公共卫生研究摘要 (2026-05-21)

共收录 54 篇研究文章

1. Smoking Cessation, Weight Change, and Risk of Dementia: A Prospective Cohort Study.

期刊: Neurology 发表日期: 2026-Jun-23 链接: PubMed

摘要

Smoking cessation is universally prioritized for the prevention of cardiovascular disease and cancer, but its impact on dementia risk remains uncertain. We aimed to evaluate the associations of smoking cessation and postcessation weight gain with long-term risk of dementia and cognitive trajectories. We conducted a prospective cohort study using data from the US Health and Retirement Study (1995-2020). A total of 32,802 dementia-free adults (mean age 60.5 years [SD 10.7]; 57.1% female) were included. Smoking status and body weight were assessed biennially through structured interviews. The primary outcome was incident dementia identified using the Langa-Weir algorithm, and the secondary outcome was cognitive function measured on a 27-point scale. Over 25 years of follow-up (median 9.9 years, interquartile range 4.4-16.4 years), 5,868 dementia cases were documented. Compared with current smokers, individuals who quit during follow-up had a lower dementia risk after quitting (hazard ratio 0.84, 95% CI 0.73-0.95), similar to those who had quit before baseline (0.79, 0.72-0.87) and to never smokers (0.75, 0.69-0.83). The benefits of cessation were largely limited to participants with no or modest 2-year postcessation weight gain (≤5 kg). By contrast, the association of quitting accompanied by >10-kg weight gain was not statistically significant (1.33, 0.87-1.82). Restricted cubic spline analysis showed decreasing dementia risk with longer time since quitting, and the risk approached that of never smokers and plateaued at around 7 years after cessation. Cognitive trajectory analyses showed that quitting was associated with long-term slower cognitive decline (slope difference 0.19 points per decade, 95% CI 0.00-0.38) but no transient cognitive change (0.57; 95% CI -0.69 to 1.83), especially among those with minor weight gain (slope difference 0.23 per decade, 95% CI 0.03-0.43). Smoking cessation was associated with a sustained lower dementia risk and slower cognitive decline, comparable to never smokers and those without short-term risk increase. However, postcessation weight gain may attenuate these advantages, highlighting the need for weight management in cessation programs. These findings should be interpreted cautiously, given the potential residual confounding and measurement error.

2. Comparing Approaches for Deriving Diabetes Care Cascades to Inform Policy: A Cross-sectional Analysis Using National Data From 88 Countries.

期刊: Diabetes care 发表日期: 2026-Jun-01 链接: PubMed

摘要

Care cascade indicators are widely used to monitor national diabetes control efforts. However, diabetes definitions used to derive care cascades vary across studies, which may markedly affect results and subsequent policy decisions. Here, we examine the magnitude of resultant differences between approaches. We analyzed nationally representative, cross-sectional data of 800,348 individuals aged ≥25 years from 88 countries in 2008-2021. We used two different diabetes definitions: elevated biomarkers (glycated hemoglobin [HbA1c] ≥6.5%; fasting plasma glucose ≥7.0 mmol/L; or random plasma glucose ≥11.1 mmol/L) or self-reported diagnosis (“diagnosis-based definition”) versus elevated biomarkers or self-reported treatment (“treatment-based definition”). Care cascade estimates included 1) proportions of individuals with diabetes who were diagnosed, and proportions of individuals with diagnosed diabetes who 2) received treatment and 3) attained glycemic control. We benchmarked results against World Health Organization (WHO) diabetes targets. Diabetes prevalence was 12.9% (95% CI 12.1-13.8) applying the diagnosis-based definition and 11.3% (95% CI 10.5-12.1) with the treatment-based definition. Using the diagnosis-based rather than treatment-based diabetes definition to derive care cascades consistently increased the percentages of those who attain diagnosis and control stages but decreased percentages of those receiving treatment. Across countries, median differences between approaches were 11.3% (interquartile range [IQR] 5.1-24.7) for diabetes diagnosis, 21.6% (IQR 14.5-37.8) for treatment, and 16.4% (IQR 7.8-26.8) for control. The WHO 80% glycemic control target was met by 22% versus 6% of countries when using the diagnosis-based versus treatment-based definition, respectively. Care cascade estimates diverged substantially and consistently across diabetes definitions, skewing policy implications in predictable ways. Harmonizing diabetes performance metrics may improve decision-making and facilitate cross-country comparisons.

3. Rising Hypertension Mortality Rates Are Independent of Coding Drift.

期刊: Hypertension (Dallas, Tex. : 1979) 发表日期: 2026-Jun 链接: PubMed

摘要

4. RORA Targeting PRNP Modulates Age-Related Cataract via Activation Oxidative Injury-Induced Cellular Senescence and Apoptosis of Lens Epithelial Cells.

期刊: Aging cell 发表日期: 2026-Jun 链接: PubMed

摘要

Age-related cataract (ARC) is a severe vision-impairing disorder primarily caused by oxidative stress-induced senescence and apoptosis of lens epithelial cells (LECs). In this study, a sodium selenite-induced oxidative stress cataract model in neonatal rats was established to simulate the pathological progression of ARC. We found that retinoic acid receptor-related orphan receptor α (RORA) exacerbates cellular senescence and oxidative damage by targeting prion protein (PRNP), and its small-molecule inhibitor SR3335 exhibits therapeutic potential in regulating ARC progression. In vitro experiments showed that inhibiting RORA significantly alleviated cellular senescence, enhanced the anti-apoptotic capacity of LECs, and improved their resistance to oxidative stress, whereas activating RORA exerted opposite effects. In vivo, intravitreal injection of recombinant PRNP protein was demonstrated to abrogate the protective effect of RORA silencing, thereby exacerbating the progression of ARC. Mechanistically, RNA sequencing and dual-luciferase reporter assay revealed that RORA binds to its downstream target PRNP. RORA targets PRNP to regulate the p53/p21/Bax signaling pathway, thereby suppressing both cellular senescence and apoptosis. These findings highlight the critical role of the transcription factor RORA in ARC development by modulating oxidative stress injury, apoptosis, and senescence in LECs. The identification of PRNP as a downstream target of RORA may provide a novel dual-target strategy for ARC treatment.

5. Response to Comment on Schumacher et al. Addressing the Feasibility Gap in Shared Decision-Making for Obesity and Type 2 Diabetes Care.

期刊: Diabetes care 发表日期: 2026-Jun-01 链接: PubMed

摘要

6. Comment on Pop-Busui et al. Screening Natriuretic Peptide Levels Predicts Heart Failure and Death in Individuals With Type 1 and Type 2 Diabetes Without Known Heart Failure. Diabetes Care 2025;48:2145-2153.

期刊: Diabetes care 发表日期: 2026-Jun-01 链接: PubMed

摘要

7. Comment on Shah and Ayala. Interpreting Stage-Dependent Changes in Semaglutide Response: From Patterns to Mechanisms.

期刊: Diabetes 发表日期: 2026-Jun-01 链接: PubMed

摘要

8. Comment on Lin et al. Reconsidering Adipose Tissue Lipolysis Dysfunction: Evidence for a Distal Machinery Defect Beyond Insulin Resistance.

期刊: Diabetes 发表日期: 2026-Jun-01 链接: PubMed

摘要

9. Biomonitoring of Occupational Exposure to Mercury Among Dental Health Workers in LMICs: A Systematic Review.

期刊: International dental journal 发表日期: 2026-May-20 链接: PubMed

摘要

Mercury exposure remains a significant occupational hazard for dental health workers, especially in low- and middle-income countries (LMICs), due to the continued use of dental amalgam. This systematic review synthesizes the existing evidence on mercury exposure in dental professionals, focusing on biomonitoring data and associated health outcomes in LMICs. In December 2024, a comprehensive literature search was conducted across three electronic databases, PubMed, Scopus and Web of Science to identify primary research studies published from January 2014 onwards. Studies assessing occupational mercury exposure through biomonitoring in dental health workers were included. Nine studies, encompassing 524 dental professionals, met the inclusion criteria. Mercury biomonitoring was conducted using blood (n = 3), urine (n = 7) and hair samples (n = 2). Most studies reported elevated mercury levels in dental workers compared to control groups. Environmental monitoring data further indicated that mercury vapor concentrations in dental clinics may exceed recommended safety thresholds. However, current evidence regarding potential health effects associated with occupational exposure to mercury is inconclusive due to methodological limitations. Mercury remains an occupational hazard for dental health workers in LMICs. As dental amalgam continues to be used in resource-limited settings, implementing biomonitoring programs could enable early detection of mercury-related health issues, protecting workers’ health until global mercury phase-down goals are achieved.

10. Age trumps metabolism: No independent association between lipids, statins, and prostate enlargement in a metabolically controlled cohort.

期刊: Clinics (Sao Paulo, Brazil) 发表日期: 2026-May-20 链接: PubMed

摘要

To evaluate the association between lipid profile, statin use, metabolic syndrome, and clinic. Prostate Enlargement (PE) in adult men attending a urology outpatient clinic. A cross-sectional study was conducted among 1117 men aged 40-years or older. Prostate volume was measured by ultrasonography; a volume ≥ 40 mL was considered the threshold for enlargement. Independent variables included lipid fractions, prescription-based statin use, and components of metabolic syndrome. Multivariate logistic regression models were applied, adjusted for age, hypertension, and medication exposure. The median age was 63-years (IQR: 55-71), and the median prostate volume was 34.0 mL (IQR: 26.0-48.0). Statin use was identified in 36.5% of the sample, and the prevalence of PE was 38.9%. Age was the only factor independently associated with PE (OR = 1.07; 95% CI: 1.05-1.09; p < 0.001). Metabolic syndrome was associated with PE in crude analysis; however, this association lost statistical significance after adjustment for potential confounders. Age was the only independent determinant of prostate enlargement in this metabolically controlled cohort. Lipid parameters and prescription-based statin use showed no adjusted association with prostate volume; however, the lack of detailed statin exposure data warrants cautious interpretation of these findings.

11. Explainable AI in Cancer Imaging: Scoping Review of Methods, Modalities, and Clinical Integration.

期刊: Journal of medical Internet research 发表日期: 2026-May-20 链接: PubMed

摘要

Explainable artificial intelligence (xAI) is increasingly used in medical imaging to enhance transparency, clinical interpretability, and trust in artificial intelligence (AI)-assisted diagnostics, particularly in oncology. Evidence on how explainability is implemented, validated, and reported in cancer imaging remains fragmented. This scoping review aimed to systematically map research applying xAI methods to radiologic cancer imaging, summarize methodological and clinical trends, and identify persistent gaps in validation and integration. We conducted a structured search of PubMed and Scopus (final search executed on October 20, 2025), covering studies published from 2017 to December 2024. Eligible peer-reviewed articles using machine learning or deep learning were analyzed with a focus on xAI components. Data from 371 studies were extracted into predefined categories covering cancer type, imaging modality, AI model, xAI method, terminology, validation, code availability, and decision support system integration. Studies focused primarily on breast (112/371, 30.2%), lung (87/371, 23.5%), and brain (56/371, 15.1%) cancers, with prostate, thyroid, and liver cancers also represented. The primary imaging modalities were computed tomography (139/371, 37.5%) and magnetic resonance imaging (104/371, 28%). Deep learning was used in 70.1% (260/371) of studies, classical machine learning in 18.1% (67/371), hybrid pipeline methods for 10% (37/371), and emerging concept-, prototype-, or causal-based approaches accounted for 1.9% (7/371) of studies. Post hoc xAI methods were dominant (305/371, 82.2%), with visualization (163/371, 53.4%), and feature relevance (111/371, 36.4%) as the most common subcategories. Hybrid post hoc or inherent approaches comprised 12.1% (45/371) and intrinsically interpretable methods 5.7% (21/371). Data sources were mostly public (149/371, 40.2%) or mixed (100/371, 26.9%); 22.9% (85/371) used private institutional datasets, and 7.8% (29/371) did not report data sources. Among validated studies, expert or user-based validation was most common (104/193, 53.9%), followed by mixed methods (74/193, 38.3%), while quantitative metrics (10/193, 5.2%) and clinical knowledge-based (8/193, 4.1%) validation remained rare. Only 17.5% (65/371) of studies provided code and 12.1% (45/371) reported decision support system integration, with few achieving actual clinical deployment. This scoping review maps xAI implementation across multiple cancer imaging modalities, revealing methodological inconsistency and insufficient validation. Most research emphasizes visualization over quantitative interpretability, and few models are reproducible or clinically implemented. These findings provide an evidence base for researchers, clinicians, and regulators to prioritize standardization of xAI reporting, quantitative validation, and user-centered frameworks to advance trustworthy AI in oncology imaging.

12. Detecting Spatiotemporal Patterns of Newly Diagnosed HIV Infection in the China-Myanmar Border Region, 2010 to 2022: Longitudinal Observational Study.

期刊: JMIR public health and surveillance 发表日期: 2026-May-20 链接: PubMed

摘要

Geospatial analysis plays an essential role in informing targeted human immunodeficiency virus (HIV) intervention. The Dai-Jingpo Autonomous Prefecture of Dehong (hereinafter referred to as Dehong), located along the China-Myanmar border in the Yunnan province, has been heavily impacted by HIV infection. Given the complex local epidemic context, particularly frequent cross-border population movement, there is an urgent need to apply spatiotemporal analytical approaches to guiding resource allocation. Existing evidence has demonstrated the substantial spatial variations of newly diagnosed HIV infection this region. However, these spatiotemporal variations have not been fully explored at a finer geographic and temporal resolution. This study aims to comprehensively investigate the spatiotemporal variations of newly diagnosed HIV infection at a finer scale in this border region to inform targeted interventions. Data on newly diagnosed HIV cases at the township level in Dehong were collected from 2010 to 2022. The rate of newly diagnosis HIV cases was calculated annually. GeoDetector q statistics were performed to assess the spatially stratified heterogeneity of the rate of newly diagnosed HIV cases. The Bayesian space-time hierarchical model was applied to detect the spatiotemporal patterns of newly diagnosed HIV infection across the region. A total of 5045 newly diagnosed HIV cases were identified in Dehong from 2010 to 2022. The rate of newly diagnosed HIV cases decreased from 57.1 cases per 100,000 population in 2010 to 13.3 cases per 100,000 population in 2022, a decrease of 76.7% over the past 13 years. The overall temporal relative risk decreased from 2.11 (95% CI 1.84-2.41) in 2010 to 0.48 (95% CI 0.40-0.56) in 2022. There was substantial spatiotemporal heterogeneity in the risk of newly diagnosed HIV infection, with townships near the China-Myanmar border having a higher spatial relative risk. Notable spatially stratified heterogeneity in the rate of newly diagnosed HIV cases when stratified by the distance of townships to the China-Myanmar border was observed (q=0.27; P=.004). Among the 51 townships in Dehong, 22 (43.1%) hotspots and 22 (43.1%) coldspots were identified. Notably, in comparison to the overall declining temporal trend, 2 hotspots and 4 coldspots exhibited a slower declining trend, suggesting that these regions may require additional intervention efforts. This study comprehensively estimated the spatiotemporal risk of newly diagnosed HIV infection across Dehong, revealing high-risk areas concentrated near the China-Myanmar border. Priority should be given to implementing targeted interventions to control cross-border HIV transmission, including the establishment of cross-border HIV control mechanisms, as well as the strengthening of management measures for cross-border populations. Furthermore, this study offers methodological insights into the use of routine surveillance data and Bayesian spatiotemporal modeling to better understand HIV transmission dynamics at finer geographic scales and to support precision-oriented HIV prevention services.

13. A Digital Toolkit for Weight Loss Maintenance in European Adults (NoHoW): 2×2 Factorial Randomized Controlled Trial.

期刊: Journal of medical Internet research 发表日期: 2026-May-20 链接: PubMed

摘要

Digital approaches to weight management have the potential to produce cost-effective and scalable weight management solutions. Effective behavior change interventions typically promote self-regulation of energy balance behaviors, which may be enhanced by incorporating emotion regulation strategies. This study aimed to evaluate the effectiveness of a digital behavior change toolkit for weight loss maintenance in European adults who had achieved ≥5% weight loss in the previous 12 months. We hypothesized that a combined intervention targeting self-regulation or motivation and emotion regulation would be more effective than either component alone, and that each would outperform an active control. The Navigating to a Healthier Weight (NoHoW) trial was a 2×2 factorial randomized, single-blind, controlled trial involving 1627 adults who had achieved ≥5% weight loss in the previous 12 months (initial BMI ≥25 kg/m2) across 3 European centers (the United Kingdom, Denmark, and Portugal). The trial evaluated a digital toolkit for weight management subsequent to an initial ≥5% weight loss in the prior 12 months. Participants were assigned using adaptive stratified sampling to one of four groups: (1) self-regulation or motivation (n=403), (2) emotion regulation (n=416), (3) combined motivation and emotion (n=408), or (4) active control (generic content, regular self-weighing, and Fitbit use, n=400). The primary outcome was weight change from baseline to 12 months. Prespecified secondary outcomes included cardiometabolic markers. Linear models adjusted for recruitment center, sex, age group, BMI group, and pretrial weight loss. Subgroup analyses were conducted by sex. At 12 months, 76% (364/1627) of participants remained in the study. In the primary ITT analysis in all participants, none of the intervention arms (motivation, emotion, or combined) differed significantly from the active control for weight change at 12 months. Completer and per-protocol analyses produced similar patterns and did not change the overall interpretation. In the per-protocol sample, men regained 0.14 kg, and women regained 0.54 kg of their pretrial weight loss. Subgroup analyses indicated a small effect of the motivation intervention in men, but this was not clinically meaningful and did not alter the primary null findings. Nearly half of ITT participants regained weight, and no significant intervention effects were observed for cardiometabolic secondary outcomes. The NoHoW trial was the first large-scale, multicountry 2×2 factorial randomized controlled trial to evaluate a digital-only toolkit based on self-regulation or motivation and emotion regulation techniques for weight loss maintenance. NoHoW found no evidence in the primary ITT analysis that digital interventions targeting self-regulation or emotion regulation improved weight loss maintenance compared with the active control. A small subgroup effect in men should be interpreted cautiously and does not change this conclusion. The trial provides evidence on both the limitations and potential of digital behavior change interventions for long-term weight outcomes. Future digital interventions may benefit from enhanced engagement and tailored content to improve long-term weight outcomes.

14. Patient and Designer Collaboration in Cocreating Technical Innovations in a Hospital-Based Makerspace: Qualitative Interview Study.

期刊: JMIR human factors 发表日期: 2026-May-20 链接: PubMed

摘要

Hospital-based makerspaces have emerged as collaborative environments for technical innovation, where designers cocreate with health care professionals and patients to resolve specific problems experienced in practice. As end users, patients can offer unique insights that could drive the development of patient-centered health care services or research. However, cocreation with patients within a makerspace environment is still rare-representing a missed opportunity to use their insights to develop innovations that meet their needs. Patient-designer interactions are underaddressed in the literature, and a deeper understanding could enhance their effectiveness. The study aimed to explore the experiences of designers and patients (or their carers) cocreating in an academic hospital-based makerspace, using a bottom-up approach. A generic qualitative study was conducted using semistructured individual interviews based on the Sunnybrook team-based competencies and design thinking methodology. A heterogeneous sample of 12 participants was recruited from a makerspace in an academic hospital in the Netherlands, comprising 6 with a designer’s perspective and 6 with a patient’s perspective. Most participants were involved in collaborative pairs, representing both perspectives within the same innovation project. Data were analyzed thematically. Four key themes emerged from the data: (1) dealing with the patient’s situations, (2) integrating different perspectives, (3) feeling valuable and useful, and (4) dynamic interplay and engagement. Collaboration with patients in this hospital-based makerspace was perceived as valuable for innovation development, benefiting from diverse perspectives. However, the degree of patient involvement varied, influenced by factors such as the patient’s health status, reachability, and interest in innovation development. This study highlights the complexity of developing technical innovations that involve hospitalized patients. It offers valuable insights into how both patients and designers generally viewed their collaboration in the makerspace positively. Practical recommendations for hospital-based makerspaces include respecting patient autonomy, involving patients early and consistently throughout all development phases, maintaining communication beyond the formal collaboration period, and actively seeking feedback.

15. Patients' mHealth Apps Usage and Data Privacy, Security, and Confidentiality Concerns: Exploratory Study.

期刊: JMIR formative research 发表日期: 2026-May-20 链接: PubMed

摘要

The Technology Adoption Model (TAM) offers a potential framework for elucidating the relationships between data privacy or security concerns and behavioral intention, perceived usefulness (PU), and perceived ease of use (PEOU) of mobile health (mHealth) apps, particularly for patients’ self-care management. In Saudi Arabia, limited information is available on these pertinent research areas despite the government’s relentless efforts to bolster the use of mHealth apps. This study applies the TAM and the psychosociocultural framework to explore the influence of patients’ data privacy and security concerns on the PU, PEOU, and behavioral intention to use mHealth apps for self-care management in Saudi Arabia. A cross-sectional study was conducted by recruiting patients using mHealth apps for self-care from various provinces in Saudi Arabia. Research instruments were developed based on the components of 2 theories: the psychosociocultural framework and TAM, which were then piloted, validated, and distributed to participants via Google Forms. Linear regression models were performed to test the hypothesized relationships. Overall, 567 patients using mHealth apps participated in the study. Slightly more than one-third (217/567, 38.2%; range 35.6%-41.4%) of the participants expressed a high level of concern regarding data privacy, confidentiality, and security, with significant predictors being female gender, higher educational qualifications, and younger age groups (<46 years). About 18% to 25% of the variance in PU, PEOU, and behavioral intention to use mHealth apps was explained by the tested factors. Patients were more likely to have higher PU following a unit decrease in data confidentiality (β=.31; P=.01) and security concerns (β=.47; P=.01). The PEOU of mHealth apps increased as users demonstrated less concern regarding data privacy (β=.18; P=.001), confidentiality (β=.24; P<.001), and security (β=.43; P=.02). Likewise, behavioral intention to use mHealth apps also increased significantly following a reduction in respondents’ concerns toward data privacy (β=.18; P=.02), confidentiality (β=.24; P=.03), and security issues (β=.36; P=.01). Specific demographic factors and concerns regarding data security and privacy influence patients’ PU, PEOU, and behavioral intention to use mHealth apps for self-care management. Targeting the age-, education-, and gender-based differences regarding the usage of mHealth apps. Health care providers and policymakers may consider age-, education-, and gender-based differences when developing strategies to improve the adoption of mHealth apps among the Saudi patient population.

16. Feasibility of Videoconference-Based Cognitive Behavioral Therapy for Somatic Symptom Disorder: Single-Arm Pilot Trial.

期刊: JMIR formative research 发表日期: 2026-May-20 链接: PubMed

摘要

Somatic symptom disorder (SSD) is a mental disorder marked by persistent somatic symptoms and maladaptive health-related thoughts, feelings, or behaviors. Cognitive behavioral therapy has been shown to be effective in treating SSD, reducing patients’ somatic symptoms, depressive symptoms, and anxiety symptoms. However, challenges remain-including limited access to treatment. Videoconference-based cognitive behavioral therapy (vCBT) has emerged as a promising approach, offering flexible and tailored treatment while addressing the shortage of medical resources and potentially reducing patient dropout. This study examined the feasibility of vCBT for patients with SSD and explored secondary outcomes related to the physical component of health-related quality of life (HRQOL) as assessed using the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) physical component summary (PCS) score and other exploratory clinical outcomes. This single-arm pilot trial evaluated feasibility as the primary outcome assessed via recruitment rate, retention rate, session completion rate, and safety. Ten participants with SSD were enrolled, and all received 6 weekly 50-minute vCBT sessions. Secondary outcomes included physical HRQOL (SF-36 PCS) as the key secondary outcome, as well as mental HRQOL, depressive symptoms, somatic symptom severity, anxiety symptoms, health anxiety, pain, insomnia, and generic HRQOL. These outcomes were measured at the preintervention (week 0) and postintervention (week 6) time points and 1-month follow-up (week 10) and were analyzed using 2-sided paired t tests. All feasibility criteria were met, with a recruitment rate of 83.3% (10/12), a retention rate of 100% (10/10), a session completion rate of 100% (10/10), and no adverse events reported. The SF-36 PCS score improved by 4.99 points at the postintervention time point, representing a large within-group effect (Cohen d=0.99, 95% CI 0.21-1.74). Medium to large improvements were also observed in mental HRQOL, depressive symptoms, anxiety symptoms, health anxiety, pain, insomnia, and generic HRQOL, and most of these improvements were observed at the 1-month follow-up. Our findings indicate that vCBT is a feasible and safe approach for SSD, with findings suggesting acceptability and preliminary evidence of effectiveness.

17. Association Between Low Chinese Visceral Adiposity Index Values and Chronic Lung Disease in Older Adults: Cohort Study.

期刊: JMIR public health and surveillance 发表日期: 2026-May-20 链接: PubMed

摘要

Visceral fat content, a key indicator of obesity, has been increasingly linked to chronic lung diseases (CLDs). However, the precise relationship between the Chinese visceral adiposity index (CVAI) and CLD remains unclear. This study aimed to investigate the association between the CVAI and CLD risk. Data from 6695 participants aged ≥45 years in the China Health and Retirement Longitudinal Study were analyzed. Restricted cubic spline models were applied to evaluate dose-response relationships between the CVAI and CLD across 3 population subgroups. Cox models were used to assess the hazard ratios and 95% CIs for the relationship between CVAI quintiles and CLD incidence in the significantly associated population. Restricted cubic spline analysis revealed a significant L-shaped relationship between the CVAI and CLD incidence in the older adult population (≥60 years; P value for overall=.01; P value for nonlinearity=.04), rather than in the middle-aged and older adult population (≥45 years; P value for overall=.12) or middle-aged population (45-59 years; P value for overall=.55). The inflection point of the CVAI for CLD risk was identified at 126 in the older adults. After multivariable adjustment, compared with participants in the fourth quintile (Q4), those in the first quintile (Q1) exhibited a significantly increased risk of CLD (hazard ratio=1.38, 95% CI 1.05-1.83). The subgroup analyses, which were stratified by sociodemographic factors and lifestyle, showed consistent results across most subgroups (P value for interaction>.05). In adults aged ≥60 years, a lower CVAI was associated with a higher risk of CLD. No such association was observed in middle-aged adults.

18. Virtual Consultations for People With Intellectual Disabilities in General Practice and Community Care: Mixed Methods Qualitative Study.

期刊: Journal of medical Internet research 发表日期: 2026-May-20 链接: PubMed

摘要

Virtual consultations (VCs) using video or telephone were embraced at speed in general practice (GP) and community care during the COVID-19 pandemic. People with intellectual disabilities, their families, and support workers (SWs), along with health care professionals (HCPs), had to adapt quickly to this change in provision, but little is known about how this new way of working was experienced. This study aims to explore the views and experiences of people with intellectual disabilities, their families, SWs, GP, and community care professionals on the quality and safety of VCs. This paper reports on users’ experiences of VCs, as part of a larger Experience-Based Co-design study. This paper relates to 2 stages of data collection. Observed video consultations in GP and community care (n=3), and semistructured interviews with people with intellectual disabilities, their family members or SWs, GP, and community care professionals (n=34). The 30-month study was conducted from November 2021 ending in April 2024. Data were analyzed using framework analysis. Integrated results are presented through 5 themes, encompassed under an overarching theme of safety and quality. The five themes highlight critical factors in planning, delivery, and aftercare of VCs in GP and community services for people with intellectual disabilities in the United Kingdom: (1) context, space, and purpose-showing the importance of safe spaces to talk, and having clear consultation objectives and purpose; (2) choice-facilitating choice over time about modality of health care contact; (3) familiarity, online relationships, and trust-the building blocks for quality consultations; (4) prepare and personalize-to ensure that HCPs are aware of reasonable adjustments, and recognition of caregiver involvement; and (5) continued connection-where patients or families are offered continued contact with a named or same HCP enhancing access to regular or ongoing care. All participants were aware of the limitations of VC, which may impact safety, such as gaps in home monitoring due to the absence of appropriate equipment or recording, inability to identify vital risk indicators, and limited field of vision on screen. However, participants were also aware of the distinct benefits they offer in terms of quality provision, such as timeliness of care, building and sustaining comfortable relationships, support for more frequent attendance, and continuous connection to health teams. VCs offer an opportunity to improve digital inclusion in health care for people with intellectual disabilities. However, the quality and safety of VCs for this population are dependent on continuous review of patients’ needs over time and ensuring that their choices and preferences are considered when planning and providing ongoing care.

19. Development, Feasibility, Acceptability, and Usability of an Artificial Intelligence-Powered Chatbot (Suzy) to Support Patients in Substance Use Disorder Recovery: Multiphase Study.

期刊: JMIR formative research 发表日期: 2026-May-20 链接: PubMed

摘要

Substance use disorder (SUD) remains a major public health crisis in the United States, with significant challenges in treatment access, retention, and workforce capacity. SUD care teams, including addiction medicine physicians and peer recovery coaches (PRCs), support patients receiving SUD treatment but face heavy workloads and burnout. Artificial intelligence (AI) innovations, particularly large language model (LLM)-based chatbots, may extend PRC support and provide patients with on-demand recovery support between clinic visits and PRC contacts. However, evidence on their development, feasibility, acceptability, and usability in addiction services remains limited. This study describes the development, feasibility, acceptability, and usability of an AI-powered health coaching chatbot (Suzy) designed to support patients in SUD recovery. A total of 2 clinicians, 5 researchers, and 2 technology developers led a small, multiphase pilot study. In the formative phase, they conducted focus groups and qualitative in-depth interviews with 12 health care professionals and 8 patients with substance use histories to specify chatbot functions and develop a rule-based chatbot. In phase 2, they conducted usability testing of the rule-based chatbot with 8 patients who reported substance use and completed standardized tasks, surveys, and qualitative interviews. Measures included the System Usability Scale (SUS), Net Promoter Score (NPS), and Single Ease of Use Question (SEQ). In phase 3, they developed an LLM-based chatbot co-designed and fine-tuned with PRCs and other SUD experts. Rule-based chatbot functions included craving management, appointment reminders, resource referrals, care team contacts, and goal setting. Usability task testing supported feasibility. In this small pilot sample, quantitative and qualitative feedback indicated acceptability and usability, with an average SUS score of 93 (benchmark 68), an NPS of 63 (benchmark 35), and a mean SEQ score of 6.5/7. Patients valued Suzy’s approachable, nonjudgmental language and features that promoted accountability, self-monitoring, and 24/7 availability, while emphasizing that chatbots should supplement but not replace human support. The LLM-based chatbot development emphasized information accuracy, safety escalation protocols to mitigate risks of inappropriate chatbot responses, human-in-the-loop features, and expanded conversational flexibility and personal tailoring. In this pilot study, a rule-based chatbot designed to support SUD care demonstrated feasibility, usability, and acceptability. LLM-based chatbot development required more robust safety and emergency reporting features, while offering more patient-responsive conversational functions. By providing on-demand coaching, referrals, and reminders, Suzy may extend the reach of care teams, alleviate provider burden, and enhance patient engagement. Additional work is needed to understand how to best integrate Suzy into patients’ recovery journeys to ensure human support remains accessible and prioritized. LLM evaluation was based on expert testing and safety review. Clinical effectiveness, including the impact on substance use, was not evaluated. Next steps include evaluating the LLM chatbot in real-world settings with larger samples and assessing its efficacy in reducing substance use.

20. Treatment of Multiple Myeloma: ASCO Living Guideline, Version 2026.1.1.

期刊: Journal of clinical oncology : official journal of the American Society of Clinical Oncology 发表日期: 2026-May-20 链接: PubMed

摘要

Living guidelines are developed for selected topic areas with rapidly evolving evidence that drives frequent change in recommended clinical practice. Living guidelines are updated on a regular schedule by a standing expert panel that systematically reviews the health literature on a continuous basis, as described in the ASCO Guidelines Methodology Manual. ASCO Living Guidelines follow the ASCO Conflict of Interest Policy Implementation for Clinical Practice Guidelines. Living Guidelines and updates are not intended to substitute for independent professional judgment of the treating clinician and do not account for individual variation among patients. See appendix for disclaimers and other important information (Appendix I and Appendix II). Updates are published regularly and can be found on the ASCO Publications website.

21. Opinion Leadership among Nurses in Public Debate: Moral Conviction, Credibility, and Collective Support.

期刊: Policy, politics & nursing practice 发表日期: 2026-May-20 链接: PubMed

摘要

Nurses’ involvement in public and policy debates is increasingly recognised as essential for shaping health care systems, yet their voices remain largely invisible. When nurses do engage publicly, they may act as public opinion leaders, using their professional expertise and credibility to influence policy discussions. Little is known, however, about how public opinion leadership (POL) manifests in practice and what motivates nurses to take on such a role. A proposed health care reform in the Netherlands, known as the BIG2 proposal, triggered an unexpected wave of nurses speaking up in national media and on social platforms. This study explores how POL manifested during this reform and what motivated nurses to raise their voices. A qualitative design was used, combining a thematic and abductive approach. Twelve semi-structured interviews were conducted with Dutch nurses who publicly responded to the reform through newspapers or social media. The findings show that nurses who engaged in POL acted from moral conviction and professional credibility, rather than formal authority. Their motivation stemmed from feeling misunderstood or undervalued, which evoked emotions such as frustration and anger. Responsibility, encouragement, and solidarity sustained their engagement. Nurses used social and traditional media to connect with peers, journalists, and politicians, making their leadership visible and collective. POL appeared as a collective process grounded in moral conviction, professional expertise, and mutual support. These findings highlight how nurses can extend their influence beyond clinical settings and contribute to shaping health policy debates.

22. Associations between hematologic dynamics during pregnancy and obstetric complications: A retrospective observational study.

期刊: PLoS medicine 发表日期: 2026-May-20 链接: PubMed

摘要

Pregnancy alters hematologic state as measured by complete blood count (CBC), but the longitudinal changes in CBC indices that define healthy pregnancies are not well established. In a large cohort based at an academic health system in the United States, we aimed to define reference intervals and typical longitudinal changes in CBC indices during pregnancy. We then tested for associations between extreme CBC values for gestational age or extreme longitudinal changes in CBC indices and obstetric complications. We studied nine CBC indices in individuals with singleton pregnancies who delivered after 30 weeks’ gestation and presented for prenatal care prior to 20 weeks. The electronic health record (EHR)-based Maternal Health Cohort (Massachusetts General Hospital; 1998-2016) formed our discovery cohort of 45,992 pregnancies, 18% of which had relevant complications. We developed a validation cohort of 48,868, 27% with complications from EHR data in the Mass General Brigham healthcare system from 2016 to 2024. In pregnancies without complications in the discovery cohort, we derived gestational-age-specific reference intervals (2.5th-97.5th percentile) and established typical intra-pregnancy longitudinal changes. In the validation cohort, we then tested CBC values outside of the 26-29 weeks’ gestation reference interval and CBC rare changes (uncommon changes in magnitude and direction) between 7-14 and 26-29 weeks’ gestation for association with a composite outcome (hypertensive disorders of pregnancy, small for gestational age birthweight, preterm birth) and its individual components using generalized estimating equations. Derived reference intervals differed from those in the literature for mean red cell volume, mean red cell hemoglobin, red cell count, and mean red cell hemoglobin concentration; reference intervals for other indices were similar to those previously published. In validation, hematocrit, hemoglobin, and red cell count values above their gestational-age specific reference intervals were associated with increased risk of the composite obstetric outcome: odds ratios (ORs) of 1.4 (95% CI [1.2, 1.5 p < 0.0001) for hematocrit; 1.6 (95% CI [1.4, 1.8] p < 0.0001) for hemoglobin; and 1.6 (95% CI [1.4,1.7] p < 0.0001) for red cell count. Extreme increases in hemoglobin (>0.67 g/dL) or red cell count (>0.07 106/mm3) between 7-14 weeks’ and 26-29 weeks’ gestation were associated with increased risk for preterm birth, OR for hemoglobin 1.9 (95% CI [1.5, 2.5] p < 0.0001) and red cell count 2.1 (95% CI [1.7, 2.6] p < 0.0001). Limitations include the retrospective nature of the study and the exclusion of both pregnancies without prenatal care prior to 20 weeks’ and pregnancies delivered before 29 weeks’ gestation. Elevated red blood cell-related measurements and unusually large intra-pregnancy increases in those measures are associated with subsequent obstetric complications.

23. The hyaluronan receptor CD44 drives COVID-19 severity through its regulation of neutrophil migration.

期刊: PLoS pathogens 发表日期: 2026-May-20 链接: PubMed

摘要

The novel respiratory disease COVID-19 caused by the coronavirus SARS-CoV-2 continues to be a public health emergency worldwide, and there is a need for more effective therapy for patients. The relationship between the extracellular matrix and the host immune response to infection is severely understudied. Deposition of the polysaccharide hyaluronan (HA) into the lungs is associated with more severe COVID-19 disease outcomes. HA is a major component of the extracellular matrix in connective tissues and is abundant in many parts of the body, including cartilage, skin, brain, and vitreous body. HA is a major component of the extracellular matrix in connective tissues and is abundant in many parts of the body, including cartilage, skin, brain, and vitreous body. Polymers consist of repeating units of N-acetylglucosamine and glucuronic acid and are synthesized by the three hyaluronan synthase (HAS) enzymes, HAS1-3. CD44 is the primary receptor for HA and is found on almost all immune cells in the lung. Known functions of CD44 include mediation of immune cell migration, activation, and differentiation. We hypothesized that increased HA deposition during COVID-19 increases CD44-mediated immune cell infiltration into lungs and results in more severe pathology. Here, we report that in mice infected with a mouse-adapted strain of SARS-CoV-2, treatment with a combination of two anti-CD44 monoclonal antibodies confers a significant survival benefit and reduces weight loss and clinical score of the mice on Day 4 post infection. We show that anti-CD44 treatment decreases many key cytokines and chemokines in the bronchoalveolar lavage fluid on Day 4. With flow cytometry, we show that anti-CD44 reduces the numbers of neutrophils in infected lungs. We also show through immunofluorescence that treatment with anti-CD44 antibodies reduces colocalization of HA and CD45 in lung sections, indicating that HA’s interaction with immune cells contributes to pathology. Our findings demonstrate that disruption of HA-receptor interactions is a way to prevent inflammatory pathology in pulmonary infection.

24. An intronic variant in Ferredoxin Reductase (FDXR) creates a cryptic exon in Quarter Horses with Equine Juvenile Spinocerebellar Ataxia.

期刊: PLoS genetics 发表日期: 2026-May-20 链接: PubMed

摘要

Equine Juvenile Spinocerebellar Ataxia (EJSCA) is a novel autosomal recessive neurologic disease in Quarter Horses. Affected foals display a progressive proprioceptive ataxia by 1-5 weeks of age, leading to recumbency and necessitating euthanasia. Whole genome sequencing was performed on 7 EJSCA cases and unaffected horses that included 4 obligate carriers, 4 unaffected half or full-siblings, and 28 unrelated, unaffected control Quarter Horses. An 82 kb region of association was identified (EquCab3.0, chr11: 6963986-7045999), containing 9 candidate SNPs across four genes (FADS6, FDXR, GRIN2C and TMEM104). Decreased FDXR mRNA expression and a cryptic exon was identified in spinal cord tissue from EJSCA cases via RNA-sequencing. One of the 9 associated SNPs (FDXR-203 c.177 + 1778G > C) was the eighth base pair of this cryptic exon. Affected foals were all homozygous for the variant. Protein concentrations of FDXR were lower in EJSCA cases in spinal cord and liver compared to unaffected controls. The FDXR-203 c.177 + 1778G > C mutation represents the first non-coding neurological genetic variant in horses. Additionally, this is the first genetic cause of a degenerative axonopathy in the horse and a spontaneous disease model to study FDXR pathology in humans.

25. Long-Term Efficacy of a Web-Based Sexual Health Promotion Program Using a Media Literacy Education Approach in a National Sample of Community College Students.

期刊: Prevention science : the official journal of the Society for Prevention Research 发表日期: 2026-May-20 链接: PubMed

摘要

Young adults attending community college are an underserved population that is at high risk for STIs and unplanned pregnancy. A recent evaluation of a web-based, sexual health program, Media Aware, that uses a media literacy education approach, revealed positive short-term effects after 1 month on the sexual health cognitions and behaviors of community college students (ages 18-19) including a reduction in risky sexual behaviors. The purpose of the current study is to replicate and extend the findings reported in this earlier evaluation to a larger sample of community college students from across the USA in a longer-term study examining 12-month follow-up data. In a cluster randomized controlled trial, students from 23 community college campuses (N = 1139) either received the intervention (i.e., Media Aware) or were assigned to the Wait-list Control group, and the two groups were compared on their media literacy cognitions and sexual health cognitions and behaviors. Using an intent-to-treat design, results indicate that after 12 months, students who received Media Aware held healthier normative beliefs about risky sex and reported media messages to be less realistic, compared to students in the control group. There were no differences across groups in sexual health behaviors. Moderation analyses by gender and pretest scores were conducted. Findings show the efficacy of Media Aware for bringing about long-term changes in media and health cognitions. The findings also underscore the need for multi-level interventions that reduce community- and system-level barriers to engaging in sexual health behaviors. TRN: NCT04950686; Date of registration: 5/03/2021.

26. The Effect of Spiritual Interventions on Hope in Patients with Chronic Diseases: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

期刊: Journal of religion and health 发表日期: 2026-May-20 链接: PubMed

摘要

The present study aimed to determine the effect of spiritual interventions on hope among patients with chronic diseases. This systematic review and meta-analysis study was conducted based on the PRISMA 2020 guidelines. International databases (PubMed, Web of Science, Scopus, Embase, Science Direct, Google Scholar) and Iranian databases (Magiran, SID) were searched up to September 8, 2025, using the operators “AND” and “OR” without time restrictions. The inclusion criteria consisted of randomized controlled trials or clinical trial studies that examined various spiritual interventions to promote hope in adults with chronic physical illnesses. After removing duplicates, initial and secondary screenings were independently performed by two reviewers, and finally, a total of 18 eligible studies were included. Risk of bias was assessed using the Cochrane tool. A total of 18 studies involving 1410 participants (intervention = 708; control = 707), conducted between 2008 and 2024 across five countries, were included in the review. The interventions consisted of structured spiritual care, religious counseling, self-care education, and prayer. Hope was assessed using validated instruments, including the Herth Hope Index (HHI), the Miller Hope Scale (MHS), and Snyder’s Adult Hope Scale (AHS). The majority of studies reported significant improvements in hope among participants in the intervention groups compared with controls, whereas only one study found nonsignificant results. Overall, the meta-analysis demonstrated a strong and significant effect in favor of the intervention group (Cohen’s d = 1.90, p < 0.001). According to the findings, spiritual interventions effectively enhance hope in patients with chronic physical diseases. These results highlight the importance of integrating spiritual interventions into the care plans of such patients and underscore the need for further research on standardized protocols and long-term outcomes.

27. Investigating the relationship between water fluoride level and anthropometric parameters and blood pressure in adults of Zarand and Sarbisheh cities.

期刊: Environmental geochemistry and health 发表日期: 2026-May-20 链接: PubMed

摘要

Drinking water is the main source of fluoride, which prevents dental caries at recommended levels; however, excessive intake has been associated with adverse outcomes, including noncommunicable diseases. This cross-sectional study, conducted in 2023, included 600 adults aged 18-75 years residing in urban and rural areas of Zarand and Sarbisheh cities, Iran. Demographic characteristics and determinants of fluoride exposure were collected using a structured questionnaire. Anthropometric measurements, including body mass index (BMI) and waist circumference (WC), as well as blood pressure parameters, including systolic blood pressure (BP) and diastolic blood pressure (DBP), were measured through physical examinations. Drinking water samples were collected from 43 villages and 4 cities. Simple linear regression and generalized linear model-based tree (GLM-tree) analyses were applied to assess the associations, while accounting for potential confounding and moderating factors. The mean age of participants was 40.27 ± 14.54 years, and 68.8% were female. The mean fluoride concentration in drinking water was 1.06 ± 0.45 mg/L in Zarand and 0.51 ± 0.18 mg/L in Sarbisheh. After adjustment for confounding variables, fluoride exposure at low to moderate levels (0.5-1.5 mg/L) was positively associated with BMI and negatively associated with DBP (P < 0.05). In contrast, high fluoride exposure (> 1.5 mg/L) showed a positive association with WC (P < 0.001). GLM-tree analysis showed that health status, lifestyle, and water composition factors moderated the associations between fluoride exposure and anthropometric and blood pressure measures. Overall, the results suggest a possible association between drinking water fluoride levels within recommended standards and anthropometric indicators.

28. Bortezomib synergizes with homoharringtonine in FLT3-ITD-relapsed/refractory acute myeloid leukemia by inducing FLT3-ITD protein degradation.

期刊: Clinical and experimental medicine 发表日期: 2026-May-20 链接: PubMed

摘要

Mutations in Fms-like tyrosine kinase 3 (FLT3) are strongly associated with relapse and resistance in acute myeloid leukemia (AML) patients, and the treatment of relapsed or refractory AML (R/R AML) remains a major clinical challenge. We previously conducted a prospective clinical trial on R/R AML with chemotherapy regimen BHA (bortezomib, homoharringtonine and cytarabine), which demonstrated promising efficacy in patients with FLT3-mutated R/R AML. However, the therapeutic mechanism remains unclear. In this study, we aim to elucidate the therapeutic mechanism of BHA regimen on the basis of its efficacy for FLT3-mutated R/R AML. We retrospectively analyzed twenty-nine patients with R/R AML, after one course of therapy, patients harboring FLT3 mutations had a significantly higher complete remission/complete remission with incomplete hematologic recovery rate than those without FLT3 mutations (46.67% vs. 7.14%, respectively; P = 0.035). To further explore the underlying mechanisms, we conducted combination index analysis, inhibition of proliferation and apoptosis assays. Compared with 293 T-FLT3 cells, 293 T-FLT3-ITD cells were more sensitive to bortezomib, with significantly lower IC50 values. Bortezomib in combination with homoharringtonine had a synergistic effect on FLT3-ITD cells. Moreover, compared with monotherapy, the combination of bortezomib (4 nM) and homoharringtonine (1 nM) markedly increased total cell death in FLT3-ITD cell lines (MV4-11 and Molm-13). Mechanistically, bortezomib promoted the degradation of FLT3-ITD protein, and the degradation of FLT3-ITD protein was further enhanced by homoharringtonine. Notably, this degradation effect was partially reversed by chloroquine. These findings demonstrate that bortezomib and homoharringtonine have synergistic effects and lead to degradation of FLT3-ITD oncoprotein, potentially contributing to a higher complete remission rate in FLT3-ITD R/R AML.

29. Salivary MicroRNA Reflects Neurodevelopment and Oral Health Traits in Children With Autism.

期刊: International dental journal 发表日期: 2026-May-20 链接: PubMed

摘要

Autism spectrum disorder (ASD) is a multifactorial neurodevelopmental condition associated with poor oral health in children. ASD lacks sensitive, non-invasive diagnostic tools, and the relationship between neurodevelopment and oral health remains unclear. This observational study aimed to identify salivary microRNAs (miRNAs) differentially expressed between children with ASD and healthy controls and to determine whether these profiles are associated with dental caries and periodontal status. Unstimulated saliva was collected from 26 children with ASD and 20 healthy controls and subjected to small RNA sequencing. Differentially expressed miRNAs were identified and functionally annotated. Oral health was assessed using dmft/DMFT and periodontal indices, and associations between miRNA expression patterns and clinical parameters were evaluated. A total of 125 salivary miRNAs were differentially expressed between ASD and control groups (FDR < 0.05). Principal component analysis showed clear group separation, with PC1 accounting for 46.5% of total variance. Several dysregulated miRNAs were linked to neurodevelopmental and immune regulatory pathways and overlapped with neurological and inflammatory conditions. After miRDB/SFARI filtering, 40 ASD-relevant miRNAs were prioritized, including 21 upregulated and 19 downregulated candidates; representative examples were hsa-miR-145-5p (log2FC 2.11, adjusted P = 1.74E-08) and hsa-miR-200a-5p (log2FC -0.58, adjusted P = 6.11E-06). Children with ASD had higher dmft/DMFT scores and poorer periodontal/behavioural outcomes, with dmft/DMFT differing significantly between groups (P = .02). In exploratory pooled-cohort regression analysis, miR-151a-3p and behaviour remained significant predictors of dmft/DMFT (adjusted R2 = 0.31, P = .003). Children with ASD exhibit a distinct salivary miRNA profile with increased caries burden and gingival inflammation, indicating shared molecular influences on neurodevelopment and oral disease susceptibility. Salivary miRNAs offer a non-invasive biomarker platform to support earlier ASD identification, individualized preventive dental strategies, and interdisciplinary management of this high-risk paediatric population.

30. Aspects of Quality of Life in Interstitial Lung Disease: Pilot Observational Cross-Sectional Study in a Single Center.

期刊: JMIR formative research 发表日期: 2026-May-20 链接: PubMed

摘要

Quality of life (QOL) is an important aspect of every chronic disease, including interstitial lung disease (ILD). QOL is perceived as a significant patient-centered outcome. This study aims to identify factors correlating with different aspects of QOL in patients with various ILDs. We recruited 57 participants hospitalized in a tertiary care clinical center to this pilot observational cross-sectional study. These included 22 patients with idiopathic interstitial pneumonia (IIP), 19 patients with connective tissue disease-associated ILD (CTD-ILD), and 16 patients with interstitial pneumonia with autoimmune features (IPAF). The Saint George’s Respiratory Questionnaire (SGRQ) and World Health Organization Quality of Life Questionnaire (WHOQOL-BREF) were used to assess QOL, and the Hospital Anxiety and Depression Scale - Modified Version (HADS-M) and Patient Health Questionnaire - 9 (PHQ-9) were used to evaluate depression severity. Functional parameters including forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), transfer lung capacity for carbon monoxide (TLCO), and 6-minute walk distance (6MWD) were assessed. Assessment of QOL was a secondary outcome measure in a multicenter prospective study aimed at determining the characteristics of Polish patients with interstitial pneumonia with autoimmune features. In each study group, positive correlations existed between the WHOQOL-BREF physical domain score and FEV1 % predicted value (P=.001) and TLCO % predicted value (P=.03). Regardless of diagnosis, higher depression, anxiety, and aggression scores (ie, worse mental health) correlated negatively with multiple domains of QOL measured using the WHOQOL-BREF. Predictors of QOL aspects varied in each study group. In the IPAF group, the TLCO % predicted value was a predictor of QOL expressed as the SGRQ total score (P=.005). In the CTD-ILD group, short 6MWD (P<.001) and high HADS-M aggression score (P=.01) correlated with low QOL (expressed as a high SGRQ total score). In the IIP group, 6MWD (P=.002) and PHQ-9 scores (P<.001) were predictors for SGRQ symptoms score. Gender-based differences were revealed: In all study groups, men had higher scores in the psychological, social, and environmental domains of the WHOQOL-BREF, indicating better QOL, without a statistically significant difference in the physical domain scores between genders. Diagnosis-based differences in the psychological aspects of QOL were also revealed: The QOL psychological domain scores were significantly lower in the CTD-ILD and IPAF groups than in the IIP group, indicating worse QOL (P=.01). QOL is a multifaceted issue with various factors impacting its assessment. 6MWD, TLCO predicted value, and worse functional ability might specifically impact QoL in ILD. Mental health is an important aspect of QOL in the ILD population, as patients with a chronic, potentially life-limiting disease may be more prone to developing depression or anxiety. Assessment of QOL should be taken into account in clinical decision-making and research on chronic diseases, as this patient-related outcome may impact therapeutic decisions and patient compliance.

31. Machine Learning-Based Prediction of NOECs for over 10,000 PFAS across Multiple Fish Species Enables Large-Scale Toxicological Analysis.

期刊: Environmental science & technology 发表日期: 2026-May-20 链接: PubMed

摘要

Per- and polyfluoroalkyl substances (PFASs), comprising over 10,000 persistent chemicals, are prevalent in aquatic ecosystems and threaten ecological health. Fish no-observed-effect concentrations (NOECs) are a key ecological safety indicator; however, NOECs remain undefined for most PFASs. Here, we develop a machine learning model to predict mortality-based NOECs for 10,863 PFAS in Danio rerio using compiled toxicity data and mechanistically meaningful molecular structural descriptors. The model achieved robust predictive performance (Rtest2 = 0.7096), with predicted NOECs ranging from 0.239 (0.131-1.129) to 163.452 (77.207-341.332) mg/L, highlighting a wide toxicity variation that suggests further structural investigation would be beneficial. Analysis reveals a “U-shaped” toxicity chain-length trend, with higher toxicity observed for C8-C12 PFAS and polar functional groups (e.g., sulfonates and carboxylates). We further extrapolate these toxicity profiles to 12 additional fish species through trait-based inference and found that warm water and omnivorous species are more sensitive, reflecting trait-mediated differences in bioaccumulation potential and metabolic vulnerability. Structure-species interactions jointly shape toxicity patterns across species. Together, these results extend the mechanistic understanding of the toxicological responses of fish to PFASs. Integrating chemical structures with ecological characteristics enables high-throughput toxicity predictions using limited data, provides mechanistic insights into PFAS toxicity, and establishes a transferable framework for ecological risk screening and prioritization.

32. Long-Term Exposure to Multiple Environmental Factors and Late-Life Cognitive Decline.

期刊: Environmental science & technology 发表日期: 2026-May-20 链接: PubMed

摘要

Individual environmental exposures have been linked to later-life cognition, but their combined effects, particularly on cognitive decline, remain unclear. Using data from 18,462 participants in the Nurses’ Health Study cognitive substudy, we assessed the independent and joint associations of long-term exposure to multiple environmental factors with cognitive function and decline, using generalized estimating equations (GEE) and quantile g-computation models, allowing exposures to operate in both protective and harmful directions. Cumulative average exposures to air pollution, seasonal temperature, noise, greenness, light at night (LAN), and neighborhood socioeconomic status (nSES) from 1988 onward were assigned to updated residential addresses. In multiexposure GEE models, each interquartile-range increase in greenness and nSES was associated with 0.026 (95% CI: 0.013, 0.040) and 0.017 (0.005, 0.029) standard-unit increases in cognitive function, respectively. Higher summer temperature was associated with a 0.011 (-0.023, 0.000) standard-unit decrease. Jointly, each quartile increase across all exposures corresponded to a 0.013 (0.001, 0.024) standard-unit higher cognitive score. Higher summer maximum temperature and LAN were associated with faster cognitive decline only in single-exposure models, while no significant joint association with decline was observed. These findings suggest that enhancing protective exposures (greenness, nSES) may help offset the adverse effects of harmful exposures (high temperature, LAN) and support healthier cognitive aging.

33. High-Throughput Phenolic Profiling in Virgin Olive Oil Using Fourier Transform Near-Infrared Spectroscopy: A Tool for Breeding and Quality Assessment.

期刊: Journal of agricultural and food chemistry 发表日期: 2026-May-20 链接: PubMed

摘要

Phenolic compounds determine virgin olive oil (VOO) quality, health benefits, and cultivar characterization, but routine analysis by high-performance liquid chromatography (HPLC) is slow and unsuitable for large genetic studies. This study evaluated Fourier transform near-infrared spectroscopy (FT-NIR) as a high-throughput alternative for VOO phenolic profiling. A three-year data set covering broad genetic and environmental variability, including cultivars from the World Olive Germplasm Bank and breeding genotypes from Córdoba (Spain), was used to calibrate Partial Least-Squares models. An independent data set from four cultivars across four environments enabled external validation and broad-sense heritability estimation. FT-NIR models showed strong predictive performance for total phenols and major secoiridoids, with R2 values of 0.62-0.88 and Range Error Ratio (RER) values above 10. Variance analysis indicated genotype-driven variation for ligstroside aglycone and environmental effects for other phenols. FT-NIR estimates closely matched laboratory results, confirming its value for phenolic evaluation in olive breeding programs.

34. End-of-life decision-making: A cross-sectional study on knowledge and views of the Dutch general public.

期刊: Death studies 发表日期: 2026-May-20 链接: PubMed

摘要

Physician-assisted dying (PAD) has been legal in the Netherlands since 2002. We examined public knowledge of PAD regulation and views on self-determination at the end of life. A cross-sectional survey among citizens aged ≥16 (N = 1,456) included 10 knowledge items and 18 statements on termination of life on request. Knowledge scores were calculated; exploratory factor analysis and linear regressions examined underlying constructs and associations with sociodemographic factors. Respondents answered on average five of ten knowledge questions correctly (response 75%; N = 1,097). Sixty‑eight percent agreed that everyone should have the right to euthanasia or assisted suicide. Four factors explained 60% of variance; most statements loaded on a self‑determination factor. Higher age, education, and no migration background were associated with greater knowledge and appreciation for self-determination; being female and non-religious also with stronger appreciation. Public knowledge of PAD’s legal framework remains limited, while most citizens value self-determination, influenced by sociodemographic and cultural factors.

35. Introduction to the Festschrift: The State of the Art of Exposure Variation and Its Relevance to Occupational Health Through the Lens of the Scientific Career of Professor Svend Erik Mathiassen.

期刊: IISE transactions on occupational ergonomics and human factors 发表日期: 2026-May-20 链接: PubMed

摘要

36. Predictive Modeling of Work-Rest Schedule for Agricultural Workers Using Heat Stress and Physiological Data.

期刊: IISE transactions on occupational ergonomics and human factors 发表日期: 2026-May-20 链接: PubMed

摘要

Occupational ApplicationsThis study provides practical, field-tested predictive tools to schedule work and rest in hot agricultural settings. Using routinely measured inputs (wet-bulb globe temperature [WBGT], heart-rate metrics, age, mechanization status, and simple lifestyle indicators), practitioners and supervisors can estimate safe continuous work durations and the necessary recovery periods for individual workers. Applicable to smallholder and mechanized tillage operations, these models support on-site decision-making to reduce heat-related fatigue, minimize injury risk, and maintain productivity. The models can be integrated into supervisor checklists, simple mobile apps, or wearable-sensor dashboards to immediately improve heat-stress management policies and worker scheduling. Background Agricultural tillage involves prolonged physical exertion under heat stress, increasing fatigue and injury risk. Existing work–rest guidance for industrial settings does not directly translate to small-scale agricultural work in hot climates.Purpose To develop and validate predictive models that estimate (a) the working time to reach targeted heart-rate thresholds and (b) the resting time required to recover under field heat-stress conditions, using physiological, environmental, and behavioral inputs.Methods Field measurements were collected from 48 male agricultural workers during manual and power-tiller tillage (WBGT, continuous heart rate). Factor analysis identified body-composition factors; stepwise multiple regression models were developed to predict working time (WT) and resting time (RT). Models were validated against independent observations using mean absolute percentage error (MAPE), Theil’s U, and normalized root mean square error (NRMSE).Results Significant predictors for WT included age, WBGT, resting heart rate, alcohol and smoking habits, and mechanization status; for RT, predictors included age, actual working time, resting heart rate (RHR), recovery heart rate (ReHR), lifestyle habits, and mechanization. Model performance was strong: WT (R2 = 0.858, MAPE = 3.87%, Theil’s U = 0.0216, NRMSE = 0.1102) and RT (R2 = 0.879, MAPE = 4.76%, Theil’s U = 0.0256, NRMSE = 0.1124). Mechanization increased WT, while lifestyle factors and higher WBGT reduced WT and increased RT.Conclusions Regression models accurately predict work and rest durations for agricultural tillage under heat stress and can inform evidence-based, field-applicable work–rest schedules to improve worker safety and productivity.

37. Screening and evaluation of potential histone deacetylase inhibitors against Babesia infections.

期刊: International journal for parasitology. Drugs and drug resistance 发表日期: 2026-May-17 链接: PubMed

摘要

Babesia spp., a group of blood protozoa transmitted via the bites of tick vectors, cause enormous economic losses for livestock industry and pose significant risk to public health. Currently, the drugs available for treating babesiosis are limited and possess certain toxicity, making the discovery of new and safer drug candidates an urgent priority. Inhibitors targeting histone deacetylase (HDACs) have attracted increasing attention for its antiparasitic effects as a drug targeting epigenetic regulatory enzymes. However, little is known about the effects of HDAC inhibitors on Babesia parasites. Here, 69 compounds targeting HDAC were evaluated for inhibiting Babesia xinjiangensis (B. xinjiangensis) growth in vitro. Among them, 7 compounds (at 2 μM) exhibited high growth inhibition (≥50%) and the cytotoxicity on MDOK cells of the compounds was assessed subsequently. The half-maximal inhibitory concentration (IC50) values of the seven compounds for MDOK cells are greater than 3 μM. Two compounds, namely panobinostat and belinostat were chosen for in vivo assays. In our study, panobinostat and belinostat demonstrated outstanding activity in vitro at the nanomolar level. The IC50 values of panobinostat and belinostat were determined to be 30(±2) nM and 235(±21) nM at 48 h, respectively, and both exhibited low cytotoxicity, with IC50 values of 3 (±0.4) μM and 20 (±3) μM respectively. In addition, panobinostat effectively and safely inhibited B. microti growth in BALB/c mice. Our findings support that panobinostat is a potential alternative drug to control babesiosis.

38. Comparative epidemiology of gastrointestinal parasites in cattle and buffalo under smallholder systems in Thailand.

期刊: Veterinary parasitology 发表日期: 2026-May-17 链接: PubMed

摘要

Gastrointestinal parasite (GIP) infections significantly limit livestock productivity in tropical smallholder systems, yet comparative epidemiological data between cattle and buffalo remain scarce. This study examined co-infection dynamics, parasite patterns, and risk factors in cattle and buffalo in Thailand. A cross-sectional study of 302 animals (30 farms) used fecal examinations to detect nematodes, rumen flukes, and Fasciola spp. Risk factors were assessed using univariable and multivariable logistic regression. Animal-level GIP prevalence was 69.54% (buffalo 78.07%; cattle 64.36%), with 100% herd-level positivity. The GIP infection in cattle was nematode-dominant (32.98%), while buffalo showed high rumen fluke (59.65%) and Fasciola spp. (22.81%) prevalence. Multivariable analysis for cattle identified grazing (aOR = 3.72, p = 0.020) and presence of other animals (aOR = 2.72, p = 0.011) as primary risks. In buffalo, young age (aOR = 0.23, p = 0.016) and male (aOR = 0.19, p = 0.005) were protective against rumen flukes, while shared grazing increased risk (aOR = 2.84, p = 0.039). Buffaloes frequently exhibited rumen fluke and Fasciola spp. co-infections, reflecting distinct host-specific dynamics. GIP epidemiology in cattle and buffalo within smallholder systems is shaped by interactions between environmental exposure, host characteristics, and parasite-specific transmission pathways. While nematode infections in cattle are primarily driven by pasture-based exposure, trematode infections in buffalo are closely linked to water-associated environments. These findings underscore the importance of adopting parasite-specific and species-adapted control strategies rather than uniform approaches.

39. Streptococcus pneumoniae: Pathogenesis, virulence factors, antimicrobial resistance mechanisms, and therapeutic strategies.

期刊: Diagnostic microbiology and infectious disease 发表日期: 2026-May-12 链接: PubMed

摘要

Streptococcus pneumoniae is a Gram-positive, facultative anaerobic bacterium and a leading cause of community-acquired pneumonia, meningitis, bacteremia, and otitis media, responsible for an estimated 1.6 million deaths annually. Despite widespread polysaccharide and conjugate vaccine programs and decades of antibiotic therapy, pneumococcal disease continues to pose major public health challenges. These challenges are increasingly understood to reflect the organism’s sophisticated capacity for adaptive recombination, allowing it to exploit every selective pressure applied through vaccination and antimicrobial treatment. This review aims to synthesize current understanding of pneumococcal molecular pathogenesis, virulence factor biology, vaccine evolution, antimicrobial resistance mechanisms, and novel therapeutic strategies, with explicit attention to unresolved questions and clinically consequential knowledge gaps that are inadequately addressed in existing literature. A comprehensive review of the primary and review literature was conducted. The review encompassed pneumococcal colonization biology, capsule and protein virulence factor mechanisms, pilus structure and host-cell interactions, the evolutionary trajectory of conjugate vaccines from PCV7 to PCV21, global antimicrobial resistance surveillance data, and the pharmacology and clinical trial evidence for recently approved antibiotics. Particular attention was given to serotype epidemiology in low- and middle-income country (LMIC) and Indigenous populations, and to resistance dynamics driven by vaccine-era lineage shifts and antimicrobial stewardship challenges. Pneumococcal pili-particularly the RrgA adhesin of pilus islet 1-mediate binding to PECAM-1/CD31 on human brain microvascular endothelial cells, providing mechanistic insight into blood-brain barrier penetration and bacteraemic complications. Capsule expression is dynamically regulated, and the paradox of serotype 1 (thick capsule, high invasiveness, rare carriage) remains unresolved with direct implications for surveillance-guided vaccine design. Analysis of conjugate vaccine evolution reveals that PCV21’s deliberate omission of serotypes 4, 6A, 9 V, and 10A creates coverage gaps for Indigenous communities where serotype 4 has re-emerged. Post-vaccine resistance dynamics are coupled to serotype replacement. Multidrug-resistant lineages expressing serotypes 15A, 15C, and 35B are expanding in the post-PCV13 era. Ceftriaxone minimum inhibitory concentration creep among phenotypically susceptible isolates presents an underappreciated clinical risk, particularly in meningitis where cerebrospinal fluid penetration is inherently limited. Azithromycin mass drug administration programs in sub-Saharan Africa generate macrolide resistance prevalences exceeding 60% in treated communities within 12-24 months, with potential for international dissemination. Of the four novel agents approved for community-acquired bacterial pneumonia-ceftaroline, lefamulin, omadacycline, and delafloxacin-none have established pharmacokinetic or clinical efficacy data supporting use in pneumococcal meningitis. S. pneumoniae functions as an integrated adaptive system rather than a pathogen with independent resistance and evasion mechanisms. Iterative vaccine reformulation is approaching diminishing returns without parallel investment in serotype-independent protein vaccines and whole-genome sequencing surveillance. The mismatch between surveillance infrastructure in high-income countries and LMIC settings, where the greatest burden is concentrated, represents a structural inequity limiting global applicability of current policies. Priority areas include expansion of genomic surveillance to LMIC settings, clinical trials with mucosal protection endpoints for protein vaccine candidates, and explicit development of therapeutics with demonstrated cerebrospinal fluid penetration against multidrug-resistant pneumococci.

40. Surgical approach and oncological outcomes in Siewert type II junctional tumors.

期刊: Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus 发表日期: 2026-May-12 链接: PubMed

摘要

Optimal surgery for Siewert type II tumors remains controversial. We compared outcomes between transthoracic esophagectomy (TTE) and extended total gastrectomy (EG) in a high-volume center. This study included consecutive patients with Siewert type II tumors undergoing curative-intent surgery between 2013 and 2023. Patients treated with TTE or EG were analyzed. Primary outcomes were oncological parameters (lymph node yield, margin length, R0-rate, positive lymph nodes). Secondary outcomes included postoperative morbidity, overall survival (OS), disease-free survival (DFS), and recurrence patterns. Survival was analyzed using Kaplan-Meier and multivariable Cox regression. A total of 136 patients were included (TTE n = 71; EG n = 65). Baseline characteristics were largely comparable. TTE resulted in a significantly higher median lymph node yield (45 vs. 28, P < 0.001) and longer proximal margins (P < 0.001). R0 resection rates were similar (94.4% vs. 86.0%, P = 0.217), as was the number of positive lymph nodes. Clavien-Dindo ≥3b complications occurred in 38.0% vs. 38.5% (P = 1.000). Median OS was 2.9 years in both groups, with no difference in OS (log-rank P = 0.611) or DFS (log-rank P = 0.530). On multivariable analysis, surgical approach was not associated with OS (aHR 1.08, 95% CI 0.64-1.82), whereas advanced pathological stage (pT3-4) independently predicted worse survival (aHR 2.03, 95% CI 1.18-3.51). Despite differences in lymph node yield and proximal margin length, TTE and EG provide comparable oncological and survival outcomes in Siewert type II tumors. These results were sustained even after multivariate adjustment. These findings support an individualized, multidisciplinary approach to surgical strategy selection.

41. Dietary supplementation of endo-1,4-ß-D-mannanase improves turkey growth through enhancement of immune response and jejunal barrier integrity.

期刊: Poultry science 发表日期: 2026-May-07 链接: PubMed

摘要

In-feed beta-mannanase supplementation has been used for decades to improve gut health and growth performances in poultry, yet its underlying molecular mechanisms are not completely defined. The aim of the present study was to determine the effect and potential mode of action of a new endo-1,4-β-D-mannanase (Natupulse® TS, NPU) on gut integrity and growth performances of turkeys. A total of 640 one-day-old male Hybrid Converter poults were randomly assigned to two dietary treatments without (control, CON) or with Natupulse® TS (NPU, 800 TMU/kg feed) for a 49 day-trial, each treatment having 16 replicate pens of 20 birds each. Body weight (BW), BW gain (BWG), feed intake (FI), and feed conversion ratio (FCR) and intestinal permeability using fluorescein isothiocyanate-dextran (FITC-d) were measured on days 21 and 49. Jejunal samples (16 birds/treatment) were analyzed for markers of stress, inflammation, and gut barrier integrity using real-time quantitative PCR and immunoblot. Dietary NPU supplementation significantly reduced serum FITC-D levels in turkey at day 49 and increased BWG at both day 21 and day 49 compared to the CON group. Molecular analyses showed that dietary NPU supplementation significantly increased jejunal protein levels of HSP60/70/90 on day 21. On day 49, HSP60 remained unchanged, HSP70 was high and HSP90 protein levels were significantly decreased compared to the CON diet. In-feed NPU administration significantly downregulated the jejunal expression of IL8, IL18, Crp and Tnfsf4 genes on day 21, and only IL8 gene on day 49. In addition, NPU supplementation decreased jejunal protein levels of claudins (CLDN1/4/5) on day 21 and CLDN5 on day 49. The expression of genes coding for gap junction proteins was also affected by NPU supplementation, with a significant downregulation of Gja1, Gjb1, Gjc1, and Gjd2 on day 21, and Gjc1 and Gjd2 on day 49. Dietary supplantation of NPU significantly downregulated the jejunal expression of the adherens junction protein afadin (afdn1) gene on day 49 compared to the CON group. In summary, dietary NPU supplementation improved growth performance and jejunal barrier integrity potentially through modulation of the expression of HSPs, pro-inflammatory cytokines, tight junction, gap junction, and adherens junction proteins.

42. An ageing biomarker signature predicts chronic disease cluster trajectories, physical function and mortality: validation in the TILDA and HRS cohorts.

期刊: Age and ageing 发表日期: 2026-May-04 链接: PubMed

摘要

Global population ageing is progressing at an unprecedented rate. Early identification of subpopulations at risk of chronic diseases could mitigate deteriorating health and increasing health service use, while revealing key biological cues and therapeutic targets. We hypothesised that a multisystem biomarker signature could identify future chronic disease trajectories, multimorbidity, functional decline and mortality. Eighteen blood biomarkers, representing key systems that become dysregulated with ageing, were assessed among n = 4961 participants aged 50+ years from Ireland. Probabilistic clustering classified participants as belonging to one of three biomarker signatures at baseline. Biomarker signatures were designated as low, medium and high risk based on relative levels of biomarker dysregulation within the signatures and previously described associations with chronic disease and mortality. These biomarker signatures were utilised to predict 4-year functional decline; 8-year cardiovascular disease (CVD), diabetes, frailty, disability and 12-year mortality. Results were validated in a US cohort (n = 3914). Low (58.5%), medium (9.2%) and high-risk (32.3%) biomarker signatures were identified in the cohort from Ireland. The high-risk signature was associated with higher 12-year mortality (HR: 1.89, P < .001); higher 8-year incidence of CVD, diabetes, multimorbidity, frailty and disability (OR range: 1.46-2.49. P < .05); and lower 4-year physical function (P < .01). Findings were corroborated in the US cohort. We identified and tracked 6 disease classes over 8 years: healthy, arthritis, diabetes/angina, hypothyroid/osteoporosis/respiratory, vision/anxiety/CVD and multisystem. Associations between the high-risk biomarker signature and two of the five 8-year incident disease classes were observed, implicating dysregulated immune and cardiometabolic pathways. This study provides evidence that biomarker signatures and profiling of disease patterns can be used to risk stratify and identify ageing subpopulations that would benefit most from targeted preventative or secondary intervention strategies.

43. Protective effect of cornel iridoid glycoside against isoniazid- and rifampicin- induced liver injury via regulating JAK/STAT pathway.

期刊: The Journal of pharmacy and pharmacology 发表日期: 2026-May-02 链接: PubMed

摘要

Hepatotoxicity associated with Isoniazid (INH) and Rifampicin (RIF) is one of the major impediments in antituberculosis therapy. We aimed to investigate the protective effects of the cornel iridoid glycoside (CIG) on liver injury caused by INH and RIF in vivo and in vitro. Liver injury model was induced by INH and RIF (150 mg/kg). Then the mice were orally administered with CIG (50, 100, and 200 mg/kg) and silymarin (100 mg/kg) for 2 weeks. HepG2 cells were treated with 0.1 mg/ml INH and 0.2 mg/ml RIF to establish injury model. Blood samples and cell lysis were used for biochemical analysis and western blot assay. Liver tissues were harvested for histological examination. Treatment of CIG significantly restored liver function, reduced the levels of inflammatory factors, enhanced the antioxidant activity, and alleviated lipid metabolism disorder compared with the model group in vivo. CIG restored cell viability and activities of alanine aminotransferase (ALT), aspartate aminotransferase (AST) in vitro. Furthermore, CIG inhibited the protein expression of JAK/STAT pathway. CIG is effective in preventing INH and RIF-induced hepatotoxicity in vivo and in vitro. These findings provide scientific basis for the clinical application of cornel in treating liver injury.

44. Reduced Uncoupling Protein 1 Expression in Periprostatic Adipose Tissue and Its Association With Higher Prostate Cancer Grade.

期刊: International journal of urology : official journal of the Japanese Urological Association 发表日期: 2026-May 链接: PubMed

摘要

Periprostatic adipose tissue (PPAT) is increasingly recognized as a component of the prostate cancer (PCa) microenvironment. However, the role of uncoupling protein 1 (UCP1) in PPAT remains unclear. We investigated the association between PCa grade and UCP1 expression in PPAT. After institutional review board approval, we collected PPAT and abdominopelvic adipose tissue (APAT) samples from 83 Japanese patients who underwent robot-assisted radical prostatectomy for clinically localized PCa. UCP1 mRNA expression in PPAT was quantified by RT-qPCR and normalized to APAT expression (PPAT/APAT ratio). PPAT volume was estimated by computed tomography. Associations with pathological stage and International Society of Urological Pathology (ISUP) grade were evaluated, and logistic regression was performed to identify factors associated with high-grade disease (ISUP 4/5). In the univariable logistic regression analysis, lower (log-transformed) UCP1 expression was significantly associated with high-grade PCa (ISUP 4/5) (odds ratio [OR] 0.415, 95% confidence interval [CI] 0.180-0.883, p = 0.027). Age, prostate serum antigen (PSA) concentration, and PPAT volume were not significantly associated with high-grade disease. In the multivariable analysis adjusted for age, PSA concentration, and PPAT volume, UCP1 expression remained independently associated with high-grade PCa (OR 0.438, 95% CI 0.188-0.945, p = 0.035). No other clinicopathological variables demonstrated independent associations. Reduced UCP1 expression in PPAT was independently associated with high-grade PCa. PPAT UCP1 expression may represent a microenvironment-associated marker reflecting PCa severity.

45. Low-dose radiation exposure and risk of self-reported cataract in Fukushima nuclear emergency workers.

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

摘要

Cataract is a well-established radiogenic condition and recent evidence suggests an increased risk even at radiation doses of <100 mGy. Following the 2011 Fukushima Daiichi Nuclear Power Plant accident, ∼20 000 workers participated in emergency operations. This study aimed to investigate the association between cumulative low-dose occupational radiation exposure and the risk of cataract among workers enrolled in the Epidemiological Study of Health Effects in Fukushima Nuclear Emergency Workers. Data from 5773 nuclear emergency workers participating in the cohort were analysed. The cumulative lifetime occupational radiation dose was estimated by combining pre-2011 individual dose records from a nationwide nuclear radiation worker dose registry with radiation doses received during the 2011 emergency-work period. Self-reported, physician-diagnosed cataract was identified through baseline and first follow-up questionnaires. A Cox proportional hazards model was applied to estimate hazard ratios (HRs) with 95% confidence intervals (CIs) for incident cataract, with adjustments for major covariates. More than 90% of the participants had cumulative occupational radiation exposure of <100 mSv, including doses received both prior to the accident and during the emergency period (March-November 2011). During 52 921 person-years of follow-up from 2012 to 2024 (mean, 9.2 years), 310 participants reported new-onset cataract. The risk of cataract increased with lifetime occupational exposure up to November 2011, with an HR of 1.03 per 10-mSv increase (95% CI, 1.02, 1.05). This association persisted after excluding participants with doses of ≥100 mSv. For exposure during the emergency period (March-November 2011), the HR was 1.06 per 10-mSv increase (95% CI, 1.03, 1.09). When the cumulative lifetime occupational radiation dose was recalculated by using 2-year and 5-year lag periods before diagnosis or censoring, the HRs per 10-mSv increase were 1.03 (95% CI, 1.01, 1.04) and 1.01 (95% CI, 0.99, 1.04), respectively. This study suggests an excess risk of cataract at doses of <100 mSv and adds to the evidence base suggesting an association between low-dose occupational radiation exposure and cataract risk.

46. Who gets help? Analyzing disparities in diagnosis, treatment, and care seeking of anxiety and depression among women in Bangladesh.

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

摘要

Reproductive-aged women in Bangladesh exhibit low rates of anxiety and depression diagnosis, treatment, and care-seeking. This study investigated these factors and their correlates. Using data from the 2022 Bangladesh Demographic and Health Survey, we analyzed diagnosis (whether a healthcare provider ever informed), treatment (prescribed medication), and care-seeking (ever sought help and source). Log-binomial and Poisson regression models identified associated factors. Overall, 7.6% of respondents reported ever being diagnosed with anxiety and/or depression. When disaggregated, 3.39% were diagnosed with anxiety only, 0.56% with depression only, and 3.62% with both conditions. Furthermore, 11.85% had sought care from the formal sector. Compared with women aged 15-19 years, those aged 25 years and above showed significantly higher prevalence of diagnosis and care-seeking, while treatment was significantly higher among women aged 40-49 years. After adjustment, regional and residence-based differences in treatment were not statistically significant; however, some divisions showed significantly higher odds of care-seeking. Women with a positive attitude towards wife beating showed higher levels of diagnosis (PR = 1.28, CI: 1.06, 1.45, p = 0.008), treatment (PR = 1.50, CI: 1.17, 1.92, p = 0.001), and care-seeking (PR = 1.52, CI: 1.34, 1.72, p < 0.001) but 37% lower formal care-seeking (PR: 0.63, 95% CI: 0.43, 0.91, p = 0.013). Middle class (PR = 1.19, CI: 1.00, 1.41, p = 0.046) and working women (PR = 1.22, CI: 1.09, 1.38, p = 0.001) had a higher care-seeking, while non-internet users (PR = 0.67, CI: 0.59, 0.77, p < 0.001) had a lower prevalence of care-seeking. Women with a bank account were 42% more likely to seek formal care (PR: 1.42, 95% CI: 1.06, 1.91, p = 0.019). Policy actions are needed to reduce mental health stigma and establish specialized departments in government hospitals. Efforts to improve mental health care utilization should focus on enhancing financial access, expanding internet use, and addressing women’s attitudes that influence care-seeking behavior.

47. Between the scales and the scars: The interpersonal moderators of the association between Body Mass Index and parent-reported depression/anxiety diagnoses in U.S. children: Evidence from the 2021-22 National Survey of Children's Health (NSCH).

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

摘要

Adverse childhood mental health outcomes have emerged as a significant public health concern, with an increasing body of evidence linking children’s obesity with increased risk of mental health outcomes. This is a cross-sectional study of 40,820 U.S. children aged 6-17 used survey-weighted logistic regression on the 2021-22 National Survey of Children’s Health (NSCH) data. The study examined whether interpersonal factors such as bullying, poor mothers’ or fathers’ mental health, poor family resilience and greater difficulty in making or keeping friends modified the associations between BMI category and parent-reported lifetime depression (LDD) or anxiety (LDA) mental health outcomes, using interaction terms and adjusting for age, sex, race/ethnicity and federal poverty levels. Obesity was significantly associated with higher odds of both LDD and LDA in children aged 6-17 years. Obese children had 2.08 times higher odds of LDD (aOR 2.08; 95% CI: 1.64-2.64) and 1.48 times higher odds of LDA (aOR 1.48; 95% CI: 1.25-1.76) compared to normal-weight peers. Significant effect modification in the statistical model was observed for LDD: never bullied (aOR = 2.12; 95% CI: 1.45-3.11), mother’s mental health (aOR = 1.70; 95% CI: 1.70- 2.70), and father’s mental health (aOR = 2.54; 95% CI: 1.51-4.29). For LDA, effect modification in the statistical model was seen for making friends (aOR = 1.91; 95% CI: 1.13-3.22) and father’s mental health (aOR = 2.14; 95% CI: 1.34-3.41). In this cross-sectional sample, obesity was associated with higher LDD and LDA, with associations varying by interpersonal and family factors. Given parent-reported, cross-sectional data, findings are associative and not causal. The results emphasize integrating mental health screening into obesity programs, strengthening anti-bullying efforts, and adopting family-centered approaches; future research should use longitudinal, multi-informant designs to establish temporal relationships and reduce bias.

48. Advancing inclusion in sports for students with disability: A mixed-methods study on awareness and perspectives toward adaptive sports.

期刊: PloS one 发表日期: 2026 链接: PubMed

摘要

Adaptive sports promote inclusion, participation, and well-being in individuals with disabilities. However, limited research has examined the knowledge, awareness, and perceptions of adaptive sports, as well as institutional support and barriers within Saudi universities. An explanatory sequential mixed-methods design was employed. A cross-sectional survey (n = 350; 18.29% reported disabilities; 70.57% females; mean age 28 ± 11 years) assessed knowledge, awareness, perceptions, and perceived barriers to adaptive sports among students, faculty, and administrative staff. Survey findings informed purposive sampling for the qualitative phase, which included focus group discussions with faculty and semi-structured interviews with students with disabilities (SWDs) to contextualize quantitative patterns. The qualitative phase included a focus group discussion, and six interviews were conducted virtually using Microsoft Teams. Participants demonstrated uneven knowledge of adaptive sports (mean score: 8/16). While most correctly recognized their role in enhancing physical education and promoting participation through adapted equipment (>83%), but low understanding of classification (19.71%) and healthcare roles (30.57%). Awareness was low across all domains, particularly in training (75.71% unaware) and participation (80.57% unaware), indicating significant gaps in exposure and education. Although most participants recognized the benefits of adaptive sports, they noted the lack of sufficient policies, accessible facilities, promotion, and staff support. Less than 30% reported inclusive programs, and 16.29% perceived equal funding for parasports training. The key barriers included a lack of awareness (43.14%), inaccessible facilities (41.42%), and limited resources (40%). Interviews with students with disabilities and focus groups with faculty and specialists revealed positive experiences, emphasizing personal growth and social inclusion, but also identified challenges in infrastructure, recruitment, and policy. Despite favorable perceptions, substantial gaps persist in knowledge, accessibility, and institutional commitment. Addressing these issues through awareness campaigns, improved facilities, and inclusive policy development is vital for advancing adaptive sports participation and fostering a culture of inclusion in Saudi higher education.

49. Digital motivation for cervical cancer screening: A quasi-experimental trial of the SeDAR Video among middle adulthood Malaysian women.

期刊: PloS one 发表日期: 2026 链接: PubMed

摘要

Cervical cancer screening (CCS) is a well-established method for preventing cervical cancer (CC). Electronic health (e-health) interventions have shown potential in disseminating health education and are widely used in developed countries to enhance preventive efforts against CC. This study aimed to evaluate the effectiveness of the electronic health video SeDAR® in increasing CCS uptake, knowledge, and motivational factors related to screening. The SeDAR® e-health video was designed based on the Protection Motivation Theory (PMT), incorporating elements such as perceived vulnerability, perceived severity, threat appraisal (fear), coping appraisal, response efficacy, perceived self-efficacy, and protection motivation. It was validated by health experts, media professionals, and female users. A quasi-experimental study was conducted among 76 women, with 38 participants each in the intervention and control groups. The control group received digital pamphlet as intervention tool. Logistic regression was used to assess the impact of SeDAR® on CCS uptake, while repeated measures ANCOVA examined changes in knowledge and motivational constructs. The attrition rate of participants is 13.2% with the final sample sizes of 35 (7.9%) and 36 (5.3%) in the SeDAR® and control group, respectively. Participants in the SeDAR® intervention group were significantly more likely to undergo CCS (adjusted odds ratio: 7.26, 95% CI: 1.71-30.74, p = 0.007). While no significant difference was observed in knowledge levels between groups, three motivational constructs showed significant changes. Increases in perceived self-efficacy and protection motivation, along with a reduction in threat appraisal (fear), were associated with greater CCS uptake. The SeDAR® e-health video demonstrates effectiveness as a health promotion tool for enhancing motivation and uptake of cervical cancer screening. It offers a promising, scalable approach to support preventive health behavior among women. The authors confirm that all related trials for this intervention are registered under ClinicalTrials.gov with protocol registration number NCT05426642 and release date on June 20, 2022.

50. Journal Prestige as Perceived by Health Administration Faculty in the United States.

期刊: Journal of healthcare management / American College of Healthcare Executives 发表日期: 链接: PubMed

摘要

Journal rankings play a critical role in guiding academic publishing decisions, assessing the productivity of health administration (HA) faculty, and informing their tenure and promotion evaluations. Healthcare executives and practitioners rely on rankings to help them assess the quality of empirical analyses and the underlying peer-review process of published articles. Despite periodic assessments in the HA field, journal prestige-an important metric for faculty success-has not been evaluated in more than a decade, leaving a gap in understanding current perceptions amid the rapidly evolving landscape of scholarly publishing. The objective of this current study is to update perceptions of journal prestige among HA faculty and examine changes over the past decade. As part of a larger, periodic, anonymous online survey distributed to a nationally representative group of HA faculty members in 2024, respondents were asked to list three journals they considered most prestigious in the HA field. Data were coded and analyzed to identify top journals, assess changes in rankings since 2012, and examine variations by faculty characteristics and areas of expertise using logistic regression models. The top-ranked journal was Health Affairs (35.1%), followed by Health Services Research (20.7%), Journal of the American Medical Association (JAMA) (15.9%), and Journal of Healthcare Management (10.9%). Rankings largely aligned with previous findings, though JAMA experienced a notable rise in prestige (+5 positions since 2012), partially driven by the emergence of its open access subjournal, JAMA Health Forum. Journal prestige was not correlated with journal impact factors (Spearman’s Rho [ρ] = 0.053; p = .41). Variations in journal selection were observed among faculty with expertise in informatics and outcomes research, who ranked discipline-specific journals higher. This study’s findings provide faculty with a current reference for selecting publication outlets and for documenting scholarly impact in promotion and tenure reviews. For department chairs and program directors, the findings offer a field-specific benchmark that can inform evaluation standards. For healthcare executives and practitioners, the top-ranked journals highlight priority sources for evidence-based decision-making and practice-oriented dissemination. The growing prominence of newer and open access journals further underscores the need for periodic reassessment of preferred outlets to ensure continued relevance in the HA field.

51. Service providers' perspectives on strategies to reduce caregiver burden among informal carers of people living with mental health conditions in rural South Africa: A qualitative descriptive study.

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

摘要

Caregiver burden is a public health problem affecting the emotional, physical, and mental health of informal caregivers of persons with severe mental health conditions worldwide. When caregivers feel overwhelmed, their ability to provide quality care is compromised. Although global evidence highlights the need for interventions to alleviate caregiver burden, such evidence is limited in low-resource settings, particularly in sub-Saharan Africa. This study addressed this gap by exploring service providers’ perspectives on formal and informal mental health services aimed at alleviating caregiver burden in rural South Africa. Descriptive qualitative design was adopted, and seven semi-structured individual interviews and two focus groups were conducted with twenty-nine (n = 29) mental health service providers in the Bushbuckridge municipality. Reflexive thematic analysis was performed using NVivo 12 software. Two themes were identified: caregiver and health system support strategies, and community and structural support strategies. Participants highlighted the need for caregiver-oriented mental health services and proposed multilevel strategies, including caregiver empowerment, psychoeducation, support groups, family therapy, and psychosocial rehabilitation. They also emphasised community-based support, awareness, respite and recreational services, intersectoral collaboration, and the development of targeted policies and guidelines to strengthen support for informal caregivers. The findings reflect service providers’ practical understanding of caregivers’ complex challenges and a clear vision for actionable, context-appropriate strategies to strengthen caregiver support. Given the service providers’ frontline role in mental health care, these perspectives are essential for informing the planning and implementation of interventions that are realistic, acceptable, and sustainable in low-resource settings. Future research should focus on developing and testing these strategies to enhance support systems for informal caregivers and improve outcomes for both caregivers and people living with mental health condition.

52. Spinal mechanisms and feasibility of Dry Needling versus Botulinum Toxin Type A in post-stroke lower limb spasticity: A proof-of-concept randomized clinical trial protocol (STROKE-POC).

期刊: PloS one 发表日期: 2026 链接: PubMed

摘要

Stroke often causes spasticity, impacting mobility and quality of life. Botulinum Toxin type A (BTX-A) and Dry Needling (DN) are treatments that reduce spasticity, although Botulinum Toxin type A injections can cause adverse effects. No studies have directly compared their effects at spinal, muscular, functional, quality-of-life, and cost-effectiveness levels. This study aims to determine the spinal mechanisms of BTX-A and DN on post-stroke lower limb spasticity, while also assessing feasibility, safety, and exploratory effects at muscular, functional, quality-of-life, and cost-effectiveness levels. This is a protocol of a proof-of-concept, feasibility randomized clinical trial including 90 participants from Canada, Belgium, and Spain who experienced a first stroke in the previous 12 months and present plantar flexor spasticity. Time since stroke (0-12 months) will be recorded and explored as a potential modifier of treatment response. Participants will be randomly assigned to receive either one session of BTX-A or 12 weekly sessions of DN. Blinded evaluators will assess outcomes before, during, and after treatment, with a 4-week follow-up. The primary outcome will be spinal mechanisms of spasticity, measured using the Tonic Stretch Reflex Threshold and its velocity sensitivity. Secondary outcomes will assess: a) muscular architecture and echotexture (measured with ultrasound); b) muscle tone/resistance using the Modified Ashworth Scale; c) gait and mobility (instrumented analysis, Timed Up and Go, 10-Meter Walk Test); d) muscle strength with dynamometry; e) quality of life with the EuroQoL questionnaire; and f) cost-effectiveness (analytic model). The findings will provide preliminary data to inform a future definitive trial. This research project has secured funding from the NEURON ERA-NET 2022 call, supported by the European Union’s Horizon 2020 program (GA 964215) and co-funded by the European Union-Next Generation, and has undergone peer review. Ethical approval has been obtained from Spain, Canada, and Belgium. The study is registered in ClinicalTrials.gov (NCT06296082) and the Clinical Trials Information System (CTIS) under the number 2024-510866-18-00. The study protocol is registered on Zenodo (https://doi.org/10.5281/zenodo.20034064). Clinical Trials NCT06296082; https://clinicaltrials.gov/study/NCT06296082.

53. Occupational stress, coping strategies, and associated factors among primary healthcare workers in Vietnam.

期刊: PloS one 发表日期: 2026 链接: PubMed

摘要

Occupational stress is a growing concern among healthcare workers (HCWs), particularly in primary care settings where responsibilities are multifaceted and resources are limited. This study aimed to determine the proportion of perceived stress levels, identify the coping strategies employed, and explore sociodemographic, familial, and occupational factors associated with stress among HCWs in a district-level health system in Ho Chi Minh City, Vietnam. A cross-sectional study was conducted from 19 February 2025-31 March 2025 involving 212 HCWs selected through total population sampling. Data were collected using a structured self-administered questionnaire comprising the 10-item Perceived Stress Scale (PSS-10) and the Brief COPE inventory. Descriptive statistics summarized participant characteristics and stress levels. Comparisons were performed using independent t-tests and one-way ANOVA, while Spearman’s rank correlation explored associations between continuous variables. Variables with p < 0.20 in univariate analysis were included in a multivariate linear regression model with backward elimination to identify independent predictors of stress. Multicollinearity was assessed using the Variance Inflation Factor (VIF). The mean PSS-10 score was 16.7 ± 2.3, with 93.4% of participants experiencing moderate stress and 6.6% low stress. The most frequently endorsed coping strategies were denial (5.8 ± 1.2), behavioral disengagement (5.4 ± 1.4), and substance use (5.0 ± 1.1). Multivariate analysis revealed that younger age, having chronic diseases, and being a physician were independently associated with higher perceived stress. The study reveals a high prevalence of moderate stress among HCWs in primary care, with frequent use of ineffective coping strategies. Interventions should be tailored to promote effective coping, reduce occupational burdens, and provide targeted support to vulnerable subgroups.

54. Skeletons in the permafrost: Exploring climate-driven heritage loss and occupational health at the early modern whaling burial site of Likneset, Svalbard.

期刊: PloS one 发表日期: 2026 链接: PubMed

摘要

Rapid Arctic warming is accelerating the degradation of permafrost-preserved archaeological sites, threatening both cultural heritage and the scientific information it contains. Early modern whaling burial sites on Svalbard are particularly vulnerable due to their organic-rich burial contexts and exposed coastal settings. This study presents an integrated taphonomic and osteological analysis of the Likneset whaling burial site in northwestern Svalbard, addressing climate-driven changes in preservation conditions (RQ1) and the embodied health costs of labour in early modern Arctic whaling (RQ2). The material comprises 20 individuals excavated across three phases (Phase I: 1985-1990, n = 14; Phase II: 2016, n = 3; Phase III: 2019, n = 3). The dataset allows comparison across excavation phases and between contrasting geomorphological settings within the burial site, distinguishing erosion-exposed areas (A) from a more stable central zone (B). Burial structures, coffins, skeletal remains, and textiles were assessed using a unified preservation scoring system, combined with osteological analyses of demography, metabolic disease, developmental stress, musculoskeletal degeneration, and trauma. Results show that preservation at Likneset is structured by local geomorphology and ongoing environmental change. Burials in erosion-exposed areas display extensive disturbance and loss of organic materials, while graves in more stable settings retain better-preserved structures, skeletons, and textiles. Comparison of closely spaced burials within the same erosion-exposed area, excavated several decades apart, documents continued in situ degradation, with textile materials declining more rapidly than skeletal remains. Osteological evidence indicates a largely homogeneous burial population composed predominantly of young adult men. Despite generally robust stature, the skeletal record documents widespread physiological stress, including metabolic disease, developmental stress markers, and extensive activity-related skeletal changes developing early in adulthood. Trauma is predominantly healed, suggesting that mortality was more closely linked to cumulative nutritional deficiency and prolonged physical strain. The results highlight growing challenges for heritage management on Svalbard, where strategies based on in situ preservation and managed decay are increasingly strained under warming permafrost conditions, underscoring the need for systematic monitoring, targeted documentation, and integration of archaeological data into climate adaptation planning before irreplaceable archives are lost.