公共卫生研究摘要 (2026-05-23)

共收录 60 篇研究文章

1. A tailored pain self-management intervention for patients with cirrhosis is acceptable and improves pain control.

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

摘要

Chronic pain is common and uniquely challenging to manage in people with cirrhosis. The purpose of this pilot study was to evaluate the feasibility and acceptability of a tailored pain self-management (PSM) intervention for people with cirrhosis and chronic pain. This single-arm, single-site pilot study recruited patients with a diagnosis of cirrhosis and chronic pain to a virtual, health coach-led, modular PSM intervention. After 6 weekly one-on-one sessions, patients were invited to attend 6 weekly group sessions. Outcomes were measured at baseline, 6 weeks, 12 weeks (end of intervention), and 24 weeks (maintenance). The primary outcomes were acceptability, defined by a 4/5 rating on the Treatment Acceptability Questionnaire, and feasibility, defined as the ability to retain patients in 80% of the intervention sessions. Secondary outcomes of pain and function were measured using the Pain intensity, Enjoyment of life, and General activity (PEG) scales, and a rating of percent improvement with the intervention. Among 21 participants who started the intervention, 16 (76%) attended ≥80% of sessions. Acceptability thresholds were met at all time points. On a scale of 0-100, where 30 is considered to be a meaningful change, participants rated their improvement in pain symptoms an average of 50 ± 25. The average PEG score decreased from 6.1 at baseline to 5.3 at 24 weeks. Participants reported increases in PSM behaviors, including cognitive and stress-reduction methods, physical activity, healthy sleep behaviors, and changes in diet. This pilot identified a reduction in pain and an increase in PSM activities and demonstrated the acceptability of a health coach-led PSM intervention for adults with chronic pain and cirrhosis.

2. Antibiotic regimen optimization for severe exsanguination in a live swine model.

期刊: The journal of trauma and acute care surgery 发表日期: 2026-Jun-01 链接: PubMed

摘要

Sepsis is a significant contributor to mortality for trauma patients beyond 48 hours from their initial trauma, in addition to being a major source of morbidity in the elective surgery population. Prophylactic antibiotics are recommended for patients presenting with penetrating trauma due to this risk. Current guidelines do not provide definitive recommendations on redosing for patients requiring blood transfusions. We sought to characterize the bioavailability of prophylactic antibiotics in the setting of severe hemorrhage and whole-blood resuscitation in a swine model. Sus Scrofa swine underwent a controlled hemorrhage and whole-blood resuscitation protocol following the administration of weight-based vancomycin. Control animals did not undergo hemorrhage or transfusion. Experimental animals underwent a controlled hemorrhage followed by a whole-blood resuscitation starting at 2 units and increasing to 10 units in 2-unit increments. Serum vancomycin levels were collected at regular time intervals over a 4-hour period. There was a shorter time to reach subtherapeutic serum vancomycin levels within the 4, 6, 8, and 10-unit arms compared with the control arm. There was a significant decrease in serum vancomycin level immediately following the hemorrhage and transfusion in the 4, 6, 8, and 10-unit arms when compared with similar time intervals from vancomycin infusion of the control arm. Prophylactic vancomycin dosing was subtherapeutic after four units of whole-blood resuscitation for massive hemorrhage in our swine model. Redosing at more frequent intervals may be considered for patients who have more than four to six units of hemorrhage. (J Trauma Acute Care Surg. 2026;100:929-935. Copyright © 2026 Wolters Kluwer Health, Inc. All rights reserved.). Prognostic; Level II.

3. Smoldering Multiple Myeloma: From Clinical to Immunogenomic Risk Stratification and Therapeutic Implications of Early Intervention.

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

Smoldering multiple myeloma (SMM) is an asymptomatic precursor state that precedes the development of symptomatic active MM. Newer immunogenomic data highlight the monoclonal gammopathy of undetermined significance-SMM-MM spectrum as a continuous genomic gradient rather than a series of discrete clinical categories. Current risk stratifications to define high-risk SMM use a progression rate of ≥50% within 2 years. The International Myeloma Working Group uses the 20/2/20 model that identifies serum M-protein >2 g/dL, bone marrow plasma cells >20%, and involved/uninvolved free light chain ratio >20 as independent predictors for risk of progression to MM. Having ≥2 risk factors increases the 2-year risk of SMM progression to 40%-50%. This risk is further increased by the presence of adverse cytogenetics [del13, t(4;14), t(14;16), +1q]. The model is purely based on tumor burden and cytogenetics and could be further refined by using genomics that predict tumor evolution. Key genomic features identified as independent risk factors for SMM progression include mutations in the MAPK pathway (KRAS and NRAS single nucleotide variants [SNVs]), alterations of the DNA repair pathway (TP53, ATM SNVs, and deletion 17p), MYC alterations (translocations or copy number variations), and APOBEC-associated mutational signatures. Integrating the molecular and clinical determinants to define high-risk SMM is described as the holy grail of risk stratification in SMM. Three large, randomized phase III studies demonstrated the benefit of early intervention by meeting their primary end points, one demonstrating an overall survival (OS) benefit (QuiRedex) and another showing a trend toward OS benefit (AQUILA) favoring early intervention. In this context, identifying the patients with high-risk SMM is crucial as the optimal patient might benefit from a therapeutic intervention aimed at preventing progression to MM and prolonging OS.

4. Advances in Stroke 2026: Recovery and Rehabilitation.

期刊: Stroke 发表日期: 2026-Jun 链接: PubMed

摘要

5. Ac-SDKP Attenuates Silica-Induced Pulmonary Fibrosis by Inhibiting ALKBH1-Mediated m6A Demethylation of miR-129-5p.

期刊: FASEB journal : official publication of the Federation of American Societies for Experimental Biology 发表日期: 2026-May-31 链接: PubMed

摘要

Silicosis, one of the most common and severe forms of pneumoconiosis, remains a major occupational health concern worldwide. Given the lack of effective therapies, understanding the underlying molecular mechanisms is urgently needed. Here, we report that ALKB homolog 1 (ALKBH1), an N6-methyladenosine (m6A) demethylase, is upregulated in silica-induced pulmonary fibrosis and plays a pro-fibrotic role. The antifibrotic peptide Ac-SDKP inhibited Alkbh1 expression and alleviated pulmonary fibrosis. Mechanistically, ALKBH1 suppressed the biosynthesis of miR-129-5p by removing m6A modification from pri-miR-129-5p, thereby reducing DGCR8-mediated processing and leading to decreased mature miR-129-5p levels. Ac-SDKP reversed this process, restoring miR-129-5p expression. Functionally, overexpression of miR-129-5p attenuated silica-induced pulmonary fibrosis by suppressing macrophage activation. Collectively, these findings identify the Ac-SDKP-ALKBH1-miR-129-5p axis as a critical regulatory mechanism, with ALKBH1-mediated m6A demethylation of pri-miR-129-5p representing a key node and a promising therapeutic target for silicosis.

6. Maternal triclosan exposure impairs female offspring neurodevelopment via MeCP2 hypomethylation and enhanced MeCP2/HDAC3 interaction.

期刊: Ecotoxicology and environmental safety 发表日期: 2026-May-22 链接: PubMed

摘要

Triclosan (TCS), a broad-spectrum antimicrobial agent widely used in personal care products and medical disinfectants due to its potent antibacterial properties, is an emerging environmental endocrine-disrupting chemical. While its potential neurodevelopmental toxicity to offspring has raised significant concern, the precise epigenetic mechanisms involved remain unclear. Methyl CpG binding protein-2 (MeCP2), a crucial epigenetic regulator in brain development, recognizes DNA methylation marks and recruits co-factors such as Histone Deacetylase 3 (HDAC3) to form transcriptional repressor complexes that precisely control the expression of neuron-related genes. Dysfunction of MeCP2 is implicated in numerous neuropsychiatric disorders. This study employed a murine model of long-term, low-dose TCS exposure during gestation and lactation to investigate its neurotoxicity and epigenetic mechanisms in female offspring. The results demonstrate that gestational and lactational TCS exposure induced anxiety-like behavior and cognitive memory impairments in female offspring, accompanied by neuronal disorganization in the prefrontal cortex (PFC), increased pyknotic neurons, and ultrastructural damage to synapses. Specifically, TCS exposure downregulated the methylation level of the MeCP2 promoter region in the PFC of female offspring, increased the expression of MeCP2 and HDAC3, and enhanced their interaction, consequently repressing the protein expression of PSD95, SYN, BDNF, DCX, and PCNA. Notably, an exposure dose of 8 mg/kg TCS emerged as a critical threshold for these epigenetic alterations. In summary, TCS exposure during pregnancy and lactation may mediate neurodevelopmental impairment in female offspring by downregulating MeCP2 promoter methylation, subsequently enhancing MeCP2 recruitment of HDAC3 and their interaction. These findings provide novel experimental evidence elucidating the epigenetic mechanisms underlying TCS-induced neurodevelopmental toxicity.

7. Mediating effects of depression, stigma, and self-efficacy on self-management improvement in an evidence-based epilepsy self-management program.

期刊: Epilepsy & behavior : E&B 发表日期: 2026-May-22 链接: PubMed

摘要

To evaluate whether improvements in depressive symptoms, epilepsy self-efficacy, and perceived stigma mediate the association between the SMART intervention and epilepsy self-management. 160 people with epilepsy were enrolled in a randomized controlled trial comparing SMART with standard care. Potential mediators included depressive symptom severity, self-efficacy, and perceived stigma measured at baseline, 13 weeks, and 6 months. Multivariable linear regression models estimated direct and indirect effects, with the indirect effect defined as the average causal mediation effect (ACME). Improvements in potential mediators were evaluated over three intervals: baseline to 13 weeks, 13 weeks to 6 months, and baseline to 6 months. Improvement in depressive symptoms from baseline to 6 months was significantly associated with mediation of SMART on ESMS improvement (ACME = 0.83; p = 0.0089), accounting for 23.2% of the total effect (95% CI 4.4, 41.9%; p = 0.015). Increases in self-efficacy from baseline to 6 months were also significantly associated with mediation of the effect of SMART on ESMS improvement (ACME = 0.155; p = 0.0095), accounting for 4.6% of the total effect (95% CI 2.0, 7.3%, p = 0.00063). Changes in perceived stigma did not significantly mediate the association between SMART and self-management. Findings suggest that SMART may improve epilepsy self-management competency in part through reductions in depressive symptoms and increases in self-efficacy, with depressive symptom improvement representing the larger of the two significant mediating pathways observed. Perceived stigma did not significantly mediate the intervention’s association with self-management. These findings suggest that mood and self-efficacy may be important targets in epilepsy self-management interventions.

8. Willingness to receive Ebola vaccines among pregnant and lactating women in Kampala, Uganda: insights from a post-outbreak cross-sectional study.

期刊: Vaccine 发表日期: 2026-May-22 链接: PubMed

摘要

Pregnant and lactating women face heightened risk of mortality due to Ebola disease during outbreaks, yet have historically been excluded from vaccine trials and emergency vaccination campaigns. This study assessed willingness to receive an Ebola vaccine and identified associated factors among pregnant and lactating women in Kampala-Uganda, in the aftermath of the 2022 Sudan ebolavirus outbreak and amid the COVID-19 pandemic. A cross-sectional survey was conducted in 2023 among pregnant/lactating women receiving antenatal/postnatal services at Kawempe National Referral Hospital. Data were collected using a structured questionnaire adapted from the WHO SAGE Working Group on Vaccine Hesitancy and included additional items on Ebola vaccine attitudes, socio-demographics, prior vaccination experiences, vaccine preferences (oral vs injectable) and health status, including chronic illness. The primary outcome was willingness to receive an Ebola vaccine. Modified Poisson regression was done using STATA version 15 and a p-value <0.05 was considered statistically significant. Among 424 participants (212 pregnant, 212 lactating), 252(59.4%) expressed willingness to receive an Ebola vaccine. In multivariable analysis, willingness was significantly associated with previous COVID-19 vaccination (adjusted Prevalence Ratio [aPR] = 1.32; 95%CI:1.02-1.70) and a preference for injectable vaccines only, compared to those open to oral or injectable modes (aPR = 1.54; 95%CI:1.18-2.00). Among those who were unwilling or unsure (n = 172), the most cited reasons for hesitancy were fear of side effects (22.1%) and lack of awareness about Ebola vaccines (20.3%). While just over half of the pregnant and lactating women in this study were willing to receive an Ebola vaccine, concerns about safety and limited awareness remain important barriers. Prior COVID-19 vaccination and preference for injectable vaccines were positively associated with willingness, suggesting that trust and familiarity with vaccination influence acceptance. Tailored risk communication and community engagement, and inclusion in vaccine planning are essential to ensuring equitable protection during EVD outbreaks.

9. Conjugate vaccine technology enhances responses to influenza virus.

期刊: Vaccine 发表日期: 2026-May-22 链接: PubMed

摘要

Influenza remains a major public health concern due to its high mutation rate and the limited efficacy of current seasonal vaccines. Traditional subunit and inactivated virus vaccines often elicit strain-specific responses and fail to generate long-lasting or broadly protective immunity. To address these limitations, we utilized the iBoost platform, a conjugate vaccine strategy based on a chimeric designer peptide (CDP) derived from bacterial immunogens, to enhance immune responses against influenza virus antigens. Using hemagglutinin (HA) and neuraminidase (NA) constructs from the A/Wisconsin/588/2019 (H1N1) strain, we developed CDP-H1 and CDP-N1 vaccine candidates and assessed their immunogenicity in murine models. Compared to unconjugated counterparts, CDP-fused constructs induced significantly stronger and more rapid antibody responses, with broader IgG subclass distribution and higher IgG2a levels, potentially indicative of enhanced effector functions. CDP-H1 elicited measurable HA-inhibiting activity by hemagglutination inhibition (HAI) assay and demonstrated partial binding cross-reactivity to heterologous H1 and H3 strains, while CDP-N1 induced antibodies with cross-reactive potential to N2. These preliminary findings suggest that iBoost may enhance both the magnitude and quality of humoral responses, supporting its potential as a platform to improve the breadth and kinetics of antibody induction. However, further studies incorporating functional and in-vivo challenge assays will be required to confirm protective efficacy and validate the translational potential of this approach.

10. Landmark Clinical Trials Shaping Contemporary Guideline-Directed Medical Therapy for Heart Failure.

期刊: ESC heart failure 发表日期: 2026-May-22 链接: PubMed

摘要

11. Prediction of 30-Day All-Cause Hospital Readmissions Using Limited Structured Electronic Health Record Data: Retrospective Comparative Study.

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

摘要

Unplanned hospital readmissions represent a critical operational and financial challenge for health care systems in the United States, with 3.8 million 30-day all-cause readmissions in 2018 at an average cost of US $15,200 each, totaling US $58 billion in costs. Many published prediction models rely on comprehensive information (eg, full billing abstractions, discharge summaries, laboratory tests, and vitals) that becomes available only late in the encounter, limiting usefulness for real-time, in-hospital intervention. This creates a timeliness-accuracy trade-off: models that are most accurate retrospectively may arrive too late to act upon. This study tests whether a clinically meaningful predictive signal for 30-day all-cause readmission is present within a limited set of structured clinical codes recorded during the patient’s hospital stay. This approach evaluates whether predictive signals are retained when using a restricted set of structured clinical codes. We conducted a retrospective comparative modeling study using a large, deidentified electronic health record dataset of 50,000 inpatient encounters from the 2019 New York State Emergency Department Database. Two feature sets were constructed: (1) a limited set consisting of the first 5 ICD-10 (International Classification of Diseases, 10th Revision) diagnosis codes, the first 5 Current Procedural Terminology (CPT) codes, and Charlson Comorbidity Index (CCI; 11 input features); and (2) a rich set using all available ICD-10 and CPT codes plus CCI (up to 135 input features). We trained 4 models: random forest, CatBoost, multilayer perceptron, and DistilBERT (a distilled Bidirectional Encoder Representations from Transformers [BERT] model; structured codes mapped to text and tokenized with DistilBERT-base-uncased). Evaluation used an untouched hold-out set of 10,000 encounters, preserving the natural 21.1% readmission prevalence. Primary metrics were area under the receiver operating characteristic curve (AUROC), F1-score, and accuracy. To address class imbalance, the training split only was balanced via undersampling of the majority class and bootstrap oversampling of the minority class; validation/test distributions were left unchanged. Models trained on the limited feature set achieved AUROC values ranging from 0.5369 to 0.5596 and F1-scores from 0.2555 to 0.3434. Across 3 of 4 architectures, models trained on the limited feature set matched or exceeded the discrimination of their rich counterparts. The best model (random forest, limited) achieved an area under the curve AUROC 0.5596 (95% CI 0.5440-0.5739) compared to the best performing rich model (DistilBERT) at 0.5703 (95% CI 0.5565-0.5842), an absolute difference of 0.0107. The highest F1-score (0.3434) was achieved by DistilBERT on the limited feature set. Differences across architectures were small in absolute terms, with threshold-dependent metrics (eg, F1-score) being comparable. The findings suggest that models using a limited set of structured clinical codes can achieve performance comparable to those using more comprehensive coding information.

12. Gut microbiota dysbiosis and osteoporosis: pathogenesis and novel intervention strategies.

期刊: Future microbiology 发表日期: 2026-May-22 链接: PubMed

摘要

Osteoporosis represents a major global public health challenge, with current pharmacological treatment often limited by substantial side effects. Recent research identifies the gut-bone axis as a key regulatory pathway linking gut microbiota to bone metabolic homeostasis. This review synthesizes findings from PubMed, Web of Science, and Scopus (up to March 2026) to elucidate how gut microbiota dysbiosis drives osteoporosis pathogenesis through interconnected mechanisms: aberrant immune modulation, altered microbial metabolites, impaired nutrient absorption, endocrine disruption, and systemic inflammation stemming from intestinal barrier failure. Consequently, these pathways disrupt the delicate balance of bone remodeling. Based on these insights, we outline novel microbiota-targeted therapeutic strategies, including probiotics, prebiotics, fecal microbiota transplantation, natural bioactive compounds, traditional Chinese medicine, and nanomaterials. These interventions aim to prevent and manage osteoporosis by reshaping the intestinal microecology via multi-target modulation. Future endeavors should prioritize in-depth mechanistic exploration, personalized precision interventions, and enhanced clinical translation to integrate these strategies into comprehensive osteoporosis care frameworks. This review explains the important two-way communication between the microbes in your digestive system (your gut microbiome) and your bones, known as the “gut-bone axis.” We describe how an unhealthy imbalance in these gut microbes can lead to or worsen osteoporosis, a condition that makes bones weak and prone to breaking. This happens through several connected ways: the imbalance can cause long-term, low-level inflammation throughout the body, reduce helpful substances that bones need, make it harder for your body to use key nutrients like calcium and vitamin D, and damage the lining of the gut, allowing harmful bacterial products to enter the bloodstream.The article then explores new treatment ideas that focus on fixing this gut imbalance to protect bones. These include taking supplements like probiotics and prebiotics, a procedure called fecal microbiota transplantation to restore a healthy gut community, using natural plant compounds and traditional herbal medicines, and developing new technologies like nanomaterials to deliver treatments precisely. Finally, we look to the future, where research will pinpoint the exact bacteria involved and test these gut-focused approaches in people, aiming to create personalized plans for keeping bones strong and preventing fractures.

13. Harmonization of Health Data Governance, Oversight, and Policy: Reimagining Stewardship.

期刊: Healthcare management forum 发表日期: 2026-May-22 链接: PubMed

摘要

The Pan-Canadian Health Data Charter advocates for new legal institutions, that would empower organizations to steward health data for future use. We propose three potential legal mechanisms to realize this vision: (i) data stewards as fiduciaries, (ii) licensed data stewards, and (iii) licensed data trusts. These mechanisms would enable representative decision-makers acting on behalf of affected communities and publics to make binding choices about whether proposed health information uses respect applicable norms. This would help to foster public trust in health sector use of information. It would also enable data stewards to base their decisions on data re-use upon actionable feedback from affected populations regarding their preferences in balancing competing norms, which these institutions would produce. Our proposals hope to move the literature beyond narrow debates about the benefits of increasing or reducing regulation, towards an actionable vision of adaptive data governance in practice.

14. Innovation Deimplementation in Emergency Departments During the COVID-19 Pandemic: Qualitative Study of Clinicians' Decision-Making.

期刊: Interactive journal of medical research 发表日期: 2026-May-22 链接: PubMed

摘要

During a public health emergency, emergency department (ED) clinicians can improve care delivery if they identify and adopt innovations that are safe and effective. However, little is known about the factors that impact ED clinicians’ decision-making around using or discontinuing innovations when evidence-based information is limited. The goal of this study was to understand the processes and factors that led ED clinicians to discontinue (deimplement) the use of COVID-19 care innovations. This is a qualitative study using semistructured focus groups with ED clinicians from 8 hospitals across the United States. Hospitals were purposively sampled and recruited to capture a diversity of perspectives based on location, facility type (academic or community hospital), rurality (urban or rural), and safety-net status. In this study, 17 physicians, 7 advanced practice providers, 18 nurses, and 7 respiratory therapists participated. We utilized both inductive and deductive techniques to perform content and thematic analysis of transcripts. Clinicians shared that their own experiences (eg, direct observation of patient outcomes), contextual factors, and emerging research evidence contributed heavily to decisions about deimplementing innovations during the COVID-19 pandemic. Processes related to discontinuing innovations depended on leadership guidance and collaboration among colleagues. However, in some cases, there were no official processes to discontinue innovations, and innovations were passively deimplemented. Decision-making regarding the discontinuation of innovation in ED settings during the COVID-19 pandemic differed from routine conditions due to the lack of information and the rapid evolution of evidence within a short period of time. The level of evidence required to implement and deimplement innovations was significantly lower. Our findings indicate that factors influencing deimplementation during a public health emergency were highly localized and were treated similarly to pilot tests of new innovations. Future work is necessary to develop mechanisms for implementing promising innovations during evolving public health emergencies and monitoring their effectiveness and safety after implementation, enabling evidence-based decisions about whether to continue implementation or proceed with deimplementation.

15. Childhood vaccination uptake and associated determinants among caregivers of young children in Cape Town, South Africa.

期刊: Vaccine 发表日期: 2026-May-22 链接: PubMed

摘要

Despite high overall vaccination coverage in South Africa, maintaining optimal coverage is persistently challenged by complex factors, including vaccine hesitancy and access barriers. The World Health Organization’s Behavioural and Social Drivers (BeSD) framework provides a comprehensive framework for systematically analysing the determinants of vaccine uptake. This study aimed to estimate the rate of uptake of vaccines and identify associated factors among a sample of caregivers of children aged 0-2 years in the Cape Town Metropolitan Health District. A cross-sectional survey was conducted in high, mixed, and low-density subdistricts of Cape Town between August 2024 and February 2025, recruiting 250 caregivers of children aged 0-2 years. Demographic and behavioural determinants of vaccination uptake were analysed using binomial regression, informed by the BeSD framework. Overall uptake was high, with 93% (95% CI: 89% to 95%) of children fully vaccinated for their age, and 99% having received at least one dose of any vaccine. Caregiver motivation was robust, as 97% expressed being “very willing” to ensure their child receives all recommended vaccines. However, significant demographic associations and barriers persisted. Full vaccination was significantly associated with married caregiver status (RR = 1.07, p = 0.015) and residence in the low-density Tygerberg subdistrict compared to Mitchells Plain (RR = 1.09, p = 0.049). Conversely, the likelihood of full vaccination decreased significantly with increasing child age (RR = 0.99, p = 0.039) and higher birth order (RR = 0.97, p = 0.007). Practical constraints were notable, with 81% of caregivers reporting unemployment. Furthermore, 63% reported long queues, and 26% reported unsatisfactory service quality. Socially, decision-making was primarily driven by mothers (77%), and only 22% of caregivers reported recently hearing about vaccines, suggesting gaps in external communication. Caregivers recruited in the study demonstrate high motivation and vaccine confidence. However, structural vulnerabilities related to single parenting, larger family sizes, and geographic location persist as barriers to full vaccination. The decline in uptake as children grow older highlights a particular need to strengthen retention strategies for the 18-month visit. Findings indicate the need for interventions targeting structural barriers that influence childhood vaccination rates.

16. Impact of intracranial pressure monitoring on 30-day mortality in severe traumatic brain injury: a retrospective cohort study in Kenya.

期刊: Journal of neurosurgery 发表日期: 2026-May-22 链接: PubMed

摘要

The objective of this study was to evaluate 15-year trends in epidemiology, baseline severity, management, and outcomes of severe traumatic brain injury (sTBI) at a Kenyan tertiary center, and to determine the impact of invasive intracranial pressure (ICP) monitoring on 30-day mortality in a low- and middle-income country (LMIC) context. A retrospective quasi-experimental cohort analysis of consecutive sTBI admissions (postresuscitation Glasgow Coma Scale [GCS] score ≤ 8, age ≥ 13 years) from January 1, 2010, to December 31, 2024, was conducted. This time period was divided into two eras: era 1 (2010-2014), premonitoring, and era 2 (2015-2024), routine monitoring. Patient demographics, injury severity (Injury Severity Score [ISS], pupillary response, and Marshall CT class), physiology, therapies utilized (hyperosmolar agents, CSF drainage, barbiturates, and decompressive craniectomy [DC]) and outcomes were collected. Propensity score analysis with 1:1 nearest-neighbor matching for age, sex, ISS, GCS score, pupillary response, hypotension, hypoxemia, time to admission, and Marshall CT class was applied. The primary outcome was 30-day mortality. Among 126 sTBI patients (median age 32 years, 80% male), 52 (41%) received ICP monitoring (56% parenchymal, 44% external ventricular drain). In the unmatched analysis, the mortality rate was 27% with monitoring versus 54% without (risk ratio [RR] 0.50, p = 0.002). In the matched analysis (41 pairs), the mortality rate was 29% with monitoring versus 51% without (RR 0.57, OR 0.39, p = 0.043). Era 2 showed a higher use of hypertonic saline (62% vs 35%, p = 0.003), CSF drainage (37% vs 1.4%, p < 0.001), and DC (22% vs 2.4%, p = 0.011). Complication rates from use of the monitoring device were low (infection 7.7%, hemorrhage 7.7%). Over the 15-year period, sTBI admissions rose while early mortality declined following the adoption of ICP monitoring and protocol-based care. In this LMIC setting, ICP monitoring was independently associated with lower 30-day mortality, supporting the use of guideline-concordant neuromonitoring and scalable multimodality bundles.

17. Effect of a Personalized Mobile Health Intervention Using Artificial Intelligence (the WARIFA App) Versus a Nonpersonalized Intervention on User-Defined Objectives, Healthy Lifestyles, and Management of Type 1 Diabetes (T1D): Protocol for a Randomized Controlled Trial.

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

摘要

Noncommunicable diseases are the leading cause of death worldwide. Cardiovascular and respiratory diseases, cancer, and type 2 diabetes share common risk factors that can be addressed: physical activity, a healthy diet, and avoiding smoking and alcohol. The Watching the Risk Factors (WARIFA) mobile health app was created for general health awareness and to support users in adopting healthier behaviors, as well as to support type 1 diabetes (T1D) self-management. This study aims to evaluate the effectiveness of the WARIFA app with personalized artificial intelligence (AI)-driven messages, compared to a nonpersonalized version, in promoting health-related behavior change among the general population and individuals with T1D. A total of 108 European participants, including individuals with T1D, were to be randomized (computer-generated sequence, double-blind, 1:1 ratio) to an intervention or control group. In the intervention group, participants used the WARIFA app with personalized messages and the use of AI. This applied to certain functionalities, such as providing recommendations on healthy dietary habits based on food logging and offering advice and encouragement through daily step tracking. It also provided risk predictions for cardiovascular and respiratory diseases, cancer, and type 2 diabetes. Participants with T1D were offered glucose predictions based on previous measurements. In the control group, participants used a WARIFA app without personalized messages or AI. Both WARIFA app versions offered access to air quality and UV index information for the geographical area, as well as displaying physical activity in the form of daily steps and sleep hours, as well as glucose results for participants with T1D. Both groups were provided with an activity monitor and used the WARIFA app for 8-12 weeks. The primary outcome is a self-defined goal, chosen from a set of proposed objectives at baseline and assessed at the end of the study using a Likert scale (1 to 10 points, 0 being no achievement at all and 10 being full achievement of the objective). Secondary outcomes include: engagement with the app, changes in lifestyle behavior, body composition, lipid profile, glycated hemoglobin (T1D only), hypoglycemic events (T1D only), and health-related quality of life, as well as acquired knowledge, self-efficacy, and usability. The clinical trial took place between January and June 2025. A total of 88 participants were finally recruited. The data are being analyzed, and the results are expected to be published in 2026. There is evidence that improving lifestyle behavior can prevent noncommunicable diseases. In this study, we aim to evaluate the effectiveness of the WARIFA app to improve lifestyle behaviors and T1D management. ClinicalTrials.gov NCT06918444; https://clinicaltrials.gov/study/NCT06918444. DERR1-10.2196/84510.

18. One-month delay in methotrexate initiation on rheumatoid arthritis outcomes: One-year ancillary analysis of the VACIMRA trial.

期刊: Rheumatology (Oxford, England) 发表日期: 2026-May-22 链接: PubMed

摘要

The VACIMRA trial demonstrated that delaying methotrexate initiation in rheumatoid arthritis (RA) by one month after the 13-valent pneumococcal conjugate vaccine (PCV13) improves humoral responses at 1 and 12 months. Whether this delay impacts disease activity and radiographic progression over one year remains uncertain. This ancillary study compared changes in disease activity (DAS28-ESR) from inclusion (M0) to months 1, 2, 3, 6, and 12 between patients with early RA who started methotrexate immediately vs one month after PCV13. Structural progression was assessed using the van der Heijde-modified Sharp score (mSHS) on X-rays at inclusion, 6 and 12 months. The primary outcome was the proportion of patients in remission (DAS28-ESR < 2.6) or low disease activity (LDA) (DAS28-ESR ≤ 3.2) at one year. Among 276 VACIMRA participants, 100 were enrolled at the Montpellier center (96 analyzable at M0, 83 at M12). Both groups had similar baseline characteristics: mean age 58 ± 14 years, DAS28-ESR 4.88 ± 0.94, total mSHS 1.53 ± 3.62. Treatments during follow-up were comparable except for methotrexate cumulative dose at 1, 3, 6 months. At 12 months, remission (53.7% vs 46.3%, p= 0.51) and LDA rate (75.6% vs 61.0%, p= 0.15) were similar.DAS28-ESR was similar at 1 and 3 months but favored the DELAY group at 6 (2.66 ± 1.07 vs 3.28 ± 1.34, p= 0.02) and 12 months (2.23 ± 1.03 vs 3.00 ± 1.16, p< 0.01). mSHS progression was comparable at 6 and 12 months. Deferring methotrexate for one month after PCV13 to enhance immunity did not worsen RA disease control, radiographic progression, or treatment escalation after one year of follow-up.

19. Pulse Discovery Toolkit, a Multicomponent Nutrition Intervention for Preschool Children in Childcare Centers: Mixed Methods Pilot Study.

期刊: Interactive journal of medical research 发表日期: 2026-May-22 链接: PubMed

摘要

Children’s eating habits are formed at an early age, making childhood a crucial period for introducing novel foods, such as pulse-based food products. Pulse Discovery Toolkit (PDTK) intervention was designed to increase familiarity with pulses and to eventually contribute to the consumption of pulse-based foods among preschool children in childcare centers (CCs). To determine PDTK’s impact on knowledge, acceptability, and consumption of pulse-based foods among preschool children attending CCs, and to assess its feasibility and acceptability by early childhood educators (ECE) and cooks. The nutrient contents and food group servings of pulse-based intervention recipes in the PDTK were also compared with regular CC recipes. The PDTK intervention was delivered over a 3-month period in 2 CCs in Saskatoon (50 children, 8 staff). The intervention, which integrated taste exposure and nutrition education, consisted of 12 child-friendly weekly lessons, a food service guide for cooks, 15 recipes for pulse-based foods, 4 intervention recipes incorporated in the CC menu, and 4 parent newsletters. Mixed methods were used with pre- and postintervention knowledge tests, plate waste measurement, sensory evaluation, ECE and cook’s perspective, and nutrient content comparison of the intervention and control foods from the regular childcare menu to evaluate the intervention’s impact. Improvements in correct identification of chickpeas (2/21 [10%] at preintervention to 7/21 [33%] at postintervention, P=.074), beans (8/21 [38%] to 11/21 [52%], P=.68), and peas (6/21 [27%] to 8/21 [38%], P=.61) were not statistically significant. Children consumed higher amounts of the regular recipes (293.54, SD 27.65; 178.46, SD 24.33) than the intervention recipes (211.56, SD 25.61; 108.83, SD 21.97) at both times, respectively. However, at the end of the intervention, significant differences were only observed in the amount of total food consumption (P=.049) and the protein content (P=.04) when consumption proportion was examined, with both being higher for the control recipes in comparison to the intervention recipes. The majority (92% and 72%) of the children rated the refried bean wrap and lentil smoothie, “yummy,” respectively. Most of the intervention recipes have lower energy, fat, and sodium content compared with the regular CC recipes. Findings from ECE semistructured interviews and the lesson plan evaluations revealed that the ECEs reacted favorably to the curriculum. The cooks from the participating CCs did not report any barriers to cooking pulses in their facility. However, the need for modification to make the recipes easier to cook in CCs was noted in our study. With a few modifications to make some of the lessons more age-appropriate and some of the recipes easier to cook, it is feasible to implement the PDTK in CCs in order to promote regular consumption of pulses.

20. Reporting of Telehealth Implementation in Cystic Fibrosis: Scoping Review Using a Novel Theory-Based Evaluation Lens.

期刊: Journal of medical Internet research 发表日期: 2026-May-22 链接: PubMed

摘要

Many inductive reviews exploring telehealth and its application in health care have identified missing or inconsistently reported implementation data, calling for a standardized approach to telehealth research. Using cystic fibrosis (CF) as a case exemplar, this study evaluated the adherence of telehealth research to standardized reporting frameworks through a theory-based evaluation lens to assess implementation reporting quality and identify knowledge gaps and strengths across the literature. We conducted an updated systematic review of the PubMed, Scopus, and Web of Science databases using a novel deductive approach to identify relevant scientific papers available in English and focusing on the delivery of telehealth interventions to CF populations as part of or alongside routine CF care. Two relevant reporting checklists were identified in the Equator Network database (Guidelines and Checklist for the Reporting on Digital Health Implementations [iCHECK-DH] and Template for Intervention Description and Replication for Telehealth [TIDiER-telehealth]) to extract data from the papers. Each checklist category was described as being “fully reported” (score=2), “partially reported” (score=1), and “did not report” (score=0) for each paper. An overall score was calculated for adherence to the checklists. In total, 98 studies published between 2006 and May 2025 were included in this review, with the majority appearing during the COVID-19 pandemic (2021-2022). Most studies were conducted in a single country, predominantly the United States, Australia, and the United Kingdom, and were published in medical journals. Telehealth was variably described, with video call-based models in combination with remote monitoring being most common. The median score was 22/40 (range 11-29, 55.0% adherent) for iCHECK and 15/24 (range 6-23, 62.5% adherent) for TIDiER, demonstrating moderate overall reporting quality. For iCHECK, ≥50% of studies fully reported 6/20 categories, partially reported 9/20 categories, and did not report 3/20 categories. For TIDiER, ≥50% of studies fully reported 4/12 categories, partially reported 6/12 categories, and did not report 1/12 categories, indicating persistent gaps in intervention description despite improved partial reporting. Key areas, such as justification for telehealth, target populations, and outcomes, are well documented, offering valuable insights into the rationale for and outcomes associated with telehealth. However, implementation processes remain underreported, partly due to the more recent adoption of frameworks like iCHECK and TIDiER. The clinical implications of the current evidence limit the implementation of telehealth in terms of the ability to assess feasibility and readiness for adoption; understand financial implications and plan sustainably; ensure patient safety, data protection, and equity; interpret outcome data in context; and share, replicate, or scale evidence-based models of care. Strengthening the commitment to standardized telehealth reporting will ultimately support clinical decision-making and improve the effective and equitable integration of telehealth into care.

21. Determining the Impact of a Physiotherapist-Led Primary Care Model for Hip and Knee Pain: Protocol and Analysis Plan for a Cluster Randomized Controlled Trial With Process Evaluation.

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

摘要

Hip and knee pain are leading contributors to disability, reduced quality of life, and health care burden in Canada. Primary care is often the first point of contact for patients with these conditions, yet timely and appropriate care is limited due to provider shortages and system pressures. Interest is growing in interprofessional primary care models that integrate physiotherapists to enhance care delivery for musculoskeletal conditions such as hip and knee pain. This study aims to communicate the protocol and analysis plan for a trial with two objectives: (1) to evaluate the effectiveness of a physiotherapist-led primary care model for hip and knee pain on physical functioning (primary outcome), pain intensity, quality of life, global rating of change, patient satisfaction, and adverse events, compared to usual physician-led primary care; and (2) to assess the impact of this model on health care system and societal outcomes, including access to care, health care use, productivity loss, and cost-effectiveness. A process evaluation will examine implementation, potential mechanisms, and patient experiences. A cluster randomized controlled trial involving 14 primary care organizations randomized equally to either a physiotherapist-led or usual physician-led primary care model for patients with hip and knee pain. Patients were recruited over 1 year, with data collected at baseline and at 3, 6, 9, and 12 months. The intervention integrates a physiotherapist as the initial point of contact within the primary care team for patients seeking care for hip or knee pain. It includes four components: (1) comprehensive assessment and screening, (2) brief individualized interventions during the initial visit, (3) guidance for accessing additional health care resources, and (4) follow-up physiotherapy for patients with unmet needs. Effectiveness will be assessed using linear mixed regression, accounting for clusters and prespecified covariates. The multimethods process evaluation will include descriptive and comparative analysis of implementation, mediation analysis to explore potential mechanisms, and qualitative exploration of patient experiences. This research was funded in December 2022. Primary care sites (clusters) were recruited and randomized in June and July 2023, respectively. Patient enrollment occurred from October 2023 through November 2024. The final patient follow-up survey was completed in November 2025. Extraction of data from electronic health records is expected to finish in December 2025. Data analysis will begin after data collection is complete and will follow the predefined protocol and analysis plan. No interim analyses are planned. Findings from this trial will provide actionable evidence on whether integrating physiotherapists into primary care teams for hip and knee pain improves patient outcomes and health care system efficiency. Effectiveness and process evaluation evidence will inform policymakers and health system leaders on the adoption and implementation of interprofessional, team-based primary care models. ClinicalTrials.gov NCT06358521; https://clinicaltrials.gov/study/NCT06358521. DERR1-10.2196/89006.

22. Developing and validating a sequence-aware deep learning model for infection risk prediction in home care.

期刊: International journal of medical informatics 发表日期: 2026-May-22 链接: PubMed

摘要

Infections are a leading cause of hospitalizations and emergency department (ED) visits in home care. Existing prediction tools often underutilize longitudinal patterns of home care electronic health record (EHR) and narrative clinical notes. To evaluate a sequence-aware deep learning approach that integrates longitudinal structured EHR data with Natural Language Processing (NLP)-derived features from clinical notes to predict infection-related hospitalizations or ED visits, derive a three-tier risk stratification tool from model outputs, and assess performance, interpretability, and fairness. This retrospective cohort study analyzed 23,321 home care episodes (2015-2017), of which 1,528 (6.5%) involved an infection-related hospitalization or ED visit within 30 days of admission. We compared sequence-aware models against a non-sequential baseline. Models used 28 admission-level and 30 visit-level features (6 structured measures and 24 NLP-derived indicators) to represent longitudinal home visit data. Models estimated the risk of first infection-related hospitalization or ED visit over 2-, 3-, and 4-day windows. Evaluation metrics included the Area Under the Receiver Operating Characteristic (AUROC) curve, Area Under the Precision-Recall Curve (AUPRC), and F1-score. Sequence-aware models consistently outperformed the non-sequential baseline, with larger gains observed when NLP-derived features were included. The best configuration (bidirectional long short-term memory at 4-day lead time) achieved AUROC 0.991, AUPRC 0.885, and F1-score 0.774. The three-tier stratification concentrated 77.7% of infection events within the highest-risk 5% of episodes. Interpretability analyses highlighted the importance of recent visit information, and fairness analyses showed equitable performance across most demographic and socioeconomic subgroups. A sequence-aware deep learning model integrating longitudinal structured EHR data with NLP-derived features can accurately and equitably predict near-term risks of infection-related hospitalizations or ED visits among home care patients. The three-tier tool may support targeted triage and early intervention for patients at risk of infection-related acute care utilization.

23. The Use of Silver Fluoride for Oral Health and Well-Being in Aged Care Residents: Protocol for a Cluster Randomized Controlled Trial.

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

摘要

Older adults living in residential aged care facilities (RACFs), particularly in regional and rural areas, experience a high burden of untreated dental caries, tooth sensitivity, and oral pain. Workforce shortages, limited access to dental services, and competing health priorities make the delivery of timely oral health care challenging in these settings. Poor oral health contributes to pain, impaired nutrition, reduced quality of life, and increased health service use. There is an urgent need for context-appropriate, accessible, and cost-effective interventions for RACF residents. Aqueous silver fluoride (AgF), a minimally invasive topical agent with caries-arresting and desensitizing properties, offers a pragmatic approach suitable for aged care settings. This protocol aims to test the effectiveness of an AgF intervention package in reducing tooth sensitivity and tooth pain, arresting caries, and improving oral health and well-being in older adults living in regional and rural RACFs. This study is a 2-arm, parallel-group cluster randomized controlled trial, with RACFs as the unit of randomization. The trial is conducted in public and private RACFs across regional and rural Queensland and New South Wales, Australia. Eligible participants are residents with at least 1 natural tooth. At baseline, calibrated examiners perform standardized oral examinations to assess dental caries status, lesion activity, and dentin hypersensitivity. AgF is applied to eligible carious lesions and sensitive tooth surfaces following a standardized clinical protocol. Follow-up assessments at 3 months include a repeat clinical examination to assess caries arrest and changes in hypersensitivity, along with resident-reported measures of oral pain and oral health-related quality of life collected using validated instruments. Outcomes include change in tooth sensitivity and oral pain at the 3-month follow-up, caries arrest rates, and change in oral health-related quality of life. Analyses will follow intention-to-treat principles and account for clustering using mixed-effects regression models with facility-level random effects. Models will adjust for baseline covariates and prespecified confounders. Sensitivity analyses will examine the robustness of the findings. The trial will also inform a planned economic evaluation embedded within the broader research program. This trial forms part of a broader program funded by the Medical Research Future Fund Dementia, Aging and Aged Care Grant (2024439). Recruitment and data collection commenced in May 2025 and are expected to conclude in June 2026. Recruitment is ongoing across participating RACFs. Data analysis is expected to commence in mid-2026, with primary findings anticipated for publication in early 2027. This protocol outlines a rigorous evaluation of a minimally invasive, scalable oral health intervention tailored to RACF settings. The findings will provide high-quality evidence on effectiveness to inform policy, service delivery, and economic evaluation aimed at improving oral health and well-being among older adults in residential aged care.

24. The Use of Speculative Fiction in Future-Focused Health Care Research.

期刊: Journal of medical Internet research 发表日期: 2026-May-22 链接: PubMed

摘要

Health care is undergoing rapid change due to digitalization, artificial intelligence, data-driven decision-making, and shifting patient needs. These developments raise complex ethical, social, and organizational questions that cannot always be addressed by conventional research methods alone. There is a growing need for tools that help stakeholders imagine alternative futures to surface underlying values. Futures studies and speculative fiction respond to this need by presenting “what if” scenarios that make uncertain futures concrete and discussable, enabling dialogue among diverse stakeholders such as health care professionals, researchers, policy makers, and decision makers. This paper examines how speculative fiction can be used as a structured yet imaginative tool in health care research. It positions speculative fiction as a tool within futures studies and participatory research approaches, outlining its conceptual grounding and clarifying its role that stimulates interpretation and reflection within methods such as focus groups, workshops, and surveys. In this way, speculative fiction complements established approaches such as human-centered design, contextual inquiry, and value specification by addressing what does not yet exist and making abstract future issues tangible. The paper presents a case study, The Digital Data Divide, in which speculative fiction was used to explore the use of personal data in health care. Two contrasting short films were developed to stimulate dialogue and invite participants to reflect on associated values. Insights from this case are structured into a 6-step practical reporting guide: determining whether speculative fiction fits the research aim, choosing an appropriate form of speculative fiction, creating or selecting speculative scenarios, engaging participants, analyzing responses, and sharing and disseminating results. Across these steps, the paper discusses methodological and ethical considerations, including alignment between scenarios and study aims, balancing utopian and dystopian elements, questions of plausibility and interpretability, and the need for researcher reflexivity. Overall, this paper contributes to the growing discussion on future-oriented tools in health care research by showing how speculative fiction can help address complex and uncertain challenges in ways that are accessible to a wide range of stakeholders and that support dialogue across perspectives, provided that its use is ethically transparent, methodologically explicit, and carefully reported. The paper concludes with a call to other researchers to also experiment with speculative fiction and to share their experiences with the health care research community to learn and advance its use.

25. Protocol for Monitoring Postpartum Hypertension Outcomes via a Smartphone App (MOMitor): Ecological Momentary Assessment.

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

摘要

Postpartum hypertension defined as elevated blood pressure after childbirth, affects approximately 20% of women after delivery. Digital health interventions that include remote monitoring therefore, present an important opportunity to facilitate regular blood pressure assessment in this high-risk population. The primary objective is to assess within- and between-person changes in hypertension status over the first 6 weeks postpartum using a smartphone-based ecological momentary assessment protocol. The secondary objective is to characterize the trajectory of hypertension indicators across the 6-week period and to compare hypertension screening results from week one and week six within participants. This study uses a time-series design using data from prospectively enrolled patients within a large health system. Patients eligible for recruitment were women aged 18 years or older who spoke English, owned a smartphone, had a liveborn neonate, and were willing to download an app and respond to survey questions within the app. Throughout the study period, all participants received hypertension screening items that asked whether their blood pressure was greater than 140/90 mm Hg and whether they felt dizzy or lightheaded, short of breath, or had a severe headache. A subset of participants were additionally asked to report their blood pressure readings. We estimate within- and between-participant effects using a generalized linear mixed model for a positive hypertension screen during weeks one through six. The model includes both fixed and random effects, controlling for age, race, marital status, education, insurance status, mode of delivery, total number of pregnancies, and history of diabetes mellitus. The study was funded July 2021 and data collection was initiated in November 2021. Data collection for this study, per protocol, was completed in June 2025, though other participants continue to be enrolled in the ongoing parent study. Data analysis is expected to be completed by Spring 2026 with publication planned for Summer 2026. The study findings will provide insight into trajectories of hypertension outcomes in postpartum women and the utility for smartphone app-based remote blood pressure monitoring among postpartum women whose blood pressure was regularly tracked. Findings will provide evidence to support whether widespread implementation of this digital health surveillance approach to improve outcomes in maternal health, especially in the postpartum period, is clinically warranted.

26. Emotion-Adaptive Large Language Model-Driven Clinical Decision Support: User Evaluation of the Empathic Clinical Decision Support System Framework for Trust and Explainability.

期刊: JMIR human factors 发表日期: 2026-May-22 链接: PubMed

摘要

The increasing prevalence of cannabis use has motivated researchers to develop computational behavioral models that predict usage patterns and related health impacts in naturalistic environments. However, the opaque nature of many artificial intelligence (AI) systems limits users’ ability to interpret outputs and undermines trust. Existing explainable artificial intelligence techniques often remain overly technical and do not account for the confusion or frustration clinicians may experience when interpreting complex model explanations. We propose and evaluate an empathic clinical decision support system (empathic-CDSS) that integrates large language models (LLMs) with real-time emotion recognition and explainability modules. The goal is to provide transparent, adaptive, and emotionally attuned explanations that enhance interpretability, user confidence, and trust in AI-assisted clinical decision-making. Our empathic-CDSS integrates explainable artificial intelligence, causal inference, and affective computing within an interactive LLM-driven framework. Users’ affective states were inferred using the circumplex model of affect, which characterizes emotions along 2 dimensions: valence (the degree of pleasure or displeasure) and arousal (the level of physiological activation or energy). Based on the captured emotional signals, the system dynamically adjusts the tone, structure, style, and complexity of its explanations generated by a fine-tuned LLM, enabling personalized and plain-language explanations. A total of 33 participants with diverse medical and technical backgrounds engaged with the system through guided evaluation tasks and postsession assessments to evaluate 6 dimensions of user-centered questions: usability, personalization and relevance of insights, clarity and comprehensibility, system benefits, satisfaction, and trust and reliability. Our empathic-CDSS effectively generated personalized and transparent explanations that revealed the causal reasoning behind model predictions while enhancing users’ emotional engagement and trust in the system’s decision logic. Continuous, affect-based feedback enabled the system to dynamically adapt explanation delivery to individual user needs. Participants reported significantly improved usability, clarity, satisfaction, and trust compared with a baseline clinical decision support system without emotion adaptation. Improvements were also observed across additional evaluation dimensions, including personalization and perceived system benefits, supporting the feasibility and added value of integrating empathy-aware communication into AI-driven clinical decision support. This study introduces a transparent, trustworthy, and emotionally adaptive framework for AI-assisted prediction and clinical decision support. By uniting causal reasoning, affective sensing, and LLM-based natural-language explanations, the empathic-CDSS offers a novel direction for developing emotionally intelligent and user-centered AI systems, with potential applications in behavioral monitoring and personalized interventions, including cannabis use and related health domains.

27. Assessing the feasibility of linking Section G and Section GG measures of function in skilled nursing facilities.

期刊: The Gerontologist 发表日期: 2026-May-22 链接: PubMed

摘要

In skilled nursing facilities (SNFs), Section GG replaced Section G as the instrument for measuring function in 2023. To inform how previously validated scales and scores derived from Section G items might be re-produced from Section GG items, we examined key measurement assumptions in both instruments. We identified 1,131,694 Minimum Data Set 3.0 assessments of unique persons with complete Sections GG and G between October 2018 and September 2023 across 2,200 SNFs in the Long-Term Care Data Cooperative. We examined: (i) assessment instructions, (ii) item-level Spearman’s correlations, (iii) measures of fit and factor structure in confirmatory and exploratory factor analyses (CFA and EFA), and (iv) graded response item response theory (IRT) parameters. Several Section GG items were conceptually similar and highly correlated (ρ ≥ 0.7). After removing redundant items, a combined scale of both instruments was not unidimensional in CFA (Comparative Fit Index = 0.753, Tucker-Lewis Index = 0.724, root-mean-square error of approximation = 0.153) and items from each instrument generally loaded onto separate but correlated factors (inter-factor correlation 0.735) in EFA. In IRT analyses, Section GG items better captured independence while Section G items better captured dependence. Sections GG and G measure related yet distinct constructs, emphasizing the need for caution when interpreting a sum of Section GG items as a reflection of underlying health in SNF patients. Scales and scores derived from Section G items cannot be presumed to be equivalent when derived from Section GG items, and further work is needed examining interchangeability.

28. Effectiveness of a Blended Intervention to Promote Physical Activity Among Office Employees: Randomized Controlled Trial.

期刊: Journal of medical Internet research 发表日期: 2026-May-22 链接: PubMed

摘要

Regular moderate-to-vigorous physical activity (MVPA) reduces the risk of noncommunicable diseases, yet one-third of adults globally fail to meet MVPA recommendations. Office employees, among the least active groups, face heightened risks due to prolonged sedentary behavior and barriers like lack of time, fatigue, and low motivation. Although scalable, web-based interventions frequently face challenges, such as low engagement, high attrition, and limited personalization. Blended interventions, combining digital tools with interactive components, show promise but lack robust evidence among office employees. This study aimed to evaluate the effectiveness of a theory- and evidence-based blended intervention in increasing MVPA among office employees. This 24-week, 3-arm randomized controlled trial included 141 office employees, randomized equally into blended (web-based+electronic workshops [e-workshops]), web-based only, and control groups. The intervention was developed using the intervention mapping framework, ensuring a systematic, evidence- and theory-based design tailored to the needs of the target population. All participants accessed a study website; the control group used the “Library” module with general MVPA information, while intervention groups also accessed a tailored, theory-driven “Intervention” module. The blended group additionally attended 3 live e-workshops (weeks 2, 4, and 8). MVPA was objectively measured using hip-worn accelerometers at baseline (T1), postintervention (12 wk, T2), and follow-up (24 wk, T3). Retention, engagement, and acceptability were assessed. Analyses followed the intention-to-treat principle, and generalized linear mixed models were used to evaluate between-group differences at T2 and T3, adjusted for baseline MVPA, sex, and ActiGraph LEAP (Ametris) wear time. A total of 141 participants (mean age 32.1, SD 9.2 y; 75/141, 53.2% female) were randomized evenly across groups with comparable baseline characteristics, except for sex (P=.002). The blended group showed significantly greater MVPA increases than the control at T2 (β coefficient=0.247, 95% CI 0.013-0.480; P=.04) and T3 (β coefficient=0.373, 95% CI 0.139-0.607; P=.002), and greater increases than the web-based at T2 (β coefficient=0.287, 95% CI 0.062-0.512; P=.01) and T3 (β coefficient=0.368, 95% CI 0.138-0.597; P=.002). Sensitivity analyses confirmed the robustness of these findings. Retention and engagement rates were 83% and 56%, respectively. Participants reported high acceptability across all domains. A blended intervention integrating tailored web content with interactive e-workshops significantly increased MVPA at T2 and T3 compared with both web-based and control groups. This success stems from the rigorous intervention mapping framework, which systematically identified effective behavior change and habit formation theories, while the blended approach addressed key limitations of traditional and web-based methods. These findings underscore the potential of evidence- and theory-based blended approaches to address common barriers to MVPA and promote sustainable MVPA in workplace settings, offering promising opportunities for broader scalability and personalization.

29. Strengthening Primary Care With a Minimal Digital Ecosystem in Burkina Faso: Protocol for a Pragmatic Mixed Methods Implementation Study.

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

摘要

In Burkina Faso, the Minimal Digital Ecosystem (MDE)-a suite of 9 integrated digital tools-was introduced to support key health system functions, including care delivery, financial management, medication oversight, governance, and data use. However, evidence regarding the maturity of its real-world implementation and the determinants influencing its adoption remains scarce. This pragmatic mixed methods study aims to (1) measure MDE implementation maturity across 4 dimensions (adoption, fidelity, penetration, sustainability), (2) identify multilevel determinants using the Consolidated Framework for Implementation Research (CFIR 2.0) and Normalization Process Theory (NPT), and (3) examine associations between implementation degree and primary health care (Centre de Santé et de Promotion Sociale [CSPS]) performance. We use a sequential explanatory design (quantitative → qualitative) in 4 districts covering 72 CSPSs. Phase 1 involves a cross-sectional survey of all eligible health workers, facility managers, and community health workers (estimated 612 respondents nested within facilities) using CFIR- and NPT-informed questionnaires. Following psychometric validation (exploratory/confirmatory factor analysis; reliability assessment via Cronbach α and McDonald ω), we will fit multilevel models with CSPS random intercepts and district fixed effects to (1) quantify between-facility implementation variance, (2) test associations with CFIR and NPT determinants, and (3) examine relationships with CSPS performance indicators. Phase 2 involves purposive sampling of facilities with varying implementation profiles for interviews, focus groups, and observations, analyzed using reflexive thematic analysis to explain quantitative patterns. Ethics approval was obtained from Burkina Faso’s National Ethics Committee (number 2023-06-136). The study was funded in June 2022 (Gates Foundation, Grant INV-056021) and is being conducted across 72 primary health care facilities in 4 districts (Manga, Sapouy, Ténado, and Ziniaré) in Burkina Faso. Qualitative data collection commenced in November 2025 and was completed in January 2026. Quantitative data collection took place from January 2023 to October 2025. As of May 2026, qualitative data collection was completed, and quantitative analyses had commenced. Psychometric analyses are underway. By addressing key evidence and measurement gaps in digital health implementation, this protocol will (1) generate context-specific guidance on implementing and institutionalizing a complex digital health ecosystem and (2) provide validated, ready-to-use instruments to quantify implementation at the CSPS level. Together, these outputs will help policymakers and program managers define and track “implementation success,” informing-and accelerating-the scale-up and optimization of the MDE in resource-constrained settings.

30. Co-Develop-IT! Unifying Methodological Guideline for the Co-Design, Development, and Evaluation of Individually Tailored Technology-Enhanced Training and Rehabilitation Concepts: Consensus Development Study and Tutorial.

期刊: Journal of medical Internet research 发表日期: 2026-May-22 链接: PubMed

摘要

Applying digital health technologies (DHTs) for health promotion and disease prevention is recommended by official bodies such as the World Health Organization. User-centered co-design with systematic patient and public involvement is considered best practice for developing such complex interventions. Although well-established methodological guides and frameworks are available, an important gap is that they are either holistic but generic, offering minimal operational guidance, or context-specific and operational, but focusing only on subphases of establishing DHT-enhanced interventions. This paper presents a unifying consensus-based methodological guideline directed toward multidisciplinary expert teams coordinating projects on individually tailored DHTs. It delineates best practices with operational guidance for each step along the full lifecycle of DHT-enhanced training and rehabilitation concepts-from contextualization, through codevelopment, and evaluation to implementation. The Co-Develop-IT guideline was cocreated through a structured expert consensus process that integrated, refined, and expanded on well-established existing guides and frameworks to delineate holistic and context-specific, yet flexible enough, best practices. The process consisted of biweekly 90-minute hybrid meetings between August 2024 and February 2025, in combination with written elaboration, feedback, and revisions between meetings to gradually develop a consensus on best practice recommendations. The Co-Develop-IT guideline consists of 8 iterative phases. It is applicable to any type of end users, exercise types, intended contexts of use (eg, primary health care, community health services, and telemedicine), and overarching goals (eg, health promotion and primary through tertiary disease prevention, including rehabilitation). The Co-Develop-IT guideline introduces 5 distinct preparatory contextual research phases preceding generative codevelopment. These phases are dedicated to the structured establishment of a more robust foundation to better tailor and steer codevelopment efforts toward successful implementation. In 2 application examples, we provide proof of concept that the resulting guideline fulfills its primary purpose of providing comprehensive, context-specific, and operational, yet flexible enough best practice recommendations. The unifying Co-Develop-IT guideline provides comprehensive best practices with actionable operational guidance for establishing an appropriate balance between scientific theories and frameworks and the real-world needs of interest-holders in the establishment of individually tailored DHT-enhanced training and rehabilitation concepts. Applying Co-Develop-IT contributes to overcoming the lingering evidence-to-practice gap by consistently establishing a shared mission with relevant interest-holders and ensuring that all codevelopment steps are directed toward addressing an unmet need in (clinical) practice-ultimately promoting the practical application and impact of purpose-developed DHTs.

31. Does intracytoplasmic sperm injection outperform conventional in vitro fertilization in couples without severe male factor infertility? A systematic review and meta-analysis of randomized controlled trials.

期刊: Human reproduction (Oxford, England) 发表日期: 2026-May-22 链接: PubMed

摘要

Does ICSI improve the live birth rate in couples without severe male factor infertility compared to conventional IVF (cIVF)? High-quality evidence showed no benefit of ICSI over cIVF in improving live birth or cumulative live birth rates among couples without severe male factor infertility. Although ICSI is an effective method within ART for severe male factor infertility, it is frequently used for other infertility etiologies despite insufficient evidence. The effectiveness of ICSI compared with cIVF in couples with mild male or without severe male factor infertility remains uncertain. Systematic review and meta-analysis. PubMed, EMBASE, MEDLINE, Web of Science, Cochrane Library, ProQuest Dissertations & Theses Global, Scopus, CINAHL Plus, Chinese Wan Fang, and CNKI databases were searched from inception to 31 May 2025 without language restrictions. The search strategy encompassed three key domains: ICSI, cIVF, and ART treatment outcomes. We included randomized controlled trials (RCTs) comparing outcomes of ICSI versus cIVF per couple. Exclusion criteria were duplicate studies, conference abstracts or proceedings, trial registry records, editorials, letters, non-randomized designs, RCTs that did not randomize participants to ICSI or cIVF, studies comparing effects per oocyte rather than per couple, studies lacking complete outcome data, and those not meeting predefined criteria for trustworthiness. Study characteristics and ART outcomes were extracted. The risk of bias and study trustworthiness were independently evaluated by two investigators using the Cochrane Collaboration’s Risk of Bias 2 Tool and TRACT checklist, respectively. GRADE decision-making was used to evaluate the quality of evidence. Six RCTs reporting on couples without severe male factor infertility were included. The meta-analysis showed no benefit from ICSI over cIVF in live birth rate (four studies, N = 1438, 32.8% vs 34.5%, pooled risk ratio (RR) = 0.96, 95% CI: 0.85-1.09, I2 = 37%, high-quality evidence) or cumulative live birth rate (three studies, N = 1911, 43.2% vs 47.4%, pooled RR = 0.92, 95% CI: 0.84-1.01, I2 = 41%, high-quality evidence). ICSI was associated with a lower preterm birth rate (three studies, N = 222, 4.6% vs 6.0%, pooled RR = 0.77, 95% CI: 0.59-1.00, P = 0.0447, I2 = 0, high-quality evidence). No significant differences were observed for other fertility or pregnancy outcomes. The findings should be interpreted with caution due to the limited number of high-quality studies reporting live birth data, limited subgroup-specific evidence, and some heterogeneity in outcome measures. Evidence from this meta-analysis shows no advantage of ICSI over cIVF in improving live birth or cumulative live birth rates among couples without severe male factor infertility. Based on current evidence, ICSI should not be routinely recommended for indications other than severe male infertility. The study was funded by the National Natural Science Foundation of China (No. 82204052), the National Key Research and Development Program of China (No. 2022YFC2703102), and Peking University Third Hospital (No. BYSYDL2022001, BYSYDL2024003) with salaries for J.Q., Y.W., K.K., Y.F., Y.Y., T.T., F.L., and J.G. The funders of the study played no role in study design, data collection, data analysis, data interpretation, or writing of the report. S.B. has received scientific grants from Gedeon Richter and Læge Sofus Carl Emil Friis og Hustru Olga Doris Friis’ Fond. K.V. has received speakers’ fees from Gedeon Richter, Merck, and IBSA. L.N.V. has received grants, speakers’ fees, and conference fees (including travel support) from Merck Sharp & Dohme, and Ferring, and scientific board fees from Ferring. T.M.H. has received speakers’ fees from Merck, Merck Sharp & Dohme, and Ferring. A.P. has received speakers’ fees (including those classified as honoraria) from Ferring Pharmaceuticals, Merck, Gedeon Richter, IBSA, Abbott and Consulting fees from Gedeon Richter and Ferring and travel support from Gedeon Richter. H.S.N. received speakers’ fees from Ferring Pharmaceuticals, Merck, Astra Zeneca, Cook Medical, Gedeon Richter, Ibsa Nordic, Novo Nordisk, and Bessins. B.W.M. reports consulting fees, travel support, and research funding from Merck and consulting fees from Ferring, Organon, Repronovo, UNILAB, Vitra, and Norgine. N.l.C.F. has received speakers’ fees from Merck and Ferring Pharmaceuticals, consulting fees from Merck, and meeting support/registration fees from Merck, Ferring Pharmaceuticals, IBSA, and Gedeon Richter (paid to institution). She is also an unpaid chair in the steering committee for the guideline groups of The Danish Fertility Society. All other authors declare no competing interests. CRD42023479967.

32. Potassium bromate as a probable human Carcinogen: multi-organ toxicity and chemopreventive potential of dietary antioxidants-a comprehensive review.

期刊: Mutagenesis 发表日期: 2026-May-22 链接: PubMed

摘要

Potassium bromate (KBrO₃), classified as a probable human carcinogen, has long been used as a flour-improving and oxidizing agent in baking and food processing industries. It is also generated as a by-product during ozonation of drinking water, raising concerns about widespread, low-dose exposure. Experimental studies consistently demonstrate that KBrO₃ induces multiple-organ toxicity primarily through oxidative stress-mediated mechanisms. Exposure to KBrO₃ leads to excessive generation of reactive oxygen species, resulting in depletion of glutathione reserves, enhanced lipid peroxidation, and oxidative DNA damage. Such genotoxic effects include DNA strand breaks, micronuclei formation, and chromosomal aberrations, which collectively contribute to its well-documented carcinogenic and mutagenic potential. Consequently, these molecular alterations promote renal, hepatic, and thyroid tumor formation reported in experimental animal models, while emerging epidemiological evidence suggests possible associations between chronic dietary exposure to KBrO₃ and gastrointestinal malignancies in humans. However, recent research has thoroughly investigated the chemopreventive potential of dietary antioxidants in mitigating KBrO₃-induced toxicity, highlighting their ability to attenuate oxidative damage through enhancement of endogenous antioxidant defenses, modulation of the key cytoprotective signaling pathways and restoration of cellular redox homeostasis. With continued usage of KBrO₃ and the inconsistency of regulatory enforcement worldwide, strengthening risk assessment, surveillance and preventive strategies-particularly the substitution of KBrO₃ with safer alternatives and the promotion of antioxidant-rich diets is crucial to reduce long term carcinogenic risk and safeguard global public health.

33. Outcomes and Adverse Events Among Patients with Vancomycin-Resistant Enterococcal Bloodstream Infection Treated with Daptomycin Doses Greater than 12 mg/kg.

期刊: Infectious diseases and therapy 发表日期: 2026-May-22 链接: PubMed

摘要

Daptomycin is commonly used for vancomycin-resistant enterococcal bloodstream infections (VRE-BSIs); however, its optimal dosing remains uncertain. Although doses > 12 mg/kg may improve attainment of pharmacodynamic targets, clinical outcomes and safety data for very-high-dose daptomycin are limited. This multicenter cohort study included adults with a VRE-BSI treated with daptomycin doses > 12 mg/kg, between 2011 and 2024. The primary outcome was 28-day all-cause mortality. Daptomycin-associated adverse events, including creatine kinase (CK) elevation, were assessed, and multivariable logistic regression models were used to identify factors associated with mortality and an elevated CK level. Among 101 patients, the median age was 70.2 years, and 67.3% had an underlying malignancy. The 28-day mortality was 41.6% and was primarily associated with host factors and illness severity. Daptomycin dose was not associated with mortality when modeled as a continuous variable; however, in exploratory post hoc analysis, doses > 13 mg/kg were associated with lower mortality compared with 12-13 mg/kg [adjusted odds ratio (aOR), 0.22; 95% confidence interval (CI) 0.05-0.98; p = 0.047]. CK elevation occurred in 13.9% and was independently associated with higher daptomycin dose (aOR, 2.99; 95% CI 1.05-8.50). Eosinophilic pneumonia was identified in 10.9% of patients. In patients with VRE-BSI treated with daptomycin doses > 12 mg/kg, mortality remained high and was primarily driven by host factors and severity of illness. Although exploratory findings suggest a potential mortality benefit at doses > 13 mg/kg, this must be balanced against a significantly increased risk of dose-related toxicity, including a notably high incidence of eosinophilic pneumonia.

34. Interventions that prolong multidimensional indicators of healthspan in humans: a systematic review of randomised controlled trials.

期刊: The journals of gerontology. Series A, Biological sciences and medical sciences 发表日期: 2026-May-22 链接: PubMed

摘要

Maximising healthspan, the period of life spent in good health, is a public health priority. This review aimed to summarise the current evidence from randomised controlled trials on interventions that can prolong healthspan in humans. The specific focus was on multidimensional person-centred outcomes which reflect functioning rather than disease, such as intrinsic capacity and quality of life. This review was registered (CRD420251015780) and conducted with adherence to the PRISMA guidelines. MEDLINE, EMBASE, and grey literature were systematically searched for studies evaluating interventions that improve intrinsic capacity or quality of life. The search included articles published to 16/10/2025. Of 1 960 publications identified, 15 articles (4 656 participants) met the inclusion criteria. There was high heterogeneity between the included studies in terms of the interventions examined, which varied from exercise alone (seven studies), to multidomain interventions (six studies, all of which included an exercise component), daily oral supplementation (two studies), or caloric restriction (one study). Overall, 11 studies reported that exercise or multidimensional intervention (which included an exercise component) improved intrinsic capacity and quality of life. However, due to the small number of studies and heterogeneity, no conclusion could be drawn regarding other interventions. There is some evidence that exercise could extend intrinsic capacity and quality of life, either aerobic or resistance training alone, or a combination of different types of exercise. Further research is required to evaluate the effect of other interventions that may prolong healthspan and across more diverse populations.

35. The cross-city mobility patterns and incubation period of the early-stage chikungunya fever outbreak in Guangdong Province, China, in 2025.

期刊: PLoS neglected tropical diseases 发表日期: 2026-May-22 链接: PubMed

摘要

Chikungunya fever (CF), an arthropod-borne disease caused by Chikungunya virus (CHIKV), is a serious public health threat globally. In July 2025, an outbreak occurred in Foshan City, Guangdong Province, China. A large number of these cases involved cross-city movements, which complicated containment efforts and provided a unique opportunity to study transmission patterns and key epidemiological parameters. We obtained information on 400 confirmed cases of CF with cross-city exposure histories reported across Guangdong Province in southern China by 21 August 2025. Demographic, clinical, and mobility data were mainly obtained from the National Notifiable Infectious Disease Reporting System and supplemented by epidemiological investigations. The incubation period was estimated using a parametric accelerated failure time model, with log-normal, gamma, Weibull, and Erlang distributions used to fit the model. Subgroup analysis was performed based on mobility patterns and exposure windows. Significant demographic differences were observed compared with local Foshan cases: cross-city cases had higher proportions of males (58.3%), individuals within the age groups of 15-24, 25-34, and 35-44,and individuals with occupations of general staff/workers, business/service workers, and students. Fever (86.4%), arthralgia (79.3%), and rash (61.2%) were the most common symptoms. Mobility analysis revealed that Foshan and Guangzhou were the major sources of infection, with cases spreading mainly to cities within the Pearl River Delta and provinces such as Guangxi (43.3%) and Hunan (15.4%). The median incubation period was estimated to be 5.4 days (95% CI: 5.0-5.7), with 2.5th and 97.5th percentiles of 2.5 days and 11.4 days, respectively. This study underscores the central role of population mobility in the spread of CHIKV and highlights distinct epidemiological characteristics of cross-city cases. The estimated median incubation period of 5.4 days provides important evidence for surveillance and response strategies during chikungunya outbreaks. Notably, students and migrant workers accounted for a higher proportion of cross-city cases, suggesting that highly mobile populations may contribute to inter-regional transmission. These findings highlight the importance of strengthened surveillance and coordination across regions for the prevention and control of future outbreaks in Guangdong and other high-risk areas in China.

36. Ecotoxicological insights into fluoride pollution affecting soil, plant and human health.

期刊: Ecotoxicology and environmental safety 发表日期: 2026-May-22 链接: PubMed

摘要

Fluoride contamination impacts the water-soil-plant continuum, with consequences for soil functions, crop performance, and dietary exposure. Although fluoride occurrence data are extensive, interpretation and cross-study comparability remain constrained by inconsistent reporting of total fluoride versus fluoride fractions up taken in edible plant parts, limited co-measurement across matched water-soil-plant compartments, and a shortage of long-term field evaluations of mitigation impacts on soil fertility and ecosystem services. To address these limitations, we (i) consolidate dominant sources and transfer pathways linking groundwater, soils, crops, and food webs; (ii) summarize the geochemical and soil controls governing the fluoride mobility and uptake, including pH/alkalinity, major-ion chemistry, Ca/Al/Fe-mediated complexation and precipitation, and sorption to clays and metal (hydr)oxides; (iii) integrate ecotoxicological evidence for soil processes and crop-relevant physiological endpoints; and (iv) critically assess the remediation and management options. Across the literature, a central finding is that risk is governed less by total soil fluoride inventories than by the fluoride concentrations up-taken in edible plant parts, which increases under alkaline conditions and in bicarbonate-, and sodium-rich systems and can be sustained through chronic irrigation loading. Evidences indicate that elevated fluoride suppresses microbial activity and enzyme functions essential for nutrient cycling, disrupts Ca-P homeostasis, reduces photosynthetic capacity in sensitive crops, and transfers to edible tissues and beverages, thereby increasing dietary exposure, including in vulnerable populations such as children. Hotspot assessments require explicit consideration of co-contaminant stressors and confounding geochemical conditions. We conclude that effective management should emphasize source control, mechanism-based immobilization (e.g., Ca-based amendments and targeted sorbents), and integrated approaches validated through multi-season field trials. Future priorities include standardized fraction metrics, matched compartment monitoring, crop dose-response datasets, and evaluation of remediation durability, agronomic trade-offs, and cost-effectiveness.

37. Micro- and nanoplastics in the central nervous system: Transport pathways, neurotoxicity, and implications for brain disorders.

期刊: Ecotoxicology and environmental safety 发表日期: 2026-May-22 链接: PubMed

摘要

Micro- and nano-plastics (MNPs) are widely distributed across global ecosystems and have been extensively detected in human tissues, including the brain. The levels of MNPs are highly correlated with the occurrence of various brain disorders, suggesting the potential central nervous system (CNS) toxicity of MNPs. In this review, we summarize the major circuits by which MNPs may transport into and out of the CNS, including blood-brain barrier crossing, nasal-to-brain routes, and glymphatic system transport. Small-sized MNPs are difficult to eliminate from the brain, which may explain why MNPs may accumulate in the brain. We further discuss the potential neurotoxic effects of MNPs, such as inducing synaptic and neuronal injury, promoting neuroinflammation, dysregulating the neuroendocrine system, and modulating the gut-brain axis. MNP-induced CNS toxicity follows a pattern in which increased susceptibility occurs before direct toxicity. We also review evidence that MNPs, together with environmental and genetic factors, may synergistically contribute to cognitive impairment in Alzheimer’s disease, motor dysfunction in Parkinson’s disease, and depression- and anxiety-like behaviors. Prenatal exposure to MNPs might induce autism spectrum disorder-related phenotypes in offspring. MNPs could also obstruct cerebral vessels and trigger acute cerebrovascular diseases, as well as promote the entry of viruses such as SARS-CoV-2 into the CNS, thereby increasing the occurrence of neurological symptoms. Finally, this review discusses physical, pharmacological, and plastics substitution interventions designed to regulate MNPs transport in the brain and enhance neuroprotection, thereby reducing CNS toxicity of MNPs.

38. Stress-Activated Pathways Mediate PFAS Effects on Human Placental Syncytiotrophoblast Cells.

期刊: Toxicological sciences : an official journal of the Society of Toxicology 发表日期: 2026-May-22 链接: PubMed

摘要

Per- and polyfluoroalkyl substances (PFAS) are persistent environmental pollutants associated with placenta-mediated pregnancy complications, including preeclampsia, fetal growth restriction, and preterm birth. The syncytiotrophoblast (STB), which forms the placental barrier at the maternal-fetal interface and is directly exposed to maternal blood, is a primary site of PFAS exposure. Although PFAS induce STB apoptosis, the upstream stress-signaling pathways involved remain poorly defined. Here, we investigated stress-responsive signaling mechanisms mediating PFAS-induced STB cell death. STB differentiated from human trophoblast stem cells were exposed to vehicle or an environmentally relevant mixture of five PFAS (PFOA, PFOS, PFHxS, PFNA, and PFDA; 0.0138-34.5 µM) for 3 or 6 hours. Cytotoxicity, apoptosis, mitochondrial membrane potential, and stress-signaling pathway activation were assessed by lactate dehydrogenase release, immunoblotting, JC-10 assay, and RT-qPCR. PFAS mixtures did not induce cytotoxicity at 3 hours but significantly increased cytotoxicity at 6 hours at 34.5 µM, coinciding with induction of cleaved caspase-3, cleaved PARP, and NOXA. The pan-caspase inhibitor z-VAD-FMK prevented cytotoxicity, indicating caspase-dependent apoptosis. PFAS exposure reduced mitochondrial membrane potential and activated the integrated stress response (ISR), as evidenced by eIF2α phosphorylation, ATF4 induction, and increased ATF4 target gene expression. In parallel, c-Jun N-terminal kinase (JNK) signaling was activated, as evidenced by JNK phosphorylation and induction of immediate-early genes (JUN, FOS, EGR1). Pharmacologic inhibition of the ISR modestly attenuated PFAS-induced cytotoxicity, whereas pharmacologic inhibition of JNK rescued cytotoxicity and apoptotic signaling. Together, these findings identify JNK-driven stress signaling as the dominant mediator of PFAS-induced STB apoptosis, with a secondary contribution from the ISR.

39. Sperm mitochondrial DNA copy number: a marker of male fertility and reproductive success.

期刊: Human reproduction update 发表日期: 2026-May-22 链接: PubMed

摘要

Sperm mitochondrial DNA copy number (mtDNAcn) has emerged as a promising biomarker of sperm health, providing molecular insight beyond what is captured by standard semen analysis. Elevated sperm mtDNAcn has been consistently associated with lower sperm motility, concentration, and morphology, as well as prolonged time-to-pregnancy in natural conception and reduced fertilization potential in ART. This review summarizes current evidence on the biological underpinnings of sperm mtDNAcn, including its regulation during spermatogenesis, the role of nuclear-encoded mitochondrial proteins such as TFAM (mitochondrial transcription factor A), and its potential epigenetic modulation through sperm DNA methylation. We evaluate general population and clinic-based studies linking sperm mtDNAcn to semen quality, couple fecundity, and early embryo development, while highlighting methodological considerations such as quantification techniques and somatic cell contamination. A literature search was conducted to identify human studies evaluating sperm mtDNAcn in relation to male fertility, semen quality, reproductive outcomes, and embryology outcomes, as well as experimental models investigating the underlying biological mechanisms of mtDNA regulation during spermatogenesis via TFAM up to 1 April 2026. Searches were performed in PubMed, Web of Science, and Scopus using combinations of keywords and Medical Subject Headings (MeSH), including sperm mitochondrial DNA copy number, mtDNAcn, male infertility, pregnancy outcomes, ART outcomes, semen quality, sperm epigenetics, TFAM, mitochondrial transcription factor A, and sperm mtDNA regulation. Reference lists of relevant reviews and primary articles were manually screened to identify additional studies. Eligible studies included observational epidemiologic studies, clinical cohort studies, and experimental investigations that quantified sperm mtDNAcn and examined associations with semen parameters, fertility outcomes, or sperm epigenetics. No restrictions were placed on geographic location, while only articles published in English were considered. Across 21 epidemiologic, experimental, and clinical studies, elevated sperm mtDNAcn has been consistently associated with reduced sperm quality and inconsistently associated with diminished couple-level reproductive potential. Higher mtDNAcn is associated with lower sperm concentration, total sperm count, motility, and normal morphology, as well as higher sperm DNA fragmentation and chromatin abnormalities. It has also been linked to reduced likelihood of pregnancy and poorer embryo quality. Emerging evidence indicates associations between sperm mtDNAcn and altered nuclear DNA methylation patterns, supporting a role for mitochondrial-nuclear crosstalk. Collectively, these findings position sperm mtDNAcn as a biologically informative and clinically relevant indicator of male reproductive health that may complement, or potentially enhance, traditional semen analysis in both research and clinical settings. Sperm mtDNAcn holds promise as a biomarker for male fertility assessment, yet its full clinical potential has not been yet to be realized. Establishing standardized measurement protocols across sperm fractions and laboratory platforms will be essential for enabling cross-study comparability and facilitating clinical translation. Large prospective studies are needed to define clinically meaningful thresholds and better characterize the relationship between mtDNAcn alterations and spermatogenic impairment. Intervention strategies targeting mtDNA biogenesis and depletion, including antioxidant strategies and mitochondria-directed pharmacotherapy, warrant further investigation in the context of male fertility and fecundity. Collectively, sperm mtDNAcn may serve as an adjunctive marker in the assessment of male reproductive health and may inform future precision medicine approaches. N/A.

40. Comparing Real and Virtual Nature Exposure on Cognition, Well-Being, and Brain Activity in Adults With and Without Attention-Deficit/Hyperactivity Disorder: Protocol for a Randomized Experimental Study.

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

摘要

Natural environments are associated with improved cognitive functioning and psychological well-being, potentially through attentional restoration and stress reduction. Virtual reality (VR) offers an accessible way to simulate natural settings; however, it remains unclear whether VR nature engages the brain and cognition in the same way as real nature, particularly in adults with attention-deficit/hyperactivity disorder (ADHD), who show atypical neural oscillations and heightened sensitivity to environmental demands. This protocol describes a randomized experimental study designed to compare the effects of a single exposure to real vs virtual nature on cognition, well-being, and brain activity in adults with and without ADHD and to examine how neurocognitive profiles and ADHD symptom dimensions shape these responses over time. A total of 80 adults (40 with a confirmed ADHD diagnosis and 40 neurotypical controls) will be recruited and randomly assigned to either a real nature condition or an immersive VR-simulated nature condition. After a baseline assessment, participants will complete a 20-minute seated exposure in the assigned condition while 32-channel mobile electroencephalography (EEG) is recorded. Immediately post exposure, they will complete gamified cognitive tasks assessing cognitive flexibility and metacognition, self-report measures of mood, perceived restoration, simulator sickness, and nature connectedness. ADHD symptomatology and functional impact will be assessed with standardized scales at preexposure and postexposure and at the final follow-up. Ecological momentary assessment of emotional well-being, weekly self-reports of real-world nature and VR exposure, and repeated nature connectedness ratings will be collected via a mobile app over an 8-week follow-up period to characterize the decay or maintenance of effects. EEG analyses will focus on alpha-band markers of cognitive restoration, complemented by dimensional modeling of ADHD symptoms in linear mixed-effects models. The study has been preregistered on the Open Science Framework and will be prospectively registered with the Australian New Zealand Clinical Trials Registry (ANZCTR) before enrollment of the first participant. Ethical approval has been received from the Research Ethics Committee at Sligo University Hospital. At the time of manuscript submission, participant recruitment had not yet begun and no outcome data were available. The project received funding in May 2025. Participant recruitment is expected to begin in January 2026, followed by data collection in April 2026 to ensure suitable outdoor conditions. Data analysis will follow data collection, and study findings are expected to be published in May 2028. This study will test whether VR nature can reproduce key cognitive and neural benefits of real-world nature exposure and whether these effects differ between adults with ADHD and neurotypical adults. By integrating EEG, cognitive performance, symptom dimensions, and longitudinal self-report data, the findings are expected to clarify when VR nature may serve as a useful, scalable complement to real nature-based approaches for supporting attention and psychological well-being. PRR1-10.2196/82970.

41. Establishing bone tissue level changes associated with cognitive impairment.

期刊: The journals of gerontology. Series A, Biological sciences and medical sciences 发表日期: 2026-May-22 链接: PubMed

摘要

Alzheimer’s disease (AD) and osteoporosis are common chronic conditions of ageing. Although several studies have reported an association between the two conditions, there is limited information on tissue-level mechanisms. In the current study, we performed unbiased proteomics on thoracic vertebral samples collected from female participants enrolled in the ROS and MAP cohorts to assess bone tissue-level changes associated with AD and other dementia-associated neuropathologies. Cognitive functioning and other participant characteristics were collected as part of ROSMAP study visits. Post-mortem evaluations assessed the burden of β-amyloid and paired helical filament tau (PHFtau) tangles, and other common age-related neuropathologies. A total of 45 bone samples were utilized from 19 female participants with a clinical diagnosis of AD dementia and 26 without AD dementia. The association between bone tissue protein abundance and cognition measured proximate to death, as well as neuropathologic indices, were evaluated using linear regression or logistic regression models, as appropriate. Bone tissue abundance of minichromosomal maintenance protein 3 (MCM3) and ubiquitin carboxyl-terminal hydrolase 24 (USP24) were positively associated with cognition and negatively associated with PHFtau tangle density. MCMC3 was also associated with cerebral arteriosclerosis, while USP24 was associated with cerebral amyloid angiopathy. Our findings suggest that processes regulating bone cell division may be involved in the link between brain and bone aging in a relationship that may not be specific to AD.

42. Developing a Culturally Tailored Narrative Video for Skin Cancer Prevention Among Spanish-Speaking Hispanic Outdoor Workers: Co-Design Study.

期刊: Journal of participatory medicine 发表日期: 2026-May-22 链接: PubMed

摘要

Hispanic individuals face a higher risk of skin cancer due to disproportionate occupational sun exposure; yet, culturally tailored resources for this demographic are scarce. The aim of this study was to codevelop a culturally tailored narrative video to enhance skin cancer prevention among Spanish-speaking Hispanic outdoor workers. We partnered with the National Conservatory of Dramatic Arts, medical specialists, national skin cancer prevention organizations, occupational health experts, and Hispanic outdoor workers to create an educational video that promotes sun protection and skin cancer awareness and prevention among Hispanic outdoor workers and their families. Development was based on extensive formative research, health behavior models, and interactive script review by multistakeholder and community advisory boards. The final result is a 27-minute video that follows Miguel, who is taking ownership of his father’s landscaping business as he is diagnosed with basal cell carcinoma. Throughout the video, Miguel and his wife, Sofía, learn about skin cancers, their warning signs, and steps for prevention, ultimately using this knowledge to protect and empower his employees and family. Key engagement strategies include cultural tailoring, story-driven learning, and visual modeling. This culturally and theoretically informed video represents a tool to increase knowledge and self-efficacy among Spanish-speaking Hispanic outdoor workers and their families, potentially reducing their skin cancer risk. Future research should evaluate the video’s acceptability and impact on enhancing awareness, knowledge, and sun-protective behaviors.

43. Moral Distress, Work Engagement, and Meaningful Work in Healthcare: A Narrative Review.

期刊: Acta medica portuguesa 发表日期: 2026-May-22 链接: PubMed

摘要

The psychological well-being of healthcare professionals is increasingly recognized as a critical determinant of patient safety, quality of care, and healthcare system sustainability. Among the constructs most relevant to this domain are moral distress, work engagement, and meaningful work. This narrative review aimed to synthesize conceptual and empirical evidence on these three constructs and to examine their interrelations and implications for healthcare practice. A selective narrative review of the literature was conducted, integrating theoretical frameworks, systematic and integrative reviews, and empirical studies, resulting in a final synthesis of 41 articles. Moral distress arises when clinicians are prevented from acting in accordance with their ethical convictions, often due to institutional or systemic constraints, and has been consistently associated with burnout, turnover, and compromised quality of care. In contrast, work engagement - characterized by vigor, dedication, and absorption - and meaningful work - reflecting the perception that professional activities have meaning and purpose - function as protective factors that enhance resilience and sustain intrinsic motivation. Evidence highlights the central role of organizational climate, leadership, resource availability, and ethical culture in shaping experiences of distress, engagement, and meaningfulness, a dynamic further intensified during the COVID-19 pandemic. The synthesis emphasizes that organizational and systemic interventions, including ethics consultation, supportive leadership, workflow redesign, and resilience-building programs, are essential to mitigate moral distress and promote engagement and meaningful work. The integration of these constructs aligns with the Quadruple Aim, reinforcing the premise that caring for healthcare professionals is indispensable to caring for patients.

44. Effect of Concurrent Power and Sprint Training on Physical Fitness in Well-Trained Youth Soccer Players: A Pilot Study.

期刊: Journal of strength and conditioning research 发表日期: 2026-May-22 链接: PubMed

摘要

Kyriacou-Rossi, A, Ieronymides, D, Hadjipantelis, A, Stampoulis, T, Hadjicharalambous, M, Avloniti, A, Chatzinikolaou, A, and Zaras, N. Effect of concurrent power and sprint training on physical fitness in well-trained youth soccer players: A pilot study. J Strength Cond Res XX(X): 000-000, 2026-The purpose of the study was to investigate the effect of 5-week concurrent power-sprint training on power, repeated sprint ability (RSA), and aerobic capacity in well-trained youth soccer players. Sixteen male players (15.9 ± 0.5 years; height: 173.8 ± 5.0 m; mass: 65.3 ± 8.2 kg) participated in the study. After baseline evaluation, players were matched and divided into the concurrent (Conc) and the compound (Comp) groups. Players in the Conc group performed power-sprint training in the same training session, while the Comp group performed power and sprint training the following day. At the beginning and end of the 5-week training program, measurements included body composition, flexibility, countermovement (CMJ) and drop jumps (DJ), isometric mid-thigh pull (IMTP), 5-step long-jump, 0-30 m linear sprint, t test agility, RSA, and 30-15 intermittent fitness test (IFT). No changes were found for body composition and flexibility, although both groups improved CMJ height (Conc: 6.4%, p < 0.000; Comp: 5.6%, p < 0.001) and DJ reactive strength index (Conc: 38.2-42.5%, p < 0.000; Comp: 27.5-44.7%, p = 0.001), but only Conc increased IMTP (8.6%, p = 0.014). Five-step long-jump increased for both groups (Conc: 2.8 ± 2.6%, p = 0.027; Comp: 3.3 ± 3.6%, p = 0.012) but no chances were observed for 0-30 m linear sprint and agility. Repeated sprint ability increased in both groups, but Conc induced greater increases than Comp (p < 0.001). Significant increases were found for 30-15 IFT V̇o2max (Conc: 4.8%; Comp: 4.0%) for both groups. In conclusion, concurrent power-sprint training improves strength, power, and aerobic fitness in youth soccer players. Implementing both modalities within the same training session yields superior gains particularly in RSA, a key factor in soccer performance.

45. Self-disclosure to Peers and Changes in Personal Recovery in Community-dwelling People with Mental Disorders: A One-year Longitudinal Study.

期刊: Community mental health journal 发表日期: 2026-May-22 链接: PubMed

摘要

This study examined whether overall and domain-specific self-disclosure to peers at baseline was prospectively associated with changes in personal recovery over one-year among community-dwelling adults with mental disorders in Japan. A longitudinal questionnaire survey was conducted among adults with mental disorders. Self-disclosure was assessed using the Self-Disclosure Scale for People with Mental Illness, and personal recovery was measured with the Japanese version of the Recovery Assessment Scale. Linear mixed-effects models were used to examine recovery at baseline and at one-year follow-up as a continuous outcome, including time, baseline self-disclosure, and their interaction, with random intercepts for participants. Models were adjusted for age, sex, and service utilization. Fifty-four participants (mean age = 41.1 years; 48% female) responded to both the baseline and follow-up surveys. Mean recovery scores did not change significantly over one year. In domain-specific analyses, greater baseline self-disclosure about mental illness and psychiatric disability was associated with less positive changes in recovery over one year (Estimate = - 4.162, SE = 1.589, 95% CI [- 7.316, - 1.008], p = 0.010). Conversely, no significant time-by-disclosure interactions were observed for the other disclosure domains (life conditions, own strengths, and experiences of distress). Among community-dwelling people with mental disorders, baseline self-disclosure about mental illness and psychiatric disability to peers was associated with less positive changes in personal recovery over one year, whereas the other disclosure domains were not significantly associated with changes over time. These findings suggest that disclosure about mental illness and psychiatric disability in peer contexts may have context-dependent implications. Moreover, they underscore the importance of fostering safe and supportive peer environments that respond constructively to such disclosures within recovery-oriented care.

46. Associations Between Parental Socioeconomic Position, Health Behavioral Profiles in Adolescence, and Socioeconomic Position in Adulthood: a 31-Year Follow-Up of the Northern Finland Birth Cohort 1986.

期刊: International journal of behavioral medicine 发表日期: 2026-May-22 链接: PubMed

摘要

Parental socioeconomic position (SEP) shapes adolescent health behaviors, which may contribute to adulthood socioeconomic outcomes. Clustering health behaviors into distinct health behavioral profiles helps broaden understanding of these associations. We examined whether (1) parental SEP, measured in early life and in adolescence, is related to adolescents’ health behavior profiles and (2) whether these profiles in adolescence are associated with own socioeconomic position in adulthood. The data comprised 5612 adolescents and their parents from the Northern Finland Birth Cohort 1986. Health behaviors in adolescence were clustered into healthy and unhealthy health behavioral profiles. Parental SEP was measured at the child’s birth in 1986 using parental employment status, and in 2001 using parental education and household income. Own SEP in adulthood (education and employment status) was measured in 2017-2018. Multinomial logistic regression was used to examine associations between health behaviors and SEP over time. Low parental education was associated with an unhealthy health behavioral profile in adolescence among girls (adjusted odds ratio [OR] 2.48; 95% confidence interval [CI] 1.63-3.78). Adolescents with unhealthy profiles were more likely to have lower educational attainment in adulthood (men: OR 2.45; 95% CI 1.52-3.93; women: OR 3.18; 95% CI 1.65, 6.15). Additionally, individuals with unhealthy profiles were more likely to have manual occupations (men: OR 1.91; 95% CI 1.40, 2.60; women: OR 2.45; 95% CI 1.67, 3.62) or be unemployed (men: OR 1.67; 95% CI 1.18, 2.35; women: OR 2.10; 95% CI 1.50, 2.94). Providing early support may promote health equity by enabling adolescents from socioeconomically disadvantaged backgrounds to engage in healthy behaviors and access higher education in adulthood.

47. Alcohol Use Disorders in Primary Care: Screening, Risk Factors, and Clinical Implications.

期刊: The primary care companion for CNS disorders 发表日期: 2026-May-21 链接: PubMed

摘要

The Psychiatric Consultation Service at Massachusetts General Hospital sees medical and surgical inpatients with comorbid psychiatric symptoms and conditions. During their twice-weekly rounds, Dr Stern and other members of the Consultation Service discuss diagnosis and management of hospitalized patients with complex medical or surgical problems who also demonstrate psychiatric symptoms or conditions. These discussions have given rise to rounds reports that will prove useful for clinicians practicing at the interface of medicine and psychiatry. Prim Care Companion CNS Disord 2026;28(3):25f04133. Author affiliations are listed at the end of this article.

48. Tracking industrial relocation and air pollution redistribution in China: a multi-dimensional satellite-based assessment framework.

期刊: Environment international 发表日期: 2026-May-19 链接: PubMed

摘要

Conventional Air Quality Index (AQI) systems in China are typically based on the single pollutant with the highest concentration, which limits their ability to capture cumulative exposure and multi-pollutant health risks. This study develops an integrated assessment framework and discusses how large-scale changes in air quality can be used to explore spatial patterns potentially associated with industrial relocation and environmental transformation at the national scale. We propose a multidimensional air quality evaluation system comprising the Total Atmospheric Quality Index (TAQI), Potential Atmospheric Quality Index (PAQI), and Effective Atmospheric Quality Index (EAQI), which respectively represent total pollutant load, toxicity-weighted hazard intensity, and governance effectiveness. To facilitate the identification of spatial patterns potentially associated with industrial relocation, air quality dynamics were further coupled with vegetation greenness (NDVI) and economic activity (GDP). Based on this coupling, the Vegetation-Air Quality Index (VAQI), Financial-Air Quality Index (FAQI), and an integrated Industrial Transfer Intensity (ITI) indicator were constructed to screen regions where concurrent environmental and economic changes may indicate intensified industrial transfer processes. An ERA5-based meteorological background comparability analysis was further conducted to assess whether large-scale differences in weather conditions between 2015 and 2019 could confound the interpretation of air-quality redistribution patterns. Applying this framework to China during 2015-2019, we find that national total pollutant load (TAQI) declined by 16.3% and toxicity-weighted hazard intensity (PAQI) by 32.2%, while signals indicative of industrial relocation intensified in northwestern and southwestern regions. The derived ITI shows strong spatial correspondence with independent satellite-based indicators of anthropogenic activity, including VIIRS nighttime light change (r = 0.68, p < 0.001) and Proba-V built-up expansion (r = 0.73, p < 0.001). Overall, this study provides a transferable, satellite-supported framework and discusses how to use it to identify emerging patterns of pollution redistribution and potential industrial relocation hotspots. The results offer policy-relevant evidence to support differentiated air quality governance and sustainable industrial transition in rapidly developing economies.

49. Hokkaido phase II study of photo-immunotherapy combination with ASP-1929 for recurrent or persistent EGFR-positive vulvar, vaginal, and cervical cancers not amenable to further radiotherapy (HICARi study).

期刊: Journal of gynecologic oncology 发表日期: 2026-May-18 链接: PubMed

摘要

Photoimmunotherapy using ASP-1929 (ASP1929-PIT) is a novel approach targeting epidermal growth factor receptor (EGFR)-expressing tumors. ASP-1929, an anti-EGFR monoclonal antibody conjugated to IRDye 700DX (IR700), binds to EGFR in tumor cells. Upon exposure to 690-nm red laser light, IR700 is activated, disrupting the cellular membrane. Approved in Japan for head and neck cancer, this therapy is the first of its kind globally. Given its mechanism, ASP-1929 may also treat other EGFR-positive malignancies accessible to red light. Thus, we are conducting a phase II clinical trial of ASP1929-PIT for localized recurrent and persistent vulvar, vaginal, and cervical cancers refractory to radiotherapy (RT). These severely impact quality of life, highlighting an unmet need. This single-arm, open-label, phase II investigator-initiated trial evaluated the efficacy and safety of ASP1929-PIT for recurrent or persistent vulvar, vaginal, or cervical cancer post-RT (jRCT2011240034). Participants had EGFR expression confirmed by immunohistochemistry, prior RT (including chemoradiotherapy) for the primary lesion, and at least one measurable vulvar, vaginal, or cervical lesion. Patients with uncontrolled distant disease or suspected mucosal invasion of the rectum or lower urinary tract were excluded. ASP-1929 (640 mg/m²) was administered via a 2-hour intravenous infusion, followed 20-28 hours later by 690-nm laser illumination. Day 1 was designated for ASP-1929 administration, with efficacy assessed between days 29 and 56. Patients could receive up to three additional treatments if a complete response was not achieved. The primary outcome was tumor shrinkage in laser-treated lesions. Sixteen patients were enrolled, with the first 4 forming a safety cohort. Japan Registry of Clinical Trials Identifier: jRCT2011240034.

50. Comparison of mRNA-based and next-generation sequencing HPV assays in a population-based cervical cancer screening program in China.

期刊: Journal of gynecologic oncology 发表日期: 2026-May-18 链接: PubMed

摘要

To evaluate and compare the diagnostic performance of the Food and Drug Administration-approved APTIMA® human papillomavirus (HPV) assay (E6/E7 mRNA-based) and the Mygene HPV-STI Assay (MHSA) in detecting cervical intraepithelial neoplasia (CIN) 2+ and CIN3+ lesions among Chinese women in a screening setting. A total of 3,166 women were enrolled from Wuxiang County, Shanxi Province, China, and followed for 3 years. APTIMA and MHSA were performed using cervical cytology specimens. Histopathology served as the reference standard. Diagnostic accuracy (sensitivity, specificity, and predictive values), assay concordance, and receiver operating characteristic (ROC) analyses were conducted for baseline and longitudinal detection of CIN2+/CIN3+. Among 2,683 women with complete follow-up, the prevalence of high-risk-HPV was 17.22% by APTIMA and 20.16% by MHSA. Substantial concordance was observed (κ=0.798). APTIMA showed higher specificity than MHSA when combined with cytology (CIN2+: 88.42% vs. 87.96%, p=0.038; CIN3+: 87.28% vs. 86.87%, p=0.063), while sensitivity and predictive values were comparable. The MHSA demonstrated broader HPV genotyping, while APTIMA yielded slightly superior performance in post-test probability for CIN3+ over 3 years. ROC analysis confirmed comparable diagnostic discrimination. Both assays offer high clinical accuracy within 3 years. While APTIMA remains the validated standard, the MHSA may serve as a promising next-generation sequencing-based alternative, particularly in expanded genotyping.

51. Prevalence of epilepsy in Portugal: An epidemiologic population-based study (EPIPORT).

期刊: Epilepsy research 发表日期: 2026-May-16 链接: PubMed

摘要

Epilepsy is prevalent among ∼50 million people worldwide. Updated information is lacking on the epidemiology and characteristics of epilepsy in Portugal. Therefore, a population-based study was conducted to estimate the prevalence and identify potential undiagnosed cases of epilepsy in children and adults in Portugal. This cross-sectional population-based study, conducted from May 2023 to July 2024, involved a nationwide door-to-door survey in Portugal (mainland and islands), screening 10,666 individuals. Trained interviewers visited selected households to recruit and interview participants, applying questionnaires to identify undiagnosed epilepsy cases and gather information about positive epilepsy diagnosis and management. Participants reporting positive screening were further evaluated by steering committee epileptologists for a potential epilepsy diagnosis. The study estimated a crude prevalence of epilepsy of 9.76 cases per 1000 people (95% CI 86,7-115,5) in Portugal. The average age of the prevalent cases was 44.22 years (±21.99). Epilepsy was more common among females (55.8%), adults (∼82%), and residents of the North (45.5%), Center (26.6%), and Lisbon (15.3%) regions. Around 20% of the participants had not experienced seizures in the last 10 years. Also, ∼44% of the participants were taking three or more antiseizure medications. The study indicates that Portugal’s epilepsy prevalence is twice as high as reported in a 1998 study conducted in the north of Portugal and exceeds both global and European averages. Due to limitations such as the small number of confirmed cases and low physician contact rates, the representativeness of the study in certain regions or age groups should be interpreted with caution. Nevertheless, the high burden of epilepsy highlights the need for effective health programs and resource allocation.

52. Nationwide distribution, transformation, and risks of p-Phenylenediamines and their quinone transformation products in Chinese agricultural soils.

期刊: Environment international 发表日期: 2026-May-15 链接: PubMed

摘要

p-Phenylenediamines (PPDs) are widely used as antioxidants in tire formulations and are released to the environment via tire wear, where they can be transformed into more toxic p-phenylenediamine-derived quinones (PPD-Qs). Despite growing recognition of their environmental importance, information on the occurrence and behavior of these compounds in farmland soils remains limited. In this study, 122 surface soil samples were collected from agricultural regions across China to quantify six PPDs and five PPD-Qs and to examine their spatial patterns, sources, transformation drivers, and potential risks. The PPD and PPD-Q compounds were detected in all samples, with national mean concentrations of 1.02 and 0.28 ng/g, respectively. Spatially, the ΣPPD concentrations were 0.19‒4.93 ng/g in southern China and 0.13‒4.13 ng/g in northern China, while the ΣPPD-Q concentrations were 0.06‒1.37 ng/g in southern China and 0.03‒1.48 ng/g in northern China. 6PPD and 6PPD-Q were the dominant congeners, indicating strong inheritance from parent compounds to transformation products. Source apportionment implicates both direct inputs from agricultural rubber materials and indirect inputs via atmospheric transport of industrial rubber-derived emissions. Conventional statistical approaches together with non-linear dependence analyses identified sunshine duration and soil total organic carbon (TOC) as key factors influencing their composition and transformation. Risk assessment showed that current non-carcinogenic human and ecological risks were within acceptable limits. These findings advance understanding of the environmental occurrence and transformation of PPDs and PPD-Qs in agricultural soils and highlight key factors relevant to their management and risk control.

53. Dissolved inorganic phosphorus enrichment in groundwater of phosphate mining areas driven by multiple biogenic pathways.

期刊: Water research 发表日期: 2026-May-15 链接: PubMed

摘要

The role of microbial mediation in the enrichment of phosphorus (P) is often mentioned but has rarely been explored, particularly regarding microbially mediated P cycling in P-contaminated groundwater within phosphate rock mining areas. To bridge this gap, this research explored the multiple biogenic pathways involved in dissolved inorganic phosphorus (DIP) enrichment by an approach combining comprehensive field investigations with hydrochemical and molecular biological analyses. Hydrochemical characteristics revealed that carbonate mineral dissolution and dissolved organic matter (DOM) degradation were the two key pathways controlling DIP enrichment in karstic water. Moreover, correlations between functional genes and DIP revealed that the indirect biological pathway involving CO2-driven carbonate weathering and the direct biological pathway mediated by gcd-governed gluconic acid acidification exhibited the strongest associations with DIP enrichment. Intense water-rock interaction drove the differentiation of inorganic P dissolution pathways and enabled the gcd pathway to dominate microbial DIP mobilization. Next were the direct biological pathways mediated by phosphatases encoded by the ppa and ppx genes, as well as the organic P mineralization pathway utilizing high O/C (≥ 0.4) unsaturated and aromatic P-containing compounds as core substrates. Substrate concentration and species might control the dominant pathways of DIP release, given the overwhelming dominance of inorganic P over organic P. These findings provide new insights into P enrichment in groundwater from a microbial perspective and offer valuable implications for the P management and remediation in phosphate mining areas.

54. Does inflammatory bowel disease play a role in cognitive decline? A systematic review.

期刊: Journal of Crohn’s & colitis 发表日期: 2026-May-08 链接: PubMed

摘要

Inflammatory bowel disease (IBD) has been increasingly linked to cognitive impairment (CI) and dementia, yet the underlying mechanisms driving this association remain poorly understood and population, clinical and experimental studies show controversial results. Among others, factors such as chronic inflammation, gut-brain axis dysfunction, and psychological comorbidities have been proposed as contributors to cognitive deficits in IBD patients. The objective of this systematic review was to evaluate the existing literature on the relationship between IBD and cognitive function, considering observational and preclinical studies, with the aim to identify key factors influencing CI and potential clinical implications. The main focus of this review is on the use of IBD treatments, which may have a potential impact on CI. We conducted a systematic review according to PRISMA guidelines. PubMed and Scopus were searched from database inception up to August 30, 2024, for studies assessing cognitive performance in individuals with IBD. Clinical and epidemiological studies, genetic investigations (Mendelian Randomization and Genome-wide Association studies), and preclinical models examining memory, attention, and executive functions were included. Two reviewers independently extracted data and assessed methodological quality and risk of bias. The research yielded 66 included studies, including 31 populations studies, 13 genetics studies, and 22 preclinical research studies. Our findings suggest that patients with IBD may exhibit impaired cognitive function, particularly in memory, attention, and executive processing. Disease activity, chronic inflammation and psychological stress appear to contribute to these deficits, while some treatment strategies seem to mitigate the risk of CI. IBD is associated with CI and increased dementia risk, with biologics potentially mitigating neuroinflammation-related decline. More longitudinal studies and randomized clinical trials, also on intermediate endpoints, are needed to clarify the neuroprotective role of some therapies and optimize treatment strategies.

55. Engaging individuals in digital health research panels: A qualitative study including participants in vulnerable positions.

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

摘要

Individuals in vulnerable circumstances often face challenges in accessing and utilizing digital health tools. They are also underrepresented in digital health research. Consequently, digital health tools may not be aligned with their specific needs and requirements, potentially intensifying health disparities. A research panel especially involving individuals in a vulnerable position could increase their representation in digital health research. This study examined motivation, facilitators and barriers, and prerequisites for initial participation and sustained involvement in a panel for digital health research. We conducted 23 semi-structured interviews with mainly individuals in vulnerable positions. Interviews were audio recorded, transcribed, coded and thematically analysed. The results indicated that most participants were motivated for engagement in a research panel on digital health. They aspired to contribute to the accessibility and usability of digital health, thereby benefiting not only themselves but also their peers. Additional motivations were to stay informed and to learn from developments in the field. Participants perceived recruitment efforts in community centres or the distribution of inclusively designed flyers as the most effective methods. Clear communication and timely feedback of results emerged as the most significant factors in sustaining long-term enthusiasm for panel participation. As the study was conducted in the Dutch context, cultural and contextual factors may limit the generalisability of the results to other settings. Nonetheless, by fostering intrinsic motivation, tailoring recruitment approaches, and addressing practical barriers, research panels can facilitate meaningful participation and contribute to the equitable development of digital health interventions.

56. Effect of mesenchymal stem cell treatment on retinopathy of prematurity in patients with bronchopulmonary dysplasia: experience of a tertiary center.

期刊: The Turkish journal of pediatrics 发表日期: 2026-Apr-30 链接: PubMed

摘要

Retinopathy of prematurity (ROP) and bronchopulmonary dysplasia (BPD) share overlapping mechanisms involving oxidative stress, inflammation, and aberrant angiogenesis. Mesenchymal stem cell (MSC) therapy has shown promise in the treatment of BPD through paracrine modulation and anti-inflammatory effects, but its influence on retinal vascular development remains uncertain. This retrospective case series included five extremely low birth weight (ELBW) infants (<1000 g) who received allogeneic umbilical cord–derived MSC therapy for severe BPD between October 2021 and May 2023. Each infant received intravenous (2 × 10⁶ cells/kg) and intratracheal (1 × 10⁷ cells/kg) MSC administration in a single session. ROP screening and treatment were conducted in accordance with national guidelines. Clinical data and ocular outcomes were analyzed descriptively. The mean gestational age was 26²/₇ weeks (range, 25–28³/₇) and the mean birth weight was 810 g (580–1060 g). MSC therapy was given between postnatal days 36–126 (mean, 74 days). No systemic or ocular complications occurred during hospitalization or follow-up. One infant had no ROP, one developed Type 2 ROP with spontaneous regression, and three developed Type 1 ROP requiring intravitreal bevacizumab. All treated cases achieved complete regression after a single intravitreal bevacizumab injection, without recurrence, repeat injection, or need for laser therapy. MSC therapy appeared clinically safe in ELBW infants with BPD, with no adverse ocular effects. However, ROP developed in most infants despite MSC treatment, suggesting that MSCs do not prevent disease onset. The potential modulatory role of MSCs on retinal angiogenesis warrants further investigation through larger, controlled trials.

57. Influenza vaccination rates in children: a multicenter nationwide study.

期刊: The Turkish journal of pediatrics 发表日期: 2026-Apr-30 链接: PubMed

摘要

Influenza remains a major cause of morbidity and mortality in children worldwide, yet vaccination coverage is still suboptimal in many countries. We aimed to understand parental awareness, attitudes, and determinants of vaccine uptake to guide effective strategies for increasing coverage and protecting vulnerable pediatric populations. A cross-sectional study was conducted between October 2023 and May 2024 in 38 hospitals across 23 provinces in Türkiye. Data were collected from 5002 families through face-to-face interviews, with 4404 valid responses analyzed. The overall influenza vaccination rate among children was 4.4% (n=195/4404). Vaccination coverage was slightly higher in high-risk groups compared to non-high-risk groups (5.2% vs. 3.5%, p=0.003). Factors positively associated with vaccination uptake included the presence of chronic illness in the child (15.1% in vaccinated vs. 4.7% in unvaccinated, p<0.001), higher parental education levels, and parental history of influenza vaccination (42.8% vs. 4.4%, p<0.001). Logistic regression identified poor attendance at routine pediatric check-ups, lack of awareness of influenza vaccination, and absence of private vaccination as the strongest predictors of non-vaccination. The overall influenza vaccination rate among children was 4.4% (n=195/4404). Vaccination coverage was slightly higher in high-risk groups compared to non-high-risk groups (5.2% vs. 3.5%, p=0.003). Factors positively associated with vaccination uptake included the presence of chronic illness in the child (15.1% in vaccinated vs. 4.7% in unvaccinated, p<0.001), higher parental education levels, and parental history of influenza vaccination (42.8% vs. 4.4%, p<0.001). Logistic regression identified poor attendance at routine pediatric check-ups, lack of awareness of influenza vaccination, and absence of private vaccination as the strongest predictors of non-vaccination.

58. Exploring drivers and management strategies of informal patient payments in hospitals: A qualitative study in Iran.

期刊: PloS one 发表日期: 2026 链接: PubMed

摘要

Informal patient payments remain a persistent and multifaceted challenge in many health systems, particularly in low- and middle-income countries. These payments, often made outside official channels, can undermine equity, transparency, and trust in healthcare delivery. This qualitative study aimed to explore the underlying causes of informal payments and identify feasible management strategies from the perspectives of key stakeholders. This applied study was conducted using a qualitative method and semi-structured interviews between September 10, 2024, and January 17, 2025. A total of 31 participants, including senior policymakers from the Ministry of Health, hospital managers, medical specialists, nursing managers, hospital supervisors, health economics and healthcare management faculty members, and patients with experience of informal payments in Iranian hospitals, were selected through purposive and snowball sampling methods. Latent content analysis was employed for data analysis, and MAXQDA software (version 2022) was used to extract the main and subcategories. Six main themes and 39 subcategories were identified regarding the causes of informal patient payments. From the perspectives of policymakers, physicians, and service providers, four main themes with 27 subcategories emerged, including factors related to salaries and benefits, structural and organizational issues, laws and regulations, and ethical and cultural considerations. From the perspective of service recipients, two main themes with 12 subcategories were identified, covering service-related and cultural factors. Regarding management strategies to address informal payments, three main themes with 14 subcategories were found, encompassing structural, legal, and cultural approaches. Informal payments in hospitals are driven by a complex interplay of economic, structural, legal, cultural, and ethical factors. Addressing this issue requires a multifaceted strategy, including tariff reform, strengthening legal and regulatory frameworks, promotion of professional ethics, improved service delivery systems, and public awareness campaigns. Sustainable reduction of informal payments demands coordinated efforts across all levels of the health system.

59. A cross-border seroprevalence study on HBV, HCV, HDV and HIV in remote Amazonian communities on the border between French Guiana and Suriname.

期刊: PloS one 发表日期: 2026 链接: PubMed

摘要

National epidemiological data are essential to achieve viral hepatitis elimination goals. However, viral hepatitis and HIV epidemiology in French Guiana (FG) and Suriname is mainly limited to urban areas. We therefore assessed the prevalence, associated determinants, and knowledge, attitudes, practices, and beliefs (KAP-B) regarding hepatitis B (HBV), hepatitis C (HCV), hepatitis D (HDV), and HIV in the isolated area of the Maroni River, bordering FG and Suriname. Between January 2018 and February 2019, adults (≥18 years) living along the Maroni were enrolled in this cross-sectional study and completed a risk factor and KAP-B questionnaire. Participants were tested for viral hepatitis and HIV using serological and molecular analyses: HBV (HBsAg, anti-HBcore antibodies, anti-HBs, HBV DNA), HCV (HCV-antibodies, HCV RNA), HDV (HDV-antibodies), and HIV (HIV-antibodies/antigen, HIV RNA). Age- and sex-adjusted HBV, HCV, and HIV prevalences were estimated using post-stratification weighting. Among 2286 participants, adjusted prevalences were respectively 2.08% (95%CI: 1.49-2.66; n = 46) for HBsAg, 25.6%, (95%CI: 20.89-29.24, n = 646) for resolved HBV infection (negative HBsAg and positive anti-HBcore antibodies), 0.13% (95%CI: 0.0-0.27; n = 5) for HCV-antibodies, and 0.65% (95%CI: 0.0-1.40; n = 12) for HIV-antibodies. There were no HDV infections. HBV exposure (acute or resolved) was independently associated with age (per 10-year increase aOR:1.27, 95%CI: 1.18-1.37, p < 0.0001), males (aOR:1.34, 95%CI: 1.10-1.65, p = 0.006), Maroon (aOR:2.22, 95%CI: 1.27-4.06) or other ethnic groups (aOR:2.94, 95%CI: 1.61-5.59) versus Amerindians, (p = 0.002), and higher education (aOR:0.71, 95%CI: 0.56-0.90, p = 0.005). Older age (per 10-years increase aOR:1.64, 95%CI: 1.11-2.44), p = 0.01) and non-autochthonous origin (aOR:3.81, 95%CI: 1.14-12.26, p = 0.02) were associated with HIV. Less than one in six participants correctly identified viral hepatitis transmission modes. HBV, HCV and HIV prevalences along the Maroni River were comparable to urban areas and remain concerning. Knowledge about viral hepatitis was low. Achieving viral hepatitis elimination goals requires awareness campaigns and test-and-treat strategies tailored to hard-to-serve populations.

60. Effects of different intensities of repetitive peripheral magnetic stimulation on corticospinal excitability and motor performance in healthy humans.

期刊: PloS one 发表日期: 2026 链接: PubMed

摘要

Repetitive peripheral magnetic stimulation (rPMS) has been applied in clinical settings to enhance the recovery of motor function following central nervous system lesions. However, the optimal intensity of rPMS for inducing neural plasticity and the mechanisms behind its action are not understood. We investigated the impacts of rPMS at two different stimulus intensities on motor performance and the motor-evoked potentials (MEPs) elicited by transcranial magnetic stimulation in the arm muscles of 20 healthy adults. The biceps brachii (BB) muscle was subjected to rPMS in a 2-s ON and 2-s OFF cycle (for a total duration of 15 min). Two levels of rPMS were used: one that was sufficient to cause muscle contraction and one that was not. When investigating the effects on motor performance, an increase in elbow flexion torque and muscle activity was observed after rPMS at an intensity that elicited muscle contraction, whereas no significant changes were observed after rPMS at an intensity that did not cause muscle contraction. The MEPs of the BB increased after rPMS at an intensity that elicited muscle contraction, but no significant changes were observed after rPMS at an intensity that did not cause muscle contraction. Cervicomedullary MEP elicited by transmastoid electrical stimulation did not change after rPMS, implying that the increase in MEP was not accompanied by changes in the efficacy of cortico-motoneuronal synaptic transmission. These findings suggest that rPMS-induced muscle contraction can increase corticospinal excitability while maintaining spinal motoneuron excitability, thereby improving motor performance.