公共卫生研究摘要 (2026-05-22)

共收录 56 篇研究文章

1. CSF1R-dependent CD169-positive macrophages locally constrain melanoma growth in the skin.

期刊: The Journal of experimental medicine 发表日期: 2026-Jul-06 链接: PubMed

摘要

Macrophages in the skin reside in multiple distinct layers and perform various functions. Here, we show that CD169+ macrophages reside in the hypodermis and comprise the major skin myeloid cell population in the steady state. In a syngeneic melanoma model, CD169+ macrophages encapsulate growing melanomas and directly suppress their growth. CSF1R blockade depleted CD169+ macrophages in tumors and resulted in unrestrained growth. This local containment of tumor growth in the skin was independent of CD169+ subcapsular sinus macrophages in the tumor-draining lymph node and did not require B or T cells. Intravital imaging revealed engulfment and ingestion of live tumor cells by CD169+ macrophages. This phagocytosis did not require the phosphatidylserine receptor MERTK. CD169+ macrophages are also enriched in the hypodermis in skin biopsies from healthy human skin and melanoma. These data identify tissue-resident CD169+ macrophages as a potential cellular target to achieve innate immune containment and reinforce adaptive immune control of tumors.

2. Land-Based Functional Rehabilitation Versus Aquatic Therapy on the Quality of Life of Individuals With Chronic Chikungunya: A Randomized Clinical Trial.

期刊: Physiotherapy research international : the journal for researchers and clinicians in physical therapy 发表日期: 2026-Jul 链接: PubMed

摘要

Chikungunya may progress to a chronic phase marked by persistent pain and functional impairment, reducing the quality of life. Exercise-based rehabilitation is essential, though comparisons between different modalities remain scarce. Exercises in an aquatic environment can be designed as a task-oriented intervention that utilizes hydrodynamic properties to modulate sensorimotor reweighting and enhance movement confidence. This study aimed to evaluate the effects of two functional rehabilitation programs-one land-based and one aquatic-on the quality of life of individuals in the chronic phase of chikungunya. A randomized clinical trial was conducted in Santa Cruz, RN, Brazil, with 53 participants of both sexes aged 18-75 years. Data were collected using a sociodemographic and health questionnaire developed for this study and 36-Item Short Form Health Survey (SF-36). Participants were randomly allocated to a land-based Functional Rehabilitation Group (FRG) or an Aquatic Therapy Group (ATG) and underwent functional exercise interventions twice weekly for 6 weeks. Descriptive statistics and linear mixed model analyses were performed, considering Group (FRG vs. ATG) as a between-subjects fixed effect, Time (pre-vs. post-intervention) as a within-subjects fixed effect, and the Group × Time interaction, adopting a compound symmetry covariance structure. The effect size was estimated using partial η2. The analysis revealed significant time effects across SF-36 domains, indicating overall improvement between pre- and post-intervention assessments. A significant Group × Time interaction was observed for the social aspects’ domain, with greater benefits in the FRG. Both rehabilitation programs, land-based and aquatic, significantly improved the quality of life of individuals in the chronic phase of chikungunya, with the land-based program showing superior results in social aspects.

3. Piloting a Tier 1 Strength-Based Parent Education Play Program: Promoting Play Within the Family Context.

期刊: The American journal of occupational therapy : official publication of the American Occupational Therapy Association 发表日期: 2026-Jul-01 链接: PubMed

摘要

Strength-based interventions can be an effective tool in promoting parental well-being in acting as change agents in their child’s early development. Play is central to early childhood and skill development. However, research rarely examines play-based interventions specifically addressing parent and child play. To assess the effectiveness of a Tier 1 strength-based play program on parents’ ability to support their child’s play and build parental sense of competence. A pilot, mixed-methods group, pre-post study. Virtual. Forty-six parents were recruited through convenience sampling methods, and 12 were assigned to either an intervention group delivered online or a control waitlist group. Tier 1 Promoting Family Resilience program. Parents completed a demographic questionnaire, the Parent/Caregiver’s View of Supporting Children’s Play and Playfulness, and the Parenting Sense of Competence Revised Scale. Open-ended pre- and postprogram questions were used to examine parents’ expectations and gains. For parents’ sense of competence, no significant differences were found between the two groups. However, a trend for significance was found for parents’ perception of their ability to support the child’s play, U = 6.00, p = .05. Parents in the experimental group reported a decrease in self-efficacy, Z = .00, p < .05. Parents’ expectations aligned with the postprogram responses emphasizing capacity building. Among the Tier 1 program benefits are capacity building and increased support for play. Limitations include a small sample size and difficulty retaining participants. Results highlight the potential of Tier 1 strength-based programs to support parents in promoting their children’s development through play education. Plain-Language Summary: Play is central to early childhood and skill development. Strength-based interventions can be an effective tool in promoting parental well-being and their child’s early development, especially if they focus on play. This pilot study assessed the effectiveness of a strength-based play program on parents’ ability to support their child’s play and build parental sense of competence. Twelve eligible parents agreed to participate in this study and were assigned to either an intervention group delivered online or a control waitlist group. We did not find differences between study groups in the parents’ sense of competence, but parents who attended the strength-based program reported an increase in their ability to support their child’s play. Parents also felt that the program met their expectations and supported capacity building. Parents benefited from the provision of educational tools to support their child’s development through play as well as ways to reduce parental stress.

4. A Correlation Study Exploring Sensory-Seeking Behavior: An Elusive Concept.

期刊: The American journal of occupational therapy : official publication of the American Occupational Therapy Association 发表日期: 2026-Jul-01 链接: PubMed

摘要

Sensory seeking (SS) is a behavior in which individuals actively pursue intense sensory experiences. It is commonly described in autistic children and those with other neurodevelopmental differences, as well as in typically developing individuals. Despite its prevalence, there is controversary regarding the underpinnings of this behavior. To determine whether, as proposed in Dunn’s model, SS is related to poor sensory registration in typical adolescents and adults. A correlational study examining relationships among factors in Dunn’s model. Schools, universities, occupational centers, and private organizations for adolescents and adults. Typically developing, Spanish-speaking adolescents and adults (>11 yr, n = 787). Pearson correlation coefficients were used to examine relationships between SS and poor sensory registration on the Spanish version of Adolescent/Adult Sensory Profile. A nonsignificant relationship (r = .004) was found between SS and poor sensory registration. Other sensory reactivity patterns showed some positive relationships. SS and poor sensory registration pattern did not show strong relationships as suggested by Dunn’s model in this sample. These data suggest that alternate views of the underlying mechanisms of SS may be needed. Plain-Language Summary: Sensory seeking has been linked to sensory reactivity problems but also to other problems, such as poor praxis and poor sensory perception. This study presents new data showing an absent or weak relationship between sensory seeking and poor sensory registration patterns and proposes alternate models of viewing sensory reactivity patterns and sensory seeking behavior.

5. Lung Cancer Screening and Prevention: Beyond Conventional Strategies in a Rapidly Changing Global Milieu.

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

摘要

Lung cancer remains the leading cause of cancer-related mortality worldwide despite advances in early detection and treatment. Furthermore, its epidemiology has undergone a profound transformation, necessitating a radical and comprehensive departure from traditional oncology frameworks. The historical paradigm, which focuses almost exclusively on tobacco smoking as the primary etiological driver, is increasingly inadequate to address the escalating global burden of lung cancer in never-smokers (LCINS). This epidemiologic shift is particularly evident in East Asian populations, where LCINS has transitioned from being a perceived outlier to becoming the dominant clinical phenotype, representing over 60% of all diagnosed cases in certain demographics especially in women. This comprehensive review integrates the exposome framework: a holistic methodology evaluating the cumulative and synergistic endogenous and environmental impact of air, water, and food pollutants across the human lifespan, with the practical and logistical implementation of precision screening. The addition of humanomics expands the concept of exposome to include societal structural inequalities. Rethinking lung cancer screening beyond a single imaging modality also requires a stronger focus on health equity. By synthesizing longitudinal data from the landmark TALENT study and integrating cutting-edge technologies such as artificial intelligence-driven risk prediction (Sybil) and advanced molecular triage using circulating tumor DNA, we advocate for a radical transition toward comprehensive computed tomography screening. This multisystem approach maximizes public health return on investment by simultaneously intercepting lung cancer, cardiovascular disease, and chronic respiratory illnesses at their earliest preclinical, asymptomatic, and most treatable stages.

6. Pregnancy and risk of melanoma: a matched retrospective cohort study.

期刊: Melanoma research 发表日期: 2026-May-22 链接: PubMed

摘要

Pregnancy-associated melanoma has long been debated, with hypotheses that gestational immune tolerance and elevated sex hormones may promote melanocytic transformation; however, large-scale, real-world evidence remains limited and conflicting. Using the TriNetX Global Collaborative Network, we conducted a retrospective cohort study of pregnant patients with documented first and third trimester encounters versus reproductive-age nonpregnant females with an encounter for contraceptive management and equivalent follow-up. Cohorts were 1:1 propensity-score matched on demographics, comorbidities relevant to immune function and cancer risk, and proxies for sun exposure and dermatologic surveillance. Incident invasive melanoma and melanoma in situ (MIS), stratified by anatomic site, were evaluated over a 21-month observation window corresponding to the duration of pregnancy plus 1 year postpartum. A sensitivity analysis restricted the pregnant cohort to patients with prior estrogen-based therapy exposure. In the primary analysis (n = 854 193 per cohort), pregnancy was not associated with increased risk of invasive melanoma [hazard ratio: 0.92, 95% confidence interval (CI): 0.78-1.07) or MIS (hazard ratio: 1.01, 95% CI: 0.82-1.24), and no significant differences emerged at head and neck, trunk, or extremity subsites. In the sensitivity analysis (n = 128 716 per cohort), findings were consistent, with no observed association with invasive melanoma (hazard ratio: 1.06, 95% CI: 0.76-1.49) or MIS (hazard ratio: 1.05, 95% CI: 0.67-1.65). Our results argue against pregnancy as an independent melanoma risk factor and point toward a baseline risk inherent to reproductive-age females.

7. Factors Associated with Burnout, Low Professional Fulfillment, and Intention to Leave Among Biomedical Research Faculty.

期刊: Journal of occupational and environmental medicine 发表日期: 2026-May-22 链接: PubMed

摘要

This study assessed the prevalence and correlates of burnout (BO), low professional fulfillment (PF), and intention to leave (ITL) among biomedical research faculty at an urban healthcare system. An anonymous survey was distributed to faculty in 2024, assessing demographics, workplace characteristics, culture, and stressors, leadership perceptions, and outcomes (BO, PF, ITL). Among research faculty (n=445; 43.3% response rate), an uncaring work environment and lower psychological safety were associated with both BO and low PF, with stress from uncompensated service additionally linked to BO. Lower leadership perceptions, uncaring work environment perceptions, and lower faculty rank were associated with higher odds of ITL. The consistent association of workplace culture, psychological safety, and leadership support with occupational well-being among biomedical research faculty underscores the importance of targeting these modifiable factors through institutional interventions.

8. Patterns of contextually sensitive adverse childhood experiences and associations with adult mental health outcomes in a longitudinal South African community sample: a latent class analysis.

期刊: Child abuse & neglect 发表日期: 2026-May-21 链接: PubMed

摘要

Adverse Childhood Experiences (ACEs) are associated with poor adult mental health, particularly in low-and middle-income countries where ACE exposure is high. This study used latent class analysis (LCA) to characterise patterns of ACEs in a longitudinal sample of South African adolescents and explored associations between ACE classes and adult mental health, including anxiety, depression, post-traumatic stress disorder, psychosis, and suicidality. Fourteen ACEs were assessed in 1648 adolescents (54.92% girls) from Mpumalanga using data collected across three waves (2010/2011, 2011/2012, and 2022/2023). Each ACE was dichotomised (exposed vs. not exposed), with exposure defined as meeting threshold criteria at either childhood wave. A four-class solution was identified: Low ACEs, High Parental AIDS-Affectedness and High Parental Sickness, High Parental AIDS-Affectedness and High Parental Death, and High multi-type ACEs. Compared to the low ACEs class, other classes had significantly higher poverty levels with further differences in gender, age and location. Adults in the highest multi-ACEs class reported significantly worse symptoms across all five mental health outcomes. Contextually sensitive ACEs (such as parental AIDS-affectedness) played an important role in differentiating ACE classes. Adults who experience multiple ACEs may be particularly at risk for poor mental health. In the two classes with, on average, the worst mental health outcomes, classes were primarily characterised by expanded ACEs, suggesting these broader adversities may confer unique risks in low-resource settings. Findings highlight the value of person-centred approaches like LCA to understand the complexity and multiplicative effects of ACEs and their long-term mental health impacts.

9. Childhood emotional maltreatment and psychosocial functioning in adulthood: Associations with generalized interpersonal trust, life satisfaction, and self-reported psychiatric morbidity in a representative German sample.

期刊: Child abuse & neglect 发表日期: 2026-May-21 链接: PubMed

摘要

Child maltreatment represents a major risk factor for psychological, physical, and social impairment across the lifespan. While the consequences of physical and sexual abuse are well documented, the impact of emotional abuse and neglect has long been underestimated. Recent evidence suggests that these forms of psychological maltreatment exert particularly far-reaching effects on social functioning and overall well-being. This study aimed to examine the long-term associations between different forms of childhood maltreatment - particularly emotional abuse -and key psychosocial outcomes in adulthood, including generalized interpersonal trust, life satisfaction, and self-reported diagnosed psychiatric morbidity. Analyses were based on data from a population-representative cross-sectional survey conducted in Germany (N = 2484; age range = 16-92 years; 46% female) between October 2024 and February 2025. Childhood maltreatment was assessed using the German version of the Childhood Trauma Questionnaire (CTQ). Emotional abuse and emotional neglect were combined into a single index of emotional maltreatment. Psychosocial outcomes included generalized interpersonal trust, overall life satisfaction, and the number of self-reported diagnosed mental disorders. Group differences were analyzed using MANCOVA; specific associations were tested via logistic regression analyses controlling for age, gender, and education. Missing data were handled using multiple imputation. Individuals with emotional or multiple maltreatment experiences reported significantly lower generalized interpersonal trust, lower life satisfaction, and higher self-reported diagnosed psychiatric morbidity (all p < .001). As an exploratory supplementary analysis, a series of logistic regression models was conducted to examine whether specific types of childhood maltreatment were differentially associated with distinct self-reported psychiatric diagnoses. Findings remained stable after multiple imputation. Emotional abuse and neglect are associated with profound, transdiagnostic reductions in psychosocial well-being and should be considered equally severe as other forms of child maltreatment in prevention, diagnosis, and intervention.

10. Pregnancy data in tuberculosis surveillance: Practices, priorities and perspectives from national TB programs in the Western Pacific and South-East Asia.

期刊: Public health 发表日期: 2026-May-21 链接: PubMed

摘要

Tuberculosis (TB) is the leading cause of death from an infectious disease, with the Western Pacific (WPR) and South-East Asia (SEAR) regions accounting for almost two-thirds of the global burden. Despite TB being a major cause of maternal mortality and adverse neonatal outcomes, no consensus exists on routine pregnancy-related data collection in national TB programmes (NTPs). This study aimed to map current practices, priorities, and perspectives regarding pregnancy data collection in TB surveillance across WPR and SEAR. We conducted a cross-sectional, mixed-methods survey of NTPs across WPR and SEAR. The survey assessed the landscape of pregnancy data collection, including existing and recommended practices, perceived importance and impact, barriers, and resource needs. Prioritization of indicators was evaluated using 5-point Likert scales. Quantitative data were analysed as categorical variables, and qualitative responses were thematically analysed. Of 47 countries/territories invited, 31 (66.0%) responded: 26 from WPR (26/36; 72.2%) and five from SEAR (5/11; 45.5%). Seven (22.6%) routinely collect pregnancy status in TB surveillance. Indicators most recommended were pregnancy/postpartum status at TB diagnosis (80.6%) and TB treatment (61.3%), as well as pregnancy (61.3%), neonatal (61.3%), and maternal outcomes (61.3%). Perceived importance of pregnancy data collection was high (median 4, IQR 3-5), as was anticipated impact on policy change (median 4, IQR 3-4). Key barriers identified included absence of international guidelines, insufficient training, and resource constraints. Despite broad recognition of its importance, routine collection of pregnancy-related data in TB surveillance remains uncommon. Addressing barriers through development of international guidelines, targeted training, and strengthened health information systems could better quantify the burden of TB in pregnant and postpartum women and drive solutions to improve maternal and neonatal outcomes.

11. Evaluating Pay-It-Forward Strategy to Promote Hepatitis B Virus and Hepatitis C Virus Testing Among International Migrants From Low- and Middle-Income Countries in China: Protocol for a Cluster Randomized Controlled Trial.

期刊: JMIR research protocols 发表日期: 2026-May-21 链接: PubMed

摘要

Hepatitis B virus (HBV) and hepatitis C virus (HCV) are significant global health concerns, particularly prevalent in low- and middle-income countries (LMICs). In China, a significant number of international migrants from LMICs reside, many of whom are at high risk of HBV and HCV infection, while this group tends to engage in low HBV and HCV test use due to some adverse factors. Pay-it-forward (PIF) is a social innovation strategy that is based on the theories of upstream reciprocity and mutual aid. Previous studies have shown that the PIF strategy has proven effective in promoting sexually transmitted infections (STIs) testing in various populations. This study aims to evaluate the effectiveness of a PIF intervention in promoting HBV and HCV testing among international migrants from LMICs in China. A 2-arm cluster randomized controlled trial (RCT) will be conducted in Guangzhou, China. Participants will be recruited from a public hospital serving a large migrant community. A total of 100 eligible participants will be enrolled in blocks of 5 using a cluster randomization plan and randomly assigned to either the PIF intervention arm or the control arm in a 1:1 ratio. Participants in the intervention arm will watch a 2-minute video introducing the PIF concept and receive printed educational materials on HBV and HCV. Participants will then be offered free testing donated by previous participants, which they can accept or decline, and an opportunity to make a monetary donation to cover testing for a future participant. Control arm participants will receive standard medical services, with self-paid testing. The primary outcome is the proportion of participants tested for both HBV and HCV. Data will be collected through a self-administered questionnaire, and test information will be obtained from the hospital’s medical records without personally identifiable information. The survey data will be analyzed using generalized estimating equations to account for clustering effects. This protocol was completed in August 2024, and implementation was conducted from September 2024 to February 2025. According to the baseline survey findings, 73.0% (73/100) of the 100 eligible participants recruited were male, 87.0% (87/100) were from African countries, and 85.0% (85/100) came to China for business purposes. About 40.0% (40/100) earned more than US $1100 per month, 62.0% (62/100) were married, and 6% (6/100) had both stable and casual sexual partners. This study is innovative in targeting international migrants from LMICs in China and using the PIF strategy to promote HBV and HCV testing. The PIF intervention is expected to increase testing rates by addressing financial barriers and fostering community support. The findings will contribute to the understanding of HBV and HCV testing promotion among this understudied population, with potential implications for public health policy and practice.

12. Definition and Test-Retest Reliability of a Monitoring Method Integrating Accelerometric Actigraphy and Bluetooth Indoor Location Tracking Applied in a Long-Term Residential Unit for Persons With Dementia: Longitudinal Observational Study.

期刊: JMIR mHealth and uHealth 发表日期: 2026-May-21 链接: PubMed

摘要

Dementia has an impact on the physical activities performed daily in a social context. Sleeping and resting, in general, are also affected by dementia. Monitoring techniques based on miniaturized wearable sensors and on sensorized environments allow for actigraphic recordings and location tracking. The availability of contemporaneous physical activities profile led to quantify, in the social actigraphy approach, the level of correlation between individuals living in the same environment. This study has two main objectives: (1) to define a methodology for actigraphic recordings, based on wearable accelerometers, and on location tracking, based on Bluetooth wearable technology, and to apply it in a well-defined social context, a long-term care residential unit for people with dementia; and (2) to quantify test-retest reliability of the indices obtained by the monitoring methodology. Persons with dementia living in the long-term care unit have been equipped with miniaturized wearable sensors, an accelerometer at their dominant wrist, and a Bluetooth beacon at their ankle for 7 days. The raw recordings allowed for computing indices related to physical activity intensities, to the occurrence of walking bouts, to the efficiency of sleep and waking phases, to social interactions between individuals, and to locations preferably occupied. The 7-day session was repeated at short (3 weeks) and long (3 months) terms in order to quantify the test-retest reliability of the indices. Twenty-five persons with dementia were enrolled, 4 of them dropped out, and valid data were obtained, in the different sessions, from 19 to 21 individuals of the recruited group. Control data from 10 age-matched healthy participants were derived from published datasets. As a group, compared with age-matched healthy participants, persons with dementia showed a comparable duration of phases of no activity and of light activity (energy cost lower than 3 metabolic equivalents of tasks [METs]), a relevantly lower duration (-84.3%) of phases of moderate activity (energy cost ranging from 3 to 6 METs), and substantial absence (-100%) of phases of vigorous activity (larger than 6 METs); moreover, daytime and nighttime were characterized by comparable wake and sleep, respectively, efficiency; finally, as to the social interactions, persons with dementia showed a lower correlation of their motor activity profiles (-53.1%). The test-retest reliability was excellent for physical activity indices (intraclass correlation coefficients ranging from 0.76 to 0.98), good for social indices (0.65-0.67), excellent for sleep or wake efficiency (0.74-0.89), and fair for location tracking indices (0.37-0.78). The considered methodology, particularly concerning accelerometry, proved to be feasible, informative, and with a good to excellent test-retest reliability. Interestingly, the methodology clearly identified behaviors, such as wandering, in a minority of individuals inside this study’s group of persons with dementia, thus supporting a possible clinical use of the methodology.

13. Effect of Integrated Internet-Based Acceptance and Commitment Therapy and Behavioral Activation Among Ethnic Minority Young Adults With Alcohol Use Disorder in Hong Kong: Pilot Randomized Controlled Trial.

期刊: Journal of medical Internet research 发表日期: 2026-May-21 链接: PubMed

摘要

Alcohol use disorder (AUD) profoundly affected ethnic minority young adults due to unique stressors, such as acculturation challenges and discrimination. Our prior studies found that experiential avoidance behavior and discrimination significantly contributed to AUD. These findings warranted third-wave interventions, such as acceptance and commitment therapy (ACT). Nonetheless, barriers to engagement with value-based activities may affect ACT efficacy. Behavioral activation (BA) may be an alternative for this shortcoming. Integrating these interventions has shown promise. However, no studies evaluated its effectiveness in this group. Therefore, evaluating the preliminary effectiveness and feasibility of this intervention was needed. This study aimed to evaluate the feasibility measures. The secondary objective aimed to examine its effectiveness on cumulative abstinence duration, drinking days, drinks per drinking day, heavy drinking days, alcohol abstinence self-efficacy, readiness to change, psychological flexibility (Acceptance and Action Questionnaire-version II), and everyday discrimination score. A pilot parallel randomized controlled trial was conducted. Forty young ethnic minorities who can speak English and have AUD based on DSM-5 (Diagnostic and Statistical Manual of Mental Disorders [Fifth Edition]) criteria were recruited and randomly assigned to either Acceptance and Commitment Therapy with Behavioral Activation (ACT-BA; n=20) or Treatment-as-Usual (TAU; n=20) using a computer-generated random number; assessors were blinded to group assignment. Outcomes were collected at baseline (T0) and postintervention (T1). The analysis included descriptive statistics, independent samples t test, chi-square test, and generalized estimating equations with multiple imputations. To further supplement findings, a qualitative interview was conducted. A total of 148 ethnic minority young adults were screened, with an eligibility rate of 38.5% (57/148). Of these, 85.9% (49/57) consented, and among them, 81.6% (40/49) were randomized to either the ACT-BA or TAU. The retention rate was 82.5% (33/40), of which 75% (30/40) completed the postintervention assessment (ACT-BA: 16/20, 80%; TAU: 14/20, 70%). The adherence rate was 81.7% (4.9/6 sessions), and participants reported no adverse effects. Finally, 40 participants (20 for each group) were analyzed. The intervention group showed a promising improvement in drinking days (B=-4.12, 95% CI -8.10 to -0.13; P=.04, d=-0.57), drinks per drinking day (B=-1.56, 95% CI -3.06 to -0.07; P=.04, d=-1.89), alcohol abstinence self-efficacy (B=11.95, 95% CI 0.10-23.81; P=.048, d=0.81), and Acceptance and Action Questionnaire-version II (B=-6.41, 95% CI -12.77 to -0.06; P=.04, d=-0.65). This study, unlike existing evidence, presents an innovative integration of ACT and BA delivered via an internet-based self-help format. The findings contribute to the field by providing preliminary evidence that this integrated intervention is feasible and promising for AUD. The main implication in the real world is to conduct a fully powered randomized controlled trial to further examine its effectiveness with longer follow-up to serve as a stand-alone treatment option for ethnic minorities.

14. Japanese-Language AI Agent System for Human Papillomavirus Vaccine Infoveillance and Public Communication: Development and Feasibility Evaluation.

期刊: JMIR infodemiology 发表日期: 2026-May-21 链接: PubMed

摘要

Human papillomavirus (HPV) vaccine hesitancy remains a significant public health challenge in Japan, where proactive vaccination recommendations were suspended between 2013 and 2021. The resulting information gap between medical institutions and vaccine-hesitant populations is exacerbated by misinformation on social media platforms. Traditional public health communication strategies cannot address individual queries while simultaneously monitoring population-level discourse. This study aimed to develop and conduct a feasibility evaluation of a dual-purpose artificial intelligence agent system that delivers verified HPV vaccine information to the public through a conversational interface while generating infoveillance reports for medical institutions based on user interactions and social media discourse. We implemented a system with 3 components: a vector database integrating 139,803 documents, including academic papers, Japanese government sources, news media, and social media posts; a retrieval-augmented generation chatbot using a ReAct agent architecture with iterative multitool orchestration across 5 specialized knowledge sources; and an automated report generation system with modules for news analysis, research synthesis, social media sentiment analysis, including stance classification and topic modeling, and user interaction pattern identification. System performance was assessed using both automated and manual evaluation protocols on a scale from 0 to 5. The entire system functioned as expected. For single-turn evaluation, the chatbot achieved mean scores of 4.83 (SD 0.67; 95% CI 4.71-4.93) for relevance, 4.89 (SD 0.53; 95% CI 4.79-4.97) for routing, 4.50 (SD 1.29; 95% CI 4.27-4.70) for reference quality, 4.90 (SD 0.62; 95% CI 4.78-4.99) for correctness, and 4.88 (SD 0.54; 95% CI 4.78-4.96) for professional identity, with an overall mean of 4.80. Multiturn evaluation yielded higher mean scores: 4.94 for context memory (SD 0.25; 95% CI 4.84-5.00) and an overall mean of 4.98, with topic centering and identity achieving 5.00. The report generation system achieved high scores across all sections: 4.83 for completeness (SD 0.37; 95% CI 4.73-4.94), 4.88 for correctness (SD 0.33; 95% CI 4.77-4.96), and 4.12 for helpfulness (SD 0.48; 95% CI 3.98-4.27). Reference validity achieved perfect scores (5.00) across all periods, with citation correctness averaging 4.21 (SD 0.58; 95% CI 3.96-4.46). This feasibility study demonstrated that an integrated artificial intelligence agent system can support both public HPV vaccine communication and social media infoveillance in a Japanese-language context. Prospective deployment with real users is needed to assess actual public health impact.

15. Efficacy of Internet-Based Self-Help Interventions for Irritable Bowel Syndrome: Systematic Review and Meta-Analysis of Randomized Controlled Trials.

期刊: Journal of medical Internet research 发表日期: 2026-May-21 链接: PubMed

摘要

Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder that reduces quality of life and causes a heavy medical burden. Internet-based self-help interventions are flexible and scalable, showing potential for IBS symptom improvement, but relevant evidence is fragmented and lacks systematic review. This systematic review aimed to comprehensively evaluate the effects of internet-based self-help interventions on symptom severity, quality of life, and visceral sensitivity, as well as comorbid depressive and anxiety symptoms, in individuals with IBS. Only randomized controlled trials evaluating internet-based self-help interventions for individuals with IBS were included. A literature search was conducted across PubMed, Embase, Web of Science, CINAHL Complete, PsycINFO, the Cochrane Library, and 4 Chinese databases on June 25, 2025, with an updated search on March 9, 2026. Risk of bias was assessed using the Cochrane Risk of Bias 2.0 tool. Meta-analyses were performed with the Hartung-Knapp-Sidik-Jonkman-adjusted random-effects model. Effect sizes were reported as standardized mean differences (SMDs) with 95% CIs, and evidence certainty was evaluated using GRADE (Grading of Recommendations Assessment, Development, and Evaluation) criteria. A total of 17 randomized controlled trials from 7 countries were included, involving 2289 participants (predominantly female). Compared with control groups, internet-based self-help interventions were associated with a statistically significant improvement in IBS symptom severity (SMD -0.52, 95% CI -0.78 to -0.26, 95% prediction interval [PI] -1.46 to 0.42), quality of life (SMD 0.57, 95% CI 0.23 to 0.90, 95% PI -0.41 to 1.54), visceral sensitivity (SMD -0.55, 95% CI -0.89 to -0.21, 95% PI -1.43 to 0.33), and depressive symptoms (SMD -0.14, 95% CI -0.27 to -0.01, 95% PI -0.27 to -0.01). However, no statistically significant improvement was observed in anxiety symptoms (SMD -0.03, 95% CI -0.34 to 0.27, 95% PI -0.78 to 0.71). The certainty of evidence was rated as moderate to very low for all outcomes. This review synthesizes the latest evidence on internet-based self-help interventions for individuals with IBS disease-specific and comorbid psychological symptoms. It stands out by encompassing a diverse range of such interventions and incorporating visceral sensitivity as a key outcome. In doing so, it establishes a more comprehensive multi-outcome evidence base for IBS digital interventions, advancing the field by clarifying the potential of these interventions as viable alternatives to conventional treatments. For real-world practice, these findings can inform targeted strategies for primary care and telemedicine platforms, especially in resource-limited regions. However, this review is limited by moderate bias risk, high heterogeneity, and moderate to very low GRADE evidence certainty. A wide 95% PI suggests that effect variability is linked to contextual and population factors, so findings should be interpreted cautiously. Future research should prioritize technical support, patients’ digital health literacy, and standardized intervention protocols to further validate clinical utility.

16. Telemedicine Service Experience Questionnaire for Chinese Outpatients: Development and Validation Study.

期刊: JMIR human factors 发表日期: 2026-May-21 链接: PubMed

摘要

Telemedicine has rapidly expanded; however, standardized, telemedicine-specific patient-reported experience measures tailored to outpatient workflows are limited in many settings. This study aimed to develop and psychometrically validate the Telemedicine Service Experience Questionnaire (TSEQ) for Chinese outpatients using telemedicine services. We conducted a web-based survey among outpatients who completed a telemedicine consultation at Peking Union Medical College Hospital between July 1, 2021, to August 31, 2021, and who had used telemedicine services, using an adapted Chinese Patient Experience Questionnaire that encompasses 15 questions across 4 dimensions, to investigate patients’ telemedicine consultation experiences. Item generation was informed by a literature review, workflow mapping, and expert review. We evaluated the factor structure using exploratory factor analysis and confirmatory factor analysis on the full sample with cross-validation. Reliability was assessed using Cronbach α and item-total correlations. In total, 3338 participants completed the survey (mean age 45.3, SD 17.8 y; n=2182, 65.4% female participants; n=1827, 54.8% with college education or above). The exploratory factor analysis of the final 14-item scale resulted in 4 factors. After scrutinizing the content, these factors were labeled “Service Efficiency,” “Post-treatment,” “Information Guidance,” and “Humanistic Care,” and they demonstrated good internal consistency (Cronbach α values of 0.876, 0.840, 0.962, and 0.876, respectively). Moreover, as the average variance extracted values were greater than 0.5 and the composite reliability values were greater than 0.7, the TSEQ scale has high convergent validity. Our findings suggest that the psychometric properties of the 14-item TSEQ are valid and reliable for assessing telemedicine service experience among Chinese outpatients. The TSEQ demonstrates a stable multidomain structure with satisfactory reliability and validity for evaluating outpatient telemedicine service experience in China. The instrument can support routine quality monitoring and guide targeted workflow improvements. Future studies should validate the TSEQ in multisite and postpandemic samples and examine measurement invariance across key subgroups.

17. Empowering Older Adults Through Values-Informed Solutions for Technology Adoption: Protocol for a Feasibility and Acceptability Randomized Controlled Pilot Trial.

期刊: JMIR research protocols 发表日期: 2026-May-21 链接: PubMed

摘要

Although technology usage is steadily increasing among older adults, adoption and confidence greatly lag behind their younger counterparts. Sociocultural and health disparities intersect with aging to present distinct structural and psychosocial barriers to the adoption of newer technologies. Digital health literacy interventions can improve task-specific skills, technological self-efficacy, and use frequency, but most do not systematically incorporate older adults’ values and goals, which are key drivers of sustained behavior change. The proposed study aims to develop and evaluate the acceptability and feasibility of a person-directed, values-based, in-home digital literacy intervention for older adults, entitled values-informed solutions for technology adoption (VISTA). VISTA begins with a values and goals discussion rather than a skills test, mapping “What Matters Most” to individualized, SMART (specific, measurable, achievable, relevant, and time-bound) technology goals. Over 8 to 12 weeks, interventionists co-developed personalized learning plans with participants, delivering up to 6 in-home biweekly visits and interim phone calls. The study provided a tablet and assistance with obtaining home internet when needed. Outcomes included digital literacy (Mobile Device Proficiency Questionnaire), technology and chronic disease self-efficacy, social networks, multimorbidity, and frailty (Fried Frailty Phenotype). Feasibility was assessed via recruitment, retention or completion, data collection rates, survey administration time, withdrawal, intervention fidelity, and per-person cost; acceptability was assessed via a postintervention satisfaction survey (Likert and open-ended items) and willingness to recommend. Funding was secured in November 2023. Institutional review board approval, intervention development, and focus groups were completed throughout 2024. Recruitment and baseline assessments occurred from January 2025 to July 2025, enrolling 21 participants and randomizing 11 to immediate intervention and 10 to waitlist control (waitlist participants received the intervention after a 3-month control period). One consented participant was unable to participate early in the intervention and is not included in analyses. Inclusion criteria included being aged 65 years and older, having English proficiency, and demonstrating a willingness to improve digital literacy. Exclusion criteria involved severe cognitive impairment. At baseline, participants had a mean age of 75.7 (SD 7.74) years and were predominantly female (n=13, 65%) and Black (n=19, 95%); most reported having a low income (10/12, 83%), living alone (12/14, 85.7%), and multimorbidity (mean disease count 3.95, SD 2.46). Follow-up assessments concluded in March 2026; data cleaning and analysis are ongoing, with primary feasibility and acceptability findings anticipated for fall 2026. This protocol offers a unique model centering on the values and goals of older adults to improve access, use, and understanding of technology. Tapping into the motivators of older adults may provide a more beneficial way to encourage older adult technology use. VISTA could be useful in many general contexts, more specifically for older adults who are homebound or have serious illnesses, or as a preintervention for interventions involving advanced technology understanding.

18. Epidemiological and clinical data link depot medroxyprogesterone acetate to meningioma.

期刊: Neuro-oncology 发表日期: 2026-May-21 链接: PubMed

摘要

Meningiomas are among the few intracranial tumors that are more common in females than males. The majority of meningiomas express progesterone receptor (PR), and differences in exposure to progestogens are thought to contribute to sex-based disparity in meningioma. Previous epidemiological and clinical data have demonstrated that multiple progestins, such as cyproterone acetate (CPA), are linked to meningioma. More recently, international epidemiological studies have found a significantly increased risk of meningioma with depot medroxyprogesterone acetate (DMPA), a widely used injectable contraceptive sold under the trade name Depo-Provera. Although the absolute risk of meningioma remains small, exposure to DMPA increases the risk of meningioma by 1.5- to 5.5-fold. DMPA-associated meningiomas are clinically significant, as the risk of craniotomy for tumor resection, not just the risk of tumor diagnosis, is elevated after DMPA exposure. These data suggest that DMPA should be avoided in individuals with a history of meningioma when alternatives are available. The risk of meningioma should be discussed with patients during DMPA counseling, and the utility of screening patients with prolonged DMPA exposure for meningiomas should be investigated. Further work is needed to elucidate the mechanisms of PR signaling in meningioma and to understand the complex interplay of tumor genomics, hormone exposure and signaling, and social and structural drivers of health that may contribute to disparities in meningioma. Most meningiomas express progesterone receptor and are thought to be sensitive to progestogens, which include endogenous progesterone and synthetic progestins. Depot medroxyprogesterone acetate (DMPA), a progestin, is the active ingredient in a birth control known as Depo-Provera. Large-scale epidemiologic studies from France, Sweden, and the United States consistently demonstrate that exposure to DMPA increases the risk of meningioma. Through a comprehensive review of clinical and epidemiological data, we recommend that DMPA should be avoided in those with a history of meningioma if safe and tolerable alternatives are available, and that DMPA should be stopped if meningioma is diagnosed.

19. Surrogate Endpoints are Risky Business in Pulmonary Arterial Hypertension.

期刊: American journal of respiratory and critical care medicine 发表日期: 2026-May-21 链接: PubMed

摘要

20. Mobile Health Technology for Personalized Tobacco Cessation Support in Laos (Project Support Laos): Protocol for a Randomized Controlled Trial.

期刊: JMIR research protocols 发表日期: 2026-May-21 链接: PubMed

摘要

Tobacco use remains the leading cause of preventable morbidity and mortality in Lao People’s Democratic Republic (Lao PDR). Despite the prevalence of cigarette smoking in Lao PDR (51% in men and 7% in women), no national tobacco treatment programs are available. Therefore, the development and evaluation of sustainable tobacco cessation interventions suitable for widespread adoption in Lao PDR are pressing public health needs. This project aims to adapt our theoretically and empirically based mobile health (mHealth) technology to help people quit smoking cigarettes in Lao PDR. Our mHealth approach includes a fully automated, interactive, personalized, smartphone-delivered intervention for behavioral treatment. This project includes 2 main phases. In the first phase, we use formative research methods to adapt our intervention content to the sociocultural context, language, and communication styles of Laotians. In the second phase, we conduct a randomized controlled trial to evaluate the efficacy of our mHealth intervention. In the trial, adult smokers are recruited through 2 national hospitals: Setthathirath Hospital in Vientiane and Champasak Hospital in Champasak Province. Participants (n=500) are randomized to either the standard care (SC; n=250) or automated treatment (AT; n=250) group. SC consists of brief advice to quit smoking delivered by research staff, self-help written materials, and a 2-week supply of nicotine replacement therapy (transdermal patches). AT consists of all SC components plus a fully automated smartphone-based treatment program that involves interactive and personalized proactive messages, images, or videos. The primary health outcome of the trial is biochemically confirmed self-reported 7-day point prevalence abstinence 12 months post study enrollment. Secondary outcomes include abstinence at 3 and 6 months post enrollment. This study was approved by the ethical review boards of the respective domestic and international institutions. Data collection for the formative phase occurred from January 2022 to May 2023, and data analyses are ongoing. Data collection for the trial phase is ongoing and is expected to be completed by the end of 2026. If the proposed project is successful, it has the potential to transform health care services for tobacco treatment throughout Lao PDR and, ultimately, to significantly reduce tobacco-induced morbidity and mortality in the country. The AT’s potential for widespread adoption and sustainability is enhanced by the direct involvement of Lao governmental stakeholders at multiple national institutes. Furthermore, the US-Lao collaborative work and capacity-building activities in this project will contribute to creating a knowledge base for mHealth research applications and advancing mHealth research capacity in Lao PDR.

21. Scientists play catch-up to startling Ebola outbreak.

期刊: Science (New York, N.Y.) 发表日期: 2026-May-21 链接: PubMed

摘要

Testing, sequencing, and clinical trial efforts spring to life as Bundibugyo virus spreads.

22. Toward Participatory Precision Health With Co-Designed Recommendations: Systematic Review of Just-in-Time Adaptive Interventions in Adolescents and Young Adults.

期刊: Journal of medical Internet research 发表日期: 2026-May-21 链接: PubMed

摘要

The transition from adolescence to young adulthood (age 10-25 years) constitutes a sensitive developmental period marked by rapid biological, psychological, and social change, during which preventive health interventions can shape long-term outcomes. Mobile health tools offer accessible opportunities for tailored support for this population, but often adapt poorly to dynamic contexts, resulting in inconsistent engagement and effects. Just-in-time adaptive interventions (JITAIs), which tailor support in real time using ongoing data, are increasingly explored as precision health strategies. However, how these mechanisms are designed, implemented, and evaluated for adolescents and young adults (AYAs) has not been systematically reviewed. This review aimed to synthesize the evidence on JITAIs developed for AYAs, examine how their adaptive mechanisms have been designed to support specific health goals and changing AYA contexts, and assess methodological reporting quality to inform future precision health intervention development. We conducted a systematic review in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and SWiM (Synthesis Without Meta-Analysis) reporting guidelines. Twelve databases were searched for peer-reviewed studies published from 2013 to 2025. Eligible studies focused on participants aged 10 to 25 years and reported real-time adaptive mobile health interventions consistent with JITAI design principles. Two reviewers independently conducted screening, data extraction, and methodological quality appraisal using the Joanna Briggs Institute checklists. AYA coauthors contributed to all phases. Due to substantial heterogeneity in study populations, intervention content, adaptive mechanisms, comparators, and outcome measurements, findings were synthesized narratively, and no meta-analysis was conducted. A total of 61 unique interventions were included. JITAIs for AYAs addressed substance use (n=24, 39.3%), mental health (n=23, 37.7%), and physical health or chronic conditions (n=14, 23%). JITAI tailoring mechanisms relied predominantly on self-reported behavioral data. Decision rules were typically symptom threshold-based, and decision points were commonly daily or event-triggered. Methodological concerns with reporting on intervention administration, participant selection, and outcome measurement reliability were pervasive across all studies, limiting the interpretability of observed effects and cross-study comparisons. Ethical considerations, including researcher positioning and reflexivity, alongside the depth of reporting around participatory AYA engagement in design and implementation, were also inconsistent. This review contributes a novel perspective to AYA digital health by moving beyond intervention outcomes to examine how core adaptive mechanisms are operationalized for AYAs across multiple health domains, while also integrating AYA perspectives into the interpretation of findings and recommendations. Unlike prior reviews focused primarily on adults or specific conditions, it identifies broader contextual, methodological, and ethical considerations relevant to AYA precision health. These findings highlight the need for more transparent, contextually responsive, and youth-centered adaptive interventions, alongside more rigorous designs for evaluating adaptive intervention components in daily life contexts.

23. Large Language Models in Colorectal Cancer Care and Clinical Decision Support: Systematic Review.

期刊: Journal of medical Internet research 发表日期: 2026-May-21 链接: PubMed

摘要

Colorectal cancer (CRC) is a leading cause of cancer morbidity and mortality worldwide. The complexity of guideline-concordant care and unstructured clinical data has driven demand for decision-support tools. Large language models (LLMs) show promise for processing clinical data and patient-provider communication, yet evidence is fragmented, and a CRC-specific synthesis across the full care continuum is lacking. This systematic review evaluates the current applications, performance determinants, and clinical implications of LLMs across the continuum of CRC care. Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses), we searched 6 databases (PubMed, Embase, Web of Science, Scopus, CINAHL, Cochrane) through April 1, 2026. Eligible studies were peer-reviewed original investigations of LLMs on CRC tasks with extractable outcomes; reviews, editorials, and abstracts were excluded. Two reviewers assessed quality with QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies-2), PROBAST (prediction model risk of bias assessment tool), and ROBINS-I (Risk of Bias in Nonrandomized Studies - of Interventions). Data on model types, applications, prompts, input/output formats, and outcomes were analyzed descriptively, with narrative synthesis per synthesis without meta-analysis (SWiM) guidelines. Of 8880 records, 37 studies met inclusion criteria (2023-2026), mostly from China and the United States, with GPT series most frequently evaluated. Overall risk of bias was low in 10/37 studies (27.0%), moderate in 14/37 (37.8%), unclear in 7/37 (18.9%), and high or serious in 6/37 (16.2%). Problematic domains included outcome measurement, intervention classification, patient selection, and lack of blinded assessment. LLMs showed utility in automating data extraction from clinical texts, supporting patient education, aiding diagnosis, and assisting clinical decision-making, with emerging visual interpretation and multimodal capacities. Domain-specific and multimodal models showed advantages over general-purpose models in certain tasks. Performance was significantly influenced by prompt design, from zero-shot queries to fine-tuning. Despite efficiency and outcome benefits, challenges persist regarding methodological quality, data privacy, and generalizability. This review provides an integrative framework synthesizing evidence across study designs and LLM categories in CRC care. Unlike prior reviews addressing gastroenterology broadly or limited to one design, it covers the full CRC continuum and, for the first time, comparatively evaluates general-purpose, domain-specific, and multimodal LLMs, clarifying how prompt engineering and heterogeneous metrics shape outcomes. Although findings support LLMs’ clinical potential, results must be interpreted cautiously, given low overall evidence quality. Most studies lacked safeguards against bias-blinded assessment, confounder adjustment, or prospective multicenter validation. Substantial heterogeneity across tasks, LLM types, prompts, reference standards, and outcomes means reported advantages cannot be generalized. Future work should prioritize real-world integration via prospective multicenter validation, robust privacy frameworks, and rigorous human oversight. Amid rising global CRC burden and health care disparities, this review informs clinical translation, equitable scaling, and policy on LLM deployment.

24. Clinical Decision Support to Reduce Opioid Prescribing at Discharge for Inpatients Undergoing Surgery (LESS Study): An Interrupted Time Series Analysis.

期刊: Anesthesiology 发表日期: 2026-May-21 链接: PubMed

摘要

Unnecessary opioid prescribing following surgery is wasteful and expands the reservoir for non-medical use, thereby contributing to preventable morbidity and mortality. We used an interrupted time series design to evaluate whether implementing a system-wide clinical decision support (CDS) intervention reduced opioid prescribing at discharge. We included adult surgical patients hospitalized for at least 24 hours who had not received any opioids in the 24 hours prior to discharge, as prescriptions in this cohort are more likely to represent unnecessary opioid prescribing. The pre- and post-intervention two-year periods were 2/13/21-2/12/23 and 2/13/23-2/12/25, respectively. Our primary outcome was discharge oxycodone in morphine milligram equivalents (MME). Secondary outcomes included whether any opioids were prescribed, and if so, how much. Segmented regression models adjusted for confounders were used to assess the immediate and trend-level effects of the intervention. Analyzed data included 10,422 pre- and 11,795 post-intervention discharges. Total oxycodone prescribed per discharge was 27.4 MME pre-intervention and 16.5 MME post-intervention. Oxycodone MME prescribed at discharge was significantly lower post-intervention, with a ratio of geometric means of 0.83 (95% CI: 0.76, 0.90; 1-tailed superiority P <0.001) for the level change but no difference in slopes (P=0.919). For secondary outcomes, 21% of discharges were prescribed any oxycodone pre-intervention versus 18% post-intervention, with a relative risk of 0.87 (95% CI: 0.79, 0.96) assessing the level change. For the discharges with a prescription, median MME [Q1, Q3] was lower after intervention than before (75 [38, 112] vs 112 [75, 150]), with a ratio of geometric means of 0.70 (95% CI: 0.65, 0.75). An automated real-time clinical decision support tool resulted in clinically significant reductions in oxycodone prescribed at discharge. Incorporation of similarly simple decision support tools in electronic health record systems may significantly reduce unnecessary opioid prescriptions at scale and better align with guideline-concordant care.

25. Horizon Scanning for Medical Technologies: Methodological Framework Development Study of the Medical Innovation Scanning Techniques (MIST) Framework.

期刊: Journal of medical Internet research 发表日期: 2026-May-21 链接: PubMed

摘要

Strategic foresight relies on horizon scanning to detect weak signals of innovation and anticipate disruption in fast-moving MedTech. While tools such as the Rumsfeld matrix and the Three Horizons model structure thinking about uncertainty and time, their application in MedTech is limited and insufficient for addressing the regulatory, technical, and evidential complexity of emerging or disruptive technologies. Regulatory frameworks provide stability through defined safety and performance pathways, but shifts and regional variability requirements complicate anticipatory assessment. These challenges expose methodological gaps in current practice: broad foresight frameworks lack the technical granularity, regulatory alignment, and systematic processes required for MedTech, where rapid innovation intensifies uncertainty. This paper presents a structured methodological framework to support systematic, reproducible, and decision-focused horizon scanning in MedTech. The framework aims to (1) standardize methods for planning, execution, and reporting; (2) reduce uncertainty through systematic identification and interpretation of weak signals; and (3) improve transparency, quality, and comparability across policy, regulatory, clinical, and strategic contexts. The framework was developed following the 3-step process by McMeekin et al. First, data were identified through a mapping review of MedTech futures and foresight methods, mapping UK health care decision-makers, and participating in national and international horizon scanning initiatives (2021-2025). Second, the framework was constructed by integrating the sources, methods, and insights with the principles of regulatory and technology readiness, supported by ongoing consultation with UK regulatory and health system bodies. Third, the framework is being applied and tested in MedTech horizon scanning projects. Formal validation and iterative revision are planned. The MedTech Innovation Scanning Techniques (MIST) framework integrates foresight theory, horizon scanning methods, and the MedTech innovation pathway, enabling systematic weak signal detection across 3 time horizons. In the imminent horizon (technology readiness level [TRL] 8-9), uncertainty is lowest, and weak signals are more visible, supported by rapid evidence synthesis and expert engagement. In the transitional horizon (TRL 4-7), uncertainty increases due to trial outcomes, funding, and market dynamics, requiring broader evidence sources and complementary techniques such as scenario analysis and bibliometrics. In the emerging horizon (TRL 1-3), weak signals are abundant but least predictable; early-stage data (patents, preclinical research, and conference outputs) are analyzed using methods such as term-similarity visualization to reveal nascent innovations. Across all horizons, MIST supports systematic signal identification, contextualization, and prioritization to inform anticipatory decision-making. MedTech horizon scanning is challenging. MIST addresses these challenges by integrating the Three Horizons model, Rumsfeld matrix, technology pathways, regulatory considerations, and sources to guide weak signal detection. MIST provides a structured, transparent, and reproducible approach tailored to MedTech. While formal validation and integration of equity and ethical dimensions are ongoing, the framework fills a critical methodological gap in horizon scanning for MedTech.

26. Aid, Debt, IMF Conditionalities and Domestic Health Financing in Low- and Middle-Income Countries.

期刊: Health policy and planning 发表日期: 2026-May-21 链接: PubMed

摘要

Across Low- and Middle-Income Countries (LMICs), public external debt burdens as well as the number of International Monetary Fund (IMF) loan conditionalities have grown over time. These externally derived macro-fiscal factors, along with Official Development Assistance (ODA), may influence the fiscal space for health and policy decisions that co-determine to what extent countries finance their health systems with domestic government funds (GHE-S), and to what extent they rely on household Out-Of-Pocket Payments (OOP). The levels and balance of these sources have great implications for health service access and health outcomes, particularly among poorer population groups. However, we did not identify studies that have jointly examined how these key external factors are associated with GHE-S and OOP, nor compared their correlation sizes. This is key for understanding which might be the most effective policy levers for pursuing Universal Health Coverage (UHC). We performed a panel data study of 105 LMICs from 2005-2019, investigating associations between GHE-S and OOP, and a set of ODA-, public external debt- and IMF programme and conditionality variables. We used the Generalised Method of Moments estimator and performed a range of robustness checks. Increases in ODA via the recipient country public sector were associated with modest reductions in both OOP and GHE-S, measured per GDP. Increases in public external debt servicing per GDP were associated with slight relative increases in OOP and slight relative decreases in GHE-S per CHE. We found no relationship between IMF programme participation or conditionalities and GHE-S or OOP. Our findings support less donor concern of aid fungibility in the health sector, while adding that both on- and off-budget ODA for health also appear to modestly subsidise OOP. Our findings for debt indicated a small shift in the burden of payment from government onto the user from increasing public external debt servicing. This provides some added support to calls for debt resolution among more heavily indebted LMICs to avoid the negative health service access implications from OOP.

27. Stricter Regulation in the United States of Direct-to-Consumer Drug Advertising: Better, but Not Enough.

期刊: American journal of public health 发表日期: 2026-May-21 链接: PubMed

摘要

In September 2025, President Donald J. Trump directed the Department of Health and Human Services and the Food and Drug Administration to strengthen enforcement of prescription drug advertising regulations. In response, plans were announced to close digital loopholes in direct-to-consumer advertising, pursue regulatory violations, and eliminate the 1997 “adequate provision,” which permits advertisements to omit key safety information. Although these reforms aim to promote “radical transparency,” their impact on prescribing patterns is uncertain. Direct-to-consumer advertising is designed to elicit a strong positive emotional response that affects one’s ability to properly weigh risk. Even if direct-to-consumer advertisements are required to disclose more information regarding potential risks, the emotional response elicited will still positively influence demand. This is not speculation: there is ample evidence before the implementation of the 1997 adequate provision showing that pharmaceutical advertising influenced prescribing behavior. Accordingly, it is unlikely that pending regulatory and enforcement changes will meaningfully reduce overdiagnosis, overtreatment, or health care spending. However, given the current momentum to confront these problems, public health scholars should seize the opportunity and advance evidence-based policy solutions. (Am J Public Health. Published online ahead of print May 21, 2026:e1-e6. https://doi.org/10.2105/AJPH.2026.308469).

28. What does it mean to be cognitively and socially active in the context of dementia risk reduction? An integrative review.

期刊: Aging & mental health 发表日期: 2026-May-21 链接: PubMed

摘要

To examine how cognitive and social activities are defined by identifying relevant attributes in the literature on brain aging and dementia risk reduction. Using an integrative review, we analysed definitions across 43 academic and 37 grey records to formulate definitions. We observed substantial heterogeneity in terminology to describe concepts and their attributes. Nine higher-order attributes were identified: interacting with others, cognitive functions, information processing, cognitive demand, novelty, personal control, purpose, quantitative aspects, and context. A main finding was the overlap between cognitive and social activities, as both inherently involve information processing and cognitive functions. Despite the overlap, they also had distinct attributes. Specifically, cognitive activities often involve novelty, while social activities involve interaction with others and emotional purposes, such as a sense of belonging and emotional and social support. The findings indicate that currently available measurements over-rely on assessment of quantitative aspects such as frequency and duration, while neglecting the more subjective attributes such as perceived novelty, personal control, and purpose. These synthesized concepts support the development of measurement instructions and more comprehensive measurement instruments. Better measures allow for pinpointing what makes cognitive and social activities protective and may be useful to determine which participants could improve their activity engagement for healthy brain aging.

29. Personality, happiness, and health in gibbons.

期刊: Journal of comparative psychology (Washington, D.C. : 1983) 发表日期: 2026-May-21 链接: PubMed

摘要

Gibbons (family Hylobatidae) are small apes comprising lar gibbons (Hylobates spp.), crested gibbons (Nomascus spp.), siamangs (Symphalangus syndactus), and hoolocks (Hoolock spp.). These four genera are closely related to one another and to orangutans (Pongo spp.). Gibbon phylogeny and socioecology make them uniquely suited to improve our understanding of the origins of personality factors. Personality trait ratings of lar gibbons, crested gibbons, and siamangs-sufficient data on hoolocks were not available-were analyzed using exploratory factor analyses. All three genera possessed factors labeled Dominance, Extraversion, and Agreeableness. In addition, lar gibbons and siamangs possessed factors labeled Neuroticism and Conscientiousness, lar gibbons possessed a factor labeled Individualism, and crested gibbons possessed factors labeled Dyscontrol and Avoidance. Exploratory factor analysis of the combined data, which included hoolocks, revealed a Conscientiousness factor and four factors-Extraversion, Dominance, Agreeableness, and Neuroticism-that resembled four of the five orangutan personality factors. Genus- and family-level analyses revealed that better subjective well-being and health-both measured using informant ratings-were associated with higher sociability, emotional stability, and conscientiousness. Based on these results, we concluded that social group size and/or arboreality are related to factor structure, Conscientiousness evolved in hominoids 16-20 million years ago (much earlier than previous estimates), and that relationships in humans between personality and psychological and physical well-being have very early origins. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

30. Host interactions with hypervirulent Klebsiella pneumoniae along the gut-liver axis.

期刊: Current opinion in microbiology 发表日期: 2026-May-21 链接: PubMed

摘要

Hypervirulent Klebsiella pneumoniae (hvKp) represents an emerging global health threat, distinguished by enhanced virulence traits that enable it to breach the protective barriers of the gut-liver axis to cause liver abscesses that can subsequently metastasize to distal organs. Yet hvKp must contend with formidable barriers in the gastrointestinal tract that normally prevent bacterial translocation into extraintestinal sites. In this review, we examine current knowledge on the mechanisms of hvKp gut translocation and subsequent liver abscess formation, focusing on the interplay between hvKp and host immune responses along the gut-liver axis. We discuss findings across studies concerning hvKp-Kupffer cells interaction during extraintestinal dissemination, with particular emphasis on the role of phagocytosis and intracellular survival within macrophages in mediating liver abscess formation. We highlight the strengths and limitations of current murine models in faithfully recapitulating the continuum of hvKp pathogenesis and disease, especially since strain-specific and model-dependent outcomes may not be generalizable. Addressing knowledge gaps and resolving conflicting findings through well-characterized hvKp strains, diverse experimental approaches coupled with robust KLA models, are essential for advancing research in hvKp pathogenesis so as to inform the development of effective therapeutic and preventive strategies.

31. Why Gynecologists Must Become Anal Cancer-Prevention Specialists.

期刊: Obstetrics and gynecology 发表日期: 2026-May-21 链接: PubMed

摘要

Anal cancer incidence is rising in the United States, with the fastest increases among older women, a population not traditionally considered high risk. Despite its shared human papillomavirus etiology with cervical cancer, clinical capacity for anal cancer screening and prevention remains limited, even though the disease is largely preventable. Gynecologists are uniquely positioned to address this preventable gap. The principles of anal cancer prevention correspond with established gynecologic practice. Expanding gynecologic presence in anal cancer prevention efforts represents a logical, workforce-ready strategy to detect and treat anal cancer precursors and thereby limit the incidence of cancer, though collaboration and a multi-disciplinary approach are key.

32. CDC plan to retire lab monkeys draws ire.

期刊: Science (New York, N.Y.) 发表日期: 2026-May-21 链接: PubMed

摘要

Critics say proposal was rushed and could endanger animals slated to be moved to a Texas sanctuary.

33. Cardio-oncology disparities in breast cancer: mapping the social gradient of dual disease burden.

期刊: Current medical research and opinion 发表日期: 2026-May-21 链接: PubMed

摘要

Breast cancer and cardiovascular disease (CVD) increasingly coexist as a major source of morbidity and mortality among survivors. As cancer survival improves, cardiovascular complications have emerged as a leading determinant of long-term outcomes, often exceeding cancer-related mortality. This dual disease burden is unevenly distributed, with marked disparities across race and ethnicity, socioeconomic status, geographic location, comorbid risk burden, and representation in clinical trials. Evidence demonstrates that historically marginalized populations experience higher cardiovascular mortality, greater treatment-related cardiotoxicity, and reduced access to preventive and specialty care. This review synthesizes current literature on cardio-oncology disparities and applies established frameworks-including intersectionality, structural racism, and syndemic theory-to explain how social and structural factors translate into adverse clinical outcomes. We highlight emerging clinical, community-based, and policy-level strategies aimed at promoting equitable cardiovascular survivorship for breast cancer patients.

34. Effect of Branched-Chain Amino Acid Supplementation Alone or Combined With Tryptophan or Methionine on Appetite Control and Related Health Outcomes in Older Adults: Protocol for a Randomized Controlled Trial.

期刊: JMIR research protocols 发表日期: 2026-May-21 链接: PubMed

摘要

Branched-chain amino acids (BCAAs) are essential amino acids for protein metabolism. Preclinical research in mice suggested that BCAA intake relative to other amino acids, in the context of a high-carbohydrate diet, was associated with hyperphagia, obesity, and reduced lifespan. These effects were not attributed to BCAAs alone, nor did they manifest through canonical mechanistic target of rapamycin-insulin-like growth factor 1 pathways; rather, they resulted from indirect effects of other amino acids, notably tryptophan, on appetite. As population aging and obesity-related chronic diseases present significant public health challenges, understanding appetite regulation is critical. To date, no clinical trial has examined the effects of BCAAs on appetite regulation in older adults. On the basis of our preclinical results, we hypothesized that, compared to the control diet, a diet supplemented either with BCAA or with BCAAs and methionine would increase appetite and energy intake, whereas supplementation with BCAA and tryptophan would not increase appetite. We aimed to translate these preclinical findings to humans by examining the effects of BCAAs per se and in combination with tryptophan and methionine on appetite and other health measures in a cohort of older participants. This randomized controlled clinical trial recruited 110 adults (aged 65-80 y; BMI 20-35 kg/m2). Participants were randomly allocated to four 4-week intervention groups: (1) control (no supplementation), (2) BCAAs, (3) BCAAs+tryptophan, or (4) BCAAs+methionine. All participants received a controlled diet, with intervention groups additionally receiving amino acid supplements. The primary outcomes are appetite assessed via self-reports and fibroblast growth factor 21 levels (a marker of protein appetite), and energy intake quantified from dietary intake data. Secondary outcomes include body composition, cardiometabolic health, gut microbiota, blood biomarkers, sleep, and physical performance. Descriptive statistics will be used to summarize participant characteristics. Linear mixed models will assess intervention effects, with and without adjustment for relevant covariates. Diet-specific self-reported appetite and palatability scores will be analyzed using generalized additive mixed models. The trial was registered on April 12, 2021. Recruitment commenced in April 2022 and was completed in November 2025, with 308 individuals screened and 100 completing the study. Data analyses are planned for completion by December 2026, with results expected to be published in 2027. Data cleaning and analysis are currently in progress and are expected to be completed by December 2026, with trial results expected to be published in 2027. This study will clarify the effects of BCAAs, either alone or in combination with tryptophan or methionine, on appetite and related outcomes in an older population. The findings may inform nutritional strategies targeting appetite regulation and metabolic health to support healthy aging.

35. Equities and Inequities Inherent in Wastewater Surveillance Systems for Public Health: New York State, 2020-2024.

期刊: American journal of public health 发表日期: 2026-May-21 链接: PubMed

摘要

Objectives. To evaluate equity in wastewater-based infectious disease surveillance, including equity of inclusion, outbreak detection, and disease forecasting. Methods. We assessed New York State’s wastewater surveillance network using census tract-level data to compare social vulnerability and environmental burden across included, sewered but excluded, and unsewered communities during the scale-up of the network (2020-2024) and under changing coverage scenarios. We modeled outbreak detection equity by estimating outbreak sizes required for 95% confidence in the detection of hypothetical pathogens and assessed forecasting equity using county-level COVID-19 hospitalization predictions in relation to population size, coverage, and vulnerability. Results. We found similar vulnerability distributions between included and sewered but excluded communities. The 25% most vulnerable communities required median outbreak sizes 3.45 times larger for detection than did the 25% least vulnerable. At medium sensitivity, more than 80% of individuals living in poverty and minoritized populations lived in areas where outbreaks exceeded 10 infections before detection. Forecasting accuracy was lower in smaller (< 20%) than in larger urban (> 60%) counties and increased with population size and network coverage (P < .001). Conclusions. Wastewater surveillance was equitable in population coverage but not in outbreak detection and forecasting performance. Public Health Implications. Strategies such as upstream sampling, expanded wastewater treatment plant participation in smaller communities, and improved modeling for low-population areas may reduce inequities and enhance the utility of wastewater surveillance. (Am J Public Health. Published online ahead of print May 21, 2026:e1-e9. https://doi.org/10.2105/AJPH.2026.308472).

36. Sex Differences in the Peripheral Determinants of Oxygen Transport and Utilization in Patients with Heart Failure with Preserved Ejection Fraction.

期刊: American journal of physiology. Heart and circulatory physiology 发表日期: 2026-May-21 链接: PubMed

摘要

Background: Heart failure with preserved ejection fraction (HFpEF) disproportionately affects females, however the influence of sex on peripheral contributors to exercise intolerance remains poorly understood. Methods: 43 patients with HFpEF (71±7 years, 28 females; 38.3±6.7 kg/m2) performed incremental single leg knee extension (SLKE) exercise to determine peak leg blood flow (BF; duplex Doppler ultrasound), a-vO2 difference (femoral venous catheter), leg VO2, and muscle oxygen diffusive conductance (DMO2). Whole body and thigh adiposity and lean mass (TLM) were determined by DXA, and myosteatosis (TLM/fat ratio) by MRI. Results: After adjusting for differences in TLM, females had ~30% lower peak exercise leg VO2/TLM (p<0.001) and ~15% lower BF/TLM compared to males (p=0.024). However, when normalized to VO2, the leg BF/leg VO2 slope was higher in females (9.5±2.3 vs. 8.1±2.1, p=0.017) and was associated with markedly lower a-vO2 difference (p<0.001) and ~40% lower DMO2 (3.6±1.6 vs 6.4±1.7, p<0.0001). Metrics of muscle adiposity were not correlated with peak leg VO2 or its determinants (p>0.150 for all). Conclusion: Females with HFpEF have lower muscle oxygen diffusive conductance during peak SLKE compared to males. However, peripheral determinants of aerobic capacity were not differentially related to adiposity in males and females with HFpEF. Interventions to improve muscle quality and diffusive capacity are of particular importance for improving peripheral limitations to exercise in females with obesity and HFpEF.

37. Interacting effects of human presence and landscape modification on birds and mammals.

期刊: Science (New York, N.Y.) 发表日期: 2026-May-21 链接: PubMed

摘要

Sustainable human-wildlife coexistence requires a mechanistic understanding of the many ways that humans affect animals. However, progress is hampered by the lack of accessible data measuring the dynamic presence of people. Here, we leverage mobile-device data to disentangle how human presence and landscape modification differentially influence the use of geographic and environmental space for 37 mammal and bird species across the United States. Human presence affected more than 65% of species, with substantial variation across species. For ~60% of species that responded to human activities, the effects were interdependent-animals tended to react more strongly to human presence in less modified habitats. Our results demonstrate that human presence and landscape modification have complex combined effects on wildlife, which need to be considered for effective management.

38. An indicators framework to evaluate assistive technology impacts on society in emerging countries.

期刊: Disability and rehabilitation. Assistive technology 发表日期: 2026-May-21 链接: PubMed

摘要

Purpose of the article: The World Health Organisation indicates that approximately 1.3 billion people live with disabilities, many of whom face social and environmental barriers that may hinder their full participation in society. Assistive Technology (AT) is an essential tool for promoting autonomy and reducing inequalities. However, evaluating its real impact on users’ lives remains challenging, particularly in heterogeneous socioeconomic contexts, such as those in emerging economies. In this context, the objective of this article is to propose an indicators framework to measure and evaluate the impacts of AT development and dissemination on society in emerging countries. Materials and methods: To develop the framework, a Systematic Literature Review was conducted, which identified 14 dimensions of impact and 40 indicators to measure the societal impacts of AT. 15 AT experts evaluated these indicators, and the importance of the impact dimensions was assessed with 15 AT users. The Fuzzy Delphi process refined the initial set of indicators, retaining 28. Simultaneously, a preliminary application of Stepwise Weight Assessment Ratio Analysis (SWARA) demonstrated how user-derived priorities can be incorporated into the framework, generating an example set of impact weights rather than generalisable population estimates. Results and conclusions: The framework integrates user prioritisation, going beyond traditional functional metrics, and incorporates psychosocial and quality-of-life dimensions. Practical implications include supporting decision-making for developers, managers, policymakers, and AT stakeholders, while reinforcing the importance of incorporating users’ experiential knowledge into AT evaluation and development processes. The proposed framework organises 14 Assistive Technology impacts into three clusters (Work Environment and Productivity; User Quality of Life; Social and Psychosocial), providing rehabilitation professionals with a structured and multidimensional evaluation model.By operationalising these impacts through validated indicators, the framework enables systematic assessment of functional performance, independence, emotional well-being, social participation, and educational inclusion.The illustrative application of user-derived weighting using the SWARA method demonstrates how the framework can incorporate user priorities in practice, supporting person-centred prescription and follow-up while allowing impact weights to be recalibrated across different contexts, technologies, and user groups.The framework supports early identification of mismatches between AT features and user needs (e.g., adequacy, stress, and satisfaction indicators), thereby reducing abandonment and improving long-term rehabilitation outcomes.

39. Can GPT-5 Support Licensing Examination Preparation? Analysis of Accuracy, Reasoning, and Semantic Similarity Across Rehabilitation Disciplines.

期刊: JMIR rehabilitation and assistive technologies 发表日期: 2026-May-21 链接: PubMed

摘要

In this cross-sectional study of 300 board-style questions across physical therapy, occupational therapy, and speech-language pathology, we evaluated reasoning types and found high overall accuracy with variation by discipline and reasoning category; the strongest performance was in deductive and analytical reasoning and the lowest accuracy was in evaluative reasoning.

40. Longitudinal Associations Between Core Health Domains, Assessed Using the PROMIS-29, and Work Ability in a Working Population: Findings from the Lifelines Cohort Study.

期刊: Journal of occupational rehabilitation 发表日期: 2026-May-21 链接: PubMed

摘要

To investigate the longitudinal relationship between core health domains, assessed with the Patient-Reported Outcomes Measurement Information System (PROMIS-2)9, and work ability, and explore how this relationship differs for physical and mental work ability. Data representing 22,608 workers were obtained from two waves of the Lifelines Cohort Study, a large population-based cohort in the Netherlands. Eight health domains, assessed at baseline using PROMIS-29 v2.1, were analyzed in relation to work ability, assessed at follow-up with single WAI items. Ordinal logistic regression analysis was used to model these relationships, adjusting for age, BMI, leisure-time physical activity, and follow-up time, and evaluating effect modification by gender. All PROMIS health domains were significantly associated with work ability at 4.6 years follow-up. Health domains reflecting worse health, e.g., fatigue, showed an inverse association with work ability (OR: 0.75, CI: 0.72-0.78), whereas domains reflecting better health, e.g., ability to participate in social roles and activities, showed positive associations (OR: 1.28, CI: 1.23-1.34). Some health domains, like physical function (OR: 1,35 CI: 1.26-1.45) and pain interference (OR: 0.84, CI: 0.78-0.91) were associated with physical work ability only, whereas anxiety, depression, fatigue, sleep disturbance, ability to participate in social roles and activities, and pain intensity were associated with both physical and mental work ability. Health domains, assessed using the PROMIS-29, are longitudinally associated with general, physical and mental work ability. PROMIS-29 might be used to identify workers at risk of reduced work ability and potential sickness absence. Further research is needed to verify this and should directly examine the relationship between PROMIS-29 scores and objective sickness absence rates.

41. "Don't tell me I'm going to feel joy": The emotional burden of informal caregivers of patients with a fragility fracture discharged from a rehabilitation hospital.

期刊: Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA 发表日期: 2026-May-21 链接: PubMed

摘要

The emotional experience of informal caregiving is considerable and complex, consisting of tensions internally and with the care recipient, and exacerbated by pressures to adopt the caregiver role without complaint or assistance. Our findings demonstrate the need to develop policies to relieve distress for caregivers of fragility fracture patients. Informal caregiving can have considerable physical and psychosocial consequences, with the emotional strain of caregiving considered most distressing. Few studies have examined the emotional experience of caregiving for individuals with a fragility fracture or the contextual factors that may influence this experience. We aimed to explore the experience of caring for someone after a fragility fracture to understand the nuances of the emotional experience and identify ways to better support informal caregivers in the future. We used a phenomenological approach to examine caregivers’ experiences. We recruited primary caregivers of patients discharged from a rehabilitation hospital following a fragility fracture. We conducted individual interviews with caregivers and analyzed the data phenomenologically to describe the structure of caregivers’ emotional experiences and illuminate potential influencing factors. We interviewed 32 caregivers (19 females, 13 males; 37-95 years old). We found that the emotional experience of caregiving was complex, consisting of tensions internally and with care recipients, and exacerbated by multiple pressures to adopt the caregiver role. As a result of these pressures, caregivers often felt reluctant to voice displeasure or ask for help, exacerbating their burden and reinforcing a sense that they must suffer in silence. Our study demonstrates the multifaceted nature of caregivers’ emotional burden and highlights the pressures felt by caregivers of fragility fracture patients to take on caregiving roles without complaint or assistance. Our findings highlight the need to acknowledge the emotional complexity of caregiving, empower caregivers to ask for help, and develop meaningful supports and policies to alleviate caregiver burden.

42. Hematopoietic carcinogen assessment in bulk chemical products and air samples: focus on benzene exposure among subway maintenance workers.

期刊: Inhalation toxicology 发表日期: 2026-May-21 链接: PubMed

摘要

Multiple cases of hematopoietic cancer have been reported among subway maintenance workers (MWs) at a company in Korea employing about 3,400 people, prompting a need to examine the relationship between HC and maintenance job characteristics. This study aimed to identify and assess the presence and levels of hematopoietic carcinogens, including benzene, in chemical products and workplace air within subway maintenance process and to provide scientific evidence to support forthcoming epidemiological investigations of HC. A total of 169 chemical products used in cleaning, painting, and inspection processes were collected and analyzed using gas chromatography-mass spectrometry (GC-MS) in selected ion monitoring (SIM) mode. Air samples were collected during maintenance tasks and analyzed using GC-MS in SIM mode. Target substances included benzene, trichloroethylene, dichloromethane (DCM), styrene, and tetrachloroethylene. Benzene and DCM at concentrations ≥0.1% were detected in 12.4% of the 169 chemical products analyzed, including three products containing benzene and 18 containing DCM at this level. Airborne concentrations of benzene and DCM were detected in over 50% of the samples collected from painting (n=26) and cleaning operations (n=39), but all were below Occupational Exposure Limits. The findings provide quantitative and qualitative characterization of current exposure conditions and may support the reconstruction of potential past exposure scenarios to hematopoietic carcinogens among subway MWs, thereby informing subsequent epidemiological investigations.

43. Enhancing the OncoSim-Breast model using Canadian breast density information.

期刊: Health reports 发表日期: 2026-May-20 链接: PubMed

摘要

Breast cancer is the most commonly diagnosed cancer among women in Canada. Breast density substantially influences breast cancer risk and mammography performance. However, OncoSim-Breast, a Canadian microsimulation model representing breast cancer control, including cancer onset, screening, and survival, has not previously explicitly accounted for breast density. This study describes the incorporation of density-specific parameters into the OncoSim-Breast model. Breast density-specific inputs were integrated into OncoSim-Breast using data from five Canadian provinces. Three key parameters - prevalence, relative risk of breast cancer, and digital mammography performance (sensitivity and specificity) - were estimated by age group and breast density category, following the American College of Radiology’s Breast Imaging Reporting and Data System (BI-RADS) classification (categories A to D). Calibration experiments and internal validations were conducted to ensure the updated OncoSim-Breast model aligned with observed data from the Canadian Cancer Registry. The prevalence of dense breasts declined with age: BI-RADS categories C and D accounted for 58% of women younger than 50 years and 26% of those aged 70 and older. Digital mammography sensitivity also decreased with increasing density: among women younger than 50 years, sensitivity was 88% for Category A and 69% for Category D. The updated OncoSim-Breast model accurately replicated age-specific incidence, age-adjusted incidence, and stage distribution based on historical data from the Canadian Cancer Registry (2010 to 2019). Incorporating breast density-specific parameters substantially improved the accuracy and policy relevance of OncoSim-Breast. The updated model provides a validated tool to inform screening policy decisions for Canadian women, allowing consideration for the effect of the variability of breast density among women.

44. Geographic variation in female breast cancer incidence and mortality in Canada.

期刊: Health reports 发表日期: 2026-May-20 链接: PubMed

摘要

Previous work has noted variability in cancer incidence and cancer-related outcomes according to place of residence. This study examined geographic variability in the incidence and mortality of breast cancer among females in Canada. Data from the 2021 Canadian Cancer Registry (breast cancer incidence) and the Canadian Vital Statistics - Death database (breast cancer mortality) were examined across provinces and territories, community sizes, and peer groups (i.e., clusters of health regions with similar socioeconomic and demographic characteristics). Age-standardized incidence rates (ASIRs) and age-standardized mortality rates (ASMRs) per 100,000 females per year and their rate ratios were calculated, as well as age group-specific and age-standardized stage-specific incidence rates. From 2010 to 2020, the invasive breast cancer ASIR was 140.1 per 100,000 females annually, with marked geographic and community variation. Mean age at diagnosis was 62.7 years, and it was lowest in northern and remote regions. Three-quarters of cases were stages I and II, though stage-specific ASIRs varied. Overall ASIRs were highest in peer groups B (urban centres with large immigrant and racialized populations) and D (rural regions in Quebec, Ontario and the Prairies). They were lowest in peer groups F (Northern and remote regions with young populations), G (Montréal, Toronto, and Vancouver), and H (urban centres in Ontario and British Columbia). From 2010 to 2022, the ASMR was 28.3 per 100,000, highest in rural Eastern Peer Group E and lowest in large urban centres. The study found significant variability in female breast cancer incidence and mortality across the geographical classifications considered, highlighting the need for a closer look at regional- and individual-level factors and their respective associations with cancer incidence and outcomes.

45. Evaluating biosecurity practices across beef cattle production types in Illinois, USA: Differences in disease prevention and preparedness.

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

摘要

Assessing beef cattle farmers’ on-farm biosecurity practices and understanding differences across various production types is essential for implementing effective disease prevention and preparedness plans. A stratified random survey of beef cattle producers in Illinois was conducted between June and August 2022, with 537 producers responding to all or some of the survey questions. Multiple Correspondence Analysis (MCA) was used to explore associations between biosecurity practices and production types, while multinomial logistic regression models quantified the likelihood of a farm being classified into one of the four production types (cow-calf, feedlot, backgrounder/stocker, and whole-cycle) based on the presence of specific biosecurity and health management practices. Significant differences in the adoption of both internal and external biosecurity measures and animal health management among different production types were identified. Feedlot operations were more likely to check their cattle for illness and record disease events. In contrast, cow-calf operations focused less on health management but were more likely to implement external biosecurity measures such as fencing to control wild animals and limiting access points to the farm. Backgrounder operations had strong internal biosecurity practices, including illness monitoring and antibiotic treatment, but were less likely to engage in external biosecurity measures. Whole-cycle operations were characterized by a combination of disease event recording and greater control over visitor access, but showed less emphasis on personal protective equipment and handwashing compared to cow-calf operations. These findings highlight the variation in biosecurity practices across different production systems and suggest that strategies should be adapted to the needs and disease risks of each production type to enhance disease prevention and preparedness. Future research should focus on evaluating the impact of specific biosecurity measures on disease incidence to understand which practices are most successful in reducing risk.

46. Prediction of exposure to chrysotile asbestos fibers among Quebec miners and millers based on impinger measurements.

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

摘要

The cohort of chrysotile cohort workers from Quebec was established in the 1960s. It remains one of the most influential investigations into health risk of chrysotile asbestos. The cohort principally relies on measurements of asbestos-containing dust via impingers (as million particles per cubic foot of inhaled air, mpcf) for exposure assessment, though counts of fibers (fibers per cubic centimeter of inhaled air, longer than 5 µm with aspect ratio greater than 3:1 f/cm3) are more toxicologically relevant. To develop an empirical model that predicts exposure to fibers as a function of dust levels and workplace in chrysotile asbestos mining operations in Quebec. The model is intended to be used in re-analysis of epidemiologic data that accounts for measurement error in exposure. We obtained a copy of 623 individual parallel measurements of dust and fibers collected in Quebec in the 1970s and their contextual information. We fitted mixed-effects linear models that predict fiber concentrations as a function of the counts of dust particles, with random effect of sampling site. To evaluate the general model performance, we conducted a 10-fold cross-validation. Fiber concentrations ranged from 0.06 to 307 f/cm3. Dust counts ranged from 0.04 to 9.12 mpcf. The average fiber-to-dust ratio of (f/cm3)/mpcf) was 12 (SD 16, median 7), ranging from 0.07 to 227. We estimated a positive association between logarithms of fiber and dust counts, which is not materially affected by adjustment for workplaces. The model with the logarithms of dust levels per se explained 24% of between-site variance and 12% of within-site variance in the logarithms of fiber concentrations. The average cross-validated R2 was 68%. We confirmed observations that the ratio of fibers to dust counts of chrysotile asbestos is not constant but depends on a variety of work characteristics, including the number of dust particles. Our results are consistent with similar analyses conducted by others. However, we could not access all side-by-side impinger and fiber measurements that existed based on published reports, and available measurements do not cover all the times and workplaces where members of the cohort of Quebec millers and miners were exposed to chrysotile. Our models of exposure to fibers have a general form that adheres to multiplicative Berkson-type error. We cannot rule out the dependence of this error on risk of health outcomes. We conclude that it is possible to calibrate impinger counts of dust to the fiber concentrations in the air for chrysotile asbestos mined and processed in Quebec in the 1970s and quantify the associated uncertainty.

47. Frailty and intrinsic capacity: integrating complementary concepts to promote healthy ageing and transformation of care.

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

摘要

As the global population ages, especially in low- and middle-income countries, there is an urgent need to rethink how health in older age is understood and addressed. Frailty has long served as a clinical construct to identify vulnerability and guide tailored, specialist care for older people. In 2015, the World Health Organisation introduced the concept of intrinsic capacity (IC) as part of its healthy ageing framework, offering a structured, capacity-based approach to promote functional ability. While conceptually distinct, frailty and IC are complementary. Frailty highlights the need for specialised care in complex cases, whereas IC supports early intervention and prevention across broader populations. This paper explores their differences, areas of overlap and how their integration can support a continuum of care that spans primary to specialist settings. Integrating these concepts connects prevention, health promotion and complex care management. By aligning clinical and public health perspectives, the combined use of frailty and IC offers a holistic, person-centred approach to care system transformation, with the potential to drive coordinated strategies that strengthen both geriatric practice and public health across diverse populations.

48. Optimization of artificial intelligence models for prediction of new-onset cardiovascular disease in patients with arterial hypertension.

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

摘要

Advanced preventive strategies are needed to decrease the burden of cardiovascular disease (CVD). We aimed to develop a predictive tool to identify individuals at higher CVD risk and facilitate proactive interventions to improve clinical outcomes. This single-center retrospective study enrolled consecutive hypertensive subjects free of CVD at baseline and followed them up for a mean of 8.3 years. The primary outcome was new-onset CVD (ischemic heart disease, stroke or hospitalization due to heart failure). The 155-variable dataset was enriched by creating trend variables using statistical measures, Principal Component Analysis (PCA) and Latent Class Analysis (LCA). Then, an artificial intelligence (AI) XGBoost prediction algorithm was trained on 70% of the dataset and validated on the remaining 30%. XGBoost-based risk stratification was compared with risk stratification according to SCORE2. The 3,588 consecutive patients enrolled had a mean age of 54.2 ± 14 years, 53% were women. The incidence rate of new-onset CVD was 1.93 (95% CI: 1.78-2.09) per 100 patient-years. The XGBoost model incorporated 30 variables and achieved 86% ROC AUC, 81% sensitivity, and 78% specificity for predicting CVD. The number of antihypertensive drugs had the strongest predictive power within the model. SCORE2 classified at baseline only 32% of participants with a CV event in the follow-up as high or very-high risk, whereas the XGBoost model correctly identified 81% of them. AI-based modeling outperformed SCORE2 in predicting new-onset CVD in patients with hypertension, identifying the number of antihypertensive drugs as a key predictor and supporting the role of AI risk stratification in clinical practice to implement precision medicine.

49. The Neglected Older Adults in Hereditary Angioedema: Insights From the ITACA Registry.

期刊: Clinical and translational allergy 发表日期: 2026-May 链接: PubMed

摘要

Hereditary Angioedema due to C1-inhibitor deficiency (HAE-C1INH) is a rare disease that affects individuals of all ages, however, older adults have never been characterized in terms of disease severity, comorbidities, and treatments. The aim was to identify the clinical characteristics of and therapeutic approaches in HAE-C1INH patients aged 65 and older. Data from the ITACA (Italian network for Hereditary and Acquired Angioedema) Registry were prospectively collected for 10-month. Data from 647 HAE-C1INH, patients including 343 females (53%), were collected: 114 patients (17.6%) were aged 65 and older (68 females; 58.6%). Group mean age was 74.3 ± 7.5 years, mean age at first-symptom-onset was 19 ± 15 years, and mean age at diagnosis was 45.6 ± 14.3 years. Common comorbidities were: hypertension (59.6%), dyslipidaemia (28.9%), coronary artery disease (14.0%), diabetes (14.0%), endocrinopathies (14.0%), neoplasia (12.3%) and B/C hepatitis (11.4%). Half of the older patients (49%) experienced at least one attack during the study period, and 8 patients (7%) had an attack frequency of > 0.5 attacks/month. Long-term prophylaxis (LTP) was the treatment of choice in 45 patients (39.5%) and represented 15.9% of overall LTP prescriptions: 60% were treated with lanadelumab, 22.2% with attenuated androgens, 13.3% with berotralstat, and 4.5% with sub-cutaneous C1INH concentrate. Gender differences were not detected in any of the variables analyzed. Older patients with HAE-C1INH constitute a relevant subgroup, characterized by persistent disease activity and comorbidities. The availability of new therapies and guideline recommendations are driving an increase in LTP use, although shifting from older non-specific treatments, especially androgens, is still incomplete.

50. Zoonotic leishmaniasis in China: Current status and challenges to elimination.

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

摘要

Leishmaniasis is expanding worldwide along with sand fly vectors. In China, particular challenges arise from its broad climatic and ecological gradients, the diversity of phlebotomine sand fly species, and numerous potential mammalian and reptilian hosts. Two ecological types of visceral leishmaniasis (VL) are recognized: anthroponotic VL (AVL) caused by Leishmania donovani and zoonotic VL (ZVL) caused by Leishmania infantum, which is subdivided into mountain-type (MT-ZVL) where dogs are the main reservoir, and desert-type (DT-ZVL) with uncertain reservoirs. Over the last decade, VL has re-emerged in central and northern regions of China, with increasing MT-ZVL notifications and evidence of canine infections in geographical areas where transmission had not previously been reported. This review synthesizes three decades of literature on canine leishmaniasis (CanL) and its vectors in China, focusing on domestic and wild reservoirs in the maintenance of zoonotic VL. Molecular studies reveal substantial genetic heterogeneity within the L. donovani complex and frequent discordance between single-locus markers (e.g., ITS1, cytb) and higher-resolution approaches (MLST/MLMT). Leishmania infection in dogs is most common in western foci, with high detection rates ranging from 24.8% to 77.2%, especially in Gansu and Sichuan Provinces, where subclinical infections predominate. Also, evidence of co-circulating unclassified Leishmania lineages related to Sauroleishmania complicates diagnosis and surveillance. Vector ecology, including the endophilic/exophilic behavior of Phlebotomus chinensis and the role of P. sichuanensis at high altitudes, overlaps with environmental change, dog management, and increasing stray dog populations, thereby amplifying transmission risk. Based on available data, dog culling is ineffective for long-term control of CanL due to poor diagnostics, rapid replacement of culled dogs, and ecological complexity. Conversely, vector control and bite prevention, using topical pyrethroid repellents (collars, spot-on pipettes) and possibly oral isoxazolines, should be implemented in dogs as control measures after appropriate field evaluation. Key gaps include insufficient canine surveillance and validation of diagnostic tools, as well as incomplete characterization of wildlife reservoirs. Strengthened One Health surveillance, integrating genomics, vector studies, and reservoir investigations, is essential to guide targeted control and predict future spread. The PubMed, Scopus, Google Scholar, and Web of Science databases were searched from 1950 to 2025 for peer-reviewed publications reporting the genetic diversity of Leishmania species, the epidemiology and prevalence of zoonotic VL and CanL, and trends in their spatial and temporal distribution in China for this narrative review. Three search strings were employed in these databases to; (1) identify reservoir host and sand fly vectors for leishmaniasis in China, (2) identify the epidemiology (risk factors, re-emergence, trends) and control and prevention of leishmaniasis in China, (3) identify the diversity of Leishmania species in China. The protocols for database searches are provided in the Supporting Information. The China National Knowledge Infrastructure database was additionally searched to obtain Leishmania prevalence data in animals. Data were extracted from articles published in English and Chinese. After removal of duplicates, abstracts of 865 articles were screened for relevance, from which 279 full-text articles were reviewed to extract relevant information. Articles were included for final review (n = 129) if they contained data on molecular and/or serological Leishmania infection-rate data in dogs, the genetic diversity of Leishmania species in China, computational trends in VL, reservoir hosts for Leishmania species and, sand fly vectors in China.

51. Climate change induced complex shifts in snake distributions expose people to snakebite and threaten biodiversity.

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

摘要

Snakes play pivotal roles in many ecosystems. While some species, including medically important ones, are considered threatened by the IUCN, snakebite takes a heavy toll on rural agricultural populations in the developing world. Approximately 138,000 deaths and 400,000 disabilities result from snakebite annually and WHO has pledged to reduce the resulting health burden by 50% by 2030. Among a plethora of reasons for insufficient snakebite mitigation, one is limited explicit knowledge of how, where, and when humans and snakes interact, which limits the timely, accurate, and efficient deployment of resources. Here, we revise the list of medically important snakes based on recent taxonomic updates and use high-resolution data from a broad range of published and unpublished resources to compare expert-derived ranges with statistical geographical models of habitat suitability for all 508 most medically important snake species globally. Our study is the first to model every single medically important snake species including data deficient ones, at the highest resolution to date, and with the largest supporting occurrence dataset. We generate geographically explicit estimates of how much human and snake populations overlap (snake-human-overlap-index; SHOI), which is the most fundamental prerequisite for human-snake conflict to occur. Finally, we model the effects of climate change on snake distributions. We predict substantial, short- and long-term shifts in snake distributions, including range contractions for many threatened species and increased human exposure to species of major public health concern. In combination with other drivers of increased snake-human conflict, such as human behaviours and snake traits, our predictions can be used to decide where to stockpile which antivenom, how to ensure adequate capacity of individual health facilities, how to improve health care accessibility of remote at-risk communities, and where to focus conservation efforts for threatened snake species. Hence, we highlight the need for geographically targeted efforts to benefit both vulnerable human and snake populations, as part of a One-Health strategy.

52. Examining fear appeals and information seeking in tuberculosis health education campaigns: an experimental test of the extended parallel processing model with perceived barriers as a moderator.

期刊: Health education research 发表日期: 2026-Mar-31 链接: PubMed

摘要

Tuberculosis (TB) health education campaigns often struggle to motivate at-risk populations by employing one-size-fits-all fear appeals without considering how structural barriers shape audiences’ ability to respond. Drawing on the Extended Parallel Processing Model (EPPM), this study tested how varying levels of threat and efficacy in TB messages influence information-seeking intentions, with perceived barriers as a moderator. In a 2 (threat: low versus high) × 2 (efficacy: low versus high) between-subject experiment with 225 Chinese participants, results revealed that high-threat messages increased participants’ TB information-seeking intentions compared with low-threat messages. In addition, low-barrier individuals responded best to high-threat, high-efficacy messages; moderate-barrier individuals were motivated by high-threat messages even with low efficacy messages. These findings demonstrate that accounting for structural barriers extends the EPPM framework and provide health educators with a practical framework for audience segmentation and message tailoring.

53. Quality of online heatstroke information across four countries: a quantitative content analysis.

期刊: Health education research 发表日期: 2026-Mar-31 链接: PubMed

摘要

Effective heatstroke prevention depends not only on access to information but also on whether online health materials support understanding and actionable decision-making. However, evidence comparing the quality and presentation of online heatstroke information across countries remains limited. We conducted a quantitative content analysis of 120 publicly available heatstroke-related webpages from Japan, the United States, the United Kingdom, and Australia (30 per country), with one World Health Organization webpage included as a reference. Readability, information volume, credibility, and information presentation were assessed using established metrics, including the Patient Education Materials Assessment Tool for Print Materials. Cross-country comparisons and sensitivity analyses focusing on webpages targeting the general public were performed. UK webpages showed higher readability, whereas Japanese webpages more frequently incorporated visual aids and tools that facilitate preventive actions, resulting in higher understandability and actionability scores. However, actionability did not reach adequate levels in any country. Online heatstroke information differs substantially across countries. While readability improves accessibility, greater integration of visual and action-supporting design elements is needed to better promote preventive action.

54. Heavy metal footprints in landfill-proximate soils of Jashore, Bangladesh: An index-based risk assessment.

期刊: PloS one 发表日期: 2026 链接: PubMed

摘要

Disposal of the household originated and industrial hazardous materials with municipal solid waste (MSW) into the open dumping sites is the usual practice in Bangladesh which raises concerns regarding the pollution of the regions adjacent to these landfill sites. The study evaluated the impact of landfill techniques and environmental factors on soil contamination by potentially toxic elements and the corresponding environmental hazards. This study assessed the potential ecological hazards linked to a landfill site in southwestern Bangladesh. ICPMS and AAS were used to detect eleven heavy metals in soils from the landfill. This analysis aimed to uncover the origin, degree of contamination, geographical representation, and the environmental and human health hazards connected with these metals. Mean levels of the metals in mg/kg were As (12.02 ± 4.40); Hg (0.611 ± 0.441); Cd (0.606 ± 0.487); Pb (37.5 ± 14.08); Cr (46.9 ± 10.06); Zn (260.7 ± 201.0); Co (16.03 ± 3.02); Ni (39.5 ± 11.6); Cu (260.7 ± 55.79); Mn (613.2 ± 189.6); Fe (26087 ± 4396). This investigation discovered significant amounts of As, Hg, Cd, Pb, Zn, Cu, and Mn relative to established standards. The ecological risk assessment index revealed that Cd exhibited the most significant level of danger, whereas Cu and As demonstrated a moderate level of danger. The health index values indicate that the levels of As and Zn in adults and children exceeded the acceptable limit, while the levels of Pb, Cr, Fe, Cu, Ni, and Co among children came close to the borderline. The TCR values of Ni for children are beyond the permissible level. PCA revealed that the majority of heavy metals are derived from human activity. Consequently, administration strategies for remediating these open dumps nationwide should include continuous monitoring and surveillance of neutralized dumpsites to avert further contamination.

55. Assessing attention towards plants: Development and first steps to the validation of the Hidden Object Picture Instrument (HOPI).

期刊: PloS one 发表日期: 2026 链接: PubMed

摘要

Public awareness of plants remains limited despite their essential ecological and societal roles. A major challenge in addressing this issue is the absence of validated instruments that measure attentional-memory processes regarding plants. This study introduces the Hidden Object Picture Instrument (HOPI), a novel visual tool designed to assess plant-directed attention in complex natural scenes. The development involved three sub-studies: (1) designing and validating a landscape image based on biodiversity data, (2) examining attentional mechanisms using eye-tracking, recall, and species identification, and (3) testing known-groups validity among students and botanical experts. Free listing combined with salience analysis revealed cognitive prominence and recall patterns for different object types. Eye-tracking showed no correlations between object size, time to first fixation, total fixation duration, average fixation time, and number of fixations and recall salience for plants and animals. Experts exhibited higher plant salience and more specific naming, while students mainly used general terms (e.g., “tree,” “field”). These findings indicate that plants are often perceived as background elements rather than distinct entities. The HOPI provides a transparent, replicable method for assessing visual attention to plants and offers valuable applications for research and education. It represents a first step towards understanding and fostering plant awareness as part of environmental education and biodiversity conservation.

56. "Every shoulder is different": A qualitative study of clinicians' insights on the causative factors and strategies of managing work-related shoulder disorders among firefighters.

期刊: PloS one 发表日期: 2026 链接: PubMed

摘要

Work-related shoulder disorders (WSDs) are the third most prevalent work-related musculoskeletal disorder in firefighting, a significant occupational health concern among firefighters (FFs). However, comprehensive understanding of clinician perspectives on causative factors and evidence-based management strategies remains limited. To explore clinicians’ perspectives on: (a) the underlying causative factors contributing to WSDs; and (b) management strategies specific to firefighters. Semi-structured interviews were conducted with 15 clinicians (11 males, 4 females) between 30-61 years of age, who had experience managing firefighters with WSDs. Data collection and analysis followed interpretive description methodology, employing iterative thematic analysis to identify recurring themes and patterns. Eight themes emerged: 1) The Nature of Firefighting Work Exacerbates Shoulder Injuries; 2) Work-Related Slips and Falls are Linked to Traumatic Shoulder Injuries; 3) Unequal Shoulder Injury Pattern by Sex and Work Experience; 4) Lack of Formal and Targeted Training Exercises Predisposes to Shoulder Injuries; 5) Early Diagnosis is Crucial for Effective Shoulder Management; 6) Individualized Multimodal Treatment Approaches are Key to Optimal Recovery; 7) (Re-)Education on Safe Exercise Training Minimizes Shoulder (Re-)Injuries; 8) Specialized functional Assessment and Outcome Measures could Enhance Treatment Outcomes. Firefighter WSDs are multifactorial, exacerbated by occupational exposures, sociodemographic factors and delayed or non-specialized care. Clinicians emphasize the need for implementing targeted functional rehabilitation approaches that consider the unique physical and operational demands of firefighting duties.