公共卫生研究摘要 (2026-05-27)

共收录 49 篇研究文章

1. From policies to promotion: managers' views on opportunities for alcohol prevention at work.

期刊: International journal of qualitative studies on health and well-being 发表日期: 2026-Dec-31 链接: PubMed

摘要

Managers not only influence employees’ health and well-being, but also play a central role in shaping workplace culture and implementing preventive strategies This qualitative study examined managers´ reflections on the possibilities for alcohol prevention in the workplace. Interviews with 44 managers were analyzed using thematic analysis and interpreted through Ames’s 1992 four-component cultural model for alcohol prevention. Four themes described managers perceived possibilities for alcohol prevention: Shaping social activities, Shaping Alcohol Norms, Organizational Structures, and A Health-Promoting Work Environment. The first theme concerned integrating alcohol regulations into work-related social activities through limiting servings, offering alcohol-free alternatives, and choosing activities not centered around alcohol. The second concerned influencing the social alcohol climate by placing alcohol on the agenda, role modeling, and encouraging dialogue. The third emphasized how policies, control measures, education, and HR support provide a formal prevention framework. The fourth linked alcohol prevention to broader efforts toward health, psychological safety, and sustainable working conditions. Managers are central in translating organizational prevention strategies into cultural change embedded in everyday workplace practices. Organizational support, including HR, policies, education, and leadership decision, forms the foundation for long-term preventive work. Addressing alcohol use within broader health and well-being efforts may be an under-recognized prevention strategy.

2. Immunogenicity and safety of an investigational quadrivalent measles, mumps, rubella, and varicella vaccine in children aged 4-6 years: A phase II, randomized, multi-country trial.

期刊: Human vaccines & immunotherapeutics 发表日期: 2026-Dec 链接: PubMed

摘要

Two-dose childhood vaccination against measles, mumps, rubella, and varicella is widely recommended. Quadrivalent (MMRV) vaccines can be used for one or both immunizations against these diseases. In some countries, e.g. the United States, only one MMRV vaccine is licensed. Availability of another MMRV vaccine could strengthen supply resilience, optimal vaccine coverage, and disease control. In this phase II, single-blind, multi-country study, healthy children aged 4-6 y, previously primed with a first dose of any combination of measles/mumps/rubella/varicella-containing vaccine(s) in their second year of life, were randomized 2:2:2:1:1 to receive one dose of a GSK investigational MMRV (MMRVNS; three formulations) or a licensed MMRV vaccine (two lots). Immunogenicity was assessed at Day 43 post-vaccination. Adverse events (AEs) were recorded up to Day 4 (solicited administration-site and systemic AEs), Day 43 (solicited systemic and unsolicited AEs), and Day 181 (serious AEs [SAEs]) post-vaccination. Of 801 participants enrolled, 796 were vaccinated and 765 completed the study. Antigen-specific antibody geometric mean concentrations and seroresponse rates were generally comparable between MMRVNS (regardless of formulation) and MMRV recipients. Administration-site pain (29.0%-39.0% of participants) and systemic drowsiness (9.0%-15.9%) were the most common solicited AEs. Unsolicited AEs (mostly upper respiratory tract infections) were reported in 18.5%-27.2% of participants. At least one SAE (none considered vaccine-related) occurred in each group. Except for one reported fatality, all SAEs resolved. Compared to the licensed standard-of-care MMRV vaccine, the investigational MMRVNS formulations generated comparable immune responses and had a similarly acceptable safety profile, when administered as second dose. These results support further clinical development of MMRVNS. What is the context? Measles, mumps, rubella, and varicella are highly contagious diseases affecting mostly children and adolescents. Thus, a two-dose childhood vaccination against these diseases is recommended in many countries worldwide.Several countries have approved one or two vaccines that target all four diseases in the same injection (termed MMRV vaccines).One of the countries with only one approved MMRV vaccine is the United States, where the licensed MMRV vaccine is recommended as a second-dose vaccination in children aged 4 to 6 y.Developing and introducing an additional MMRV vaccine could help ensure sufficient vaccine availability and be in the interest of public health.What is new? In this study, a new measles-mumps-rubella-varicella vaccine candidate (called MMRVNS) was compared with the licensed MMRV vaccine when given as a second dose to children aged 4–6 y from four countries.The two vaccines induced comparable immune responses against the four viruses causing the diseases.Proportions of participants experiencing reactions to vaccination (such as pain at the administration site) and side effects occurring after vaccination were similar between groups who received MMRVNS and the licensed MMRV vaccine.What is the impact? The MMRVNS vaccine induced a similar immune response compared to the licensed MMRV vaccine and had a similar safety profile.The results of this study support further clinical development of the MMRVNS vaccine to collect additional data about this vaccine when used in a larger group of children.

3. Invasive Pneumococcal Disease burden, clinical characteristics, serotypes' distribution, immunization status and antimicrobial resistance: Evidence from 12-year hospital-based surveillance and cost analysis.

期刊: Human vaccines & immunotherapeutics 发表日期: 2026-Dec 链接: PubMed

摘要

We aimed to evaluate 12-y (2012-2024) burden, clinical and microbiological characteristics of Invasive Pneumococcal Disease (IPD) at one large research hospital - IRCCS Fondazione Policlinico San Matteo - in northern Italy, with focus on serotypes’ distribution, resistance trends, and vaccination impact on outcomes and costs. The study included 234 IPD cases. Data were obtained from medical records, microbiological reports, and vaccination registries. Statistical analyses included descriptive measures, multivariate regression models for risk factors (adjusted for sex, age group, comorbidities), and comparison of length of stay and costs between vaccinated and unvaccinated patients. Most cases occurred in males aged ≥65. Bacteremia with pneumonia was the most frequent presentation (55.6%). Obesity and splenectomy were associated with higher risk of severe outcome. The most common serotypes overall were 3 and 8. Among vaccinated patients serotypes 15A, 14, 19A, and 15C were more frequent. Macrolide resistance was detected in 26.9% of isolates and beta-lactam resistance in 14.9%. Collectively, 34.5% of cases were caused by serotypes preventable with Pneumococcal Conjugate Vaccine 13 (PCV13), an additional 5.1% by PCV15, 21% by PCV20 and 14.4% by V116 preventable serotypes. Vaccine-preventable serotypes accounted for 64% of cases, mostly (56%) in patients aged ≥65. Vaccinated patients reported shorter hospital stay (median 8 vs 16 d) and lower associated costs (€3313 vs €5101). IPD surveillance is critical to inform prevention strategies. Our findings quantify how much vaccination reduces disease severity and healthcare costs but highlight gaps in vaccine coverage against emerging serotypes due to replacement mechanisms.

4. Occupational HPV exposure and vaccination among healthcare workers: Implications for institutional vaccination strategies.

期刊: Human vaccines & immunotherapeutics 发表日期: 2026-Dec 链接: PubMed

摘要

Healthcare workers may be exposed to HPV physically through occupational contact or while counseling patients with HPV conditions. Despite this exposure, HPV vaccination uptake among healthcare workers remains suboptimal. The relative contributions of demographic, cognitive, and occupational factors to vaccination behavior, risk perception, and vaccine advocacy in the context of institutional prevention strategies are not well defined. Our aim is to identify independent predictors of HPV vaccine uptake, perceived occupational HPV risk, and willingness to recommend HPV vaccination among healthcare workers, with the goal of informing institutional vaccination strategies. This cross-sectional survey study included healthcare workers from different specialties and evaluated HPV vaccine uptake, perceived occupational HPV risk, and willingness to recommend vaccination. We used predictors such as age, sex, clinical role, HPV knowledge, misconceptions, and vaccine safety beliefs then analyzing using multivariable logistic regression. Among 318 healthcare workers, 41.6% reported prior HPV vaccination. The majority (53.8%) worked in Internal Medicine. Vaccine uptake was strongly associated with age; those aged 27-45 had higher odds than those >45 y (aOR 7.03). Sex and HPV knowledge were not significant predictors. Perceived occupational HPV risk was linked to specialty, with dermatology showing higher risk perception (aOR 2.35), and inversely related to age (aOR 0.97 per year). Willingness to recommend HPV vaccination was high and driven mainly by confidence in vaccine safety (aOR 14.6). These findings suggest targeted, role-specific strategies beyond education to inform institutional HPV vaccination strategies.

5. Happiness and Attention Deficit/Hyperactivity Disorder Symptoms as Mediated by Subjective Health Conditions: A Nationwide Cross-Sectional Internet Survey.

期刊: Neuropsychopharmacology reports 发表日期: 2026-Jun 链接: PubMed

摘要

There has been limited examination of happiness among individuals with attention-deficit/hyperactivity disorder (ADHD), despite growing interest in psychiatric comorbidities associated with this disorder. This study aims to fill this gap by exploring the relationship between ADHD symptoms and happiness on the basis of data from the Japan Society and New Tobacco Internet Survey (JASTIS). A nationwide, cross-sectional internet survey was conducted in Japan between January and February 2024. The analytic sample comprised 29 268 individuals aged 16 years and above in Japan. Based on questionnaire responses of the 6-item short version of the Japanese version of the Adult ADHD Self-Report Scale (ASRS-J-6), the respondents were classified as possible ADHD or not. Information on happiness was collected via a single (10-point Likert scale) measure. Multivariable ordinal logistic regression analysis and a mediation analysis were performed to examine associations. Possible ADHD was associated with increased odds of feeling less happy. Very high somatic symptoms (41.1% mediation), confusion/difficulty to concentrate (37.2%), and depression (14.8%) were important mediators of the association between ADHD and happiness. Although the majority of individuals with possible ADHD were classified as having moderate happiness, more than one in four were classified as having low happiness. To increase the happiness of individuals with ADHD, screening and treating for both physical and psychiatric symptoms might be important.

6. First year of nirsevimab use in Argentina (2025): Report from a private vaccination center.

期刊: Archivos argentinos de pediatria 发表日期: 2026-May-28 链接: PubMed

摘要

Introduction. Since March 2025, nirsevimab, a monoclonal antibody for the prevention of respiratory syncytial virus infection (RSV), has been available in Argentina. The objective of this study was to describe the use of nirsevimab at a private vaccination center in the Buenos Aires Metropolitan Area, including the profile of infants vaccinated during its first year on the market. Population and methods. A descriptive study was conducted using an online survey administered to caregivers of children who received nirsevimab. The study analyzed sociodemographic variables, medical history, maternal RSV vaccination status, and the reason for the recommendation. Results. A total of 232 caregivers responded; 93.5% were mothers, with a mean age of 37.1 years (SD 5.4); 92.7% had a college or university education; 99.6% had health insurance. The mean age of the immunized children was 6.0 months (SD 3.9; range 0-21); 53.9% were male (N=125); 19.8% attended daycare (N = 46); 10.8% (N = 25) had comorbidities, primarily heart disease (5.6%; N = 13) and chronic respiratory disease (4.7%; N = 11); 19.0% (N = 44) had ≥1 episode of bronchiolitis. Reasons for recommendation: unvaccinated mother: 51.3% (N = 119); maternal vaccination in the previous year: 18.5% (N = 43); preterm infants <34 weeks: 14.7% (N = 34); risk factors: 6.5% (N = 15). The recommendation came from the pediatrician in 81.5% of cases (N = 189). Conclusion. More than half of the administered doses were applied to infants who lacked protection from maternal immunity. Most were healthy infants during their first season and were recommended for immunization by their pediatrician. Introducción. Desde marzo de 2025, Argentina dispone de nirsevimab, un anticuerpo monoclonal para la prevención del virus sincicial respiratorio (VSR). El objetivo de este estudio fue describir el uso de nirsevimab en un centro privado de vacunación del Área Metropolitana de Buenos Aires, incluyendo el perfil de los lactantes inmunizados durante su primer año de comercialización. Población y métodos. Se realizó un estudio descriptivo, a través de una encuesta en línea a cuidadores de niños que recibieron nirsevimab. Se analizaron variables sociodemográficas, antecedentes clínicos, de vacunación materna para VSR y motivo de indicación. Resultados. Respondieron 232 cuidadores, el 93,5 % fueron las madres, cuya edad media fue 37,1 años (DE 5,4). El 92,7 % contaba con estudios universitarios/terciarios; el 99,6 %, con cobertura de salud. La edad media de los inmunizados fue 6,0 meses (DE 3,9; rango 0-21); el 53,9 % de sexo masculino (N = 125); el 19,8 % concurría al jardín maternal (N = 46). El 10,8 % (N = 25) presentaba comorbilidades, principalmente cardiopatía (5,6 %; N = 13) y enfermedad respiratoria crónica (4,7 %; N = 11). El 19,0 % (N = 44) había tenido ≥1 episodio de bronquiolitis. Motivos de indicación: madre no vacunada: 51,3 % (N = 119); vacunación materna el año anterior: 18,5 % (N = 43); prematuros <34 semanas: 14,7 % (N = 34); condiciones de riesgo: 6,5 % (N = 15). La recomendación provino del pediatra en el 81,5 % (N = 189) de los casos. Conclusión. Más de la mitad de las indicaciones se realizó a lactantes no protegidos por la vacunación materna. La mayoría eran lactantes sanos durante su primera temporada y recibieron indicación del pediatra.

7. Coconstructing CHAMP, an Artificial Intelligence Chatbot for Pediatric Infectious Symptoms Management: Protocol for a Multiphase Participatory Study.

期刊: JMIR research protocols 发表日期: 2026-May-26 链接: PubMed

摘要

Acute infectious symptoms are a leading cause of pediatric emergency department visits in Canada, many of which are low acuity and could be safely managed at home. Artificial intelligence (AI) chatbots offer a promising avenue for delivering accessible, evidence-based guidance to support families in managing these symptoms. This study aims to adapt and coconstruct CHAMP (CHatbot to Assist the Management of Pediatric patients), an AI chatbot to support patients and families with acute pediatric infectious symptoms. CHAMP aims to deliver timely, tailored, and validated health information to support safe at-home self-management and informed care-seeking. This multiphase, mixed methods participatory study will be conducted at the Montreal Children’s Hospital in Montreal, Quebec, Canada. A coconstruction committee comprised of youth, parents, caregivers, and partners will be engaged as coresearchers. Eligible participants will include (1) youth aged 14-17 years and (2) parents and caregivers of children aged 0-17 years. The study comprises 5 phases. Phase 1 involves a qualitative needs assessment using focus groups with 20 participants to explore their informational needs, preferences, and concerns regarding pediatric infections and the use of AI chatbots. Phase 2 focuses on coconstructing and validating CHAMP’s knowledge database through 3-5 workshops. Coresearchers will review pediatric clinical guidelines, map care questions and decision-making processes, and shape CHAMP’s conversational framework. Phase 3 consists of iterative prototyping and testing through 3-5 workshops. Coresearchers will engage in prototyping and scenario testing, alongside preliminary usability and acceptability assessments. Phase 4 examines equity and accessibility through focus groups with 20 participants at risk of digital exclusion, as well as multilingual evaluation of an automated large language model-based translation layer. Phase 5 uses collaborative ethnography to explore the process of participatory coconstruction and its impact on CHAMP’s design. Funding was secured in 2024, and Research Ethics Board approval was obtained in December 2024. As of December 2025, the coconstruction committee is being assembled, and Phase 1 recruitment is underway. This study will produce a functioning CHAMP prototype grounded in participatory, equitable, and responsible pediatric AI development. Findings will inform usability testing and an implementation-effectiveness evaluation, contributing to best practices for pediatric-centered AI health tools. By providing timely, tailored, and validated health information on acute infections, CHAMP may support safe at-home self-management, reduce preventable emergency department visits, ensure at-risk children are directed to appropriate care, and improve patient and family health care experiences.

8. Effect of Electroacupuncture on Postherpetic Neuralgia: A Randomized Clinical Trial.

期刊: JAMA neurology 发表日期: 2026-May-26 链接: PubMed

摘要

Postherpetic neuralgia (PHN) is a refractory neuropathic pain condition with limited therapeutic options. Although electroacupuncture has demonstrated potential analgesic effects, high-quality evidence from rigorous randomized clinical trials remains limited. To determine whether electroacupuncture reduces pain severity compared with sham electroacupuncture and evaluate its safety in patients with PHN. This multicenter, randomized, sham-controlled clinical trial took place at 7 tertiary hospitals in China and enrolled participants from October 2020 to July 2022, with the last follow-up in September 2022. Data analyses were performed from August to December 2025. Participants with PHN aged 45 to 75 years and moderate to severe pain (11-point Numeric Rating Scale [NRS-11] score ≥4) were recruited. Of 1072 patients screened, 624 were excluded. The remaining 448 participants were randomized to electroacupuncture (n = 225) or sham electroacupuncture (n = 223); 383 participants (85.49%) completed the trial. Twenty sessions of electroacupuncture or sham electroacupuncture over 4 weeks, followed by a 4-week posttreatment follow-up. The primary outcome was the change in the NRS-11 scores from baseline to week 4, with responders defined as participants achieving a 30% or more reduction in NRS-11 scores. Of 448 participants, the mean (SD) age was 63.19 (9.26) years, 233 (52.01%) were male, and 215 were female (47.99%). At week 4, the electroacupuncture group had a greater decrease in the NRS-11 scores (-1.52) than the sham electroacupuncture group (-0.99) with an adjusted mean difference of -0.53 (95% CI, -0.61 to -0.43; P < .001), and the responder rate was significantly higher in the electroacupuncture group (46.68%) than in the sham electroacupuncture group (24.28%) (adjusted risk difference, 22.40%; 95% CI, 13.02%-31.79%; P < .001). These treatment benefits persisted through a 1-month follow-up; no clinically significant adverse events were observed. Among patients with PHN in this study, electroacupuncture provided a statistically significant reduction in pain severity, increased responder rates, and improved pain-related functional outcomes. These benefits suggest that electroacupuncture may be a useful nonpharmacological option for integrated management of PHN. ClinicalTrials.gov Identifier: NCT04560361.

9. Discrepancies in Study of Vouchers for Healthy Foods and Diabetes-Reply.

期刊: JAMA internal medicine 发表日期: 2026-May-26 链接: PubMed

摘要

10. Inequities Along the Early Intervention Care Cascade for Very Preterm Infants.

期刊: JAMA pediatrics 发表日期: 2026-May-26 链接: PubMed

摘要

Infants born at less than 32 weeks of gestation have an increased risk for adverse developmental and functional outcomes. The Early Intervention program provides developmental support to at-risk infants and has been shown to improve outcomes, but inequities may exist along the complex cascade from referral to receiving an Individualized Family Service Plan (IFSP). To determine where inequities exist along the Early Intervention Care Cascade and to quantify their magnitude. This longitudinal cohort study used data from the Pregnancy to Early Life Longitudinal database, a Massachusetts population-based dataset linking live births and Early Intervention data. A total of 7169 very preterm infants (gestational age less than 32 weeks) born between January 1, 2012, through December 31, 2019, in Massachusetts were identified. These data were analyzed from January 2025 through July 2025. Infant race and ethnicity, defined as the birthing individual’s race. The primary outcomes were the steps along the Early Intervention Care Cascade, including referral to Early Intervention, evaluation, and a signed IFSP. The steps along the Early Intervention Care Cascade were modeled using sequential logistic regression models adjusted for infant and family covariables. Of the 7169 infants, 567 identified as Asian/Pacific Islander, 1644 as Hispanic, 55 as Native American or Alaska Native, 1278 as non-Hispanic Black, and 3449 as Non-Hispanic White. There were 84%, 71.3%, and 64.5% who were referred, evaluated, and received an IFSP, respectively. Compared with non-Hispanic White infants, infants in racial and ethnic minority groups were less likely to be referred, evaluated, and receive an IFSP. Non-Hispanic Black infants had a numerically lower odds of referral (81.3%; adjusted odds ratio [aOR], 0.93; 95% CI, 0.77-1.44), evaluation (62.5%; aOR, 0.57; 95% CI, 0.46-0.70), and receiving an IFSP (55.0%; aOR, 0.83; 95% CI, 0.62-1.12) vs non-Hispanic White infants (84.6%, 75.4%, and 68.4%, respectively). Associations were attenuated when adjusting for infant and family social variables. In this longitudinal cohort study of very preterm infants, there was notable inequity and attrition across the Early Intervention Care Cascade. Targeted structural interventions at each step can close the equity gap.

11. Neurological Teleconsultations in General Practice: A Stepped-Wedge Cluster Randomized Clinical Trial.

期刊: JAMA neurology 发表日期: 2026-May-26 链接: PubMed

摘要

Incorporating teleneurology into primary care aimed to improve access to neurological care in a rural region in Germany. A telemedicine network connecting neurologists, general practitioners (GPs), and patients was established. To determine whether teleneurology services in rural primary care increased the proportion of patients with neurological symptoms managed solely in general practice. The NeTKoH study (Neurological Teleconsultation With General Practitioners to Strengthen Specialist Care in Western Pomerania, Germany) was a stepped-wedge cluster randomized clinical trial conducted from January 1, 2021, through July 31, 2025, to compare teleconsultations vs standard care. Patients were continuously approached and eligible if they were aged 18 years or older and presented at one of 41 participating GP practices in northeast Germany with symptoms for which a neurological consultation was deemed necessary. The duration of patient follow-up was 3 months. Data analysis was conducted from January to July 2025. Practices were equipped with a telemedicine system to enable a video conference between the GP and patient on 1 side and a neurologist on the other side to obtain immediate neurological assessment and guide further care decisions. The primary outcome was the proportion of patients who continued to be managed solely within general practice. Between October 15, 2021, and October 25, 2024, 986 patients were enrolled (intervention: 517 patients; control: 469 patients); 3 of these patients were excluded, leaving 983 patients for analysis (605 [61.5%] female; median [range] age, 55 [18-90] years). Teleconsultations, compared with standard care, resulted in fewer patients managed solely within general practice (38.3% vs 50.7%; adjusted odds ratio, 0.58; 95% CI, 0.38-0.88). Referrals to neurologists decreased with teleconsultations compared with standard care (36.4% vs 41.4%), while referrals to other specialists (11.9% vs 4.7%) and hospitals (12.8% vs 2.6%) increased. No significant differences were observed in quality of life or health status. Adherence to recommendations was lower in the intervention phase. At follow-up, more than half of the patients in either group were still managed solely in general practice. This stepped-wedge cluster randomized clinical trial suggests that neurological teleconsultations in general practice may have helped triage patients (eg, to other specialists or hospitals) and therefore contributed to improved medical care, particularly in structurally underserved areas; however, an immediate reduction in the use of secondary care was not found. The inability to blind GPs to the randomization may have introduced selection effects, which should be considered in future studies. German Clinical Trials Register Identifier: DRKS00024492.

12. Clinical and molecular characterization of an outbreak of leptospirosis in dogs from Los Angeles County, California, USA, 2021.

期刊: Journal of clinical microbiology 发表日期: 2026-May-26 链接: PubMed

摘要

In 2021, the Los Angeles County (LAC) Department of Public Health suspected a leptospirosis outbreak in LAC affecting over 200 client-owned dogs. We aimed to characterize the outbreak and describe microbiologic findings, risk factors, diagnostic test performance, and outcomes in dogs diagnosed with leptospirosis at two specialty practices. Leptospira culture isolates from four cases were subjected to serotyping and whole-genome sequencing (WGS); WGS was also performed on one enriched genome isolate. After the outbreak, data were gathered on 59 cases and compared to the background hospital population (controls, n = 15,536). All isolates were Leptospira interrogans serovar Canicola, but each was distinct based on WGS. Cases clustered in space and in time. Cases evaluated during the outbreak peak had increased odds of exposure to indoor congregate facilities (ICFs). None of the 47 dogs with known leptospirosis vaccination history were completely vaccinated. Leptospira real-time PCR on blood and urine was positive in 15/56 (27%) and 49/54 (91%) of dogs, respectively. Initial serologic testing using the microscopic agglutination test and point-of-care tests was positive in 22/29 (76%) and 27/35 (77%) of dogs, respectively. Fifty-four (92%) of 59 dogs survived to discharge; some remained azotemic. No associated human cases were identified. In conclusion, L. interrogans serovar Canicola was associated with a leptospirosis outbreak in unvaccinated dogs, which had public health implications given widespread dog ownership rates. Data analysis suggested multiple infection sources, including ICFs. Urine PCR was the most sensitive diagnostic test. Such outbreaks might be prevented through more widespread vaccination. Leptospirosis is a zoonotic bacterial disease transmitted through the urine of infected animals. We characterized an outbreak of leptospirosis in unvaccinated dogs in Los Angeles County and showed that cases were associated with housing in dog daycare and boarding facilities. Culture of several Leptospira isolates from the post-peak period identified Leptospira interrogans serovar Canicola, supporting the potential for dogs to act both as reservoirs and incident hosts for this serovar. Across the entire study period, multiple independent infection sources seemed likely based on molecular and spatial epidemiologic analysis, which might have included exposure to other dogs in indoor congregate facilities, rodents, or rodent urine. Our findings support the need for vaccination of dogs to reduce the risk to dog and human health, a high index of suspicion for the disease in unvaccinated dogs, the combined use of molecular and serologic tests to optimize diagnosis, and early treatment to optimize outcomes.

13. Recipient-Donor Sex Combinations and Posttransplant Infections: A Swiss Transplant Cohort Study.

期刊: Transplant infectious disease : an official journal of the Transplantation Society 发表日期: 2026-May-26 链接: PubMed

摘要

Despite increasing interest in sex and gender in transplant medicine, the impact of recipient-donor sex combinations (RDSCs) on posttransplant infections, graft survival, and rejection remains unclear. To assess if RDSC is independently associated with infectious events in solid organ transplantion (SOT) recipients. This retrospective cohort study assessed a national prospectively maintained registry including six transplant centers. All adult patients, undergoing primary transplant of either heart, kidney, liver, or lung, between May 1, 2008, and December 31, 2021, were included. Endpoints were clinically significant infectious events (primary endpoint), graft survival, rejection, and overall survival within the first year. Patients were grouped as per RDSC. The primary statistical outcome of the organ-specific, a priori known risk factor-adjusted analyses are reported as incidence rate ratios (IRRs). The cohort included 5033 recipients: 2886 (57.3%) kidney, 1224 (24.3%) liver, 515 (10.2%) lung, and 408 (8.1%) heart transplants, documenting 6067 infections. Recipient-donor sex mismatch was not associated with weighted posttransplant infection risk in heart (IRR: 1.06; 95% CI: 0.75, 1.48; p = 0.75), kidney (IRR: 1.03; 95% CI: 0.90, 1.17; p = 0.69), liver (IRR: 1.10; 95% CI: 0.81, 1.50; p = 0.52), or lung (IRR: 1.02; 95% CI: 0.82, 1.26; p = 0.89) recipients. Female kidney recipients had significantly higher infection rates than males (IRR: 1.50; 95% CI: 1.32, 1.71; p < 0.001), largely explained by urinary tract infections. One-year graft survival, rejection, and overall survival were unaffected by RDSC across all organs. RDSC does not influence 1-year SOT infectious outcome, as well as rejection or graft survival as exploratory outcomes.

14. Increased risk of hypoglycemia in children and young adults after undergoing bowel preparation for colonoscopy.

期刊: The American journal of gastroenterology 发表日期: 2026-May-26 链接: PubMed

摘要

Children have a higher risk of developing fasting hypoglycemia compared to adults, and colonoscopy bowel preparation may further increase this risk. The aim of this study is to evaluate the prevalence of and risk factors for hypoglycemia in children and young adults after undergoing colonoscopy bowel preparation. We performed a retrospective analysis of pre-procedure point-of-care glucose measurements in children and young adults who underwent outpatient colonoscopy at the Children’s Hospital of Philadelphia between 1/1/2020-12/31/2024. We used Bayesian generalized linear mixed models to evaluate the relationship between demographic and clinical variables and hypoglycemia at three severity thresholds. 5129 colonoscopies of patients ages 5 months to 27 years old were included. Overall, 8% of patients were hypoglycemic (n = 391), 3% were moderately hypoglycemic (n = 128), and 1% were severely hypoglycemic (n = 41) before undergoing colonoscopy. On univariable and multivariable analysis, younger patients and patients with lower weight percentiles were significantly more likely to be hypoglycemic at all severity thresholds. Children <3 years old had the highest risk of hypoglycemia. Procedure location, having a feeding tube, and feeding problems were significantly associated with hypoglycemia on univariable analysis, but nonsignificant on multivariable analysis. Afternoon procedures were significantly associated with hypoglycemia on multivariable analysis. Children and young adults undergoing colonoscopy bowel preparation have a significant risk of hypoglycemia, especially those who are younger and with lower weight percentiles. Routine pre-procedure screening for hypoglycemia and implementation of preventative interventions during bowel preparation may be beneficial in the pediatric population.

15. Homicide Risk During 10-Day Waiting Period Among First-Time Handgun Purchasers in California.

期刊: JAMA internal medicine 发表日期: 2026-May-26 链接: PubMed

摘要

This cohort study assesses the occurrence and risk of death by homicide involving gun purchasers and their cohabitants during a mandatory period between the purchase and physical possession of the gun.

16. Prevalence of Invasive Bacterial Infections Among Febrile Infants Aged 60 to 90 Days: A Systematic Review and Meta-Analysis.

期刊: JAMA pediatrics 发表日期: 2026-May-26 链接: PubMed

摘要

The prevalence of invasive bacterial infections (IBIs), specifically bacteremia and bacterial meningitis, is not well established among febrile infants in the third month of life. International guidelines exclude or vary in management recommendations for this age group. To assess the prevalence of IBIs among febrile infants aged 60 to 90 days. MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, and Scopus were searched with deliberate limitation to studies between January 1, 2000, to October 2, 2025, and analyzed in December 2025. Studies were included that reported on previously healthy, well-appearing febrile infants 60 to 90 days old evaluated in emergency department or outpatient settings and for whom patient-level IBI status could be ascertained. Data were extracted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines, and risk of bias was assessed using the Joanna Briggs Institute critical appraisal Checklist for Prevalence Studies. Pooled prevalences were calculated using random-effects generalized linear mixed models of logit-transformed single proportions of cases. The primary outcome was the prevalence of IBI. Secondary outcomes included the prevalence of bacteremia and bacterial meningitis separately. The search yielded 13 130 records; 59 studies were included (20 distinct datasets of 34 835 infants). The pooled prevalence of IBI was 1.11% (95% CI, 0.84%-1.47%), bacteremia was 1.01% (95% CI, 0.76%-1.34%), and bacterial meningitis was 0.11% (95% CI, 0.08%-0.16%). Results were consistent across multiple sensitivity analyses excluding (1) retrospective cohorts; (2) cohorts of only infants with fever without source; (3) cohorts with shorter clinical follow-up of less than 7 days; and (4) the largest study (66% of all included patients). In this systematic review and meta-analysis, the pooled prevalence of IBI among well-appearing febrile infants in the third month of life was 1.11%; bacteremia accounted for most cases, whereas bacterial meningitis was rare. These contemporary prevalence estimates should inform guideline development and shared parent and clinician decision-making for the management of these infants.

17. Genetic variability of SARS-CoV-2 XFG lineage and its parental lineages.

期刊: Pathogens and global health 发表日期: 2026-May-26 链接: PubMed

摘要

SARS-CoV-2 XFG (nicknamed Stratus), a recombinant lineage arising from LP.8.1.2 and LF.7, is currently the most prevalent circulating lineage. Although most recombinant lineages do not pose a significant public health concern, some have shown the capacity to emerge and spread, highlighting the importance of their investigation. In this context, we performed a genome-based analysis to assess the genetic variability of XFG and to identify its recombination breakpoint. The breakpoint was mapped to approximately position 1507 within the spike (S) gene, in the distal region of the receptor-binding domain. This configuration suggests that LP.8.1.2 contributed the genomic backbone as the acceptor, whereas LF.7 acted as the donor. Phylodynamic survey suggests that XFG originated in early 2024, approximately 10 months before its first genomic detection. Bayesian Skyline Plot revealed a transient expansion phase beginning in August 2024, followed by a plateau, indicating limited and non-sustained growth. The estimated evolutionary rate of XFG (2.90 × 10-4 subs/site/year) was comparable to those of its parental lineages, supporting a relatively low level of genetic variability. Overall, these findings suggest that the widespread prevalence of XFG is more likely driven by lineage turnover rather than increased transmissibility, highlighting the importance of continuous genomic surveillance for monitoring emerging SARS-CoV-2 lineages.

18. Medication Management Among Older Adults Living Alone With Cognitive Impairment.

期刊: JAMA internal medicine 发表日期: 2026-May-26 链接: PubMed

摘要

More than one-fourth of older individuals in the US with cognitive impairment live alone. These individuals often lack support for medication management and face a high risk of medication-related harm. To elucidate barriers and facilitators to medication management experienced by older adults living alone with cognitive impairment and their social contacts. This qualitative study was conducted between May 2016 and February 2024 among adults of diverse racial and ethnic backgrounds aged 55 years or older living alone with cognitive impairment in California, Louisiana, and Michigan (ie, participants), along with their social contacts, defined as family members or other familiar persons. Data were analyzed between February 2024 and March 2025. As part of the Living Alone With Cognitive Impairment Project, participants’ and social contacts’ perspectives regarding barriers and facilitators were elicited via semistructured interviews conducted in English, Spanish, Cantonese, or Mandarin. Participants were interviewed a mean of 4 times (486 interviews total), mostly in their homes. Combined inductive and deductive thematic analysis was used to examine discussions specific to medication management. A total of 116 older adults living alone with cognitive impairment (median [range] age, 74 [57-103] years; 86 females [74.1%]) and 54 social contacts (median [range] age, 59 [29-89] years; 44 females [81.5%]) were interviewed. At an individual level, barriers to medication management included a lack of reminders to take medications due to a lack of cohabitants, fear of experiencing adverse effects while alone, and stress related to managing complex medication regimens with inadequate support. At an interpersonal level, barriers included difficulty in verifying medication behaviors without cohabitants, distrust of health care professionals related to a desire to maintain independence, and communication barriers. At a system level, barriers included difficulty navigating health system logistics without advocates. Participants received crucial but intermittent support with medication management from noncohabiting social contacts. Both groups suggested potential solutions to barriers, but they nevertheless conveyed a sense of precarity related to medication management. This qualitative study involving racially and ethnically diverse participants from 3 states highlights the substantial barriers older adults living alone with cognitive impairment experience in managing their medications. Identification of cognitive impairment in older adults who live alone should spur targeted efforts to overcome medication-related challenges. In addition, more home- and community-based services are needed to provide medication management support to individuals living alone with cognitive impairment.

19. VEPTR treatment of early onset scoliosis in children without rib abnormalities: 10-year follow-up from a prospective multicenter study.

期刊: Spine deformity 发表日期: 2026-May-26 链接: PubMed

摘要

In 2007, a prospective study on VEPTR treatment of EOS in children without rib abnormalities was initiated. Two-year and 5-year follow-up results from this cohort have previously demonstrated that scoliosis is controlled, and spinal growth continues. This study examines whether, at long-term follow-up, VEPTR continues to control scoliosis and allow spinal growth. Prospective, multicenter cohort of participants with EOS without rib abnormalities who underwent VEPTR. Pre-implantation and last available images were compared, regardless of whether VEPTR remained in vivo. 33 patients were available for evaluation (mean age at insertion 4.8 ± 2.5 yrs; mean f/u 10.6 ± 2.7 yrs; mean 14.6 surgeries. Currently 14 patients still have VEPTR, 17 have converted and 2 have had VEPTR explanted. On last available imaging (mean f/u 10.4 ± 1.7 yrs), scoliosis improved from 72 ± 16° preop to 61 ± 22° (p < 0.001) and T1-T12 coronal height increased (14.5 ± 2.3 to 19.6 ± 3.9 cm, p < 0.001). Maximum kyphosis increased from 41 ± 19 to 62 ± 26° (p < 0.001). T1-T12 sagittal length (cm) increased from 15.6 ± 2.3 to 20.2 ± 3.9° (p < 0.001). A subset of 14 patients who still have VEPTR in vivo was analyzed: mean age at insertion was 4.6 ± 2.8 yrs, with a mean VEPTR treatment duration of 10.7 ± 3 yrs. Scoliosis improved from preop (79 ± 16 to 66 ± 23°, p = 0.01). T1-T12 coronal height increased (13.9 ± 2.1 to 18.5 ± 3.3 cm, p = 0.001). Maximum kyphosis increased from 40 ± 28 to 66 ± 23° (p = 0.011). T1-T12 sagittal length (cm) increased from 15.2 ± 2.6 to 18.9 ± 3° (p < 0.001). Thirty-one patients (93%) experienced at least 1 complication, with 93 total complications observed. Eighteen patients (54%) required at least one unplanned surgery. With long-term follow up, VEPTR continues to control scoliosis and allow spinal growth. However, kyphosis increased, and most patients experienced at least one complication. Level II-prospective cohort, therapeutic study.

20. An ACMT Network of Medical Toxicology Clinics (NMTC): A Proposed Collaboration of Medical Toxicologists to Meet National Emergency Preparedness Needs.

期刊: Journal of medical toxicology : official journal of the American College of Medical Toxicology 发表日期: 2026-May-26 链接: PubMed

摘要

21. Novel framework for river health assessment: principal component-based water quality index and causal inference through regression discontinuity design.

期刊: Environmental science and pollution research international 发表日期: 2026-May-26 链接: PubMed

摘要

Rivers in industrial regions face significant pressure from anthropogenic activities, often resulting in degraded water quality. This study investigates long-term water quality dynamics of the Damodar River in West Bengal, India, using a multi-index approach and advanced statistics. Six established Water Quality Indices (WQIs) were computed using monthly data from 2014 to 2024 across ten monitoring sites. To reconcile the inconsistencies among individual indices, Principal Component Analysis (PCA) was applied to generate a unified metric termed the Principal Component Averaged WQI (PCAWQI). Furthermore, to quantify the causal impact of the COVID-19 lockdown (March-May 2020) on river health, we employed a Regression Discontinuity Design (RDD) using Bayesian structural time-series modeling (CausalImpact). The composite PCAWQI successfully captured spatial and temporal pollution gradients, highlighting critical midstream deterioration. Additionally, site-specific improvements in water quality were observed during the lockdown, with some sites exhibiting significant gains likely due to industrial inactivity. However, heterogeneous responses underscored the influence of socio-cultural and hydrological factors. Thus, by integrating dimensionality reduction and causal inference techniques, we developed a robust and replicable framework for water quality assessment. This framework can be utilized for environmental monitoring and policy evaluation in heavily industrialized river basins.

22. Text Messaging for Mental Health Promotion With Migrants Returning to Mexico: Content Development and Piloting With a Needs Assessment Approach.

期刊: JMIR formative research 发表日期: 2026-May-26 链接: PubMed

摘要

Returning migrants face a variety of challenges that limit their ability to integrate and adapt to Mexico. This represents a break in their life trajectory, with effects on family dynamics, mid- and long-term projects, and uncertainty about short-term plans. This study describes the coproduction approach used to design and develop a WhatsApp-based psychoeducational program entitled “Here Again: Coping With Return,” which aims to promote the adoption of self-care behaviors to reduce the risk of mental health and substance use problems among returning migrants. The process included four phases: (1) a situational diagnosis of the needs of migrants in preventing mental health problems and reducing the risks associated with alcohol use, (2) the design and development of content, (3) evaluation by a group of experts in mental health and substance use, and (4) pilot testing. The study identified 4 intervention pillars: emotional risk factors, coping strategies, barriers to care, and technological feasibility. Eighty WhatsApp messages were developed, focusing on mental health (n=52, 65%) and alcohol use (n=20, 25%) through a sequence of motivation, instruction, and reinforcement. Following an expert evaluation that simplified technical language, a pilot study with 14 migrants showed a 78.6% completion rate. Participants reported the successful application of emotional management tools and a preference for text-based messages over audiovisual content to conserve mobile data. This study describes the development of a psychoeducational program for returning migrants based on coproduction, integrating user needs and expert experience. The intervention addresses emotional management, self-care, and substance use prevention, using WhatsApp for its accessibility and low cost. The pilot results demonstrated high acceptability and a 78.6% retention rate over 16 weeks, highlighting that the culturally sensitive approach and accessible language enabled participants to apply mental health tools autonomously and effectively.

23. Advance directives in psychiatry to foster self-determination: a proposal for the Italian scenario.

期刊: Medicine, health care, and philosophy 发表日期: 2026-May-26 链接: PubMed

摘要

Psychiatric advance directives (PADs) are statements that allow people with mental disorders to express their preferences and wishes in anticipation of future crisis situations in which the patient’s decision-making capacity may be compromised due to their mental disorder. The fundamental value of PADs is the promotion of self-determination and personal autonomy. Although PADs have common elements, they may differ across countries in their content, development process and legal status. Italy does not have a specific regulation regarding PADs; however, we argue that important indications may be drawn from Law No. 219/2017 regulating informed consent, advance directives and shared care planning (SCP). Moving from the international context and empirical evidence regarding barriers and facilitators to the implementation of PADs, the paper provides a key for interpreting SCP in the psychiatric field. The discussion highlights the importance of an interdisciplinary collaboration among bioethics, law, and clinics to improve the quality and consistency of care for people with mental disorders.

24. Commercial-Friendly Mental Health Narratives Undermine Community Mental Health: A Call for Action.

期刊: Community mental health journal 发表日期: 2026-May-26 链接: PubMed

摘要

Community mental health aims to provide effective care to all people, especially those living with serious mental illness. However, commercial influences undermine the ability to provide this needed care. In this commentary, we use the commercial determinants of health (CDoH) framework to analyze dominant mental health narratives that frame the mental health crisis as an individual problem, encourage mental health screening, and support the commercialization of mental health. To counter this intra-individual approach, we offer nuanced narratives that are robust enough to facilitate effective and focused care across the continuum of care: mental health promotion and prevention, mental health treatment, and recovery-oriented solutions.

25. Variation in image-assessed abdominal adiposity and skeletal muscle and their associations with pathological characteristics in renal cell carcinoma.

期刊: Cancer causes & control : CCC 发表日期: 2026-May-26 链接: PubMed

摘要

Body composition varies by race and ethnicity and influences cancer prognosis, but the associations of body composition with pathological characteristics in renal cell carcinoma (RCC) remain unclear. This study investigated body composition variation and its association with RCC histology, tumor grade, and stage. Using preoperative imaging scans, we measured area (cm2) and radiodensity of adipose tissue sub-compartments and skeletal muscle. Area measurements were normalized for height squared (cm2/m2) to calculate intermuscular, visceral, and subcutaneous adipose tissue and skeletal muscle indices (e.g., IMATI, VATI, and SATI). Logistic regression analyses were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). A total of 268 patients were included. Compared to non-Hispanic White patients, SATI was higher in Hispanic (p < 0.01) and American Indian (p < 0.05), and VATI was higher in Hispanic patients (p < 0.05). High IMATI (Quartile 4 vs 2) was associated with increased odds of clear cell subtype (OR 6.93, 95% CI:1.74-27.58), while low IMATI (Quartile 1 vs 2) was associated with reduced odds of advanced-stage (OR 0.27, 95% CI:0.10-0.72). Increase in each SATI quartile was associated with higher odds of high grade (OR 1.52, 95% CI:1.02-2.28). High visceral adipose tissue radiodensity (Quartile 4 vs 1) was associated with increased odds of advanced stage (OR 4.72, 95% CI:1.25-19.41). For all adiposity measurements, the low adiposity/low SMI phenotype was associated with high grade with about three-fold increased odds compared to the low adiposity/high SMI phenotype. These findings suggest body composition varies across racial and ethnic groups and is associated with RCC pathological characteristics.

26. Adverse childhood experiences, adult adiposity, and risk of young-onset breast cancer subtypes in a population-based case-control study.

期刊: Cancer causes & control : CCC 发表日期: 2026-May-26 链接: PubMed

摘要

Adverse childhood experiences (ACEs) are hypothesized to increase breast cancer risk via social and physiological pathways, yet associations between ACEs and young-onset breast cancer (BC) subtypes-and potential mediators (e.g., adiposity) of these associations-are largely unstudied. We sought to evaluate associations between ACEs and young-onset BC molecular subtypes, and the potential mediating effects of adiposity, in a population-based case-control study of invasive young-onset BC. Cases (n = 1,754) were identified from the Los Angeles County and Metropolitan Detroit SEER registries, 2010-2015, and area-based, frequency-matched controls (n = 1,350) sampled from the 2010 Census. Associations between ACEs aged < 18 years and young-onset BC (diagnosed ages 20 to < 50 years), overall and by subtype (luminal A, luminal B, HER2 + , triple negative [TN]), were examined using weighted logistic regression. Adult adiposity (i.e., body mass index 12 months before diagnosis, waist circumference at interview) was evaluated as a mediator of these associations using weighted path analyses. ACEs (≥ 1 vs 0) were not significantly associated with young-onset BC (all ptrend > 0.10); however, reporting one ACE (vs 0) was associated with TN (odds ratio [OR] = 1.85 [95% confidence interval [95%CI] = 1.08-3.16]). For individual ACEs, death of a loved one (vs 0 ACEs) was associated with HER2 + (OR = 2.50 [95%CI = 1.06-5.88]) and potentially TN (OR = 1.72 [95%CI = 0.96-3.10]) young-onset BC; other associations were non-significant. In path analyses, ACEs had a significant total effect on luminal A (β = 0.08, p = 0.03) and TN (β = 0.13, p < 0.01) tumors, with adiposity mitigating this association for luminal A tumors (β = -0.01, p = 0.04; TN β = 0.00, p > 0.05). Bereavement during childhood was associated with higher odds of HER2 + young-onset BC, and there was some evidence of an association between ACEs and other young-onset BC subtypes, particularly TN.

27. Greater amounts of visceral adipose and lean body mass increase heart failure risk in older women.

期刊: Clinical research in cardiology : official journal of the German Cardiac Society 发表日期: 2026-May-26 链接: PubMed

摘要

Clinical body composition measures have not been well-studied in relation to heart failure (HF) risk among older women, which was the objective of this investigation. Participants were 10,521 postmenopausal women without known HF who had whole-body dual energy x-ray absorptiometry scans at baseline (mean age 63), 3- and 6-years later. Total fat and lean mass (kg), abdominal visceral (VAT) and subcutaneous (SAT) adipose tissue area (cm2) were measured. Incident acute decompensated HF hospitalizations were identified annually and adjudicated by trained physicians. A subset of 3,528 women had ejection fraction information available to characterize HF with preserved (HFpEF) and reduced (HFrEF) ejection. There were 852 cases of HF, and 116 HFpEF and 107 HFrEF cases during 16.7 (mean) years follow-up. Multivariable hazard ratios (HR) for HF across quartiles (trend, P < .001 all) were VAT 1.00 [ref], 1.16, 1.22, 2.10; SAT 1.00, 1.14, 1.18, 1.62; fat mass 1.00, 1.07, 1.14, 1.67; and lean mass 1.00, 1.02, 1.07, 1.86. HFpEF was associated with VAT (adjusted HR per 1-SD = 1.53; 95% CI: 1.26-1.86), SAT (1.31; 1.08-1.60), fat mass (1.47; 1.21-1.78), and lean mass (1.47; 1.21-1.78). HFrEF was not consistently associated with body composition. Time-varying results over repeated body composition measures were similar as above. Mutually adjusting lean mass and VAT attenuated their associations but each remained significantly positively associated with HF and HFpEF. In older women, VAT and lean mass were associated with higher risk of HF and HFpEF. The positive association for lean mass was not fully explained by greater VAT perhaps reflecting poorer lean mass quality with aging.

28. Women's heart centres: a clinical consensus statement of the European Association of Cardiovascular Imaging (EACVI), the European Association of Percutaneous Cardiovascular Interventions (EAPCI), the Heart Failure Association (HFA), and the Association for Acute CardioVascular Care (ACVC) of the ESC.

期刊: European heart journal 发表日期: 2026-May-26 链接: PubMed

摘要

Cardiovascular disease is the leading cause of death in women, yet significant disparities persist in diagnosis, treatment, and research representation. This clinical consensus statement outlines the rationale and framework for establishing women’s heart centres (WHCs) in Europe. Women’s heart centres are proposed as hub-and-spoke reference networks embedded within existing cardiovascular systems, delivering multidisciplinary, sex-sensitive care across the life course. The document defines referral pathways, operational standards, and core and advanced training competencies in women’s cardiovascular health. Key domains include ischaemia/myocardial infarction with non-obstructive coronary arteries, cardio-obstetrics, cardio-oncology, autoimmune disease, mental health, and cardiac rehabilitation. Implementation strategies emphasize scalable models, integration with primary care, telemedicine, quality improvement, and research engagement. Although long-term outcome data remain limited, available evidence suggests improved diagnostic precision, risk factor control, and patient-reported outcomes. Establishing WHC offers a structured approach to reduce inequities and strengthen cardiovascular care for women across Europe.

29. Real-World Economic Burden Associated with Progressive Pulmonary Fibrosis in the US: An Administrative Claims Database Analysis.

期刊: PharmacoEconomics 发表日期: 2026-May-26 链接: PubMed

摘要

Among patients with non-idiopathic pulmonary fibrosis (non-IPF) interstitial lung disease (ILD), developing progressive pulmonary fibrosis (PPF) is associated with increased economic burden, inpatient (IP) admissions, and mortality. However, little is known about the burden within specific payer types. This retrospective study assessed the economic burden of PPF and associated time to first IP admission among distinct cohorts of Medicare Advantage Prescription Drug (MAPD) beneficiaries and commercial enrollees in the United States (US). Medical and pharmacy claims were analyzed among patients diagnosed with non-IPF ILD between 1/1/2017 and 11/30/2023. Patients who developed PPF (cases) were matched with those who had not yet progressed (comparators) using 1:1 propensity score matching (PSM) with replacement. The index date was the earliest PPF date for cases; the respective comparator was assigned an index date to create identical pre-index durations. Variable follow-up began on the index date and lasted for ≥ 3 months. Primary outcomes were all-cause and ILD-related healthcare resource utilization (HCRU) and costs (US dollars [USD] 2023) during follow-up. Outcomes were stratified by insurance type and weighted per patient per month (wPPPM). Multivariable models assessed all-cause costs and time to first IP admission, adjusting for covariates that remained imbalanced after PSM. A total of 60,171 matched pairs were analyzed: 50,683 MAPD and 9488 commercial. PSM generated well-balanced cohorts, except for race/ethnicity, ILD diagnosis year, unique pre-index medications filled (MAPD), and age group (commercial). For both insurance types, the PPF group was associated with significantly higher economic burden than the comparator group. All-cause costs averaged $3640 versus $1897 wPPPM (p < 0.001) in MAPD and $6164 versus $2741 (p < 0.001) in commercial. Differences were primarily driven by IP burden (MAPD: $1412 vs $507; commercial: $2094 vs $559; both p < 0.001). Mean length of IP stay was significantly longer among patients that developed PPF (MAPD: 0.9 vs 0.4 days; commercial: 0.5 vs 0.2 days; both p < 0.001). A generalized linear model showed that PPF was associated with higher adjusted all-cause costs (MAPD cost ratio [95% confidence interval {CI}]: 1.861 [1.807-1.916]; commercial: 2.096 [1.897-2.316]). Cox proportional hazards ratios (95% CI) showed a significantly higher hazard of first IP admission with PPF (MAPD: 2.060 [2.005-2.116]; commercial: 2.324 [2.133-2.532]). Notably, follow-up use of antifibrotics was low among patients with PPF (0.8% MAPD; 1.0% commercial). For MAPD and commercial cohorts, PPF was associated with significantly higher HCRU, costs, and hazard of IP admission. Differences in economic burden were primarily driven by IP utilization. These findings support the prioritization of treatments or strategies that attenuate the risk and rate of progression to mitigate downstream healthcare burden. Some people with interstitial lung diseases (ILDs)—a group of conditions that cause scarring in the lungs—may develop a more serious condition over time called progressive pulmonary fibrosis (PPF). PPF makes it harder to breathe and can lead to hospital stays, higher medical costs, and early death. This study looked at how PPF affects healthcare use and costs in the United States. Because insurance plans may differ in how patients access care and what they pay, we used insurance data from two groups of people: those with Medicare Advantage plans and those with commercial insurance. The study compared people who developed PPF with similar individuals who had not yet progressed. We examined how often patients used healthcare services—like doctor visits or hospital stays—and how much their care cost over time. We found that people with PPF had more doctor visits, more hospital stays, and higher medical costs than those who did not progress. In the Medicare Advantage group, people with PPF had average monthly healthcare costs of $3640 compared with $1897 for those without PPF. In the commercial group, those numbers were $6164 and $2741, respectively. Hospital stays were the biggest reason for these cost differences. Notably, only about 1% of patients with PPF were using treatments that may slow down the disease and reduce hospitalizations. These findings show that PPF is associated with a significantly higher burden on patients and the healthcare system. Catching the disease early and finding ways to prevent hospital stays may help reduce costs and improve care.

30. A Narrative Review of Remote Biospecimen Collection Product and Implementation Considerations for Sexual Health Clinical Research.

期刊: AIDS and behavior 发表日期: 2026-May-26 链接: PubMed

摘要

Remote biospecimen collection (RBSC), such as home-based HIV testing and self-collection of dried blood spots (DBS) to assess adherence to antiretroviral drug regimens, has become an important tool to support clinical research because it can facilitate participant reach, lower participant burden, and reduce discomfort with attending research visits in clinic spaces. RBSC is common in sexual health clinical intervention trials to assess the impact of an intervention or program on primary and secondary outcomes. However, the products and strategies employed to successfully implement RBSC can vary widely across studies. The purpose of this narrative review is twofold. First, to provide an overview of currently available RBSC products, their attributes, and their suitability for various clinical research applications. Considerations for blood-based and volumetric absorptive microsampling collection products, as well as self-administered sexually transmitted infection testing and other specimen types, are described. Second, RBSC implementation considerations at each stage of the collection process are discussed primarily from the perspective of the authors’ collective expertise and experience with RBSC in HIV prevention and treatment clinical research. Successful RBSC product selection and implementation require a multidisciplinary team approach that is participant-centered to achieve high return rates, and ample time should be allotted to address the complexities of the procedures and processes. This review of RBSC product and implementation considerations offers an actionable framework and roadmap when considering incorporation of RBSC into clinical trials research. TRIAL REGISTRATION: N/A.

31. The Role of Fathers in the Intergenerational Transmission of Obesity.

期刊: Current obesity reports 发表日期: 2026-May-26 链接: PubMed

摘要

This narrative review aims to synthesize recent evidence demonstrating that paternal influences can significantly affect child obesity risk through biological, psychosocial, and behavioral pathways and to highlight implications for clinical practice, public health, and research. Paternal obesity influences offspring metabolic health through three primary mechanisms. Biologically, paternal obesity alters sperm epigenetic signatures, which are transmissible to offspring and modifiable through preconception lifestyle interventions. Behaviorally, fathers’ dietary quality, physical activity, feeding practices, and parenting styles directly shape children’s eating patterns and activity levels, with the transition to fatherhood representing a critical period when paternal weight gain and lifestyle changes commonly occur. Socioecologically, social determinants of health including food insecurity, neighborhood characteristics, and paternal mental health create shared family-level exposures that simultaneously influence paternal physiology, parenting behaviors, and childhood adversity, compounding obesity risk across generations. Fathers play a pivotal role in shaping child obesity risk from preconception through childhood. Advancing obesity prevention requires expanding preconception counseling to include fathers, implementing father-inclusive perinatal education and obesity prevention programs, adopting workplace policies that support paternal engagement, and prioritizing research that elucidates paternal contributions to intergenerational obesity transmission.

32. Optimizing Athlete Travel for Performance: A Scientific Blueprint for Athletes, Coaches, and Sports Medicine Staff.

期刊: Sports medicine (Auckland, N.Z.) 发表日期: 2026-May-26 链接: PubMed

摘要

Travel is an integral component of modern sports, with athletes frequently crossing timezones for competition. This travel introduces challenges that can impact both recovery and athletic performance. As more athletes and teams travel for competition, it is increasingly important to understand ways to mitigate common travel-related issues such as jet lag, travel fatigue, and sleep disturbances. Specific strategies to adapt to new timezones including managing light exposure, ensuring proper hydration and fueling, determining appropriate travel times, utilizing supplements and maintaining sleep consistency should be addressed. Additional considerations include the potential impact of other environmental factors, such as adapting to heat or altitude, when combined with traveling. In this narrative review, we focus on long-haul travel, where circadian misalignment and jet lag are most pronounced, and provide a scientific blueprint of how to minimize the impacts of travel on athletes with the goal of helping athletes, coaches, and sports medicine staff to develop a practical framework to enhance recovery and athletic performance amidst travel-related obstacles.

33. Carotenoids of Halophilic Archaea: Production, Properties and Biotechnological Applications.

期刊: Probiotics and antimicrobial proteins 发表日期: 2026-May-26 链接: PubMed

摘要

Halophilic Archaea possess fascinating physiological characteristics with unique ecological significance. Among the carotenoids, bacterioruberin is one of the most studied which is produced by different halophilic Archaea with beneficial characteristics such as antioxidant, antimicrobial and anticancer activity. Their metabolites exhibit distinctive characteristics such as stability in extreme conditions, structural modifications and biological activities, which may be used to develop innovative products for different biotechnological applications. At the laboratory level, carotenoid production depends on several physical and chemical parameters, such as incubation temperature, pH, and medium composition, in particular the presence and concentration of NaCl, CH3COONa, and MgSO₄. Thus, it is still terra incognita, an area that provides opportunities for research in the search of new natural compounds with numerous potential applications. This is a narrative review of carotenoids produced by halophilic archaea with an emphasis on biosynthesis, extraction, safety and potential biotechnological applications.

34. Establishment of a reference range for hair cortisol using a HPLC-MS/MS method in a Northern Italian population.

期刊: Journal of endocrinological investigation 发表日期: 2026-May-26 链接: PubMed

摘要

Hair cortisol concentration (HCC) represents a promising biomarker for long-term hypothalamic-pituitary-adrenal (HPA) axis activity. However, its routine clinical application is currently limited by the lack of well-established reference ranges. We aimed to establish population-based reference intervals for HCC in healthy adults from Northern Italy, using a liquid chromatography-tandem mass spectrometry (LC-MS/MS) method following the Clinical and Laboratory Standards Institute (CLSI) EP28-A3c guidelines. Hair samples were collected from 256 healthy volunteers selected using strict inclusion and exclusion criteria. Cortisol quantification was performed by LC-MS/MS using a deuterated internal standard, guaranteeing high sensitivity and specificity. The method was validated for linearity, limit of detection, extraction efficiency, matrix effect, robustness across different sample weights, and inter-batch reproducibility using an internal quality control sample. Reference intervals were defined nonparametrically (2.5th-97.5th percentiles). Associations with demographic, clinical, and lifestyle variables were assessed. The established reference interval was 0.84 to 8.07 pg/mg, with a median of 2.41 pg/mg. HCC was significantly associated with body mass index (ρ = 0.160, p = 0.010) and weakly correlated with perceived stress (ρ = 0.137, p = 0.028). However, no significant associations were observed with sex, age, smoking status, alcohol consumption, physical activity, hair dyeing, or hair washing frequency. This study provides, for the first time, a population-based reference interval for hair cortisol concentrations using LC-MS/MS in healthy adults. These findings offer a benchmark for future research, supporting the use of HCC as a biomarker in epidemiological and translational research contexts.

35. Advances in ecotoxicological research using planarians: a comprehensive review.

期刊: Environmental science and pollution research international 发表日期: 2026-May-26 链接: PubMed

摘要

Planarians, distinguished by their extraordinary regenerative capacity and ecological role as benthic predators, have emerged as a transformative model in ecotoxicology. This review provides a comprehensive synthesis of research on the effects of diverse classes of pollutants, including metals, pesticides, pharmaceuticals, personal care products, nanomaterials, and a dedicated category of “other pollutants,” namely biotoxins and physical stressors, on these organisms. We introduce a novel conceptual framework of “regenerative toxicology,” which focuses on how contaminants impair an organism’s innate self-repair mechanisms. Our analysis reveals a convergent toxicity pattern: despite differing initial targets, most pollutants induced oxidative stress, which triggered cellular responses, including apoptosis, ultimately disrupting neoblast function and leading to failures in regeneration, behavior, and reproduction. A key advancement of this study is its emphasis on ecological realism and complex exposure scenarios. We critically evaluate the sensitivity of planarians to real-world environmental samples and highlight the significant implications of combined toxicity, such as the “Trojan horse” effect, in which microplastics increase the bioavailability of co-pollutants such as metals. This review further integrates methodological innovations, from multi-endpoint behavioral assays to multi-omics and AI-driven predictive modelling, while underscoring the urgent need for standardization in culture and testing methods. By bridging molecular mechanisms with individual and potential population-level outcomes, the planarian model offers a unique, cost-effective platform for assessing the sublethal and long-term hazards of environmental pollution. This review establishes planarians as an indispensable tool for elucidating the consequences of contaminants on tissue homeostasis and ecosystem health, thereby informing more robust environmental risk assessments.

36. Biological Photoprotection: A Review of its Mechanisms, Evidence, and Clinical Implications.

期刊: Dermatology and therapy 发表日期: 2026-May-26 链接: PubMed

摘要

Biological photoprotection refers to the enhancement, preservation, or mimicry of the skin’s intrinsic defense systems to prevent or mitigate damage induced by solar and environmental stressors. Unlike conventional sunscreens, which primarily act by reducing photon penetration, biological photoprotection targets the downstream molecular and cellular responses triggered by these exposures. It is achieved by incorporating nonfiltering photoprotective ingredients (PINGs) into sunscreens, which act on key biological pathways involved in skin damage and recovery. Emerging evidence suggests that these ingredients may provide additive protection when combined with ultraviolet (UV) filters, particularly in mitigating oxidative damage, supporting DNA repair, and modulating inflammatory and pigmentary responses. However, the current evidence base remains limited, with many studies characterized by small sample sizes, short durations, and heterogeneous methodologies. Taken together, biological photoprotection represents a complementary, but still evolving, dimension of modern photoprotection. Further research is required to establish standardized evaluation methods and to determine its clinical relevance under real-world conditions. Sunlight does more than cause sunburn. It can trigger harmful changes in the skin, including damage to cells, inflammation, changes in skin color, and faster skin aging. Traditional sunscreens mainly work by blocking or absorbing ultraviolet (UV) rays before they enter the skin. However, they do not fully protect against all the ways sunlight and the environment can damage the skin. Biological photoprotection is an approach that helps support the skin’s natural defenses. It involves adding ingredients to sunscreens that help the skin protect and repair itself. These ingredients can help reduce damage, support the skin’s repair processes, calm inflammation, and help control changes in skin color. Research suggests that these ingredients can provide extra protection when used together with UV filters. However, most studies so far have been small and short-term, so more research is needed to understand how well they work in everyday use. For now, biological photoprotection should be seen as an addition to, not a replacement for, traditional sun protection methods such as using sunscreen, seeking shade, and wearing protective clothing.

37. Twenty Years of Data from the Middle Reaches of the Yellow River, China, Demonstrate the Complex Relationship Between Ecosystem Health and Human Well-being.

期刊: EcoHealth 发表日期: 2026-May-26 链接: PubMed

摘要

Ecosystem health and human well-being are closely interlinked components of socio-ecological systems, playing a critical role in achieving regional sustainability. We examine the coupling relationship between ecosystem health and human well-being across 228 counties in the middle reaches of the Yellow River Basin-an area facing intense resource and environmental pressure. The main findings are as follows: (1) from 2000 to 2020, ecosystem health in the study area gradually improved, with the average index increasing by 13.61%, mainly driven by enhancements in ecosystem vitality and ecosystem services. However, significant spatial disparities remain, with a pronounced polarization between counties. (2) Over the same period, human well-being increased by 132.29%, but regional inequality also intensified, as indicated by a 31.91% increase in the coefficient of variation. (3) Granger causality tests indicate a bidirectional predictive relationship, significant at the 1% level for one direction and at the 5% level for the other. Impulse response analysis suggests that both systems exhibit self-reinforcing mechanisms, with the magnitude of self-response gradually declining over time. Although ecological improvement and social development may have potential positive mutual influences, these cross-effects were not found to be statistically significant. Spatial analysis shows significant positive spatial autocorrelation within each system, yet a significant negative spatial correlation between them, with dominant cluster types characterized by “high human well-being-low ecosystem health” (distributed in urban agglomerations) and “low human well-being-high ecosystem health” (distributed in mountainous ecological areas) spatial patterns. These findings provide empirical evidence for integrated socio-ecological governance and offer scientific support for coordinated development strategies in large river basin regions.

38. DNMT1 promotes the malignant progression of colorectal cancer by silencing HOXD11 via promoter hypermethylation.

期刊: Discover oncology 发表日期: 2026-May-26 链接: PubMed

摘要

Colorectal cancer (CRC) is a prevalent malignancy worldwide, and epigenetic modifications, particularly methylation of key genes, play a crucial role in its initiation and progression. DNA methyltransferase 1 (DNMT1) is aberrantly overexpressed in CRC; however, its specific mechanisms of action and downstream targets remain unclear. This study aims to elucidate how DNMT1 epigenetically regulates HOXD11 expression and subsequently influences CRC progression. The expression and methylation status of HOXD11 in 30 pairs of CRC tissues and adjacent normal tissues were detected by RT-qPCR, Western Blot, and methylation-specific PCR (MSP). HOXD11 overexpression assays were performed in CRC cell lines, and cell proliferation, migration, invasion, and apoptosis were evaluated using CCK-8, colony formation, wound healing, Transwell assays, and flow cytometry. To identify the key enzyme regulating HOXD11, we conducted specific shRNA knockdown screening of DNA methyltransferase family members (DNMT1, DNMT3A, and DNMT3B). The regulatory effect of DNMT1 on HOXD11 was then verified using the demethylating agent 5-AzaC. Finally, a nude mouse subcutaneous xenograft model was established to validate the therapeutic potential of targeting the DNMT1/HOXD11 axis in vivo. HOXD11 was significantly downregulated in CRC tissues, accompanied by promoter hypermethylation. Overexpression of HOXD11 markedly inhibited CRC cell proliferation, migration, and invasion, while inducing apoptosis. Mechanistic studies revealed that among the three DNMTs screened, only DNMT1 knockdown significantly upregulated HOXD11 expression, confirming DNMT1 as the specific methyltransferase mediating HOXD11 promoter hypermethylation and transcriptional silencing. Treatment with 5-AzaC restored HOXD11 expression and suppressed malignant phenotypes, whereas simultaneous knockdown of HOXD11 reversed these tumor-suppressive effects. In vivo experiments further confirmed that targeted inhibition of DNMT1 significantly curbed tumor growth by upregulating HOXD11. This study reveals that DNMT1-mediated promoter hypermethylation of HOXD11 is a critical mechanism driving the malignant progression of CRC. The DNMT1/HOXD11 axis may serve as a potential therapeutic target of CRC.

39. Correction to: Impact of timing of menopause on musculoskeletal disorders and associated pain in community‑dwelling women: the Yakumo study.

期刊: International orthopaedics 发表日期: 2026-May-26 链接: PubMed

摘要

40. Multidomain correlates of burnout: A population-based study using supervised machine learning.

期刊: Social psychiatry and psychiatric epidemiology 发表日期: 2026-May-26 链接: PubMed

摘要

Burnout is a growing challenge for individuals and society and understanding risk factors is crucial to develop targeted prevention strategies. Thus, we aimed to determine whether and how burnout relates to different organisational factors, psychosocial employment conditions, sociodemographic variables and mental health. We analysed cross-sectional survey data collected in the 2023 wave with focus on occupational health within the German population-based DigiHero cohort. Using linear associations and xg-boost machine learning, we explored the relations of multidomain variables with burnout severity, which was measured with the Maslach Burnout Inventory. Machine learning results were interpreted through SHAP values. We included 27,020 participants, aged 18-67 years (median 49), 65.2% female, in the analysis. The strongest predictors of burnout were effort-reward-imbalance, work-life-interference, overcommitment and poor general mental health, particularly symptoms of depression and anxiety. Compared to psychosocial employment conditions and individual mental health, organisational and sociodemographic factors were less important. However, occupation mattered and other aspects, such as extended remote work, had small, but noticeable effects. Age and income were the only sociodemographic factors that contributed. Results from xg-boost were compared to results from univariate statistics and remained robust when adjusting for sample bias through case weights. The study emphasises the importance of psychosocial employment conditions and individual mental health in the context of burnout, which outweigh the effects of organisational and sociodemographic factors. For practice this suggests that positive social work environments may prevent burnout while mental health problems increase vulnerability. For causal insights, prospective longitudinal studies are required.

41. Ultrasound-Guided Drug Injection Combined With Suprascapular Nerve Pulsed Radiofrequency for Post-Stroke Hemiplegic Shoulder Pain: A Randomized Controlled Trial.

期刊: American journal of physical medicine & rehabilitation 发表日期: 2026-May-26 链接: PubMed

摘要

Observation on the efficacy of ultrasound-guided drug Injection combined with Suprascapular nerve pulsed radiofrequency in treating soft tissue lesions in post-stroke hemiplegic shoulder pain. A total of 30 patients with post-stroke shoulder pain and soft tissue injury were enrolled and randomly divided into an experimental group and a control group, with 15 cases in each group. The experimental group received a single ultrasound-guided drug injection combined with pulsed radiofrequency therapy of the suprascapular nerve, while the control group received a single ultrasound-guided drug injection alone. The VAS, FMA, and BI scores of the experimental group and the control group at different time points all showed statistical significance (P<0.05). The combined ultrasound-guided drug injection and suprascapular nerve pulsed radiofrequency shows superior efficacy to injection alone in treating hemiplegic shoulder pain.

42. Food processing-derived carbon dots disrupt male fertility via the gut-testis axis.

期刊: Science China. Life sciences 发表日期: 2026-May-20 链接: PubMed

摘要

Carbon dots (CDs) are unintentionally formed during thermal processing of food and are emerging environmental pollutants that may pose health risks. We investigated the reproductive toxicity of food-derived CDs via the gut-testicular axis by exposing male mice to environmentally relevant doses (25 and 100 mg kg-1 d-1) for 15 weeks. Multi-omics analysis (including metagenomics, transcriptomics, and metabolomics) revealed that CDs significantly altered the gut microbiota composition, reducing beneficial bacteria (Akkermansia muciniphila, P<0.01) while increasing pathogenic bacteria (Desulfovibrionaceae, P<0.001). Functional analysis revealed upregulation of the lipopolysaccharide (LPS) biosynthesis pathway (P<0.001) and reduced levels of barrier-protective tryptophan metabolites. Time-series studies established a mechanistic sequence: microbiota disruption (days 1-3), intestinal barrier dysfunction (days 3-5), blood-testis barrier damage (days 5-7), testicular inflammation, and reproductive dysfunction. Dose-dependent testicular toxicity included reduced testosterone synthesis (P<0.001), impaired spermatogonial stem cell maintenance due to downregulation of PLZF, and impaired fertility. Testicular transcriptomics analysis revealed activation of the IL-17 signaling pathway and inhibition of steroidogenesis. This study provides comprehensive evidence that CD induces male reproductive toxicity through microbiota-dependent mechanisms, emphasizing the environmental health implications of dietary nanoparticle exposure.

43. Spatiotemporal Patterns and Historical Overview of Aedes Mosquitoes in Iran: A Systematic Review.

期刊: Tropical medicine and infectious disease 发表日期: 2026-May-12 链接: PubMed

摘要

Aedes mosquitoes are among the most important vectors of arboviral diseases such as dengue, Zika, and chikungunya. Mapping their geographic and temporal patterns is essential for understanding disease risk and guiding vector control. This systematic review provides an updated synthesis of the spatial and temporal distribution of Aedes species across Iran. A comprehensive search of international (PubMed, Scopus, Web of Science) and national (SID, IranMedex, Magiran) databases was performed for studies published between 1980 and 2025. Eligible publications reporting the occurrence or distribution of Aedes mosquitoes were screened according to PRISMA guidelines. Data were extracted and analyzed descriptively to identify long-term spatial and temporal trends. Sixty-six studies met the inclusion criteria, covering more than 20 provinces and examining over 390,000 mosquito specimens. Aedes caspius was the dominant species nationwide, reflecting its high ecological adaptability. Invasive vectors, Ae. aegypti and Ae. albopictus, were recorded mainly in southern coastal provinces and, more recently, in the humid northern regions. Over time, surveys have evolved from scattered faunistic reports to systematic nationwide monitoring, revealing clear patterns of ecological expansion driven by climatic and environmental factors. Increasing reports, broader geographic distribution, and adaptability to diverse ecological settings indicate an ongoing expansion of Aedes mosquitoes in Iran. While these developments reflect successful entomological surveillance and public health efforts, enhanced preparedness and continuous monitoring are essential to manage potential Aedes-borne outbreaks effectively.

44. Human and Hunting Dog Interactions in the United States: Exploring Potential Transmission Pathways of Zoonotic Diseases and Highly Pathogenic Avian Influenza Virus.

期刊: Veterinary sciences 发表日期: 2026-May-02 链接: PubMed

摘要

Since 2022, numerous H5N1 highly pathogenic avian influenza virus (HPAIV) detections have been reported in wild and domestic mammals in North America. Although H5N1 HPAIV detections in dogs are rare, hunting dogs that retrieve waterfowl are at increased exposure risk due to their physical contact with reservoirs (waterfowl) and contaminated environments. A cross-sectional survey of hunters was conducted during 2024 to characterize hunting procedures, disease prevention practices, and interactions between humans and their hunting dogs to identify potential risks for zoonotic disease transmission. Descriptive analysis (N = 112) indicated a majority of participants considered their hunting dog as part of the family (93.8%), and less than half considered their dog a pet (42.9%). Of the 112 individuals, 96.4% did not utilize personal protective equipment (PPE) when handling a sick dog and 81.3% did not use PPE when handling harvested birds. This research demonstrated complex, sustained physical and personal connections between individuals and their hunting dogs. Additional research utilizing a One Health approach is necessary to define H5N1 HPAIV risk factors in hunting dogs and the environment’s role in the transmission of viruses among wildlife and domestic animals. Understanding zoonotic disease transmission in these populations can inform approaches to mitigate viral exposure.

45. Access to Medicaid-Funded Home Care-Insights From New York.

期刊: JAMA network open 发表日期: 2026-May-01 链接: PubMed

摘要

46. High-Dose vs Standard-Dose Influenza Vaccines in Older Adults: A Meta-Analysis.

期刊: JAMA network open 发表日期: 2026-May-01 链接: PubMed

摘要

High-dose inactivated influenza vaccine (HD-IIV) was developed to enhance immune responses in older adults and has demonstrated superior protection against laboratory-confirmed influenza (LCI) and severe outcomes vs standard-dose inactivated influenza vaccine (SD-IIV). A comprehensive meta-analysis of recent large-scale trials is warranted. To synthesize all evidence from randomized clinical trials comparing HD-IIV with SD-IIV for prevention of hospitalization events and mortality in older adults. Studies published between December 31, 2009, and September 15, 2025, on PubMed and Embase. Additional data were obtained from trial sponsors. Randomized clinical trials comparing HD-IIV with SD-IIV in older adults during at least 1 influenza season were eligible. Two reviewers independently screened studies, extracted data, and assessed risk of bias according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guideline. Unpublished subgroup and outcome data were obtained to enable detailed analyses. Combined relative vaccine effectiveness (rVE) estimates were calculated with fixed-effects models, with sensitivity analyses using random-effects models. Hospitalizations for influenza, LCI, pneumonia or influenza, cardiorespiratory disease, and all causes and all-cause mortality. Primary analyses included adults 65 years or older, and secondary analyses included prespecified subgroups by age and cardiovascular disease. Eight randomized clinical trials including 605 098 participants were identified, with 5 enrolling older adults from the general population (aged ≥65 years), 2 enrolling nursing home residents (aged ≥65 years), and 1 enrolling patients with cardiovascular disease. Compared with SD-IIV, HD-IIV was associated with significantly reduced hospitalizations for influenza (rVE, 38.5%; 95% CI, 26.5%-48.5%), LCI (rVE, 31.2%; 95% CI, 19.3%-41.4%), pneumonia or influenza (rVE, 11.5%; 95% CI, 5.9%-16.8%), cardiorespiratory disease (rVE, 7.5%; 95% CI, 4.7%-10.3%), and all causes (rVE, 3.3%; 95% CI, 1.8%-4.8%). Mortality did not differ significantly between groups (rVE, 0.9%; 95% CI, -2.1% to 3.8%). Results were overall consistent across subgroup and sensitivity analyses. This meta-analysis provides a comprehensive synthesis of evidence from randomized clinical trials comparing HD-IIV with SD-IIV in older adults. HD-IIV was associated with improved protection against hospitalization outcomes, from LCI to all causes, but was not associated with improvement of all-cause mortality. These findings may inform decision-makers in developing vaccine recommendations and policies.

47. Once-Weekly Semaglutide in Adults With Daily Cigarette Use: A Randomized Clinical Trial.

期刊: JAMA network open 发表日期: 2026-May-01 链接: PubMed

摘要

People who smoke cigarettes face increased risk of morbidity and mortality, in part due to elevated rates of cardiometabolic disease. Preclinical and early clinical data indicate that glucagon-like peptide-1 receptor agonists (GLP-1RAs) warrant consideration for smoking cessation and prevention of associated cardiometabolic risks. To evaluate the effects of semaglutide vs placebo on cigarette smoking, craving, and weight outcomes in people who smoke. This parallel-arm phase 2a randomized clinical trial with embedded human laboratory sessions was conducted at an academic medical center, with enrollment occurring from October 2022 to April 2024. Participants were non-treatment-seeking adults consuming at least 5 cigarettes per day. Data were analyzed in 2025. Nine weeks of subcutaneous of semaglutide (0.25 mg for 4 weeks, 0.5 mg for 4 weeks, 1.0 mg for 1 week) vs placebo. The co-primary outcomes were laboratory measures of smoking resistance and reinstatement and self-administration, assessed before and after treatment. Changes in cigarette use, cigarette craving, body weight, and other outcomes were assessed weekly. Of 45 participants enrolled, 24 participants (mean [SD] age, 44 [12] years; 20 [83%] female; mean [SD] body mass index, 33.5 [7.2]; mean [SD] cigarettes per day, 15.4 [7.9]) were randomized to placebo (12 participants) or semaglutide (12 participants), of whom 21 participants (88%) completed the primary outcome assessment. Primary treatment-by-time interactions on laboratory measures of smoking resistance (23 participants; β = 0.16 [95% CI, -0.07 to 0.40]; P = .16) and number of cigarettes (22 participants; β = -0.08 [95% CI, -0.25 to 0.08]; P = .30) were not significant. Supplementary change score analyses indicated significantly greater reductions in laboratory smoking (β = -0.69 [95% CI, -1.26 to -0.13]; P = .02; d = 0.67) in the semaglutide group vs the placebo group after treatment. Semaglutide reduced cigarette craving (treatment-by-time interaction: β = -0.11 [95% CI, -0.20 to -0.03]; P = .01) and body weight (β = -0.04 [95% CI, -0.05 to -0.03]; P < .001) over treatment weeks. Exploratory effect size analyses indicated potential effects on withdrawal symptoms. In this phase 2a randomized clinical trial, semaglutide monotherapy did not significantly increase laboratory smoking resistance or reduce weekly cigarettes per day but reduced nicotine craving and body weight. Larger trials should evaluate effects of GLP-1RA therapies on cessation, postcessation weight gain, and cardiometabolic outcomes in people who smoke. ClinicalTrials.gov Identifier: NCT05530577.

48. Direct Oral Anticoagulants, COX-2-Selective NSAIDs, and Gastrointestinal Bleeding in Atrial Fibrillation.

期刊: JAMA network open 发表日期: 2026-May-01 链接: PubMed

摘要

It is unclear whether the beneficial effects of nonsteroidal anti-inflammatory drugs (NSAIDs) that selectively inhibit cyclooxygenase 2 (COX-2) in decreasing the risk of gastrointestinal (GI) bleeding are retained in patients with nonvalvular atrial fibrillation (NVAF) concomitantly treated with direct oral anticoagulants (DOACs). To assess whether concomitant use of DOACs and COX-2-selective NSAIDs is associated with a decreased risk of GI bleeding vs concomitant use of DOACs and nonselective NSAIDs in patients with NVAF. This multinational cohort study used electronic medical records from the UK and claims data from Quebec between January 1, 2011, and December 12, 2020. Adult patients (aged ≥18 years) with NVAF who initiated concomitant use of DOACs and NSAIDs during the study period were included. Cohort entry was the first day of concomitant use. Patient data were followed until a study outcome, death, or treatment discontinuation or switch. All analyses were conducted between November 19, 2024, and July 25, 2025. Concomitant use of DOACs and COX-2-selective NSAIDs or concomitant use of DOACs and nonselective NSAIDs. The primary outcome was GI bleeding, and the secondary outcome was non-GI bleeding. Inverse probability of treatment weighting was used to control for confounding. Cox models were used to estimate site-specific hazard ratios (HRs) and 95% CIs, which were pooled using random-effects models. Further stratification was performed for potential effect modifiers. The study cohort included 30 240 patients with NVAF who initiated concomitant use of DOACs and NSAIDs (mean [SD] age, 72.1 [9.2] years, 17 146 male [56.7%]). They contributed 37 833 episodes of concomitant use of DOACs and NSAIDs (45.2% COX-2-selective NSAIDs, 54.8% nonselective NSAIDs). Concomitant use of DOACs and COX-2-selective NSAIDs was associated with a decreased risk of GI bleeding (pooled weighted HR, 0.63 [95% CI, 0.46-0.87]; I2 = 56%) and non-GI bleeding (pooled weighted HR, 0.54 [95% CI, 0.40-0.74]; I2 = 0%) vs concomitant use of DOACs and nonselective NSAIDs. Female patients had a greater decreased risk of GI bleeding associated with concomitant use of DOACs and COX-2-selective NSAIDs (pooled weighted HR, 0.50 [95% CI, 0.31-0.80]; I2 = 0%) than male patients (HR, 0.85 [95% CI, 0.55-1.32]; I2 = 78%). There was no major effect measure modification by age, order of drug initiation in concomitant use, baseline bleeding risk, or individual DOACs. These findings suggest that COX-2-selective NSAIDs may retain their beneficial effects regarding GI bleeding during concomitant use with DOACs. Future studies should examine the association of COX-2 selectivity with stroke risk among patients treated with DOACs.

49. Global Aid Cuts and Local Health Consequences in Nakivale Refugee Settlement, Uganda.

期刊: JAMA network open 发表日期: 2026-May-01 链接: PubMed

摘要

The abrupt withdrawal of humanitarian aid in early 2025 has destabilized health systems across sub-Saharan Africa, yet little is known about the frontline realities of these cuts in refugee-hosting settings. To explore health care practitioners’ perspectives and experiences of how reductions in global health funding have affected services and refugee health and to identify practitioner recommendations for sustaining care. This qualitative study used semistructured, in-depth interviews conducted in July 2025 at 6 health facilities within Nakivale Refugee Settlement, Uganda. Participants were health care practitioners representing diverse cadres and facility sizes. Reduction of humanitarian aid. The primary outcomes were health care practitioners’ perspectives on the impacts of funding reductions, including changes in service delivery, supply availability, staff conditions, and anticipated future health trends, as well as their recommendations to mitigate harms. Rapid qualitative techniques and thematic analysis were used to analyze responses to obtain actionable implications systematically and efficiently. The 26 participants (mean [SD] age, 30.92 [3.52] years; 16 men [61.5%]) had a mean (SD) duration in practice of 6.80 (2.65) years, with a mean (SD) of 3.09 (1.92) years in Nakivale. Interviews yielded 4 overarching themes and 18 subthemes: (1) reductions in health care services (HIV and tuberculosis services, nutritional support, maternal health, immunization adherence, inpatient and outpatient care, and perceptions of service availability), (2) supply shortages (medical supplies, transportation fuel, and household support), (3) deteriorating staff conditions (staff reduction, workload and burnout, and resilience), and (4) future predictions and recommendations (disease patterns, migration patterns, bridging the funding gap, and general settlement conditions). This qualitative study examined the cascading outcomes of humanitarian aid withdrawal on refugee health care through the voices of frontline practitioners. Their testimonies underscored urgent priorities for restoring and retargeting aid-investing in high-impact levers, strengthening local leadership, and advancing policy reforms-to safeguard refugee health and system resilience, while reminding us of the shared human stakes of humanitarian policy and the global responsibility to act.