公共卫生研究摘要 (2026-05-20)

共收录 54 篇研究文章

1. Accuracy of portable artificial intelligence-supported fundus camera in the screening of diabetic retinopathy in primary care.

期刊: Archives of endocrinology and metabolism 发表日期: 2026-Aug-01 链接: PubMed

摘要

Research on the use of portable fundus cameras utilizing artificial intelligence (AI) for diabetic retinopathy (DR) screening in primary care remains limited. We aimed to evaluate the accuracy and reliability of DR screening in primary care using a smartphone-based, AI-assisted device in a small municipality in southern Brazil. The reference standard was classification of fundus images by a retina specialist. Patients with diabetes enrolled in the Brazilian Family Health Program were recruited for the study. A general ophthalmologist obtained fundus images from 134 patients, and a retina specialist validated the DR diagnosis by AI. The sample was predominantly female, with most patients having type 2 diabetes mellitus (T2DM). The age ranged from 17 to 81 years. Blood pressure was controlled in 34.9% of the sample. HbA1c levels ranged from 5.4% to 13.9%, and 35.3% of participants had levels below 7.0%. After excluding eight participants due to low image quality, the DR prevalence was 24.6%. The AI-based screening test for DR in primary care demonstrated a sensitivity of 100% (95% CI 88.8-100) and a specificity of 66.3% (95% CI 55.9-75.7). The negative predictive value (NPV) was 100% (95% CI 94.3-100), and the positive predictive value (PPV) was 49.2% (95% CI 36.4-62.1). The smartphone-based, AI-assisted device showed good accuracy and excellent performance for DR screening in primary care. It can avoid unnecessary medical referrals and help prioritize patients with advanced disease who require early treatment to prevent severe complications.

2. Dietary pattern and night work: metabolic syndrome in healthcare workers.

期刊: Archives of endocrinology and metabolism 发表日期: 2026-Aug-01 链接: PubMed

摘要

To assess the relationship between night work, metabolic syndrome (MS) prevalence, and dietary patterns in healthcare workers at a large hospital in southern Brazil. A cross-sectional study was conducted with 156 healthcare workers (90 day-shift and 66 night-shift) from July 2023 to March 2024. Sociodemographic and occupational, sleep, dietary patterns, meal timing, anthropometric data, blood pressure, and lab test data were collected. Night-shift workers had higher blood pressure, lower HDL cholesterol, and 135% greater likelihood of developing MS than those who worked during the day. They consumed more fats and less fiber. Chrononutrition analysis showed night workers had later last meals (p < 0.001), longer intervals between first and last meals (p < 0.001), and shorter night fasting (p < 0.001). Ultra-processed food consumption was similar across shifts. A shorter interval between the first and last meal in night workers was linked to a 7% lower risk of MS. Findings suggest an association between night work and higher MS prevalence, with hypertension, abdominal obesity, unfavorable lipid profile, and disrupted eating timing. Circadian rhythm disruption and misaligned eating patterns, particularly prolonged eating windows and reduced nocturnal fasting, may contribute to the increased metabolic risk. Interventions targeting diet and chrononutrition are essential. Occupational health programs should address the specific challenges of night work.

3. Evolving Treatment Paradigms in Hormone Receptor-Positive, Human Epidermal Growth Factor 2-Negative Metastatic Breast Cancer.

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

摘要

Hormone receptor-positive, human epidermal growth factor 2 (HER2)-negative metastatic breast cancer (MBC) represents the most common subtype of MBC and has undergone substantial therapeutic evolution. Treatment has shifted from sequential endocrine therapy (ET) and chemotherapy toward personalized strategies incorporating molecularly targeted agents and antibody-drug conjugates (ADCs), with increasing emphasis on quality of life and shared decision making. CDK4/6 inhibitors plus ET remain a first-line standard of care in high-resource settings, demonstrating consistently improved progression-free survival (PFS) and, for select agents, overall survival (OS). Management in special populations requires additional consideration of trial and real-world data, toxicity profiles, and patient preferences. Beyond ET, ADCs are reshaping the landscape. Trastuzumab deruxtecan expanded therapeutic utility across HER2-low and HER2-ultralow disease, whereas sacituzumab govitecan and datopotamab deruxtecan provide later-line options. As ADCs emerge as earlier therapies, questions regarding sequencing, cross-resistance, and toxicity remain central to clinical decision making. Metastasis-directed therapy (MDT) in oligometastatic and oligoprogressive breast cancer also requires nuanced decision making. Despite high local control rates with stereotactic body radiotherapy, randomized trials have not demonstrated consistent improvements in PFS or OS in unselected populations. Current evidence supports systemic therapy as the foundation of management, with MDT selectively considered for oligoprogression, symptom prevention, or within clinical trials. Ultimately, management of hormone receptor-positive/HER2-negative MBC requires dynamic integration of tumor biology, systemic therapy advances, and patient-defined goals of care. As therapeutic complexity increases, shared decision making and equitable access to evidence-based and supportive care services remain essential for delivering high-quality, individualized oncology care.

4. Plasma metabolomic signature of frailty and risk of late-onset schizophrenia: A prospective cohort study.

期刊: Schizophrenia research 发表日期: 2026-May-19 链接: PubMed

摘要

With population aging, late-onset schizophrenia is attracting increasing attention. The prospective association between frailty and late-onset schizophrenia, along with its underlying mechanisms, remains unclear. This study aimed to investigate the relationship between frailty and late-onset schizophrenia, and assess the potential role of metabolic mechanisms on this association. A total of 489,302 participants without late-onset schizophrenia at baseline were included from UK biobank. Cox proportional hazard regression model was utilized to investigate the association between frailty and late-onset schizophrenia. Elastic net regression was used to determine the metabolic signature associated with frailty. Mediation analysis was employed to assess the mediating role of metabolic signature and specific metabolites on the relationship between frailty and late-onset schizophrenia. During a median follow-up of 13.49 years, 705 late-onset schizophrenia cases were identified. Compared to individuals with nonfrailty, the risk of late-onset schizophrenia was increased in those with prefrailty (HR: 1.82, 95% CI: 1.52, 2.19) and frailty (HR: 3.10, 95% CI: 2.44, 3.95). Eighty-three metabolites were identified as being related to frailty (38 positively, 45 negatively). The metabolic signature mediated the association between frailty and late-onset schizophrenia (proportion of mediation effects (PM%): 4.57, 95% CI: 2.22, 7.36). The mediation effect of metabolites from fatty acids, inflammation and lipid metabolism on the relationship between frailty and late-onset schizophrenia was significant, with PM% ranging from 2.41 to 5.93. Physical frailty was associated with an increased risk of late-onset schizophrenia, partly by disrupting metabolic signatures (fatty acids, inflammation, and lipid metabolism).

5. The Economic Burden of Unsafe Care: A Systematic Review With Narrative Synthesis on the Economic Cost of Unsafe Care in Hospitals Worldwide.

期刊: Journal of patient safety 发表日期: 2026-May-19 链接: PubMed

摘要

Unsafe care places a substantial economic and clinical burden on health care systems worldwide, yet its cost implications remain insufficiently understood. This review synthesizes recent literature to clarify the magnitude and nature of the economic burden associated with unsafe care in hospital settings. A comprehensive search of Medline, EMBASE, and CINAHL, complemented by chain referencing, identified studies published since 2019. Of the 6364 identified articles, 25 met the inclusion criteria. Extracted data included study characteristics, methodological approaches, matching or correction variables, and reported costs and indicators of unsafe care, with all cost estimates converted to 2019 US dollars. The findings show that unsafe care in hospitals leads to considerable excess costs across multiple economic perspectives. For hospitals, the additional cost per unsafe event reached as high as $140,000. From the public payer’s perspective, unsafe care accounted for up to nearly 3% of national health care spending, exceeding 0.2% of gross domestic product in some cases. From a societal perspective, unsafe care resulted in prolonged hospital stays, productivity losses, and broader economic impacts, amounting to an equivalent of up to 8% of health care expenditure. Unsafe care was consistently associated with poorer patient outcomes, including longer hospital stays, more frequent readmissions, and higher mortality. Despite heterogeneity in methods, the included studies collectively indicate that unsafe care imposes a significant economic burden while undermining patient health.

6. Outcomes of Digital Training for Community Health Workers in Low- and Middle-Income Countries: Scoping Review.

期刊: JMIR medical education 发表日期: 2026-May-19 链接: PubMed

摘要

Community health workers (CHWs) play an important role in delivering essential health services in low- and middle-income countries (LMICs). Training CHWs using digital approaches is on the rise. Although scoping and systematic reviews of digital training have been conducted for medical professionals in high-income countries (HICs), none have been conducted with lay professionals in LMICs, a population with different considerations. This review describes the characteristics of digital training for CHWs and identifies their impact on health services outcomes in LMICs. A scoping review approach based on Arksey and O’Malley’s guiding principles was used to retrieve, review, and analyze existing literature. We searched 10 foremost databases using keywords and Medical Subject Headings terms for CHWs, LMICs, and digital learning to identify primary, peer-reviewed studies published up to and including November 26, 2024. An updated search of studies in all the databases was conducted on January 12, 2026, by the research team. No registries were searched. Articles that focused on the provision of digital or blended learning training for CHWs working in LMICs in any disease domain evaluating a learning, implementation, or clinical outcome met the eligibility criteria. Two reviewers (TAT and FA) screened the articles at the title and abstract levels and at full-text review. Study details, study designs, training attributes, technology and CHW descriptions, and outcomes were abstracted using a data-charting form. Descriptive analysis was conducted of the population, training characteristics, and reported outcomes. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for reporting scoping reviews were used. A total of 892 articles were retrieved and screened for eligibility, of which 18 original articles met the inclusion criteria. Most (n=13) were conducted in Asia. Most (n=15) used nonrandomized study designs. The most common attributes included synchronous (n=8), accessible in the community (n=14), use of smartphones (n=6), and accessible online (n=9). The majority reported learning outcomes (n=14), about half reported implementation outcomes (n=10), and only one reported clinical outcomes (n=1). The learning outcomes focused on knowledge gained and were mostly positive. The implementation outcomes included CHW’s acceptability and feasibility to use the digital training approach. The clinical outcome was effectiveness. We found few evaluations of digital training for CHWs in LMICs, in spite of a proliferation of such trainings. Digital trainings had a broad range of attributes. Many evaluations had knowledge, acceptability, and feasibility outcomes. However, other learning outcomes (eg, attitudes and skills), implementation outcomes (eg, appropriateness and fidelity), and clinical outcomes were rare. Most lacked experimental designs. Although the existing evidence suggests that digital training can impact knowledge in lay health workers in LMICs, more rigorous studies with a broader range of outcomes are needed.

7. COVID-19 Knowledge, Attitudes, and Practices and Perceived Risk: Cross-Sectional Mixed Methods Study.

期刊: JMIR formative research 发表日期: 2026-May-19 链接: PubMed

摘要

The COVID-19 pandemic was marked by rapidly evolving and inconsistent public health messaging, contributing to confusion regarding recommended preventive behaviors. Knowledge, attitudes, and practices (KAP) and perceived risk frameworks offer a structured approach to examine how education, personal beliefs, and contextual factors influence health behaviors during public health emergencies. Vulnerable populations, such as patients with multiple sclerosis (MS), experience heightened risk perception compared with the general population, which may further shape behavioral responses. This study aimed to examine COVID-19-related KAP and perceived risk among patients with MS, health care providers, and laypeople during the first 6 months of the pandemic. The aim of mixed methods was to explore quantitative factors associated with KAP and perceived risk and to qualitatively describe participants’ perceptions and emotional responses to the pandemic. A descriptive, cross-sectional, partially mixed methods explanatory sequential design was used. Participants were recruited using convenience sampling and completed an online demographic questionnaire and a COVID-19 KAP instrument that included perceived risk items. Quantitative data were analyzed using descriptive statistics and inferential analyses to examine group differences and associations between perceived risk and preventive behaviors. Chi-square testing was applied to compare perceived risk across groups, and correlational analyses were used to examine the relationships between perceived risk and behavioral practices. Qualitative comments provided by participants were analyzed using thematic analysis to further contextualize quantitative findings and to explore perceived risk experiences. A total of 148 participants were included, comprising 43 (29%) individuals with MS, 50 (33.8%) health care providers, and 55 (37.2%) laypeople. Overall, 90% (n=133) of participants demonstrated basic knowledge of COVID-19 transmission and prevention. Attitudes toward public health guidance and self-reported preventive behaviors varied across groups. Lay participants most frequently reported a moderate perceived risk of COVID-19 infection, whereas participants with MS and health care providers more commonly reported high perceived risk (χ²6=12.65, P=.049). Neither immunosuppressive treatment status nor vaccine hesitancy significantly predicted perceived risk. However, higher perceived risk was significantly associated with greater avoidance of crowded and public places. Qualitative analysis yielded 5 interrelated themes describing participants’ perceived risk experiences: uncertainty related to evolving scientific information; anxiety regarding personal and family safety; fear of infection and long-term consequences; vulnerability, particularly among individuals with chronic illness and frontline exposure; and accountability toward protecting others through adherence to preventive measures. These themes provided contextual insight into the emotional and cognitive processes underlying reported attitudes and behaviors. Knowledge of COVID-19 is associated with favorable attitudes and engagement in preventive practices across populations. Differences in perceived risk highlight the importance of tailoring risk communication and educational strategies to specific populations. KAP-focused educational interventions that explicitly address uncertainty, emotional responses, and behavioral translation may strengthen preparedness and promote sustained protective behaviors during future public health emergencies.

8. Understanding Remission of Long-Term Conditions Through Electronic Health Records: Scoping Review.

期刊: Journal of medical Internet research 发表日期: 2026-May-19 链接: PubMed

摘要

Multiple long-term conditions (MLTCs) require complex and prolonged treatment regimens. Remission in long-term conditions (LTCs) is important for understanding disease progression and evaluating treatment effectiveness. Electronic health records (EHRs) are increasingly used to monitor clinical outcomes, but how remission is defined within EHRs remains unclear. This study aimed to summarize and collate the previous literature on how remission of LTCs has been defined in EHRs. Systematic electronic searches were performed on OVID MEDLINE, Embase, CINAHL EBSCO, the Cochrane Library, and the Bielefeld Academic Search Engine for eligible studies published from inception to November 27, 2025. Quantitative studies, published in any language, on adult populations, and using EHRs to assess remission of LTCs, were eligible for inclusion. Studies that did not clearly define remission and studies on cancer remission were excluded. Data were extracted from each eligible study using a structured table. Risk of bias was not assessed, in line with scoping review methodology. A narrative approach was taken to summarize and present data from the included studies. The number and characteristics of studies were described, both overall and by condition. Findings were discussed with clinicians and data experts to ensure applicability in clinical practice. Ninety-one studies were included. Sample sizes ranged from 12 to 72.9 million adults. Studies were conducted in 18 countries, with the majority being from the United States. The majority of included studies used a cohort study design. Studies assessed how remission was defined in 12 LTCs, including inflammatory bowel disease (41/91, 45.1%), type 2 diabetes (n=15, 16.5%), depression (n=15, 16.5%), alcohol or drug misuse (n=8, 8.8%), asthma (n=3, 3.3%), multiple sclerosis (n=3, 3.3%), epilepsy (n=1, 1.1%), anemia (n=1, 1.1%), chronic kidney disease (n=1, 1.1%), autoimmune pancreatitis (n=1, 1.1%), hypertension (n=1, 1.1%), heart failure (n=1, 1.1%), and MLTC (n=1, 1.1%). Remission was typically defined using a combination of clinical codes (n=7, 7.7%), validated rating scales (n=56, 61.5%), biochemical markers (n=29, 31.9%), absence of symptoms (n=10, 11%), absence of condition-specific events (eg, hospital admissions; n=4, 4.4%), and cessation of pharmacological treatments (n=26, 28.6%). There was substantial variation in the criteria and duration of follow-up used to define remission across studies. This review demonstrates that remission of LTCs can be identified and operationalized within EHRs, although remission criteria varied across studies. The review extends the literature on remission in EHRs by combining evidence synthesis and consultation with clinical and data experts to propose standardized comprehensive definitions to reliably define and implement remission of multiple LTCs in EHR-based research. This will allow cross-study comparisons and present an opportunity to advance understanding of disease trajectories and improve evaluation and monitoring of patient outcomes. Further research may apply, compare, and evaluate standardized definitions across different data sources to assess generalizability and further improve our understanding of remission of LTCs.

9. Identifying Preferences for Prostate Cancer Screening Among American Indian Men (Project AIMEPCCo): Protocol for a Discrete Choice Experiment.

期刊: JMIR research protocols 发表日期: 2026-May-19 链接: PubMed

摘要

American Indian men are disproportionately impacted by prostate cancer (PC) compared to White men and experience the worst PC outcomes of any racial or ethnic group. To address these disparities, it is important to better understand American Indian men’s preferences regarding PC screening. The objectives of this study are as follows: (1) conduct a literature review, followed by qualitative, culturally responsive formative research with American Indian men, (2) develop and field a discrete choice experiment (DCE) survey to elicit the preferences of American Indian men toward PC screening, and (3) identify feasible, culturally appropriate, preference-concordant screening strategies that are targeted for American Indian men. In this protocol, a scoping literature review to identify previous PC DCEs has been created. We will follow that review by conducting rigorous, theoretically grounded qualitative work to identify plausible DCE attributes and attribute levels among men from the Lumbee Tribe in North Carolina. We will pilot the DCE among Lumbee men to assess cultural responsiveness and comprehension of the choice context and choice tasks. Finally, the DCE methodology will be used to elicit the PC screening preferences among 100 Lumbee men between the ages of 40 and 69 years. Choice data will be analyzed using mixed logit models, and trade-offs will be described using marginal rates of substitution. The study was funded in 2024. Formative qualitative research is still ongoing. DCE data collection is expected to start in April 2026 and end in June 2026. This will be the first study to use a culturally responsive approach to DCE development in an indigenous population. The findings of this study can be used to educate providers regarding culturally responsive PC screening and to inform the design of interventions to increase preference-concordant PC screening in American Indian men.

10. Mobile App-Based Smoking Cessation in Hispanic or Latino Adults: Culturally Tailored Spanish-Language Formative App Development Study.

期刊: JMIR formative research 发表日期: 2026-May-19 链接: PubMed

摘要

Despite the notable proliferation of smoking cessation mobile apps, to date, no validated, Spanish-language, culturally tailored mobile intervention exists for Spanish speakers in the United States. The aim of this study was to conduct formative research to inform the adaptation of an evidence-based smoking cessation intervention developed for Spanish-speaking Hispanic and Latino individuals from a printed format into a mobile app. Guided by a user-centered approach and in collaboration with product design industry experts, wireframes were developed to present the app’s layout and functionality. Focus groups were conducted over Zoom (Zoom Communications) with Spanish-speaking individuals who currently smoke to assess their previous mobile app experience, attitudes toward mobile apps, and feedback on app architecture and design. Two independent reviewers (RB in collaboration with another member from the qualitative core) trained in qualitative methods coded the focus group data using a thematic analysis approach and identified emerging themes. The app wireframes included 4 navigation buttons on the home screen to organize and deliver evidence-based intervention content-Home (Inicio), Learn (Aprende), My Coach (Mi Couch), and Profile (Perfil). Different wireframe designs were generated in distinct color palettes. Data saturation was reached after three focus groups. Participants were 54% (7/13) women, had a mean age of 56 (SD 14.9) years, 39% (5/13) had an education ≤high school, and 31% (4/13) were married or cohabitating. All participants smoked daily, a mean of 14 (SD 7.8) cigarettes per day, for 32 (SD 16.9) years, and 54% (7/13) smoked ≤30 minutes of waking. Participants reported using social media, news, shopping, and gaming apps, but few used mobile health apps. Salient barriers for app use included worries regarding privacy breaches and fears about misinformation. Desired features included community-building elements, personalization, reward badges, knowledge checks, and audiovisual presentation of content within the app. Participants disliked having a countdown to quit date, preferring an “I quit” button to initiate monitoring progress. They also viewed sharing progress with support networks as a source of unwanted pressure, although a few saw it as motivational. Overall, participants liked the app design and indicated willingness to use it. This formative research provides critical insights into preferences related to the development of culturally tailored mobile smoking cessation interventions for Spanish-speaking individuals. Key findings highlighted enthusiasm for a smoking cessation app and the importance of including features that foster social connection and allow for personalization.

11. Recognizing Non-Human Animals as a Vulnerable Class in Assessments of "Dangerousness to Others": Application in Animal Hoarding.

期刊: Behavioral sciences & the law 发表日期: 2026-May-19 链接: PubMed

摘要

We argue that the forensic concept of “dangerousness” should be expanded to protect non-human animals when danger is readily foreseeable and before it materializes into substantial harm. The criminal justice approach is limited in this respect because it relies on cruelty statutes that are largely reactive, embodying the adage that “some must suffer first” before intervention can occur. We demonstrate that dangerousness principles and/or language are already embedded-often implicitly and sometimes explicitly-in at least five areas of animal law. We highlight the well-accepted “grave disability” criteria used in assessing dangerousness to self because of the parallels to the deficits noted in animal hoarding, with the main difference being the absence or presence of animals. A civil approach focused on forfeiture (and when appropriate, mental health intervention) rather than prosecution could help bridge the gap between the care animals deserve and the deficiencies that criminal law will currently tolerate.

12. Nicotine Dependence and Quit Self-Confidence in a Smoking Cessation Program Using a Group-Based Digital Peer-Supported App and Cigarette Consumption-Adjusted Nicotine Aids Among Japanese Workers: Retrospective Cohort Study.

期刊: Journal of medical Internet research 发表日期: 2026-May-19 链接: PubMed

摘要

Completion rates for smoking cessation treatments under Japan’s national health insurance system remain suboptimal. A workplace cessation program, combining nicotine gum or patches with a group-based digital peer-supported app, has reported high cessation success rates. Although nicotine dependence is generally associated with lower cessation success, and self-confidence is generally associated with higher success, these associations may differ by tobacco product type. Evidence on these relationships in app-based cessation programs remains limited. This study aimed to examine the independent and combined associations of nicotine dependence and self-confidence in quitting with smoking cessation success among cigarette-only smokers, heated tobacco product-only users, and dual users. This retrospective cohort study used data from a workplace cessation program in Japan. Participants were eligible if they were employed, owned a smartphone, and self-enrolled in the program. Recruitment was conducted through workplace promotion and individual outreach, primarily via email from companies. The program combined a digital peer-support app with nicotine gum or patches, adjusted according to cigarette consumption. The app included anonymous peer-support group chats of up to 5 participants, where participants shared progress, photos, and comments. Nicotine dependence was assessed by the time to the first cigarette after waking (high: ≤30 min; low: >30 min). Self-confidence for quitting was rated on a 0-10 scale and dichotomized at the median. A 4-level variable combined nicotine dependence and self-confidence for quitting. Logistic regression analyses were conducted by tobacco product type, and odds ratios (ORs) and 95% CIs were estimated. A total of 2143 participants were included in the analysis. Their mean age was 46.5 (SD 10.9) years, and approximately 90% were men. Overall cessation success was 53.8% (1152/2143). Participants with high self-confidence had a higher cessation success rate than those with low self-confidence (529/834, 63.4% vs 623/1309, 47.6%), with an OR of 1.81 (95% CI 1.55-2.12). Nicotine dependence was significantly associated with cessation success only among cigarette-only smokers; those with low nicotine dependence had a higher OR than those with high dependence (OR 1.59, 95% CI 1.07-2.37). Across all tobacco product types, the subgroup with low nicotine dependence and high self-confidence showed the highest cessation success, followed by the subgroup with high nicotine dependence but high self-confidence. By distinguishing cigarette-only smokers, heated tobacco product-only users, and dual users in a workplace cessation program, this study provides novel, product-specific evidence regarding nicotine dependence and self-confidence related to cessation success. This study extends prior research beyond cigarette-only smokers by examining tobacco user groups and suggests that self-confidence may predict cessation across tobacco product types, whereas the role of nicotine dependence may be product-specific. These findings may inform tailored, scalable smoking-cessation support in workplaces; however, they should be interpreted with caution because cessation outcomes were self-reported.

13. A comparative study of the far lateral approach of uni-portal non-coaxial spinal endoscopic surgery versus percutaneous endoscopic transforaminal discectomy (PETD) for L5/S1 foraminal stenosis with high iliac crest: a retrospective cohort study.

期刊: International orthopaedics 发表日期: 2026-May-19 链接: PubMed

摘要

To compare the clinical efficacy and radiological outcomes of the far lateral approach of uni-portal non-coaxial spinal endoscopic surgery versus traditional percutaneous endoscopic transforaminal discectomy (PETD) for the treatment of L5/S1 foraminal stenosis with a high iliac crest. A retrospective analysis was conducted on 82 patients with L5/S1 foraminal stenosis and a high iliac crest treated at our hospital from June 2023 to June 2025. Patients were divided into a uni-portal non-coaxial spinal endoscopic surgery group (n = 42) and a PETD group (n = 40) based on the surgical procedure. Operative time, the fluoroscopy time estimated blood loss, length of hospital stay, and complication rates were recorded and compared between the two groups. Clinical outcomes were evaluated using the Visual Analogue Scale (VAS) for leg pain, the Oswestry Disability Index (ODI), and the modified MacNab criteria. Radiological assessments included postoperative foraminal area, facet joint preservation rate, and segmental stability. All patients were followed up for at least 12 months. The uni-portal non-coaxial spinal endoscopic surgery group had a significantly shorter operative time (68.5 ± 12.3 min vs. 92.6 ± 18.4 min, P < 0.001) and significantly fewer fluoroscopy time (5.4 ± 1.5 vs. 15.8 ± 4.2, P < 0.001) compared to the PETD group. There were no significant differences between the two groups in estimated blood loss (42.5 ± 15.3 mL vs. 40.2 ± 16.1 mL, P 0.05) or length of hospital stay (3.2 ± 1.1 days vs. 3.6 ± 1.4 days, P 0.05). Both groups showed significant improvement in VAS and ODI scores at all postoperative time points compared to preoperative values (P < 0.05). At one week postoperatively, the uni-portal non-coaxial spinal endoscopic surgery group had noticeably better leg pain VAS scores than the PETD group (2.2 ± 0.7 vs. 3.3 ± 1.3, P < 0.01), while clinical outcomes were comparable between the two groups at three, six and 12 months postoperatively (P 0.05). The excellent-to-good rate according to the modified MacNab criteria was 90.5% in the uni-portal non-coaxial spinal endoscopic surgery group and 87.5% in the PETD group (P 0.05). Radiologically, the uni-portal non-coaxial spinal endoscopic surgery group demonstrated a noticeably larger postoperative foraminal area (79.8 ± 13.2 mm2 vs. 63.5 ± 12.1 mm2, P < 0.001) and a noticeably higher facet joint preservation rate (93.5% vs. 75.8%, P < 0.01) compared to the PETD group. The complication rate was 7.1% in the uni-portal non-coaxial spinal endoscopic surgery group and 17.5% in the PETD group (P 0.05). Both the far lateral approach of uni-portal non-coaxial spinal endoscopic surgery and PETD are effective treatments for L5/S1 foraminal stenosis with a high iliac crest, yielding satisfactory clinical outcomes. Compared to PETD, uni-portal non-coaxial spinal endoscopic surgery offers advantages including shorter operative time, less fluoroscopy, more thorough foraminal decompression, and better preservation of the facet joint, making it a valuable and comparable alternative with additional perioperative benefits for managing pathologies in the L5/S1 region with a high iliac crest.

14. Efficacy and safety of Nrf2 activators for schizophrenia: a systematic review and meta-analysis.

期刊: European archives of psychiatry and clinical neuroscience 发表日期: 2026-May-19 链接: PubMed

摘要

This systematic review and meta-analysis aimed to investigate the efficacy and safety of adding nuclear factor erythroid 2-related factor 2 (Nrf2) activators to antipsychotic treatments for individuals with schizophrenia. The primary outcome was overall symptom improvement. Other efficacy outcomes involve the improvement of positive symptoms, negative and depressive symptoms, Positive and Negative Syndrome Scale general subscale (PANSS-G) scores, and cognitive function composite scores and individual cognitive domain scores (only for sulforaphane). Further, we included all-cause discontinuation, adverse event-related discontinuation, incidence of individual adverse events, and changes in blood inflammatory biomarkers, lipid profiles, and glucose levels. Our review included 16 randomized-controlled trials (n = 953, mean age = 35.27 years; 66.74% male). Among these, 15 were placebo-controlled, while the remaining study did not utilize a placebo. This systematic review comprised six studies on ascorbic acid, four on curcumin, two on resveratrol, and four on sulforaphane. Curcumin showed marginal superiority over placebo for the primary outcome (standardized mean difference = - 0.53, 95% confidence interval: -1.08, 0.02); however, non-significant subgroup results (all p > 0.05) with wide confidence intervals across formulations and co-interventions suggest that these findings lack robustness. Curcumin significantly outperformed placebo in reducing positive symptoms, negative symptoms, and PANSS-G scores but did not differ from placebo for other outcomes. Sulforaphane showed a lower all-cause discontinuation rate than placebo, suggesting potential efficacy and better treatment adherence. Additionally, sulforaphane reduced total cholesterol, low-density lipoprotein cholesterol, and triglyceride levels, though no significant differences were found in other outcomes. Meta-analysis of efficacy outcomes for ascorbic acid and resveratrol could not be conducted due to insufficient data.

15. Living, traveling, and dialysis: a qualitative analysis of patient experiences shared in an online forum.

期刊: Journal of nephrology 发表日期: 2026-May-19 链接: PubMed

摘要

The ability to travel is one of the most valued aspects of quality of life among people undergoing maintenance hemodialysis. However, little is known about how people undergoing hemodialysis experience travel. This study aimed to qualitatively explore the significance of travel from this group’s perspective by analyzing posts on an online forum, and to provide insights to support patient-centered dialysis care. We collected posts made between April 1, 2015, and March 31, 2025, on Japan’s largest Q&A social media platform, covering hemodialysis and travel. Using reflexive thematic analysis, we inductively coded the content and generated themes and subthemes about the travel experiences of people undergoing hemodialysis. In total, 150 threads with 744 posts were included in the analysis. We identified two overarching contexts: asking questions about living with hemodialysis, and seeking travel-related information. Travel experiences were mainly categorized as either once-in-a-lifetime or an extension of everyday life, with an intermediate theme of travel as a way to reclaim life and freedom. The feasibility of travel was determined by two key factors: the vulnerability of people undergoing hemodialysis and acceptance and cooperation from healthcare providers. For people undergoing hemodialysis, travel is a symbolic opportunity to reclaim autonomy and meaning in their lives. Clinicians should recognize travel as a critical element of quality of life and respect patients’ aspirations and independence, while ensuring their safety through active collaboration and coordination among healthcare providers.

16. Burden of disease-specific late effects after proton beam therapy in pediatric solid and CNS tumor survivors: a single-institution survey in Japan.

期刊: Japanese journal of clinical oncology 发表日期: 2026-May-19 链接: PubMed

摘要

Proton beam therapy (PBT) has been increasingly adopted in pediatric oncology to reduce radiation-related toxicity; however, its long-term comorbidities remain incompletely understood. Because tumor types and treatment patterns often overlap across diagnostic groups, disease-specific evaluation may help clarify late effects following PBT. A mailed questionnaire survey was conducted between 2015 and 2021 among 304 pediatric cancer survivors who had received PBT at the University of Tsukuba Hospital between 1984 and 2020. Responses from 110 patients diagnosed before the age of 20 years and alive at the time of the survey were analyzed. A non-PBT cohort treated between 1976 and 2013 served as a comparison group. The median follow-up duration was 6.3 years (range, 0.4-34.6). Thirty-six patients (33%) reported no comorbidities. Severe (grade ≥3) comorbidities occurred in 3 PBT patients (gait disturbance, renal failure requiring dialysis, and hemianopsia) and 1 non-PBT patient (secondary colorectal cancer that might have been avoided with PBT). Skeletal abnormality was the most frequent late effect, followed by hair abnormality, growth retardation, chronic skin disorders, endocrine dysfunction, dental abnormalities, and neurocognitive impairment. Skeletal abnormality was significantly associated with rhabdomyosarcoma and Ewing sarcoma family of tumors, whereas hormone replacement therapy was more common among patients with central nervous system germ cell tumors. This single-institution disease-specific analysis revealed distinct comorbidity patterns among childhood cancer survivors treated with PBT. Although severe late effects were rare, musculoskeletal and endocrine disorders were frequent, underscoring the need for diagnosis-tailored, long-term follow-up strategies.

17. Comparison of influenza hemagglutination inhibition titers from capillary blood versus venipuncture.

期刊: Journal of clinical virology : the official publication of the Pan American Society for Clinical Virology 发表日期: 2026-May-19 链接: PubMed

摘要

Capillary blood self-collection devices offer a minimally invasive alternative to venipuncture, potentially expanding access to serologic studies in outpatient and remote settings. We aimed to evaluate the concordance of influenza HAI titers between capillary blood collected using a minimally invasive device and venous blood collected via standard venipuncture. We compared three paired samples collected from participants during a single visit: venipuncture, staff-assisted capillary device collection (clinic-collect), and participant self-collected capillary device with 72-hour delayed processing (self-collect) to simulate both on-site and at-home blood collection conditions. We compared HAI titers against influenza A(H1N1) antigen across collection methods using Pearson correlation coefficients, Bland-Altman plots, and paired t-tests. Sample volume adequacy and correlation thresholds for clinical interpretability were also assessed. Among 27 participants, HAI titers correlated strongly between venipuncture and both minimally invasive device approaches (clinic-collect: r = 0.955; self-collect: r = 0.937). Venipuncture titers were modestly higher, with mean differences of + 0.26 log₂ units (clinic-collect) and + 0.35 log₂ units (self-collect); these differences were below the 1-dilution (2-fold) threshold and not clinically meaningful. Most device samples (89-96%) fell within ±1 log₂ unit of venipuncture. On first attempt, 78% of device collections met the ≥ 600 μL volume threshold, increasing to > 93% with use of a second device. Minimally invasive devices yielded influenza HAI titers highly comparable to venipuncture, with clinically acceptable differences in adults. Self-collection with a minimally invasive device could serve as a practical, scalable alternative for serologic studies.

18. [Position paper on the clinical impact of anemia and iron deficiency prior to cardiac surgery. Part 1: diagnosis].

期刊: Archivos de cardiologia de Mexico 发表日期: 2026-May-19 链接: PubMed

摘要

Anemia and iron deficiency (ID) are highly prevalent among patients undergoing cardiac surgery and are consistently associated with worse clinical outcomes. Despite their clinical relevance, these conditions remain underdiagnosed in routine practice. With this document, we aim to summarize the pathophysiological basis, diagnostic criteria, and clinical impact of anemia and ID in the perioperative setting of cardiac surgery. This position statement was developed by the Inter-American Society of Cardiology through a multidisciplinary panel of experts from multiple countries across the continent. Recommendations were formulated based on the best available evidence and adapted to the Latin American context. The recommended threshold for defining preoperative anemia in both sexes is a hemoglobin level < 13 g/dL. Iron deficiency may occur with or without anemia; absolute ID is defined as ferritin < 100 μg/L, whereas functional ID is characterized by normal or elevated ferritin levels with a transferrin saturation < 20%. Functional ID is particularly common in cardiovascular disease due to chronic low-grade inflammation. The combined interpretation of hemoglobin, ferritin, and transferrin saturation is essential; in selected cases, additional laboratory testing or specialist evaluation may be required. Both anemia and ID independently correlate with higher perioperative morbidity and mortality, increased transfusion requirements, prolonged hospitalization, and greater healthcare resource utilization, with risk proportional to the severity of these conditions. In conclusion, systematic preoperative screening for anemia and ID is critical to prevent avoidable complications and to optimize clinical outcomes in patients undergoing cardiac surgery. La anemia y la deficiencia de hierro (DH) son altamente prevalentes en pacientes candidatos a cirugía cardiaca y se asocian a peores desenlaces clínicos. A pesar de ello, estas condiciones continúan subdiagnosticadas en la práctica. Debido a esto, nos propusimos describir los fundamentos fisiopatológicos, los criterios diagnósticos y el impacto clínico de la anemia y la DH en el perioperatorio de cirugía cardiaca. Se elaboró un documento de posición de la Sociedad Interamericana de Cardiología, desarrollado por un panel multidisciplinario de expertos de distintos países del continente. Se propusieron lineamientos basados en la mejor evidencia disponible y adaptados al contexto latinoamericano. El umbral recomendado para definir anemia en ambos sexos previo a cirugía cardiaca es hemoglobina < 13 g/dl. La DH puede coexistir con o sin anemia; se define como DH absoluta cuando la ferritina es < 100 μg/l, y como DH funcional cuando la ferritina es normal o elevada, pero con saturación de transferrina < 20%. Esta última es frecuente en enfermedades cardiovasculares debido a la inflamación crónica de bajo grado. La interpretación combinada de la hemoglobina, la ferritina y la saturación de transferrina es esencial; en ciertos escenarios se requerirán estudios adicionales y una evaluación por un especialista. Tanto la anemia como la DH se asocian de manera independiente con mayor morbimortalidad, incremento del riesgo transfusional, estancias prolongadas y mayor uso de recursos sanitarios, con un riesgo proporcional a su gravedad. La incorporación sistemática del tamizaje de la anemia y la DH previo a la cirugía cardiaca es fundamental para reducir complicaciones prevenibles y optimizar los resultados clínicos.

19. Nanofiber, Microfiber, or Hybrid: Which Architecture Excels in Soft Tissue Reinforcement and Constructive Regeneration?

期刊: ACS applied materials & interfaces 发表日期: 2026-May-19 链接: PubMed

摘要

Despite extensive efforts, existing scaffolds for soft tissue reconstruction fail to simultaneously provide durable mechanical reinforcement and prevent fibrotic encapsulation while preserving endogenous tissue regeneration, as current antifibrotic strategies rely on solid or coated architectures that hinder tissue integration and compromise long-term performance. Here, we engineer three meshes composed of poly(ε-caprolactone)/polylactic acid nanofibers, microfibers, or their hybrid and evaluate their performance in vitro and in vivo using a subcutaneous implantation model in Sprague-Dawley rats to identify the fiber architecture that best resolves the fibrosis-regeneration trade-off. The hybrid meshes dissipate stress, reduce crack propagation, and enhance tensile strength (up to 38.2 ± 4.5 N) and tear resistance beyond current commercial products through microfiber reinforcement and a dual-network architecture, while recapitulating extracellular matrix-relevant structural cues. In vitro and in vivo studies revealed that the microfiber and hybrid meshes support deep, three-dimensional cell infiltration (>60% vs ∼5% in the nanofiber mesh), neovascularization, and uniform collagen deposition, achieving antifibrotic performance without compromising structural integrity. Our study suggests that increasing the fiber diameter enlarges the pore area and reveals a pore size threshold, where larger, interconnected pores (>100 μm2) enable robust early cellular infiltration and vascularization, promoting regenerative integration, whereas smaller pore architectures (<50 μm2) are associated with limited infiltration and increased fibrotic responses. Together, these results demonstrate that hybrid fiber meshes best balance mechanical reinforcement and regenerative integration, providing structural support while reducing fibrotic encapsulation and promoting constructive tissue remodeling.

20. Dyslipidaemias in cancer patients.

期刊: European heart journal 发表日期: 2026-May-19 链接: PubMed

摘要

Dyslipidaemia in cancer patients presents several challenges with increasing survival of cancer patients. Dyslipidaemia and cancer treatments both increase atherosclerotic cardiovascular disease (ASCVD) risk; yet, most risk prediction scores for ASCVD do not include important cancer factors and thus underestimate true ASCVD. Some cancer therapies cause transient elevations of low-density lipoprotein cholesterol or triglycerides, or reduction in high-density lipoprotein cholesterol, occasionally to extreme levels requiring specific treatment and monitoring strategies. A range of lipid-lowering therapies can be used in cancer patients to manage cholesterol and triglycerides but of these, reliable data only exist for statins and ezetimibe for managing low-density lipoprotein cholesterol, and fibrates and Omega 3 fish oils for hypertriglyceridaemia. There are no robust randomized controlled trials conducted in cancer patients for reduction of adverse cardiovascular events and therefore current recommendations have been extrapolated from non-cancer trials. Cancer survivors may require combination therapies; yet, trials of newer lipid-lowering therapies excluded cancer patients and hence safety and efficacy data are limited. The initiation of lipid-lowering therapy in cancer patients requires an integration of several factors, which includes a careful assessment of ASCVD risk, drug-drug interactions, side-effect profiles, and prognosis. Further work is required to personalize individualized risk scores for ASCVD in cancer patients and survivors and new trials and ‘real-world’ or registry data would inform these existing data gaps. Beyond lipid management, the putative role of therapies such for statins as cardioprotective agent for anthracycline chemotherapy open novel avenues for further research as survival from many cancers continues to improve.

21. Lipoprotein apheresis in the era of new lipid-lowering therapies.

期刊: European heart journal 发表日期: 2026-May-19 链接: PubMed

摘要

During the 1960s, in a pioneering way, plasmapheresis was used to treat children with homozygous familial hypercholesterolaemia (HoFH). Over the years, apheresis has evolved to increasingly selective methods, which have been used in paediatric HoFH since the 1990s. Today, lipoprotein apheresis (LA) is able to selectively remove atherogenic apoB100-containing lipoproteins from the blood: the main component of LDL-cholesterol, VLDL-cholesterol, and lipoprotein(a). Lipoprotein apheresis has demonstrated protective effects in the endothelium and microcirculation, prevention of the development of new aortic and coronary lesions in HoFH, reducing the incidence of major cardiovascular events, and proving helpful in subjects who fail to reach the LDL-cholesterol target or who have elevated lipoprotein(a) levels in secondary prevention. Although advances in pharmacological therapies (proprotein convertase subtilisin/kexin Type 9 inhibitors, antisense oligonucleotides, and siRNA-based treatments) have expanded the options for lipid management, LA remains a safe therapeutic approach for patients with severe lipid disorders, including HoFH, to reduce their cardiovascular risks. Currently, to put LA into perspective, some obstacles need to be overcome, including (i) the underdiagnosis of HoFH and high lipoprotein(a) level; (ii) therapeutic inertia resulting from the use of new lipid-lowering drugs with partial achievement of lipid targets; and (iii) availability of qualified LA centres and practitioners. Further prospective studies may prove useful to identify other therapeutic scenarios for LA, such as renal disease, diabetic foot ulcer, peripheral arterial disease, pre-eclampsia, macular degeneration, or sudden sensorineural hearing loss. In these clinical settings, prospective, randomized clinical trials are therefore warranted.

22. Gestational and lactational exposure to phthalates and nanoplastics induces inflammation and oxidative imbalance in the prostate of adult rats.

期刊: Toxicological sciences : an official journal of the Society of Toxicology 发表日期: 2026-May-19 链接: PubMed

摘要

The intrauterine microenvironment is highly susceptible to environmental disturbances, which may result in persistent effects on offspring health. Given that plastic-derived contaminants can cross the placental barrier and act as endocrine-disrupting chemicals, this study evaluated the effects of perinatal exposure to an environmentally relevant phthalate mixture (PM) and nanoplastics (NPs) on the prostate of adult rats. Pregnant Sprague-Dawley rats were allocated into six experimental groups: Ctrl (vehicle), T1 (20 μg/kg/day PM), T2 (200 mg/kg/day PM), T3 (NPs : 1.0 mg/kg/day), T4 (20 μg PM + NPs), and T5 (200 mg PM + NPs). Treatments were administered orally from gestational day 10 to postnatal day (PND) 21. Male offspring were euthanized on PND120, and ventral prostate samples were collected. Histological evaluation revealed increased inflammatory foci and stromal expansion in all exposed groups (T1-T5), along with reduced luminal compartment in T1, T3, and T4 compared to controls. All treated groups showed increased total and degranulated mast cells and enhanced androgen receptor immunoreactivity. Tumor necrosis factor (Tnf) expression was increased in all exposure groups, while Rela gene expression was elevated in the T4 and T5 groups. Oxidative stress analysis demonstrated increased lipid peroxidation and glutathione S-transferase (GST) activity in all treated animals. Catalase (CAT) activity was reduced in T1, T3, and T5, whereas superoxide dismutase (SOD) activity increased in T3, T4, and T5. Elevated levels of reduced, oxidized, and total glutathione (GSH, GSSG, tGSH) were observed in T5. Overall, perinatal exposure to PM and NPs induced persistent inflammation and altered redox status in the prostate, increasing susceptibility to pathological disorders.

23. Effect of Green Tea Extract Supplementation on Substrate Utilization: A GRADE-Assessed Systematic Review and Dose-Response Meta Analysis of Randomized Controlled Trials.

期刊: Nutrition reviews 发表日期: 2026-May-19 链接: PubMed

摘要

Several studies have assessed the effects of green tea extract (GTE) supplementation on substrate oxidation. However, no consensus has been reached due to the heterogeneity of the results, and so far no meta-analysis has been conducted on this topic. This systematic review and meta-analysis aimed to critically evaluate the effects of GTE supplementation on substrate oxidation, particularly on fat and carbohydrate oxidation during and after exercise. We conducted a comprehensive search of databases, including PubMed, Web of Science, and Scopus, to identify studies relevant to our research up until December 2024. Eligible randomized controlled trials (RCTs) that reported relevant and adequate data about substrate oxidation were included in this meta-analysis. Also, we rated the evidence certainty using the ‘Grading of Recommendations Assessment, Development and Evaluation’ (GRADE) method. Nine clinical trials evaluated the effect of GTE supplementation on substrate oxidation during and after exercise. In summary, intervention with GTE significantly increased fat oxidation both during (weighted mean difference [WMD]: 0.2 g/min; 95% CI; 0.04, 0.36; P = .016) and after exercise (WMD: 0.04 g/min; 95% CI; 0.01, 0.08; P = .023). Also, GTE significantly decreased carbohydrate oxidation after exercise (WMD: -0.16 g/min; 95% CI; -0.32, -0.01; P = .04) but did not significantly affect carbohydrate oxidation during exercise (WMD: -0.08 g/min; 95% CI; -0.29, 0.13; P = .468). Furthermore, the results of the dose-response analysis showed that an increase in the dose of GTE could augment fat oxidation after exercise (WMD: 0.03 g/min; 95% CI: 0.01, 0.06, P = .007). The quality of evidence was rated as low to high according to the GRADE criteria. Green tea extract supplementation significantly enhances fat oxidation during and after exercise, with limited effects on carbohydrate oxidation. PROSPERO registration No. CRD42024598165.

24. BEAR I Genetics Panel: An unexpected and troubling historical twist: The untold story of Hermann Muller's significant scientific confusion.

期刊: Journal of occupational and environmental hygiene 发表日期: 2026-May-19 链接: PubMed

摘要

Hermann J. Muller, Nobel Prize recipient for producing gene mutations, was the de facto leader of the radiation genetics community from the mid-1920s until he died in 1967. Muller had a major impact on US hereditary/cancer risk assessment policies/practices, and the course of the secondary school biological sciences curriculum development in the US and worldwide. Despite these accomplishments, Muller was at the center of provocative controversies. Within this context, this paper reports the discovery of a letter (April 4, 1956) from Muller to Warren Weaver, Chair of the BEAR I Genetics Panel, about a major controversy in which the radiation-induced hereditary damage estimates of Panelist Milisav Demerec were strikingly lower than those of others, especially Muller’s. In this recently discovered letter, Muller attempted to reconcile these differences and unexpectedly claimed that Demerec’s estimates were correct. However, Muller appears to have inexplicably confused the evaluation by switching his focus away from Demerec’s data on radiation-induced mutation rates in bacteria to his old unresolved dispute with Demerec regarding fruit flies. He even suggested that Demerec was correct in that Muller’s groundbreaking mutational research had induced mostly major chromosomal aberrations rather than gene mutations. Muller curiously suggested that he had thereby resolved the conflict amongst Demerec, himself, and other BEAR I Genetics Panel members. Yet, as noted, Demerec’s data for the BEAR I Genetics Panel mutation risk estimates were based on his (i.e., Demerec’s) more current research on bacteria, with Muller completely missing the entire point of the Panel’s scientific conflict with the Demerec data. Thus, Muller never addressed the real issue. This transitory detachment from factual reality by Muller is obvious and acute. Finally, if Weaver had shared this letter from Muller with the BEAR I Genetics Panel, it seems possible that many members might have been so troubled by Muller’s apparent detachment from reality (on such a consequential disagreement) that they would have questioned why they had allowed Muller to exert so much influence on their report.

25. Impacts of the Pacific northwest heat dome on preterm birth rates in Oregon and Washington state.

期刊: American journal of epidemiology 发表日期: 2026-May-19 链接: PubMed

摘要

Acute heat exposure, which is increasing with climate change, likely increases preterm birth risk. However, few studies consider susceptible exposure windows for extreme heat events, particularly among historically unexposed populations. The 2021 Pacific Northwest Heat Dome produced the highest temperatures ever recorded in usually temperate Oregon and Washington State, offering an ideal study setting. We used 2016-2022 vital statistics records to estimate the gestation month-specific impact of the Heat Dome on preterm birth. Using an interrupted time series design with a synthetic control, we compared the observed odds of preterm birth in the exposed (in utero November 2020-July 2021) Oregon and Washington conception cohorts to counterfactual odds had the Heat Dome not happened. Analysis included 716 096 exposed births across 67 monthly conception cohorts. We identified increased odds of preterm birth in cohorts exposed during months 2-3 (11% increase, 95% CI: [1%, 22%]) and 6-7 (14% increase, 95% CI: [5%, 24%]) of pregnancy. These findings partially agree with literature reporting elevated preterm birth risk after heat exposure in all trimesters. As extreme heat events are now expected once to twice per decade rather than once every thousand years, they pose risks to perinatal health.

26. Implementing psilocybin-assisted therapy in palliative care settings: A survey of stakeholders.

期刊: Palliative medicine 发表日期: 2026-May-19 链接: PubMed

摘要

While the adoption of psilocybin-assisted therapy for existential distress offers promising support for patients with life-threatening illnesses, implementing this intervention into palliative care settings presents significant real-world challenges. To examine palliative care stakeholders’ knowledge and attitudes regarding psilocybin-assisted therapy, and identify barriers and facilitators to its implementation. We conducted a cross-sectional online survey between April 15 and December 18, 2024. The survey assessed perceived knowledge, attitudes, and perceived barriers and facilitators to the effective integration of psilocybin-assisted therapy into palliative care settings. One hundred and twenty-one adults involved in palliative care (physicians, other healthcare professionals, caregivers, and managers) were recruited from Canada’s four most populous provinces: Québec, Ontario, Alberta, and British Columbia. Forty-three percent of stakeholders reported having good knowledge of psilocybin’s potential benefits and risks. Attitudes towards psilocybin-assisted therapy were predominantly non-favourable (61%), yet varied across occupational groups (p < 0.0001), with 95% of physicians reporting favourable attitudes. The lack of trained healthcare providers was viewed as the primary barrier to implementation. Key facilitators included further research and developing standardised intervention protocols. Sixty-eight percent of stakeholders endorsed the introduction of psilocybin-assisted therapy during the early stages of the illness trajectory. Translating the potential of psilocybin-assisted therapy for existential distress from clinical trials into palliative care settings requires careful consideration and collaboration with stakeholders. Given the significant divergence in perspectives between clinical and non-clinical groups, tailored interprofessional education could help build shared understanding and support effective implementation. Being conducted in Canada, transferability to different regulatory frameworks may be limited.

27. The Implementation of the Toolbox "Talk About Pain-Take Action Together" to Improve Musculoskeletal Pain Management in the Workplace.

期刊: Journal of occupational rehabilitation 发表日期: 2026-May-19 链接: PubMed

摘要

Musculoskeletal disorders (MSDs) are a leading cause of sickness absence from work and early retirement. While structured workplace dialogues about musculoskeletal pain are recommended, their implementation remains challenging. This study explored the implementation of the ‘Talk About Pain-Take Action Together’’ toolbox in two Danish public workplaces. Qualitative observational implementation study informed by reflexive thematic analysis was conducted. Two workplaces with physically demanding roles were included: one with researcher-initiated implementation during the study period and one with internally initiated implementation prior to the study. Data were collected through observations, memos, emails, and four focus group interviews with 10 participants including employees, managers, and occupational safety and health consultants. Workplace 1 (WP1) implemented the toolbox, employing seven strategies: identifying and preparing champions, conducting a local needs assessment, distributing educational materials, reminding clinicians, tailoring strategies, organising implementation team meetings, and creating learning collaboratives. Key enablers included management engagement, ongoing exposure, and creating a safe environment, whereas lack of time was identified as a barrier. At workplace 2 (WP2), three strategies were employed: identifying and preparing champions, distributing educational materials, and conducting educational meetings. However, the toolbox was never fully implemented, hindered by time-related barriers, organisational restructuring, and unclear roles and responsibilities. Effective implementation of workplace MSD interventions requires management engagement, time allocation, and clear roles.

28. "We just don't have time": a qualitative study on health care providers' experiences with smoking cessation counseling in Egyptian maternity hospitals.

期刊: The Journal of the Egyptian Public Health Association 发表日期: 2026-May-19 链接: PubMed

摘要

Despite the established risks associated with tobacco exposure during pregnancy, the implementation of smoking cessation counseling by healthcare providers in Egypt is inconsistent. This study aimed to assess health care providers’ (HCPs) knowledge about the hazards of smoking exposure during pregnancy, investigate their attitudes and practices concerning smoking cessation, and determine the perceived barriers to addressing this issue during routine care. We employed a qualitative approach to conduct semi-structured interviews with 22 health care professionals (15 obstetricians and 7 nurses) from four Cairo government hospitals. Purposive sampling was used to choose participants. Arabic-language interviews were recorded, verbatim transcribed, and subjected to thematic analysis using NVivo 12 Pro. Six major themes emerged: (1) differences in knowledge about smoking hazards; (2) differences in attitudes regarding counseling; (3) inconsistency regarding history taking and counseling practices; (4) obstacles to effective intervention; (5) recommendations for improvement; and (6) expressed desire for training. Although there was an overall sense of awareness of risk, counseling practices were found to be selective and faced barriers, including cultural sensitivity, time constraints, and role uncertainty. Targeted training and structural support are necessary for HCPs to deliver consistent smoking cessation counseling. Systematic incorporation of cessation counselling into antenatal care is necessary to tackle the impact of maternal tobacco exposure.

29. Revealing the hidden burden: wastewater-based epidemiology for underreported and emerging infectious diseases in communities.

期刊: Environmental monitoring and assessment 发表日期: 2026-May-19 链接: PubMed

摘要

Wastewater-based epidemiology (WBE) has become a transformative tool for infectious disease surveillance, providing population-level insights that complement and extend traditional case-based reporting. This review examines the expanding role of WBE in identifying and characterizing underreported, novel, and emerging human pathogens. Evidence reveals that wastewater analysis consistently detects enteric, respiratory, and neglected pathogens that are often missed by clinical systems, thereby revealing the hidden burden of infection within communities. Sequencing-based studies have identified numerous novel and divergent human viruses, highlighting the extensive diversity of the human virome. The frequent co-detection of multiple viral taxa also suggests that interactions and co-infections may influence viral evolution, disease manifestation, and transmission. Despite methodological challenges in quantification and biological validation, WBE has proven capable of detecting both known and novel pathogens before they are clinically recognized. Future developments in long-read sequencing, bioinformatics, and global data integration will enhance the precision and scope of wastewater genomics, positioning it as a central element of early-warning and One Health surveillance frameworks. By illuminating the unseen spectrum of infectious agents, WBE bridges environmental and clinical domains, offering a scalable and equitable strategy for global pathogen discovery and public health preparedness.

30. Marital status and post-radical prostatectomy outcomes: results from the SEARCH database.

期刊: Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer 发表日期: 2026-May-19 链接: PubMed

摘要

Social support, specifically marital status, has been shown as a significant prognostic factor for survival of multiple malignancies, including prostate cancer. However, this has not been investigated in an equal access Veterans Affairs (VA) cohort where other support systems exist that may minimize the potential benefit of social support from a partner. We retrospectively reviewed data from 9,931 patients undergoing primary radical prostatectomy (RP) in the VA from 1988-2020 across 9 VA centers. Univariable and multivariable Cox proportional hazards models were used to test the association between marital status and biochemical recurrence (BCR), metastasis, castration-resistant PC (CRPC) and prostate cancer specific mortality (PCSM). 8,285 patients met the inclusion criteria: 54% were married, 30% were divorced/separated, 9% were single/never married, and 6% were widowed at the time of RP. Single/never married men were younger (median 61 vs 62-65 years), had surgery more recently (median 2009 vs 2003-2008), had higher PSA (median 6.9 ng/mL vs 6.4-6.8 ng/mL), and had lower BMI (median 27 vs 28) compared to other groups (all p < 0.05). The median time to BCR was significantly shorter for divorced/separated men (188.2 months) and single/never married men (154.8 months) compared to married men (243.0 months). Consistent with this finding, compared to married men, divorced/separated men had higher risk of BCR (HR = 1.12; 95% CI 1.03-1.21), as did single/never married men (HR = 1.13; 95% CI 1.00-1.28). However, these associations were insignificant in multivariable analyses (all p > 0.05). Among men with localized prostate cancer undergoing RP within the VA, we found no association between marital status-defined as a demographic indicator of self-reported relationship category-and oncologic outcomes. Whether marital satisfaction or perceived partner support, which were not assessed in this study, influence post-RP outcomes remains to be investigated.

31. Survey of tick species and tick-borne pathogens in pet dogs and cats in mainland China.

期刊: Veterinary parasitology 发表日期: 2026-May-18 链接: PubMed

摘要

Ticks are major vectors of zoonotic diseases, harboring and transmitting various bacteria, viruses and parasites. In mainland China, the rapidly growing population of companion animals has rendered pets important tick hosts and a critical bridge for tick-borne pathogens to infiltrate domestic environments, yet no systematic investigations have been conducted on tick species parasitizing pets and the pathogens they carry.This study was conducted from May 2024 to August 2025. We collected ticks from the body surfaces of outpatient dogs and cats at 231 pet hospitals across 27 Chinese provinces and municipalities. Tick species were identified, and four key tick-borne pathogens (Babesia spp., Anaplasma phagocytophilum, Ehrlichia spp., and Lyme disease spirochetes) were detected via polymerase chain reaction (PCR); positive samples were further sequenced and subjected to phylogenetic analysis.A total of 2158 ticks were collected, 1942 (90.0%) from dogs and 216 (10.0%) from cats, belonging to 16 species of four genera. Haemaphysalis longicornis (40.6%) and Rhipicephalus sanguineus sensu lato (35.5%) were the dominant species. A. phagocytophilum was not detected in any samples. Babesia spp. had the highest infection rate (1.44%), including B. vogeli and B. gibsoni; Ehrlichia spp. and Lyme disease spirochetes were detected at 0.37% and 0.28%, respectively, with multiple species/genotypes identified for both. Pathogen distribution exhibited distinct tick-species specificity and spatial clustering.This is the first systematic survey of the diversity of pet-parasitizing ticks and the prevalence of four key tick-borne pathogens in mainland China, confirming that pets face persistent and diverse threats from tick-borne diseases. Our findings highlight the need for regionally differentiated surveillance, year-round tick control measures, and enhanced prevention and control awareness among veterinarians and pet owners, providing a scientific basis for clinical diagnosis, treatment and public health prevention and control.

32. Incidence of oropharyngeal cancer among U.S. active component service members, 2005-2024.

期刊: MSMR 发表日期: 2026-May-15 链接: PubMed

摘要

33. Head and neck cancer among U.S. active component service members, 2010-2024.

期刊: MSMR 发表日期: 2026-May-15 链接: PubMed

摘要

This study utilized de-identified surveillance data to estimate the incidence of head and neck cancer among active component service members (Army, Navy, Air Force, Marine Corps, Coast Guard) from 2010 through 2024. This report updates the June 2021 MSMR analysis of oral and pharyngeal cancers (2007-2019) by expanding the case definition to include all head and neck cancers and extending the surveillance period through 2024. There were 549 cases of head and neck cancer diagnosed in the active component military during the 15-year period of analysis. The Army had the highest 15-year incidence rate (3.3 per 100,000 person-years) compared to the Navy (2.6 per 100,000), Air Force (2.6 per 100,000), Coast Guard (2.0 per 100,000), and Marine Corps (1.3 per 100,000). Service members ages 40 years and older had the highest overall incidence rate (12.3 per 100,000), which was 3.3 times the next highest rate observed among those ages 35-39 years. The 15-year male incidence rate (2.9 per 100,000) was greater than that among females (1.7 per 100,000). The parotid gland was the most common site of diagnosis, comprising 14.8% of cases. This report provides the most current head and neck cancer incidence data for active component service members from 2010 through 2024; it establishes baseline rates for monitoring of future trends and highlights specific high-risk populations (e.g., men, Army personnel, service members ages 40 years and older). Although head and neck cancer is the seventh most prevalent cancer worldwide, its incidence among active component service members is seldom reported. Head and neck cancer is often not diagnosed until it has metastasized. Significant physical limitations (e.g., difficulty chewing, speaking, and swallowing) and psychosocial effects (e.g., anxiety, depression, social isolation), compromising service member readiness, can accompany this type of cancer.

34. Distribution of tobacco and nicotine use indicators from the Periodic Health Assessment and medical diagnostic codes among U.S. active component service members, 2023.

期刊: MSMR 发表日期: 2026-May-15 链接: PubMed

摘要

Military service members remain a priority population for assessing the prevalence, patterns, and long-term consequences of tobacco and nicotine use. The limitations inherent to documenting use among military service members, however, complicate the design of exposure assessment. This study combined 2 data sources-by aggregating self-reported Periodic Health Assessment (PHA) survey data with International Classification of Diseases, 9th and 10th revisions, Clinical Modification (ICD-9-CM/ICD-10-CM) medical diagnostic codes-to classify nicotine and tobacco use as exposures delineated by recent use or history of any use. The study population included a total of 921,394 U.S. active component service members who completed a PHA in 2023. PHA classification for ‘recent use’ was defined by self-reported use of any tobacco or nicotine product within the past 30 days, whereas ‘history of any use’ included recent users in addition to those who reported cessation of use. The full roster of service members who completed the PHA in 2023 was matched to ambulatory and inpatient medical records within 30 days, before or after, the PHA sample period (December 1, 2022-January 31, 2024) to identify selected ICD-10-CM codes for recent use. Selected diagnostic codes for a ‘history of any use’ were queried for a period of 20 years preceding and 30 days following (January 1, 2004-January 31, 2024) the PHA sample period. Among PHA respondents, 22.0% (n=203,156) self-reported recent nicotine or tobacco use. When aggregating PHA data with recent exposure classified from diagnostic codes, the resulting assessment of recent nicotine or tobacco use increased to 28.7% (n=264,194). Critically, this aggregation identified 61,038 U.S. service members with no evidence of recent use on the PHA but with a concurrent clinical record during the specified matching period. Aggregating data sources for a history of any use only nominally improved the estimate, increasing it from 41.1% (PHA alone) to 43.1%. Agreement between sources was fair for both recent use (κ=0.28) and historical use (κ=0.36). The results of this study indicate that neither self-reported PHA data nor medical diagnostic codes alone provide a complete picture of tobacco and nicotine use among U.S. active component service members. The combination of medical diagnostic codes with self-reported PHA survey responses increases exposure estimates of recent tobacco or nicotine use among U.S. active component service members to 28.7%, in comparison to 22.0% if exclusively assessing recent use from the PHA. The integration of multiple data sources may provide a more comprehensive assessment of recent nicotine and tobacco exposure among service members, directly supporting enhanced public health surveillance.

35. NRF2 as a guardian of health: from an ancient survival pathway to a modern therapeutic target.

期刊: Redox biology 发表日期: 2026-May-15 链接: PubMed

摘要

NRF2 (Nuclear Factor Erythroid 2-Related Factor 2) has traditionally been viewed as a master regulator of the antioxidant response. However, emerging evidence redefines NRF2 as a pleiotropic and evolutionarily conserved systems-level integrator of redox, metabolic, proteostatic, and inflammatory homeostasis, i.e., an evolutionarily conserved guardian of health. From its origins as an adaptive response to rising atmospheric oxygen in early metazoans to its role in orchestrating complex cytoprotective networks in humans, NRF2 exemplifies the biological transition from stress resistance to adaptive resilience. Understanding its regulation across species, tissues, life stages and gender offers novel perspectives for combating age-related cellular dysfunction and reframing the dynamic process of redox regulation as a component of adaptive homeostasis in a precision medicine perspective. This review summarizes and integrates essential concepts currently being developed regarding the evolutionary roots of NRF2, its molecular and regulatory complexity, its dualistic role in health and disease, and its potential as a biomarker of resilience and therapeutic target. We highlight NRF2’s function as a rheostat rather than a binary stress switch, including the role of hormetic activation through lifestyle and environmental stimuli. By maintaining redox homeostasis and dynamic adaptive stress responses, NRF2 bridges molecular defense mechanisms with strategies for healthspan extension and preventive medicine from very early life stages until senescence.

36. Short fibers recruiting inflammatory exudate via smart-responsive estrogen antagonism for endometrial hyperplasia.

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

摘要

Inflammation-mediated progesterone resistance, driven by the sustained acidification of the inflammatory microenvironment from V-type H+-ATPase overexpression in inflammatory cells, critically impedes the treatment of endometrial hyperplasia (EH). Herein, a smart short-fiber scaffold (PGCL) was innovatively fabricated by covalently conjugating levonorgestrel (LNG) to poly (lactic acid)/gelatin nanofibers via a two-step click chemistry approach. The fibers recruit inflammatory fluid and respond intelligently to the acidic inflammatory microenvironment through triazole bond cleavage, enabling targeted LNG release for estrogen antagonism and microenvironment regulation. Specifically, within the mildly acidic lesion site, hydrogen ions trigger the rupture of triazole bonds, resulting in the controlled release of LNG to precisely treat EH. Meanwhile, the highly absorbent and self-expanding properties of PGCL enable adaptation to the complex uterine architecture, while its porous structure (>85% porosity) facilitates inflammatory exudate recruitment. Transcriptomic analysis revealed that PGCL alleviates progesterone resistance by inhibiting the PI3K/AKT/NF-κB pathway, which modulates macrophage polarization and reduces V-type H+-ATPase expression, thereby suppressing proliferation through DNA synthesis blockade and downregulating VEGF and pro-inflammatory factors. In EH model rats, PGCL treatment reduced endometrial thickness by 32.45%, gland density by 41.24%, and inflammatory factor expression by 38.22-55.58% in EH model rats. Short fibers that recruit inflammatory exudate enable a novel strategy for endometrial repair through smart-responsive estrogen antagonism.

37. Characterization of indoor air quality in logistics warehouses in France: environmental measurements and worker exposure assessments.

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

摘要

The objective of this study was to provide data on the concentrations of volatile organic compounds (VOCs), aldehydes, and total dust levels in logistics warehouses, in order to identify substances of concern for indoor air quality (IAQ) and worker exposure in these buildings. Seven warehouses were selected based on the diversity of stored products. Active sampling of VOCs, aldehydes and particles was carried out over the course of 1 d, at 3 to 5 locations within each building, as well as outdoors. Among the 7 warehouses investigated, tire logistics centers were found to have the poorest IAQ, as reflected by significantly higher concentrations of total VOCs compared with the other warehouses, ranging from 1,079 to 3,747 µg/m3 toluene equivalent, compared with 166 to 470 µg/m3 in the other sites. Based on the total VOC concentration, more in-depth investigations were conducted in the working environment involving the most degraded IAQ, namely 1 of the 2 tire warehouses. These additional analyses, including emission cell degassing of a tire sample, a detailed air characterization, and personal exposure measurements, revealed the presence of several CMR substances in these working environments, such as MIBK and aniline.

38. A Retrospective Analysis on Level of Suction in Digital Drainage Devices After Video-assisted Lobectomy in a Thoracic Surgery Centre.

期刊: Portuguese journal of cardiac thoracic and vascular surgery 发表日期: 2026-May-10 链接: PubMed

摘要

The management of chest tubes after pulmonary resection remains non- standardized, and suction levels are often determined by the surgeon’s preference. This retrospective study aimed to compare the clinical outcomes of low suction -2cmH2O-2cmH2​O versus the conventional suction level used in our institution -15cmH2O-15cmH2​O using digital drainage devices after videoassisted thoracic surgery (VATS) lobectomy for suspected or confirmed lung cancer in a thoracic surgery centre. We analysed 120 patients who underwent pleural drainage after VATS lobectomy between January 2023 and September 2024. The primary outcome was drainage duration. Secondary outcomes included hospital stay, prolonged air leak, complications, and readmissions. No significant differences were observed in drainage duration (2.0 vs. 4.0 days; p=0.125p=0.125) or hospital stay (3.0 vs. 4.0 days; p=0.104p=0.104 ). The incidence of prolonged air leak was similar between groups (20.3% vs. 24.6%; p=0.578p=0.578 ). However, subcutaneous emphysema occurred more frequently in the low suction group (22% vs. 8.2%; p=0.04p=0.04 ), with a higher need for intervention, despite comparable baseline forced expiratory volume in the first second (FEV1) values between suction level groups. Importantly, patients who developed subcutaneous emphysema had significantly lower baseline FEV1 values, regardless of suction level. COPD was identified as a significant predictor of longer drainage duration, longer hospital stay, and higher complication rates. Although suction level did not significantly influence postoperative recovery, the higher incidence of subcutaneous emphysema in the low suction group warrants further investigation. The presence of COPD and impaired baseline lung function should be considered when selecting suction levels after VATS lobectomy.

39. Real-time prediction of cardiorespiratory deterioration during paediatric critical care transport using interpretable machine learning.

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

摘要

Interhospital transport of critically ill children carries inherent risks, including unexpected respiratory and cardiovascular deterioration. Early warning of impending patient deterioration may allow physicians to intervene and prevent further decline. We developed and evaluated lightweight, explainable machine learning models to forecast adverse physiological events up to 15 minutes in advance using continuously streamed vital signs and clinical data. Models were trained and evaluated on 1,519 transports conducted by a specialist paediatric critical care team in London (2016-2021). Transformer-based models incorporating vital sign time-series and vector-embedded diagnoses outperformed simpler models, achieving AUROC scores of 0.851 for respiratory and 0.792 for cardiovascular deterioration. Model interpretability was provided using Integrated Gradients, revealing alignment with clinical reasoning. Designed for deployment on edge devices, these models offer real-time, interpretable risk predictions in resource-limited transport settings. These results demonstrate that real-time, explainable machine learning models can accurately predict deterioration during interhospital paediatric transport using routinely collected data, supporting their potential role in enhancing early clinical intervention.

40. Enabling health and maintaining independence for older people at home: the 'HomeHealth' Randomised Controlled Trial.

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

摘要

HomeHealth is a home-based, voluntary sector service supporting older people with mild frailty to maintain independence through behaviour change. Support workers discuss the person’s priorities and enable setting/achieving goals around mobility, nutrition, socialising and/or psychological well-being. We tested clinical and cost-effectiveness of HomeHealth for maintaining independence in older people with mild frailty in a randomised controlled trial. Design: Single-blind, parallel randomised controlled trial open between 18 January 2021 and 4 July 2023, with mixed-methods process evaluation. Setting: Community-dwelling older people aged 65+ years with mild frailty from 27 general practices and community settings in London, Yorkshire and Hertfordshire. Randomisation: Participants were randomised 1 : 1 to receive HomeHealth or treatment as usual. Outcomes: Primary outcome was independence in activities of daily living (modified Barthel Index), analysed using linear mixed models. Secondary outcomes included frailty phenotype score, extended activities of daily living, well-being, psychological distress, loneliness, cognition, falls and mortality. Health economic outcomes included quality of life, capability and service use, including hospital admissions. Cost-effectiveness acceptability curves and cost-effectiveness planes were used to represent the probability of cost-effectiveness compared to treatment as usual. Process evaluation: We conducted semistructured interviews with participants receiving the intervention, HomeHealth workers and other stakeholders supporting service delivery. Interviews were thematically analysed. Fidelity of audio-recorded appointments was assessed by two independent raters. We evaluated potential mechanisms of impact using data from appointments attended, types of goals set and progress towards goals. We recruited 388 participants, mean age 81.4 years (standard deviation 6.5), 64% female and 94% White British/European. HomeHealth did not improve Barthel Index scores at 12 months (0.250, 95% confidence interval -0.932 to 1.432). At 6 months, we found small significant reductions in psychological distress (-1.237, 95% confidence interval -2.127 to -0.348), and frailty phenotype score (-0.252, 95% confidence interval -0.487 to -0.017). At 12 months, we found significant improvements in well-being (1.449, 95% confidence interval 0.124 to 2.775), reduced unplanned admissions (incidence rate ratio 0.65, 95% confidence interval 0.54 to 0.92) with lower associated costs (-£586/participant, 95% confidence interval -351 to -821). There were no differences in other outcomes. HomeHealth dominates treatment as usual with a negative point estimate for incremental costs (-796, 95% confidence interval -2016 to 424), positive point estimate for incremental quality-adjusted life-years (0.009, -0.021 to 0.039) and high probability of cost-effectiveness. Process evaluation: Sixty-four semistructured interviews were completed, including 49 participants and 15 HomeHealth workers/stakeholders. The service was acceptable and safe, with good fidelity of delivery. Participants made progress on personalised goals, most working on enhancing mobility. They found the service empowering, and received emotional/practical support. Engagement was more challenging when participants identified no need for change, had significant memory impairment or new/declining illness. Flexibility around varying symptoms and incorporating behaviour change into existing routines promoted engagement. HomeHealth did not improve independent functioning for older people with mild frailty. There were small significant improvements in frailty status, psychological distress and well-being and a 35% reduction in unplanned admissions, with high probability of cost-effectiveness. We used a pragmatic design with intervention delivery in real-world settings during/after the COVID-19 pandemic, potentially with more variability in delivery. Our findings might not apply to other geographical settings/healthcare systems. This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme as award number NIHR128334. As we age, we may develop several health conditions that affect how we feel and our ability to manage without help. For some, it can mean they have less energy and muscle strength, and it is harder to do routine tasks such as shopping or cooking. Few services exist to prevent things getting worse. We designed a new service, ‘HomeHealth’, to enable older people to maintain their independence and activities they enjoy. Over six visits with a dedicated support worker, they identified concerns such as tiredness, low mood and anxiety, poor appetite, weakness and memory problems and developed goals and plans to address difficulties. Our research aimed to explore if HomeHealth helped people to stay independent for longer and provided value for money. Our study recruited 388 older people who were struggling with their everyday activities like cooking/shopping and getting out due to their health. Half were randomly allocated to the HomeHealth service, and half received usual care for 6 months. All participants were assessed by researchers at the beginning, 6 and 12 months later. We also interviewed 49 participants, and 15 people delivering the service about their experiences. We found that HomeHealth did not improve participants’ independence compared to usual care, though it showed small positive effects on mood and frailty at 6 months and well-being after 1 year. Those receiving the service were 35% less likely to be admitted to hospital for acute illness and had lower hospital care costs. The service was acceptable, safe, provided emotional and practical support and empowerment. Most older people made progress on goals to improve their health and well-being. Some found this more challenging, particularly those with worsening health or memory, or those who felt no need to change. The HomeHealth service is a promising intervention to reduce unplanned (emergency) hospital admissions.

41. Public health preparedness in times of regional crisis: lessons from Cyprus and the Eastern Mediterranean.

期刊: European journal of public health 发表日期: 2026-Apr-11 链接: PubMed

摘要

42. Alcohol consumption, smoking, and weight loss outcomes: findings from a 12-month digital lifestyle intervention.

期刊: European journal of public health 发表日期: 2026-Apr-11 链接: PubMed

摘要

To investigate associations between alcohol consumption, smoking, and weight loss outcomes over a 12-month digital lifestyle intervention, the Healthy Weight Coaching. Weight, height, and waist circumference were self-reported at baseline, followed by weekly weight and quarterly waist circumference reporting. Interpolated weights were used to calculate body mass index at 3, 6, 9, and 12 months. At these timepoints, relative changes from baseline in weight and waist circumference were calculated. On web-based questionnaires, participants reported alcohol consumption (frequency, single-session dose) and smoking (status, daily dose, start age, end year). Participants were categorized as abstinent, low-risk drinkers, and risky drinkers (men: >14 units/week or >6 units/occasion; women: >7 units/week or >5 units/occasion), and as current, former and non-smokers. At baseline, of the 1719 participants (83.3% women, median age 51 years, body mass index 39.1 kg/m2), 20.9% reported abstinence and 16.2% risky drinking, while 12.1% and 22.3% were current and former smokers, respectively. Alcohol consumption decreased over the program, driven by reductions among baseline risky drinkers. Among baseline non-drinkers, increased alcohol intake over 12 months was linked to smaller waist circumference reduction (weekly dose, B = 0.762, P = 0.005; single-session dose, B = 1.168, P = 0.020). Instead, among baseline risky drinkers, cutting alcohol intake was linked to greater weight loss (weekly dose, B = 0.062, P = 0.034; single-session dose, B = 0.321, P < 0.001), and larger waist circumference reduction (single-session dose, B = 0.381, P = 0.031). Higher number of pack-years was associated with attenuated waist circumference reduction (B = 0.059, P = 0.002). Addressing alcohol consumption and smoking may improve weight loss outcomes in digital lifestyle interventions. The trial is registered at clinicaltrials.gov (Clinical Trials Identifier NCT04019249).

43. Memories of Memórias: shaping a century of plague research and public health policy in BrazilFIRST REVIEW ROUND - REVIEWERS COMMENTSREVIEWERS COMMENTS.

期刊: Memorias do Instituto Oswaldo Cruz 发表日期: 2026 链接: PubMed

摘要

Plague, caused by Yersinia pestis, remains a historically significant and reemerging zoonotic threat worldwide. Often erroneously considered a medieval relic, the disease persists in natural foci, including Brazil, where it was introduced in 1899 via maritime trade. Over the past 125 years, the country has experienced cyclical outbreaks concentrated in the northeast, where ecological conditions support enzootic transmission among wild rodents and their fleas. While improved surveillance and control have reduced human cases in recent decades, the pathogen’s zoonotic nature and potential for rapid spread in a changing climate underscore its enduring public health relevance. Memórias do Instituto Oswaldo Cruz (MIOC), one of Latin America’s foremost tropical medicine journals, has been instrumental in documenting and shaping the course of plague research in Brazil. Its archives provide a unique chronological record, from pioneering studies on serum production and reservoir ecology to modern molecular analyses of bacterial virulence. This perspective synthesises the seminal contributions published in Memórias that have defined our understanding of plague in Brazil, identifies critical knowledge gaps that persist, and discusses emerging challenges in an era of climate change and shifting zoonotic disease dynamics.

44. Use of the OSCE in assessing performance in first aid of high school students.

期刊: Einstein (Sao Paulo, Brazil) 发表日期: 2026 链接: PubMed

摘要

To assess the knowledge and performance of high school students in cardiopulmonary resuscitation and foreign body airway obstruction management using an objective structured clinical examination. An interventional design was implemented with high school students, who were assessed before and after the intervention. Participants completed a theoretical questionnaire and two objective structured clinical examinations-one for cardiopulmonary resuscitation and one for foreign body airway obstruction-before receiving theoretical and practical first aid training. Subsequent assessments included the same theoretical questionnaire and objective structured clinical examinations, administered immediately after training and again after six months to measure knowledge retention. Comparison of pre-training, immediate post-training, and six-month follow-up data revealed significant improvements in knowledge and performance across all student groups and scenarios (p<0.001), with sustained retention over time. Implications for School Health Policy, Practice, and Equity: Utilizing handmade mannequins alongside the objective structured clinical examination methodology offers a cost-effective approach for training students and mitigating adverse outcomes in high schools. The objective structured clinical examination is an effective and evaluative tool for first aid training among high school students.

45. Impact of the 2024 Korean medical workforce crisis on transfers in a pediatric emergency center: including comparative analyses with adults.

期刊: PloS one 发表日期: 2026 链接: PubMed

摘要

In February 2024, the South Korean government announced a substantial increase in medical school admissions, leading to the sudden departure of most junior doctors. This unprecedented workforce shortage significantly impacted emergency departments. Pediatric care, known to require specialized readiness, may have been disproportionately affected. We conducted a retrospective study at an emergency institution with a specialized pediatric emergency center. The study period was divided into pre-policy (March 2023-January 2024) and post-policy (March 2024-January 2025) periods. All emergency visits were analyzed, and interhospital transfers were compared between periods. Interrupted time series (ITS) analysis, multivariable logistic regression and inverse probability of treatment weighting were performed to evaluate associations between the policy-driven workforce shortage and transfer occurrence. Subgroup analyses of transferred pediatric patients examined total length of stay, transfer reasons, and accompaniment by medical staff. Among 97,916 ED visits (46,165 pediatric; 51,751 adult), there were 48 and 89 pediatric transfers in the pre- and post-policy periods, respectively, and 130 and 83 adult transfers in the same periods. Notably, pediatric transfers nearly doubled (an 85% increase) despite an approximately 42% decline in pediatric ED visit volume (29,211-16,954 visits). ITS analysis showed a continuing upward trend in pediatric transfers, although this trend did not reach statistical significance. In multivariable regression, only pediatric transfers were significantly associated with the post-policy period (OR 2.49, 95% CI 1.74-3.61). Transfer reasons shifted toward the unavailability of specialized care and physician accompaniment during transfers increased significantly. This study evaluated and identified the potential association between pediatric transfers and the government policy announcement, as well as the subsequent workforce departure, using statistical analyses and adjustment methods. Compared to adults, departure of the workforce following the policy announcement was more potentially associated with rises in pediatric transfers. Also, periodic changes in characteristics of pediatric interhospital transfers were observed. These findings reflect the vulnerability and complexity of pediatric emergency care and emphasize the necessity of ensuring medical readiness and specialized workforce capacity during times of healthcare disruption.

46. "Revising the DSM-VI": Global perspectives on power and classification from lived expertise leadership.

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

摘要

47. Navigating mental health needs at sea: Perspectives from the Canadian maritime community during the COVID-19 pandemic.

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

摘要

Seafarers play a vital yet often underrecognized role in sustaining global trade, facing unique mental health challenges, that was further exacerbated by the COVID-19 pandemic. Existing literature underscores elevated risks of anxiety, depression, and suicide among seafarers, heightened by isolation, extended contracts, and diminished shore leave. This is the first qualitative study exploring seafarer mental health needs and support use in Canadian waters. Guided by the research question-What are the mental health needs of seafarers operating in Canadian waters during the COVID-19 pandemic, and what were the barriers that prevented them from accessing support?-this study sought to identify how several socio-ecological factors shape seafarers’ mental health needs and use of support. Thirteen interviews (eleven seafarers and two key informants) were conducted between February and October 2022. A hybrid thematic framework approach was adopted: an initial inductive thematic analysis generated data-driven codes, which were subsequently organized through framework analysis by deductively mapping them onto the domains of the Socio-Ecological Model. Interpretation was complemented by Ungar’s social-ecological resilience perspective to interpret how individuals “navigate” available resources and “negotiate” for mental health support. Findings reveal that pandemic-driven mobility restrictions-such as denial of shore leave and repatriation challenges-intensified the pre-existing stressors of seafaring life. Inadequate onboard connectivity, reports of workplace harassment, and limited coordination among authorities, employers, and welfare organizations further constrained mental health support access. Port-based welfare centres, ship inspectors, and collaborative interventions demonstrated a potential to mitigate psychosocial risks. The pandemic spotlighted systematic gaps in the mental health supports available to seafarers in Canadian waters. Addressing these gaps requires multi-level strategies that link onboard, port-based, and policy-level supports. Adapting Mental Health First Aid and Stepped Care 2.0 to maritime settings, coupled with stronger interagency collaboration, can enhance timely, context-specific mental health care.

48. Dipyrone use in Brazil: clinical conditions, sociodemographic characteristics, population attitudes and perceptions.

期刊: Cadernos de saude publica 发表日期: 2026 链接: PubMed

摘要

This study aims to analyze self-reported dipyrone use among the Brazilian population. We used data from the Brazilian National Survey on Access, Use, and Promotion of Rational Use of Medicines (PNAUM), conducted from September 2013 to February 2014 in urban areas of five regions of Brazil. The study population included individuals of all ages, with a minimum sample size of 960 interviews per sample domain, totaling 41,433 respondents and representing approximately 17 million Brazilians. We assessed socioeconomic and demographic characteristics, profiles of chronic and acute diseases, medication use, health perceptions, and perceived effectiveness and safety of dipyrone - either alone or in combination with other medications. The Poisson regression model was used to estimate adjusted prevalence ratios (aPR). The results showed that 10.4% of respondents reported using dipyrone, with 98.3% of these users taking it for acute conditions, such as pain (77.9%) and fever (14.5%). After adjusting for variables, dipyrone use for pain was more common among women (aPR = 1.66; 95%CI: 1.47-1.88) and among individuals living in the Central-West (aPR = 1.32; 95%CI: 1.04-1.67), particularly those with chronic conditions or acute events. Use for fever was similar between genders but more common among children aged under 10 years (PR = 0.62; 95%CI: 0.46-0.82). Half of the users combined dipyrone with other medications, and this practice was ten times more frequent for pain than for fever. Lastly, the effectiveness of dipyrone was widely perceived as positive, with few reports of adverse effects.

49. Programme for the Effective Promotion of Maternal Psychosocial Wellbeing (PREPWELL) in Ghana: Development and field-testing of a mHealth Intervention in a rural setting.

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

摘要

Poor maternal psychosocial well-being, often manifested as mental health challenges, is a significant public health concern - particularly in settings with limited access to mental health care. Although Behavioural Activation (BA) has shown strong promise in promoting psychological well-being, there is a notable lack of comparable evidence from low- and middle-income countries (LMICs). While the WHO advocates for the innovative delivery of psychosocial interventions via mobile health (mHealth) platforms, supporting data from LMIC contexts remain limited, underscoring the need for context-specific research and implementation. The PRogramme for Effective Promotion of maternal psychosocial WELLbeing (PREPWELL) sought to address this innovation and knowledge gap. Through our three-stage intervention development process - (a) formative research to identify contextual information regarding the feasibility and acceptability of Obaatanpa; (b) constructing a prototype Obaatanpa by adapting an evidence-based psychological treatment known as the Healthy Activity Programme; and (c) field testing, our research co-created a prototype psychosocial wellbeing promotion mHealth intervention (Obaatanpa) for mothers in Kintampo, Ghana. Findings showed a phasic intervention comprising psychoeducation, BA, and problem-solving delivered over 8 sessions through mobile phones is feasible, acceptable, comprehensible, and salient. However, the drop in participation from session 6 suggest a preference for smaller number of sessions but this needs further unpacking in a pilot study. The data also suggests that a core aspect of BA such as doing pleasurable activities - though possibly embedded - were less well developed, indicating an area for possible emphasis or clearer articulation in future iterations. With these enhancements, and further testing with a larger sample, Obaatanpa could be scalable and underscores the potential utility of mHealth as a platform for implementing WHO’s self-care framework. The PREPWELL programme of work has demonstrated the feasibility of adapting a treatment-focussed psychosocial intervention for promoting mental health and wellbeing.

50. The impact of sports participation on the psychological state of the Chinese population from the perspective of sports resources.

期刊: PloS one 发表日期: 2026 链接: PubMed

摘要

Against the backdrop of the Chinese people’s growing demand for health, it is of great significance to explore the impact of sports participation on different psychological states among the population, as well as the specific mechanisms and theoretical adaptations under varying conditions of sports resources-such as the sports environment, facilities, and safety. Such an investigation not only contributes to the widespread promotion of public participation in sports but also provides targeted theoretical guidance for improving psychological well-being. Using data from the China General Social Survey (CGSS) published in 2023, a linear regression model was constructed. Sports participation exerts a comprehensive positive effect on the psychological well-being of the Chinese population. Robustness tests using instrumental variable methods confirm that the impact of sports participation on psychological well-being is free from endogeneity issues and exhibits strong robustness. The influence of sports participation on psychological well-being varies significantly depending on sports resource conditions: ① Under favorable sports environment conditions, it exerts a comprehensive positive effect; under poor sports environment conditions, it has no effect on depression and despondency. ② In well-equipped facilities, it more effectively promotes calmness and vitality, while in under-equipped facilities, it has no effect on depression/despondency or calmness. ③ Under low-safety conditions, it has a comprehensive positive effect, while under high-safety conditions, it has no effect on depression/despondency. Sports participation exerts a robust, positive influence on overall mental well-being and vitality at the macro level. However, its effects manifest in complex interrelationships under specific sports resource conditions. Recommendations: Comprehensively enhance the role of sports participation in improving public mental health; Implement intelligent strategies for sports resource development to amplify the positive impact of sports participation on psychological well-being.

51. Salivary cotinine and S100A8/A9 levels in children exposed to environmental tobacco smoke: a case-control study.

期刊: Journal of applied oral science : revista FOB 发表日期: 2026 链接: PubMed

摘要

This study aimed to evaluate salivary cotinine and S100A8/A9 levels in children exposed to ETS and to examine the relationship between exposure intensity and inflammatory biomarker expression. This observational case-control study included 150 systemically healthy children aged 6-12 years. ETS exposure was determined using parent-reported questionnaires. Clinical parameters, including plaque index, gingival index, and probing pocket depth, were recorded. Unstimulated saliva samples were analyzed for cotinine, S100A8, and S100A9 using ELISA kits. Group comparisons were conducted using the Mann-Whitney U test, and correlations were assessed using Spearman’s rank correlation coefficient. Statistical significance was set at p<0.05. ETS-exposed and non-exposed groups did not differ significantly in age, sex, socioeconomic status, oral hygiene habits, or clinical periodontal parameters (p>0.05). However, salivary cotinine, S100A8, and S100A9 levels were significantly higher in ETS-exposed children (p<0.05). Cotinine demonstrated a moderate positive correlation with S100A8, while its correlation with S100A9 was weak and non-significant. Exposure intensity was positively associated with cotinine and S100A8 levels, but not with S100A9. ETS exposure in children is associated with early biochemical signs of inflammation, even in the absence of clinically detectable periodontal changes. Elevated salivary cotinine and S100A8 levels highlight the potential utility of salivary biomarkers for identifying subclinical effects of passive smoking. These findings underscore the importance of interventions aimed at reducing children’s exposure to ETS to protect long-term oral health. Clinical trial registration: NCT06791707.

52. Indoor methane consistently above outdoor levels in homes with natural gas service.

期刊: PloS one 发表日期: 2026 链接: PubMed

摘要

Methane leaks across the natural gas process chain, including in homes. To date, no studies have described how common it is to have elevated methane in homes served by gas, in comparison to homes without gas. In this study of homes in Massachusetts and Rhode Island, we utilized Cavity Ringdown Spectrometry to measure methane concentrations in outdoor air, and at mid-floor-level indoor air in basements and first, second, and third floors. We recruited a total of 195 homes in urban and rural areas, 175 of which had gas service and 20 of which did not. Indoor [CH4] in households with gas service was elevated over outdoor [CH4], averaging 1.45 parts per million (ppm) elevation over outdoor ambient [CH4] (p < 0.0001-0.0068), and up to 38.2 ppm above outdoor ambient [CH4]. Ninety-three percent of homes with gas showed higher median indoor [CH4] than the median [CH4] in non-gas homes. By contrast, indoor [CH4] in gas-free homes did not differ from outdoor conditions (p > 0.10), except marginally on the first floor (0.10 ppm elevation; p = 0.04). In 91% of a subset of homes investigated, leaks from gas equipment were confirmed. Elevated [CH4] is common in homes served with gas. Gas leaks and incomplete combustion were identified as sources of elevated [CH4]. There was no relationship between indoor [CH4] and home age or square footage; residents shouldn’t assume that newer homes are less prone to indoor gas leaks. The majority of gas in the United States comes from hydraulically fractured gas containing carcinogenic co-pollutants. It is not well understood how consistent low-dose exposure to gas co-pollutants like mercaptans and benzene affects health. Additional studies could clarify any differences in health outcomes for people living in homes serviced by gas and those who don’t use gas.

53. Association between obesity and medical expenditures among Japanese adults treated for diabetes: A secondary analysis.

期刊: PloS one 发表日期: 2026 链接: PubMed

摘要

In Japan, where obesity prevalence is lower than in Western countries, few studies have examined the association between obesity and medical expenditures among patients with diabetes, distinguishing between overweight and obesity by sex. This study examined the association between obesity and medical expenditures among patients with diabetes in Japan. Data on medical expenditures and the Specific Health Checkups obtained from 12 municipal and six union insurers for fiscal years 2008 and 2009 were analyzed. Gamma regression and quantile regression were used to compare annual total, outpatient, and inpatient medical expenditures in fiscal year 2009 among three groups: normal/underweight (body mass index [BMI] < 25 kg/m2), overweight (BMI: 25-30 kg/m2), and obesity (BMI ≥ 30 kg/m2). The analyses were performed separately for men and women, adjusting for age, hypertension, hyper-low-density lipoprotein cholesterolemia, glycemic control, and smoking. Logistic regression was performed, adjusting for the same variables to assess the occurrence of annual total medical expenditures of ¥1 million (approximately US$10,600 in 2009) or more. Annual total medical expenditures were significantly higher in the obesity group than in the normal/underweight group among both men and women (exp(β) = 1.117 [95% confidence interval (CI): 1.023-1.221] among men and exp(β) = 1.157 [1.036-1.295] among women). Both men and women in the overweight and obesity groups had significantly higher outpatient expenditures than those in the normal/underweight group. The overweight and obesity groups had significantly higher medical expenditures than the normal/underweight group in most quantiles among men. The likelihood of annual total medical expenditures exceeding ¥1 million was higher among women with obesity than among those with normal/underweight (odds ratio = 1.546 [95% CI: 1.007-2.375], p = 0.047). These findings suggest that medical expenditures among patients with diabetes who have overweight or obesity are higher than those of normal/underweight patients.

54. Validation of the third version of the Copenhagen Psychosocial Questionnaire for Portugal.

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

摘要

The prevalence and impact of exposure to psychosocial risk factors seems to be increasing in labour contexts in general. The assessment and measurement of psychosocial work factors is essential for the improvement of healthy workplaces and should be incorporated into health and safety management programmes. The assessment of psychosocial factors requires the selection of appropriate instruments that respond to the multidimensionality of that construct. The COPSOQ III covers a multitude of theoretical approaches and provides comprehensive information on psychosocial working conditions that may help to deduce actions for their improvement. The use of COPSOQ III in national context needs prior validation studies. In this regard, the paper aims to assess the psychometric properties of the middle version of COPSOQ III as to provide evidence on the validity of this instrument to be used for the Portuguese working population. The validation process comprised a national sample of 7,506 participants that included different occupational sectors based on a cross-sectional study. Construct validity was assessed through Confirmatory Factor Analysis and the internal consistency of the scales was evaluated using Cronbach’s alpha. The results revealed a satisfactory reliability and ability of the Portuguese middle version of COPSOQ III (COPSOQ III-PT) to discriminate the psychosocial dimensions. The distribution of the scores of the study sample by each scale and by sex enables a better interpretation of the results based on reference values.