PaClpP2 display distinct oligomeric states and enzymatic properties, yet the molecular basis underlying this divergence remains elusive. Here, by combining biochemical characterization, structural analysis, and molecular dynamics simulations, we identify Arg140 in PaClpP2 as the critical structural determinant governing its autoinhibited state. Mutation of this residue to alanine (R140A) relieves steric constraints, promoting the extension of the handle domain and conferring a robust proteolytic activity. Enzymatic assays further reveal that bortezomib and Z-Ile-Leu (ZIL) exert opposing, conformation-dependent effects on PaClpP. Molecular docking suggests that steric hindrance by R140 prevents canonical binding and induces a conformational switch, thereby activating the enzyme. Collectively, our findings establish the handle domain as a pivotal conformational switch, offering a structural foundation for the design of isoform-specific modulators.

26. Food insecurity and cardiometabolic diseases among people with HIV in West Africa.

期刊: AIDS (London, England) 发表日期: 2026-May-12 链接: PubMed

摘要

This study was conducted in order to evaluate the associations between food insecurity and cardiometabolic diseases among people with HIV in Togo and Côte d’Ivoire, West Africa. Cross-sectional study among ART experienced participants at lest 40 years of age contributing to the Sentinel Research Network (SRN) cohort of IeDEA West Africa. Study encounters took place from November 2021 through June 2022. Food insecurity was assessed using the Household Food Insecurity Access Scale (HFIAS). Moderate-to-severe food insecurity was defined as HFIAS category at least 3. Dietary diversity was assessed using the Dietary Diversity Scale (DDS). Poor dietary diversity was defined as DDS 0-6. Clinical data were obtained using standard, validated instruments and clinical assays. Multivariable logistic regression was used to evaluate the associations between food insecurity and clinical outcomes, including HIV outcomes (virologic failure, CD4+ cell count), cardiometabolic outcomes (hypertension, type 2 diabetes, hyperlipidemia, hepatic steatosis, obesity) and other indicators of poor nutritional status (anemia, underweight, poor dietary diversity). Among 584 participants (69% women, median age 52 years), 240 (41%) were moderately-to-severely food insecure. Food insecurity was more prevalent among women (46.3 versus 29.7%; P < 0.001), those who had not received any formal education, and those with an income less than 50k FCFA/month. Food insecurity was associated with higher odds of virologic failure [odds ratio (OR) 1.85; 95% confidence interval (CI) 1.04-3.28], CD4+ cell count less than 200 cells/μl (OR 2.98; 95% CI 1.28-6.90), and hypertension (OR 1.89; 95% CI 1.30-2.73). Food insecurity was associated with lower odds of hyperlipidemia (OR 0.34; 95% CI 0.16-0.72) and lower odds of obesity among men (OR 0.09; 95% CI 0.01-0.69), but not among women (OR 0.78; 95% CI 0.50-1.20). Food insecurity was associated with underweight (OR 2.95; 95% CI 1.09-7.97), and poor dietary diversity (OR 1.60; 95% CI 1.14-2.23) in univariable analysis but not multivariable analysis. Food insecurity was not associated with type 2 diabetes, liver steatosis, or anemia. Women had greater odds of obesity (OR 3.07; 95% CI 1.88-5.04) and anemia (OR 1.80; 95% CI 1.19-2.72) compared to men. Among people ageing with HIV in West Africa, food insecurity is common and is associated with poor clinical outcomes, including virologic failure and hypertension. Our findings support the need for integrated programs that address food insecurity and improve the prevention and treatment of cardiometabolic diseases among PWH in the region.

27. Free-living amoeba diversity in river waters of western Brazil and their in vitro and in vivo pathogenic potential.

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

摘要

Free-living amoebae (FLA) are key components of aquatic and terrestrial ecosystems, but their diversity and distribution in central-western Brazil remain poorly characterized. Some FLA are pathogenic and may harbor bacteria of public health relevance. We aimed to identify and to characterize the FLA biodiversity in the Cuiabá River basin and to infer their pathogenic potential. Water samples were collected at eight sites across two hydrological periods, and physicochemical and microbiological parameters were quantified. FLA were isolated on non-nutrient agar seeded with heat-inactivated Escherichia coli and identified by using morphology and molecular markers. We obtained 39 isolates (six genera and 14 species); Acanthamoeba (51.3%), Vannella (23.1%), and Vermamoeba (12.8%) were predominated. Only V. vermiformis was detected during both the high-water (when four exclusive species were detected) and low-water (when nine exclusive species were detected) periods. Seventeen FLA strains (n = 35) killed zebrafish larvae (Danio rerio); 11 of these strains (64.7%) were Acanthamoeba species, and the remaining strains belonged to the genera Flamella, Naegleria, Ptolemeba, Vannella, and Vermamoeba. Thermo- and osmotolerance did not correlate with zebrafish larval mortality. These findings expand current knowledge of FLA biodiversity in Brazil and reinforce that integrated FLA monitoring in the Cuiabá River basin is needed.

28. The Cumulative Effects of Three Consecutive Days of Simulated Occupational Heat Stress on Physiological Strain in Young Adults.

期刊: Medicine and science in sports and exercise 发表日期: 2026-May-12 链接: PubMed

摘要

Many workers complete prolonged shifts (≥8 h) across consecutive days in the heat, yet it is unclear whether this produces cumulative increases in physiological strain that must be considered in heat safety guidance. This study quantified physiological strain across three consecutive days of simulated occupational heat stress in physically active, young adults. Twenty participants (15 males, 5 females) were recruited to complete two 74-h trials in a randomized cross-over design trial. Each trial spanned four consecutive days. Days 1-3 involved baseline measurements (07:00-08:30h), an ~8-h work shift (08:30-16:00h) and an at home recovery (16:00-07:00h [+1 day]). Day 4 involved a final measurement period (07:00-08:00h). Work shifts involved cycles of 30 min work (~367W; ~4.3METs) and 30 min seated rest in summer clothing. Each trial differed only by environment during the work shifts: hot (35°C; 63%RH; 31°C WBGT) or control (18°C; 53%RH; 14°C WBGT). Core temperature, heart rate, mean skin temperature, fluid balance, and perceptual responses were assessed at baseline and end-of-shift. End-of-shift core temperature, core temperature area under the curve, heart rate, and mean skin temperature were higher in hot versus control (all p ≤. 003). However, with the exception of heart rate, which was 20 (95% CI; [12, 27]) beats·min⁻¹ lower on day 3 versus day 1 in the hot condition (p =.018), no outcomes differed across days in hot or control conditions (p ≥.182). Although there is still a need for larger studies with more protracted exposures in other populations. These findings indicate that there are minimal cumulative physiological effects of three consecutive days of moderate-intensity work in the heat in young, physically active adults.

29. Artificial Intelligence in Physical, Occupational and Neuro-Rehabilitation: Clinical Effectiveness, Prognostic Performance, and Pre-Implementation Feasibility - A Systematic Review.

期刊: Journal of medical systems 发表日期: 2026-May-12 链接: PubMed

摘要

Global rehabilitation needs far exceed capacity, and artificial intelligence (AI) is proposed to extend access, personalise therapy, and support adherence. We aimed to synthesise evidence on clinical effectiveness, prognostic performance, and implementation feasibility of AI-enabled rehabilitation across conditions and care settings. We conducted a mixed-methods systematic review of AI-enabled rehabilitation and rehabilitation-led prevention relevant to physiotherapy practice. MEDLINE, Embase, Web of Science, CINAHL, Scopus, and IEEE Xplore were searched. Methodological quality was appraised with MMAT and PROBAST + AI (prediction/diagnostic models), with a priori AI-reporting minimums checklist. Given heterogeneity, evidence was integrated via prespecified thematic synthesis. Thirty studies from diverse regions met inclusion, comprising randomised trials, non-randomised comparisons, cohorts, surveys, qualitative work, and prediction/diagnostic models. Clinical effects were modest and heterogeneous. Most AI-enabled interventions were comparable to conventional rehabilitation; signals of benefit appeared in selected musculoskeletal and telerehabilitation contexts but rarely persisted beyond short follow-up. Internal validity was frequently limited by asymmetric adherence measurement objective telemetry in AI arms versus self-report or attendance in controls alongside low uptake and declining engagement over time. Safety and usability were generally favourable within short horizons, although surveillance and explicit attribution to AI components were inconsistently reported. Prognostic and adaptive models showed encouraging discrimination in development settings but lacked multicentre external validation, calibration, subgroup-error profiling, and prospective impact evaluation, leaving them unready for clinical use. Stakeholders reported willingness to adopt AI while highlighting gaps in training, governance and information technology support, costs, and digital equity. Overall certainty for comparative clinical outcomes was low to moderate, for models, very low. AI in rehabilitation presently acts more as a behavioural amplifier structuring home programmes and supporting execution than as a replacement for dose-matched therapist-delivered care. Credible scale-up should position AI as an adjunct and hinge on arm-symmetric capture of adherence and execution, clinically meaningful outcomes paired with verified behaviour change over treatment and longer-term follow-up, and model deployment only after transparent development, external validation with calibration and subgroup-error characterisation, and demonstration of clinical impact. Embedding equity and economic evaluation, together with living oversight and version control, will be essential to convert promising prototypes into trustworthy, durable, and widely accessible services.

30. [Regenerative therapies with interfaces between rehabilitation, working life, and geriatrics-example of extracorporeal shock wave therapy].

期刊: Orthopadie (Heidelberg, Germany) 发表日期: 2026-May-12 链接: PubMed

摘要

ESWT is a safe, evidence-based, and effective procedure that has proven itself in almost all areas of medical care. To ensure high-quality use of this effective method, it is essential that it is applied in accordance with the applicable standards. Traditional, narrative review. The increasing proportion of physically demanding occupations, increasing lack of exercise, (over)aging of the population, and work intensification are leading to an increasing number of tendinopathies, myofascial dysfunctions, and chronic pain conditions. In this context, ESWT is becoming a relevant tool in modern, function-oriented occupational, preventive, rehabilitative, and geriatric medicine. ESWT usually acts as an “enabler” and “accelerator”, i.e., a biological activator of functional processes. ESWT is not a passive procedure, but rather an activator that often enables functional treatments through pain reduction and regenerative effects. ESWT combines regeneration, prevention, rehabilitation, mobility, participation, and economic sustainability and will continue to gain importance in an aging society. ESWT can be highly relevant in multimodal applications in prevention, rehabilitation, occupational medicine, geriatrics, and nursing care. Increased use of ESWT in prevention, rehabilitation, occupational medicine, and geriatrics, with reimbursement by the public health system, should be encouraged. HINTERGRUND: Die ESWT ist ein sicheres, evidenzbasiertes und effektives Verfahren, das sich in nahezu allen Bereichen der medizinischen Versorgung bewährt. Für einen qualitätsvollen Einsatz dieser effektiven Methode ist die Applikation entsprechend den geltenden Standards unerlässlich. Traditionelle, narrative Übersicht. Der steigende Anteil körperlich belastender Berufe, zunehmende Bewegungsarmut, (Über‑)Alterung der Bevölkerung und Arbeitsverdichtung führen zu einer zunehmenden Zahl an Tendinopathien, myofaszialen Dysfunktionen und chronischen Schmerzzuständen. In diesem Kontext wird die ESWT zu einem relevanten Instrument einer modernen, funktionsorientierten Arbeits‑, Präventions‑, Rehabilitations- und Altersmedizin. ESWT wirkt zumeist als „Enabler“ und „Beschleuniger“, d. h. biologischer Aktivator funktioneller Prozesse. Die ESWT ist dabei kein passives Verfahren, sondern ein Aktivator, der durch Schmerzreduktion und regenerative Effekte funktionelle Behandlungen häufig erst ermöglicht. ESWT verbindet Regeneration, Prävention, Rehabilitation, Mobilität, Teilhabe und ökonomische Nachhaltigkeit und wird in einer alternden Gesellschaft weiter an Bedeutung gewinnen. Die ESWT kann in der multimodalen Anwendung in Prävention, Rehabilitation, Arbeitsmedizin, Geriatrie und Pflege hohe Relevanz haben. Eine vermehrte und durch das öffentliche Gesundheitssystem refundierte operative Nutzung in der Präventions‑, Reha- und Arbeitsmedizin sowie der Geriatrie sind anzustreben.

31. Occupational distress and sleep crisis: Reframing recovery as organizational responsibility.

期刊: Work (Reading, Mass.) 发表日期: 2026-May-12 链接: PubMed

摘要

BackgroundOccupational distress is currently an underappreciated epidemic in modern work environments, which erodes both productivity and well-being in the general population. Growing evidence suggests that chronic job-related stress disrupts sleep architecture, accelerates cardiometabolic and neurocognitive decline and perpetuates a cycle of diminished resilience.ObjectiveIn this commentary, the authors call for an integrated framework that places sleep as a core dimension of occupational health policy, rather than a mere individual lifestyle choice.MethodsAn extensive literature review was conducted to search for relevant articles using relevant keywords. Articles matching the subject and relevant to occupational distress and sleep crisis were extracted, studied in detail, and included in the commentary.ResultWe found existing gaps in the literature on occupational distress and sleep crisis, emphasizing the need for wider discussion and generous debate on this subject. Most organizations recommend individual-level stress and sleep management to address occupational distress and sleep crisis in workplaces rather than advocating for organizational reforms.ConclusionAs organizations increasingly acknowledge employee wellbeing as a strategic priority, there is an urgent need to reconceptualize recovery and sleep not as personal lifestyle choices but as outcomes shaped by organizational structures, cultures, and policies. By reframing recovery as a shared responsibility, this commentary contributes to ongoing debates about sustainable work, health-protective organizational design, and the ethical obligations of employers in safeguarding employee wellbeing and also seeks to propel both academic inquiry and organizational practice towards structural change rather than mere adaptation.

32. "It's not just a matter of getting technology into buses": An activity-centred approach to bus drivers' work sustainability in an age of automation.

期刊: Work (Reading, Mass.) 发表日期: 2026-May-12 链接: PubMed

摘要

BackgroundIn the context of current challenges facing public passenger transport, automation is presented as a leading solution for achieving more efficient, safer, and more sustainable mobility. This is reflected in the growing number of pilot projects and trials with automated buses across Europe. Yet, debates on automated public transport are often dominated by either technocentric perspectives or concerns about passenger acceptance.ObjectiveThis study adopts a perspective that has been insufficiently considered in research on automated public transport: the viewpoint of bus drivers. This neglect has meant that drivers’ work experience and their knowledge of the issues affecting public transport remain residual.MethodsA qualitative research design was employed, involving bus drivers from a public transport company in a metropolitan area of Portugal. Discussion sessions were organised as spaces for dialogue and reflection on work activity and its potential evolution with automation.ResultsFour main themes emerged, illustrating the constraints that shape drivers’ current work and how these have contributed to the deterioration of job quality. Building on this, the drivers projected their probable future work with automated buses, showing that this transition intersects with much more than technology alone. It requires attention to working conditions, occupational risks, bus scheduling, and even urban planning.ConclusionsAs investment in automated public transport grows, promising to redefine drivers’ work, our results help identify key organisational and policy factors that need to be addressed to promote sustainable work and secure a worker-led just transition to automation in public transport for bus drivers.

33. Disparities in Meningococcal Vaccination by Healthcare Facility Type Among US Teens, Findings From the 2022 National Immunization Survey-Teen.

期刊: Journal of public health management and practice : JPHMP 发表日期: 2026-May-12 链接: PubMed

摘要

Meningococcal ACWY conjugate vaccines (MenACWY) are recommended for all US adolescents. However, vaccine coverage is incomplete and varies by sociodemographic factors. We used publicly available data from the US 2022 National Immunization Survey-Teen (NIS-Teen), which includes both a survey of parents of 13-17-year-olds and that teen’s provider(s) (analytic n = 15,489). We examine whether facility type of reporting provider (ie, public, private, etc.) was associated with receipt of MenACWY and whether this association varied by the MenACWY vaccination policy for the state in which the teen resided. We used confounder-adjusted multivariable logistic regression models to calculate adjusted prevalence odds ratios (aORs) and 95% confidence intervals. Compared to adolescents whose provider report was from a private facility, those with reports from public facilities had a lower odds of both having received at least 1 MenACWY dose before age 13 (aOR = 0.54 [0.40, 0.72]) and of having received at least 1 MenACWY dose before the parent/guardian survey date (aOR = 0.62 [0.42, 0.93]) in fully adjusted models. While living in a state with a MenACWY mandatory vaccination policy was associated with a greater odds (aOR = 1.51 [1.26, 1.81]) of having received at least 1 MenACWY dose before the age of 13, adjustment for MenACWY statewide policy did not change the public-private clinic disparity in coverage. Given the severity of invasive meningococcal disease and the variability of MenACWY vaccine uptake for teens receiving care across various settings, there is a need to improve MenACWY vaccination coverage among adolescents who seek care in public facilities.

34. Prenatal Air Pollution Exposure During Late Pregnancy Associates With Food Sensitization at 18 Months.

期刊: Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology 发表日期: 2026-May-12 链接: PubMed

摘要

35. Lipid metabolism links seminal PFAS exposure to IVF outcomes.

期刊: Environment international 发表日期: 2026-May-09 链接: PubMed

摘要

Per- and polyfluoroalkyl substances (PFASs) may affect reproductive health, but their impact on male in vitro fertilization (IVF) outcomes remains unclear, and the underlying mechanisms are not yet elucidated. This cohort study included 132 men, aiming to evaluate the associations of PFAS exposure with IVF outcomes and explore potential biological mechanisms through lipid metabolomics. The results showed that perfluorooctanoic acid (PFOA) [(RR (95%CI): 0.875 (0.779, 0.983), P = 0.0246)], perfluoroundecanoic acid (PFUdA) [(RR (95%CI): 0.803 (0.690, 0.935), P = 0.0047)], perfluorododecanoic acid (PFDoA) [(RR (95%CI): 0.831 (0.713, 0.968), P = 0.0173)], perfluorotridecanoic acid (PFTrDA) [(RR (95%CI): 0.833 (0.719, 0.965), P = 0.0152)], and 9-chlorohexadecafluoro-3-oxanonane-1-sulfonate (9Cl-PF3ONS) [(RR (95%CI): 0.925 (0.856, 1.000), P = 0.0497)] were inversely associated with the numbers of high-quality embryos. Increases in PFAS concentrations were associated with changes in specific lipid relative abundance, and specific lipid relative abundance was associated with IVF outcomes. In the group with poor IVF outcomes, the lipid pathways of phosphatidylcholine (PC) → diacylglycerol (DG) → PE → PS (Z-scores = -1.744 and -1.857, respectively) and triacylglycerol (TG) → DG → PE → PS (Z-scores = -1.985 and -2.080, respectively) were down-regulated, while the pathway of PS → PE → PC was up-regulated (Z-scores = 1.760 and 1.943, respectively). Network toxicology suggested that PFASs may be related to male infertility-associated lipid metabolism pathways through putative targets such as PTDSS and PEMT. This study provides epidemiological evidence that seminal PFAS exposure was associated with altered lipid metabolism and IVF outcomes. However, the associations were heterogeneous across lipid classes and IVF endpoints, suggesting that lipid metabolism may be involved in a complex biological response to PFAS exposure.

36. Mixture effects of multiple environmental factors on chronic obstructive pulmonary disease risk Trajectories: Evidence from Pearl River cohort in China.

期刊: Environment international 发表日期: 2026-May-09 链接: PubMed

摘要

COPD may be influenced by complex environmental interactions. Current evidence is limited to isolated stages and is lacking on the effects of mixture exposures. This study assessed the effects of environmental mixtures on COPD risk trajectories. We analyzed the impact of mixture exposures (air pollution, meteorological factors, built environment features) on COPD hospitalization/mortality for 67,235 participants. We applied Weighted Quantile Sum regression to quantify mixture effects and mixture contributions. In the WQS regression analysis, each quartile increase in the WQS index was associated with a 29.9% higher risk of transitioning from hospitalization to death, with NO2 (21.8%) and SO42- (19.4%) contributing the most. No significant associations were observed for the transition from baseline to hospitalization or the transition from baseline to death. Furthermore, we employed K-means clustering to identify distinct exposure patterns. Three exposure patterns were identified. Compared with the Urbanization-Dominant Pattern, the Urbanization-Ecology Balanced and Ecology-Dominant Patterns were inversely associated with transitions from baseline to hospitalization (17.5% and 9.0% lower risk, respectively) and to death (17.8% and 9.2% lower risk, respectively). The elderly had an 37.8% higher risk of the transition from hospitalization to death. Environmental mixtures significantly affect COPD trajectories. Controlling critical pollutants and optimizing ecological planning are essential for the COPD burden.

37. ASFV early protein p30 suppresses antiviral type I IFN induction by targeting TRIM21 and RIG-I like receptor signaling adaptor MAVS.

期刊: Veterinary microbiology 发表日期: 2026-May-09 链接: PubMed

摘要

African swine fever (ASF) is a highly pathogenic disease caused by the African swine fever virus (ASFV) infection, which can affect pigs of all ages and breeds, posing significant threat to the global pig farming industry. The ASFV p30 protein is an early-expressed viral structural protein; however, its function is not fully understood. In this study, the interaction of viral p30 with host TRIM21 was identified. The ectopic TRIM21 inhibited ASFV replication, while knockdown or knockout of TRIM21 promoted ASFV replication. Further, p30 was found to interact with RIG-I-like receptor (RLR) signaling adaptor MAVS, and during ASFV infection, p30-TRIM21-MAVS interacted with each other. Mechanistically, TRIM21 activated the K27 polyubiquitination of MAVS to induce IRF3 mediated type I interferon (IFN) production, whereas p30 counteracted TRIM21 activated MAVS K27 polyubiquitination to evade RLR signaling mediated antiviral IFN induction. In summary, our study revealed a novel function of ASFV p30, and provided new insights into the immune evasion of ASFV.

38. Hidden pathways: Detection and quantification of microplastics across treatment stages of pharmaceutical WWTPs.

期刊: Journal of hazardous materials 发表日期: 2026-May-09 链接: PubMed

摘要

Recently, it has been recognised that the pharmaceutical industry has emerged as a new source of microplastic contamination, particularly when treated wastewater is discharged into aquatic systems. Microplastics have been widely reported in aquatic animals, the terrestrial environment, and food systems, but the prevalence and characteristics of microplastics associated with the pharmaceutical industry remain poorly understood. This study investigates the degree of microplastic contamination, along with its loading and retention capacity, in samples collected from various treatment processes at five pharmaceutical industrial plants. Microplastics found in influent and effluent samples ranged from 720 to 920 particles/L and 170-490 particles/L, respectively. Similarly, the loading and retention capacities between the influent and effluent range from 0.99 to 1.90 × 108 and 54.76-67.07%, respectively. Microplastics were categorised by size, shape, and color using an optical microscope, with white (3290 ± 765.44 particles), fragment (4270 ± 522.2 particles), and size (100-500 µm) being predominantly identified in all samples of the treatment process. Polymer compositional analysis revealed that polyethylene was the most abundant. Further, the effluent samples were evaluated using a conditional fragmentational model and SEM analysis, which indicates that microplastics may likely be produced by the breakdown of larger plastic material under stressor environmental conditions of EC and pH, which play a role in MPs distribution, polymer characterisation and morphology. Additionally, the environmental risk assessment indicates varying ecological risks posed by effluent microplastics and emphasises the need to mitigate microplastic pollution to maintain ecosystem and human health.

39. Co-exposure profiles of PAHs and their derivatives in coking plant workers' serum and associations with liver function.

期刊: Environment international 发表日期: 2026-May-09 链接: PubMed

摘要

Coking plant workers are at great exposure risk to polycyclic aromatic hydrocarbons (PAHs) and their derivatives, with mounting evidence indicating PAH exposure being associated with liver impairment. However, impacts of co-exposure to PAHs and their derivatives on liver function remain poorly understood. Herein, serum samples were collected from coking plant workers, nearby population, and control population to study 10 PAHs, 7 methylated-PAHs (MPAHs), 17 heterocyclic PAHs (HPAHs), and 1 oxygenated-PAH (9-fluorenone). Furthermore, association between them and liver function biomarkers was explored based on quantile g-computation, weighted quantile sum regression, and Bayesian kernel machine regression models. Median levels of PAHs, MPAHs, HPAHs, and 9-fluorenone in the serum of coking plant workers were 2230, 738, 1250, and 18.8 ng/g lipid, respectively, which were significantly higher than those in other two groups. Coking process workers had higher exposure levels to PAHs and their derivatives than those in other processes. Further, results revealed positive joint effect of PAHs and their derivatives with liver function biomarkers, including total bilirubin (TBIL), indirect bilirubin (IBIL), direct bilirubin, alanine aminotransferase, and aspartate aminotransferase (AST). Notably, PAHs and their derivatives were significantly positively correlated with IBIL, TBIL and AST, with 4-methyldibenzofuran, dibenzofuran, phenanthrene, 5,6-benzoquinoline, quinoline, and indole as primary contributor. PAH derivatives had more significant effect on liver function biomarkers from a co-exposure perspective, although their concentrations were much lower than those of parent PAHs. This study emphasizes significance of PAH derivatives and contributes to better understanding the underlying mechanisms of PAH and their derivative exposure on liver function impairment.

40. Joint associations of the systemic inflammation response index and albumin-globulin ratio with all-cause and cardiovascular mortality across cardiovascular-kidney-metabolic syndrome stages 0-3: a prospective cohort study in the UK Biobank.

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

摘要

The systemic inflammation response index (SIRI) and albumin-globulin ratio (AGR) reflect inflammatory and nutritional status relevant to cardiovascular health, yet their joint prognostic relevance in early-stage cardiovascular-kidney-metabolic (CKM) syndrome remains unclear. We evaluated the independent and joint associations of SIRI and AGR with all-cause and cardiovascular mortality in CKM stages 0-3. In this prospective cohort study, 284,012 UK Biobank participants with CKM stages 0-3 were followed until August 2025. Associations of SIRI and AGR with mortality were assessed using Cox proportional hazards models. Mediation analyses evaluated contributions of cardiometabolic factors. Non-linear dose-response relationships were examined using restricted cubic splines, and joint analyses were performed based on spline-derived cut-offs. Over a median follow-up of 16.48 years, 24,022 all-cause and 2712 cardiovascular deaths occurred. Higher SIRI was associated with increased mortality (HR 1.24 [95% CI 1.22-1.25] for all-cause; 1.23 [1.18-1.29] for cardiovascular), whereas higher AGR was inversely associated (HR 0.61 [0.58-0.64]; 0.64 [0.55-0.75]). BMI and eGFR mediated 11-18% of the AGR-mortality association, whereas SIRI risk was largely independent of conventional pathways. Joint analyses identified a high-risk phenotype (high SIRI/low AGR) with the greatest mortality risk. Cardiovascular associations were stronger among participants with favorable social determinants of health (p for interaction <0.05). In early CKM stages, SIRI and AGR were independently and jointly associated with long-term risks of all-cause and cardiovascular mortality. Incorporating SIRI and AGR into the CKM framework may improve early risk stratification and identification of high-risk inflammatory-nutritional phenotypes in preclinical stages.

41. A unified liquid chromatography-mass spectrometric approach combining targeted and untargeted analyses for community exposure profiling in wastewater.

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

摘要

Wastewater-based epidemiology (WBE) has strong potential for community-level environmental exposure surveillance, but current applications remain limited in chemical scope and rarely integrate biomarker discovery with targeted quantification. Here, we developed an integrated wastewater exposomics framework combining untargeted Phase II metabolite profiling with targeted measurement of established volatile organic compound (VOC) biomarkers to characterize community-level chemical exposure. Across sixteen sewersheds in Louisville Metro, Jefferson County, Kentucky, including eleven neighborhood catchments and five centralized treatment facilities, we detected 194 Phase II metabolites derived from 145 parent xenobiotics, including mercapturic acids, glucuronides, and sulfates associated with aldehydes, aromatic hydrocarbons, epoxides, and related environmental chemicals. Several metabolites were consistently detected across sites, whereas many exhibited marked spatial heterogeneity, with greater variability at the neighborhood scale. Targeted liquid chromatography-mass spectrometry analysis of VOC biomarkers similarly revealed greater variability in neighborhood catchments than in treatment-center influent. Together, these findings demonstrate that integrating untargeted and targeted approaches extends WBE beyond limited target panels, enabling broader biomarker coverage and improved spatial resolution of community-level chemical exposures. Further refinement of normalization strategies, metabolite libraries, and data integration will enhance its utility for population-level exposure assessment.

42. Head injuries as a risk factor for amyotrophic lateral sclerosis: A systematic review and meta-analysis.

期刊: Clinical neurology and neurosurgery 发表日期: 2026-May-08 链接: PubMed

摘要

Previous studies have suggested that traumatic head injury (THI) is associated with amyotrophic lateral sclerosis (ALS). However, the evidence remains limited and inconsistent, partly due to small sample sizes. In this meta-analysis, we aimed to investigate the association between THI and the risk of ALS. We conducted a systematic review and meta-analysis of studies assessing the relationship between THI and ALS. The exposure of interest was THI, and the outcome of interest was ALS development. Odds ratios (ORs) with corresponding 95% confidence intervals (CIs) were used as effect measures. Eighteen studies comprising 578,815 participants were included. THI was associated with an increased risk of ALS (OR = 1.47; 95% CI: 1.23-1.76). The association was consistent across studies conducted in Europe (OR = 1.60; 95% CI: 1.19-2.15) and the Americas (OR = 1.27; 95% CI: 1.12-1.43). Subgroup analysis by sex showed a significant association among males (OR = 2.27; 95% CI: 1.41-3.66) but it was less significant among females (OR = 1.30; 95% CI: 0.78-2.17). Both single (OR = 1.48; 95% CI: 1.18-1.85) and multiple THIs (OR = 1.34; 95% CI: 1.15-1.56) were associated with ALS. Funnel and doi plots demonstrated asymmetry indicating significant publication bias. Our analysis demonstrated an association between THI and ALS, however the lack of dose-response relationship suggests it is less likely to be causative.

43. The efficacy of deslorelin implants in neutered male dogs that sexually attract other male dogs: a randomized controlled trial.

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

摘要

Sexual attractiveness of neutered male dogs to other male dogs is a frequently reported phenomenon of unknown pathophysiology. As gonadectomized dogs exhibit elevated luteinizing hormone (LH) concentrations, this study evaluated the efficacy of deslorelin implants in a double-blinded randomized controlled trial (RCT) to mitigate sexual attractiveness. Thirty gonadectomized male dogs attractive to other dogs were recruited for this RCT. One group (n = 15) received a 4.7 mg deslorelin implant (Suprelorin® 4.7 mg, Virbac, France) and another group (n = 15) received a placebo implant. Following the implantation, owners documented behavior after 30-45, 90, 180 and 270 days. Additionally, blood samples were collected on days 0, 30-45 and 270 to determine follicle-stimulating hormone (FSH) and luteinizing hormone (LH) concentrations. Sexual attractiveness developed within 12 months after castration in all dogs. Reduced attractiveness was observed in 11 of the 15 deslorelin-treated dogs compared to 5 of the 15 placebo-treated dogs. The overall treatment effect for behavioral improvement (across all timepoints) amounted to an odds ratio (OR) of 5.47 (p = 0.017). The LH concentration decreased to basal levels in the deslorelin group but remained unchanged in the placebo group, whereas FSH concentrations stayed elevated in both groups. Deslorelin implants are a promising option, reducing sexual attractiveness in approximately three quarters of affected dogs. Additionally, our study revealed that deslorelin reduces elevated LH but not FSH concentrations in gonadectomized dogs. Further research is needed to validate long-term efficacy, determine optimal dosages and implantation intervals, and consider the use of additional behavioral therapy.

44. Urinary orosomucoid and the risk of cardiovascular events and all-cause mortality in the general population. The Tromsø Study 2007-2021.

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

摘要

Urinary orosomucoid may reflect inflammation and endothelial dysfunction and has been linked to subclinical cardiovascular disease in selected populations. Its prognostic value in the general population remains uncertain. We hypothesised that an elevated urinary orosomucoid-to-creatinine ratio (UOCR) is independently associated with the risk of myocardial infarction (MI), ischaemic stroke, and all-cause mortality. We included participants from the population-based Tromsø Study (2007-2008) without prior MI or ischaemic stroke at baseline. Urinary orosomucoid was measured from three urine samples and expressed as UOCR (mg/mmol). Cox proportional hazard models were used to assess associations with incident MI, ischaemic stroke, and all-cause mortality, adjusting for traditional cardiovascular risk factors and urinary albumin-to-creatinine ratio. Analyses included sex-specific models and interaction testing. In total, 6607 participants (3911 women and 2696 men; mean age 63 ± 9 years) were included and followed for a median of 13.2 years. During follow-up, 488 participants experienced MI, 385 had ischaemic stroke, and 1251 died. Elevated UOCR was associated with increased risk of all outcomes. Comparing highest with lowest quartiles, UOCR predicted MI (HR 1.45, 95% CI 1.09-1.92, p = 0.01), ischaemic stroke (HR 2.34, 95% CI 1.67-3.28, p < 0.001), and all-cause mortality (HR 1.72, 95% CI 1.43-2.08, p < 0.001) in fully adjusted models. In sex-specific analyses, the association with MI was stronger in women than in men (p for interaction = 0.002). UOCR is independently associated with the risk of MI, ischaemic stroke, and all-cause mortality in the general population; however, its clinical utility remains to be established.

45. A Fit-Gap Analysis of Care Planning Tools: Evaluating FHIR Compliance.

期刊: Studies in health technology and informatics 发表日期: 2026-May-07 链接: PubMed

摘要

Standardized care plans are essential for improving care quality, enabling consistent care delivery and seamless data exchange across care settings. However, the extent to which existing care planning tools implement standards, like HL7 FHIR, remains unclear. This study evaluates existing care planning tools through a fit-gap analysis assessing their alignment with standardized, interoperable care plan requirements and identify gaps hindering standardization and system integration. Tools were evaluated based on standard compliance, particularly FHIR, output capabilities, geographical origin, and accessibility patterns. Nine tools demonstrated full FHIR compliance, two partial implementation, and five no explicit FHIR support. Geographic analysis revealed US and Australian tools exhibited higher FHIR implementation rates than European solutions. Only seven tools achieved the “fit” criterion of combining care planning functionality with full FHIR compliance. No tools from Asia, Africa, or South America were identified, suggesting global gaps in access to standardized care planning technologies. These findings highlight geographic disparities in interoperability standards adoption and a need for policy interventions, particularly in Europe and underrepresented regions.

46. "From Knowledge to Action" - Empowering Communities Through Online Vaccination Training Across 75 Countries.

期刊: Studies in health technology and informatics 发表日期: 2026-May-07 链接: PubMed

摘要

Misinformation increasingly undermines trust in childhood immunization among both the public and healthcare workers. Innovative, scalable educational approaches are needed to strengthen vaccine confidence across diverse settings. Objectives: To describe and evaluate a global initiative delivering asynchronous online vaccination courses, focusing on participant reach, completion, and qualitative experiences. We conducted a pilot evaluation using descriptive analysis of enrollment and completion data, combined with qualitative content analysis of voluntarily submitted open-text feedback. Courses were fully online, self-paced, accredited for continuing professional development, and implemented through international, local, and institutional partnerships. Between April 2024 and December 2025, seven courses were delivered. A total of 3,018 participants from 75 countries completed at least one course, with an overall completion rate of 31.5%. Sixty feedback entries from low-, middle-, and high-income settings were analyzed. Nine themes emerged, with differing emphases across contexts. Asynchronous online vaccination education can decentralize knowledge at scale, support trust-building and empowerment, and complement traditional immunization communication strategies.

47. aktivplan in Health Tourism: A Digital Prevention Platform for Sustaining Health-Promoting Behaviors Beyond the Stay.

期刊: Studies in health technology and informatics 发表日期: 2026-May-07 链接: PubMed

摘要

Health tourism can initiate health-promoting behaviors, yet sustaining these behaviors beyond on-site stays remains challenging. Digital prevention platforms may facilitate long-term transfer of health-related routines into everyday life. This study evaluates the acceptance, usability, and user experience of the aktivplan app as a digital prevention platform for sustaining healthy behaviors beyond health stays. In a mixed-methods manner, the study conducted between May 2024 and April 2025 included diaries, questionnaires, semi-structured interviews, and engagement and adherence logging with 33 participants over more than six months. Results showed that aktivplan was perceived as user-friendly, intuitive, and motivating, and often showed sustained regular use over time. Participants reported increased physical activity, motivation, and self-efficacy. Content flexibility, personalization, and regional integration were identified as key drivers of engagement and successful behavior transfer. Based on these findings, digital prevention platforms such as aktivplan show strong potential to sustain health-promoting behaviors beyond health stays.

48. From Guidelines to Action: A Systematic Approach to Translating Health Indicators into a Digital Prevention Ecosystem.

期刊: Studies in health technology and informatics 发表日期: 2026-May-07 链接: PubMed

摘要

Non-communicable diseases (NCDs) remain a major public health burden, despite widely established preventive interventions. Digital Health solutions focusing on prevention are often fragmented and weakly linked to evidence-based guidelines. This work aimed to develop a systematic approach for translating guideline-based health indicators into the PreNUDGE ecosystem, a digital prevention platform. Clinical guidelines for four NCDs were screened to identify prevention-relevant indicators suitable for self-reporting, which were structured using a standardized schema, aligned with HL7 FHIR principles and prepared for integration into qualified apps within the PreNUDGE platform. A core set of disease-specific health indicators was derived and is ready to be translated into apps and ready to be implemented in the PreNUDGE ecosystem. The approach demonstrates the feasibility of operationalizing guideline-based health indicators within a digital prevention platform to support personalized prevention and public health analyses.

49. Development and usability testing of 'Eating Smart' - A mobile application for promoting healthy eating in Chinese colorectal cancer survivors and high-risk populations.

期刊: International journal of medical informatics 发表日期: 2026-May-05 链接: PubMed

摘要

Dietary modifications are critical for reducing colorectal cancer (CRC) incidence and mortality. While our prior dietary intervention demonstrated efficacy in improving dietary patterns among Chinese CRC survivors, scalability limitations necessitated adaptation into a mobile application (app). This study aimed to develop the Eating Smart app to reduce consumption of red/processed meats and refined grains, and evaluate its usability among Chinese CRC survivors and high-risk individuals. A mixed-methods study was conducted in three phases: (1) prototype development (adapting materials from our previous dietary intervention, reviewed by an expert advisory group), (2) app development, and (3) usability testing. Participants, comprising 100 colon polyp clinic attendees and 11 CRC survivors, engaged with the app for approximately two weeks. Usability was assessed using the validated improved Chinese version of the Mobile Health App Usability Questionnaire (I-C-MAUQ) and semi-structured interviews. The I-C-MAUQ score ranges from 1 to 7, with a lower score indicating better usability. In phase 1, a culturally aligned, theory-based prototype was adapted from materials used in a prior randomised controlled trial. Building on the theoretical and cultural considerations from phase 1, phase 2 iteratively developed a functional application comprising 4 major modules (Healthy Cooking, Progress Tracking, Educational Pages, and Discussion Forum). Participants reported good overall app usability, with a mean I-C-MAUQ score of 2.49 ± 0.24 (range 1-7), reflecting a tendency to agree with usability statements. Qualitative interviews encapsulated strengths, including intuitive navigation, culturally tailored dietary recommendations, and peer support via the discussion forum. Key optimization areas included streamlining the food logging process (e.g., utensil-based portion estimation and pre-specified meal options for composite dishes) and integrating stoma-friendly recipes. The Eating Smart app is the first standalone app offering culturally tailored dietary support for Chinese CRC survivors and high-risk individuals. While further evaluation on intervention effectiveness is needed, initial feedback in this study supports its usability. Iterative optimizations - particularly simplified food logging features, predefined meal options, stoma-friendly recipes, and nutritionally labeled recipes - are warranted. Future work should optimize the app and explore its efficacy.

50. Successful use of intravenous droperidol in hyperemesis following failure of sequential antiemetic therapy.

期刊: The American journal of emergency medicine 发表日期: 2026-May-05 链接: PubMed

摘要

Nausea and vomiting in pregnancy is a common affliction, especially in the early trimesters. This is typically managed at home with doxylamine-pralidoxime or other home remedies. Many women, however, require additional adjuncts to control their symptoms. In this case we present a G2P0 female at 7 weeks gestation who arrived in the emergency department with persistent vomiting for several days. This patient already had a home medication regimen of multiple antiemetics. Additional treatment with ondansetron, prochlorperazine, and metoclopramide via IV administration as well as fluid administration resulted in minimal improvement in her symptoms in the emergency department. After stepwise escalation of antiemetic therapy and fluid resuscitation failed to provide relief, droperidol administration resulted in the rapid and complete resolution of her symptoms. This allowed for a safe discharge rather than admission for hyperemesis gravidarum. This case highlights the utility of droperidol as a rescue antiemetic in pregnancy when conventional therapies prove to be ineffective. This adds to the evidence supporting consideration of droperidol for refractory cases of nausea and vomiting and hyperemesis gravidarum in pregnancy. The purpose of this case report is to describe the safety and efficacy of droperidol in the treatment in refractory nausea and vomiting in pregnancy.

51. Overwintering waterbirds are important reservoirs for the spread of antibiotic resistance genes (ARGs): Shared patterns at the waterbird-environment interface and the risk of horizontal transfer.

期刊: Journal of hazardous materials 发表日期: 2026-May-04 链接: PubMed

摘要

The global spread of antibiotic resistance genes (ARGs) has become a critical challenge to public health. Long-distance migratory waterbirds are recognized as important biological vectors in the transregional spread of ARGs. However, the sharing patterns of ARGs and the horizontal transfer risks between these birds and their habitats during the wintering period remain poorly understood. This limits a comprehensive understanding of their role in ARG transmission. This study investigated a typical wintering wetland in southwestern China along the East Asian-Australasian Flyway, using metagenomic approaches to systematically characterize the distribution patterns, sharing profiles, and horizontal transfer risks of ARGs in the guts of overwintering waterbirds and their associated aquatic and terrestrial habitats. The results show that multidrug resistance genes are the predominant type of resistance observed both in the guts of overwintering waterbirds and in their habitats. Extensive sharing of ARGs occurs between the guts of overwintering waterbirds and their habitats, with approximately 50% of the 1250 identified ARG subtypes shared by both. We detected 55 high-risk ARG subtypes belonging to 10 resistance categories. Among these, β-lactam resistance genes (e.g., blaNDM-5 and blaCTX-M-15) were the predominant types. In addition, the co-localization of ARGs with mobile genetic elements (MGEs) (e.g., transposons and plasmids) suggests that the gut of waterbirds and aquatic environments may represent potential hotspots for horizontal transfer of ARGs. This study highlights the high connectivity of ARGs between overwintering waterbirds and their habitats, offering important insights into ecological and public health risks related to ARG spread.

52. Early stroke specialist vocational rehabilitation for REturn To work After stroKE: a synopsis from the RETAKE RCT.

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

摘要

Return to work is achieved by < 50% stroke survivors. Evidence on support for return to work is lacking. To determine whether Early Stroke Specialist Vocational Rehabilitation is more clinically effective and cost-effective at supporting return to work 12 months after stroke than usual care. Pragmatic, observer-blind, multicentre superiority randomised controlled trial with embedded health economic evaluation. Participants were individually randomised, 5 : 4, to receive occupational therapy-led Early Stroke Specialist Vocational Rehabilitation + usual care. Questionnaire follow-up at 3, 6 and 12 months post randomisation. Mixed-methods process evaluation explored intervention experience, fidelity, compliance and implementation. Twenty-one NHS stroke services in England and Wales. Patients with new stroke within 12 weeks, aged ≥ 18, in paid/unpaid work at stroke onset. People not intending to return to work excluded. Occupational therapists assessed stroke impact on participants and their job; co-ordinated NHS/employer/other stakeholders’ support; negotiated job accommodations, monitored return to work and explored alternatives if return to work were unfeasible. Usual care involved NHS rehabilitation provided by community teams and medical follow-up. Primary outcome: self-reported return to work for ≥ 2 hours/week 12 months post randomisation. Secondary outcomes: mood, functional ability, participation, productivity, work self-efficacy, health-related quality of life, confidence, mortality, carer strain, cost-consequences, COVID-19 impact. Between 1 June 2018 and 7 March 2022, 583 participants [mean age 54 years (standard deviation 11.1), 69.0% male, mean 29.9 days (standard deviation 20.0) post stroke, 452 (82.8%) ischaemic stroke] were randomised to Early Stroke Specialist Vocational Rehabilitation (n = 324) or usual care (n = 259). Primary and secondary outcome data were available for 454 (77.9%) and 316 (54.2%) participants, respectively. Intention-to-treat analysis showed no statistically significant difference in return to work between groups at 12 months [165/257 (64.2%) Early Stroke Specialist Vocational Rehabilitation vs. 117/197 (59.4%) usual-care, adjusted odds ratio 1.12 (95% confidence interval 0.8 to 1.87), p = 0.3582]. Similar proportions of adverse events occurred in both groups [40/241 (16.6%) attended accident and emergency, 24/244 (9.1%) hospital admissions, 6/266 (2.3%) work accidents at 12 months]. Exploratory subgroup analyses indicated Early Stroke Specialist Vocational Rehabilitation potentially benefits older people (60+), and those with two or more post-stroke impairments. Health economic outcomes were consistent with primary clinical outcomes. Analysis using multiple imputation, adjusting for age, sex, utility or cost at baseline and site found Early Stroke Specialist Vocational Rehabilitation had higher costs [incremental cost £1337 (95% confidence interval -1113 to 3787) and slightly more favourable incremental quality-adjusted life-years of 0.019 (95% confidence interval -0.012 to 0.051)]. Early Stroke Specialist Vocational Rehabilitation was valued by participants and service managers. In contrast, usual-care participants reported limited or no vocational rehabilitation and poor communication. Intervention compliance was achieved for 244 (75.3%) participants. Mentor support for occupational therapies appeared to increase fidelity. Most participants had mild-moderate stroke, unlike our feasibility evaluation which informed the sample size (powered to detect an absolute 13% difference in return to work). More people return to work than anticipated. There was significant loss to follow-up for primary, secondary and health economic outcomes. Employers proved difficult to recruit and engage. REturn To work After stroKE was unable to demonstrate an effect or cost effect of Early Stroke Specialist Vocational Rehabilitation on return to work 12 months post randomisation. The COVID-19 pandemic influenced employer behaviour, and remote working diluted Early Stroke Specialist Vocational Rehabilitation mechanisms in a predominantly mild-moderate sample, many of whom were able to self-navigate return to work. Research is needed to confirm Early Stroke Specialist Vocational Rehabilitation benefits in people marginalised by age or post-stroke impairment, and determine what interventions benefit younger stroke survivors. This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme as award number 15/130/11. Many people cannot REturn To work After stroKE and there is little National Health Service support for this. We developed early, stroke specialist vocational rehabilitation to support people to return to and remain in work. This was available for up to 1 year. We recruited working people aged 18 or over, within 12 weeks of new stroke and allocated at random, whether they received the new rehabilitation in addition to usual National Health Service care or usual National Health Service care only. Twelve months later we compared the potential benefits of the new rehabilitation to its costs in terms of how many in each group had returned to work. The trial recruited 583 stroke patients from 21 hospitals. Most people recruited had mild–moderate stroke. Although 5% more people returned to work with the new rehabilitation, this difference was not statistically significant and might have happened by chance rather than because of the new rehabilitation. Overall, the new rehabilitation was found unlikely to offer the National Health Service value for money in the short term. Additional exploratory analysis suggested older people and those with more stroke disability might be more likely to benefit from the new rehabilitation. However, more research is needed to confirm these findings. The new rehabilitation was delivered as intended and valued by stroke survivors and National Health Service managers. Stroke survivors who received usual National Health Service care only, received little rehabilitation, which was poorly co-ordinated with limited or no vocational rehabilitation. The COVID-19 pandemic came at a critical point. It made flexible, home-based working the norm, particularly for managerial roles, reducing the effect of the new rehabilitation. People who sustain stroke with few lasting disabilities may be able to return to work without specialist support. However, further research is needed to confirm this and determine whether this applies to people of all ethnicities and job types.

53. Targeting dihydroorotate dehydrogenase (hDHODH) beyond the barrier: discovery of MEDS700 as blood-brain barrier permeable hDHODH inhibitor.

期刊: European journal of medicinal chemistry 发表日期: 2026-Apr-27 链接: PubMed

摘要

Targeting cancer metabolism, particularly de novo nucleotide biosynthesis, has emerged as a promising and innovative therapeutic strategy for both hematologic and solid malignancies, including those of the Central Nervous System (CNS). Glioblastoma cancer stem-like cells are especially vulnerable to pyrimidine synthesis inhibition, highlighting human dihydroorotate dehydrogenase (hDHODH), a rate-limiting enzyme in the de novo pathway, as a potential therapeutic target. MEDS433 is a best-in-class hDHODH inhibitor, that shows efficacy in vivo after oral administration but lacks efficient penetration of the blood-brain barrier (BBB), limiting its utility against CNS tumors. Its lipophilic analogue MEDS613 showed enhanced cellular potency, but its poor metabolic stability and rapid conversion to hydroxylated metabolites precluded its future clinical development. In this study, we aimed to design a novel BBB-permeable hDHODH inhibitor, capable of effectively targeting CNS-localized hDHODH. We began by identifying the metabolic soft spots present in the propyloxy side chain of MEDS613 using this information to develop a metabolically stable analogue, MEDS700 (compound 3, as named in the manuscript), that was shown to inhibit hDHODH in the low nanomolar range (IC50hDHODH 1.5 nM). Subsequently, MEDS700 was fully profiled, including detailed analysis of its crystallographic binding mode, pan-antitumor activities in cell-based assays and in vitro cytotoxicity on Peripheral Blood Mononuclear Cells (PBMC). An in vivo pharmacokinetic experiment demonstrated that MEDS700 was able to cross the blood-brain barrier, maintaining therapeutically relevant intracerebral concentrations for up to 24 h after oral administration. Our findings establish MEDS700 as a potent, safe, metabolically stable hDHODH inhibitor, indicating it as a promising candidate for the treatment of hard-to-reach brain tumors.

54. Mortality in relation to smoke exposure 9 years after the Hazelwood coal mine fire.

期刊: International journal of epidemiology 发表日期: 2026-Apr-17 链接: PubMed

摘要

In 2014, a coal mine fire in rural Australia shrouded nearby towns in smoke for several weeks. In response to community concerns and a lack of available evidence, the Victorian Department of Health commissioned a long-term health study. This article evaluates smoke effects on mortality 9 years after the fire. In 2016-17, 2872 individuals living near the mine during the fire were recruited into a cohort study and consented to linkage of their data. Time-location diaries were blended with estimates of hourly fire-related fine particulate matter ≤2.5 µm (PM2.5) to generate individual exposure measures. Mortality data were obtained up to mid-2023 by linkage with the National Death Index. Cardiac, cancer, and respiratory-related deaths were identifiable up to December 2021 and predicted thereafter to mid-2023. All-cause mortality effects were evaluated with Cox proportional-hazards models and cause-specific mortality with a competing risk survival model. Nine years post-fire, 318 (11%) of the sample had died. All-cause mortality was not associated with PM2.5 exposure. There was no detectable effect on cancer deaths. However, a 10 µg/m3 increase in daily mean exposure to fire-related PM2.5 was associated with an 18% (95% CI: 2%-37%) higher risk of cardiac mortality, while PM2.5 exacerbated risk of respiratory mortality from tobacco use. Fire-related PM2.5 increased cardiac mortality and smoking effects on respiratory mortality years after the event. These findings concord with a growing body of evidence on the deadly risks of wildfire smoke. Protecting communities and individuals from smoke during and after large fire events should be a public health priority.

55. Preoperative Diastolic Dysfunction and Perioperative Risk Factors as Predictors of New Onset Atrial Fibrillation in Patients Undergoing Coronary Artery Bypass Graft Surgery: A Retrospective Cohort Study.

期刊: Brazilian journal of cardiovascular surgery 发表日期: 2026-Apr-01 链接: PubMed

摘要

Despite advancements in technique and the increasing number of coronary artery bypass grafting (CABG) procedures, new-onset postoperative atrial fibrillation (POAF) is one of the most common complications following CABG and remains a major concern. The exact mechanism is unclear, but impaired diastolic function may predispose patients to POAF. Thus, this study aims to evaluate preoperative diastolic dysfunction (DD) and associated factors as predictors of new-onset POAF. This retrospective cohort study involved patients undergoing CABG surgery who met the inclusion criteria between January 2018 to August 2022. DD was measured through preoperative transthoracic echocardiogram, while new-onset POAF was assessed through continuous electrocardiogram. A total of 191 patients who met the inclusion criteria were enrolled in this study. Data-analysis revealed no significant difference in DD between patients with and without POAF (P = 0.72). Multivariate analysis demonstrated left main coronary artery disease (LMCAD) (odds ratio [OR] = 2.51; 95% confidence interval [CI] [1.12 - 5.59]; P = 0.02), in-stent restenosis (ISR) ≥ 70% (OR = 6.34; 95% CI [1.68 - 23.92]; P < 0.01), reduced ejection fraction ≤ 50% (OR = 2.18; 95% CI [0.94 - 5.06]; P = 0.07), and electrolyte imbalance (OR = 2.14; 95% CI [2.91 - 24.75]; P < 0.01) as the independent predictors of new-onset POAF. DD was not identified as a predictor of new-onset POAF in patients undergoing CABG. The independent predictors identified in this study included male sex, comorbid LMCAD and ISR ≥ 70%, reduced left ventricular ejection fraction ≤ 50%, and postoperative electrolyte imbalance.

56. Impact of temperature, humidity, dehydration, and psychological stress on salivary flow and xerostomia in young men: An observational study.

期刊: PloS one 发表日期: 2026 链接: PubMed

摘要

Xerostomia, or subjective oral dryness, is commonly reported and may occur with or without objectively reduced salivary secretion (hyposalivation). To assess salivary gland function, the salivary flow rate must be repeatedly measured over time under consistent conditions. However, given that temperature and humidity vary throughout the year, standardized measurement is difficult. Some reports have indicated that the unstimulated salivary flow rate is lower in summer than in winter, although no studies have evaluated this pattern in conjunction with humidity or dehydration. This longitudinal observational study aimed to determine the extent to which room temperature, relative humidity, body dehydration, and psychological stress are associated with unstimulated and stimulated salivary flow rates and xerostomia in healthy young men (n = 39). A questionnaire was administered to collect data regarding participants’ body mass index, medical history, medications, and degree of xerostomia (severe, moderate, mild, or none). Unstimulated and stimulated salivary flow rates, salivary cortisol and chromogranin A concentrations, urine specific gravity, room temperature, and relative humidity were measured. Psychological stress was assessed via measurements of salivary cortisol and chromogranin A concentrations. Urine specific gravity served as an indicator of hydration status. Factors influencing the salivary flow rate and xerostomia were analyzed using generalized estimating equations. The unstimulated salivary flow rate was significantly associated with temperature (p = 0.008), humidity (p = 0.039), urine specific gravity (p = 0.045), and chromogranin A concentration (p < 0.001); the stimulated salivary flow rate was not significantly linked to these factors. Furthermore, xerostomia was only related to chromogranin A concentration (p = 0.012). These results suggest that indoor environmental conditions and hydration status should be considered when interpreting changes in unstimulated salivary flow rate over time; subjective oral dryness (xerostomia) showed a significant association only with chromogranin A in this exploratory study.

57. Potential airborne transmission of SARS-COV-2 through bathroom ventilation ducts associated with an outbreak in a residential building in Santander, Spain, 2020.

期刊: PloS one 发表日期: 2026 链接: PubMed

摘要

During the COVID-19 pandemic, airborne transmission of SARS-CoV-2 via respiratory aerosols was a critical concern in indoor environments. In the city of Santander, Spain, an outbreak in a multi-family residential building during a period of low community transmission revealed vertical clustering of 15 cases in four homes. The building’s design included single interior bathrooms without windows in each home, ventilated by a shared vertical bathroom duct system. Field measurements, computational fluid dynamics (CFD) simulations, and multi-zone airflow modeling were performed to evaluate vertical disease transmission potential in the Santander building. Epidemiological and genetic data combined with the field-collected data and modeling indicated that the most plausible transmission route was the bathroom vertical ventilation duct system, which facilitated movement of infectious aerosol between vertically connected homes. Additionally, operating the kitchen exhaust fan can augment the movement of aerosols between occupied spaces increasing the potential for infection. Recommendations for mitigating future risks include the installation of forced air exhaust fans with non-return flaps in bathroom ducts.