公共卫生研究摘要 (2026-05-29)

共收录 60 篇研究文章

1. The Power of Self-Efficacy in Fostering Caring Self-Efficacy and Overcoming Job-Related Stress and Perceived Stigma Among Psychiatric Nurses.

期刊: International journal of nursing practice 发表日期: 2026-Jun 链接: PubMed

摘要

This randomized controlled trial evaluated the effectiveness of a self-efficacy-based intervention in enhancing caring self-efficacy, reducing job-related stress and decreasing perceived stigma among psychiatric nurses. A parallel-arm RCT was conducted between July and November 2023. Seventy psychiatric nurses were randomized 1:1 to an intervention group (n = 35) receiving eight structured self-efficacy sessions or a control group (n = 35) receiving treatment as usual. Outcomes were measured using the Caring Efficacy Scale, Psychiatric Nurses Job Stress Scale and Perceived Devaluation and Discrimination Scale (stigma) at baseline, postintervention, and 3 months later. The intervention group showed significant improvements in caring self-efficacy, with Caring Efficacy Scale scores increasing from 69.83 ± 23.90 preintervention to 98.20 ± 27.92 postintervention (p < 0.001, effect size = 0.537), and remaining elevated 3 months later (95.06 ± 27.31, p < 0.001), while the control group scores showed no significant change. Job stress scores decreased significantly in the intervention group compared to controls across all Psychiatric Nurses Job Stress Scale subscales (p < 0.001). The proportion of participants reporting high perceived stigma dropped significantly from 71.4% preintervention to 2.9% postintervention (p < 0.001, effect size = 0.760), sustained at 3 months. Findings support integrating self-efficacy training into psychiatric nursing professional development; such an intervention may enhance nurses’ psychological well-being and ultimately improve the quality of patient care in clinical settings. The study protocol has been registered at ClinicalTrials.gov (Identifier Code: NCT05952414).

2. Insights into the seroprevalence of Toxocara spp. in Kuwait: A comparison between the general population and waste collectors.

期刊: One health (Amsterdam, Netherlands) 发表日期: 2026-Jun 链接: PubMed

摘要

Toxocara spp. are zoonotic nematodes transmitted primarily through environmental contamination with eggs from infected dogs and cats. Human infection is often underdiagnosed, particularly in high-income countries, and data from the Gulf region remain limited. This study aimed to investigate the seroprevalence of Toxocara spp. among the general adult population in Kuwait and to compare it with waste collectors, a vulnerable occupational group with frequent exposure to environmental contaminants and stray animals. A cross-sectional study was conducted in Kuwait. Serum samples were collected from 200 adults attending government polyclinics and 196 waste collectors recruited from residential compounds. Demographic data were obtained using structured questionnaires. Toxocara IgG antibodies were detected using enzyme-linked immunosorbent assay (ELISA), and statistical relationships with demographic variables were assessed. The overall prevalence was 16%, while Toxocara IgG seroprevalence was significantly higher among waste collectors (24.5%) compared with the general adult population (7.5%) (p-value <0.01). Significant statistical relationships were observed between seropositivity and nationality (Southeast Asian), age (>40 years), and lower educational level within the general population (p-values <0.05). Toxocara infection is present at moderate levels in Kuwait, with substantially higher seroprevalence among waste collectors, suggesting potential occupational and environmental risk despite the country’s high-income status. This may also partly reflect prior exposure in endemic regions before migration. These findings highlight the need for integrated One Health surveillance incorporating human, animal, and environmental components to inform targeted prevention strategies.

3. Efficacy of an e-Learning Module on Endocrine Disruptors for Family Medicine Residents: Matched Before-And-After Cohort Study.

期刊: JMIR formative research 发表日期: 2026-May-28 链接: PubMed

摘要

Environmental factors account for 23% of global deaths and 25% of chronic diseases. In France, the Fourth National Environmental Health Plan prioritizes training health professionals in environmental health. Endocrine-disrupting chemicals (EDCs) are chemical substances that interfere with hormonal systems, contributing to a range of health effects. In 2024, the Primary Care and Environmental Health (PCEH) program at the University of Montpellier-Nîmes introduced an innovative e-learning module on EDCs for first-year family medicine residents. This study aimed to evaluate the impact of the PCEH e-learning module on participants’ satisfaction, knowledge, and self-reported behaviors regarding EDCs in household environments. This monocentric, matched before-and-after cohort study included all first-year family medicine residents at the University of Montpellier-Nîmes. The module, developed collaboratively by clinicians and educators, integrated interactive images, artificial intelligence-generated virtual rooms, short educational videos, games, and flash cards. Participants were assessed using pretraining and posttraining questionnaires administered immediately before and after the module. These questionnaires evaluated satisfaction (using a 5-point Likert scale), knowledge (using binary “yes” or “no” questions), and behaviors (using a 5-point Likert scale). Statistical analyses included the McNemar test for paired categorical variables and paired 2-tailed t tests for continuous variables, with a significance threshold set at a P value of less than .05. This study aimed to evaluate the impact of an e-learning module on knowledge and behaviors related to endocrine disruptors. Our findings show significant improvements across all measured domains. Of 148 eligible residents, 78 (52.7%) completed both assessments over a 17-day period. Overall satisfaction was high (mean 4.0/5, SD 0.9), with positive ratings for the e-learning format (mean 4.1/5, SD 1.0) and module duration (mean 4.2/5, SD 1.0). Knowledge improved significantly, with a mean 55.56 (SD 13.54) increase in correct identification of EDCs across all substances (P<.001). Self-reported behaviors improved by an average of 2.13 points (95% CI 1.71-2.56) on the 5-point scale (P<.001), exceeding those reported in previous PCEH modules. Secondary outcomes showed high posttraining identification of at-risk populations and exposure locations, although recognition of some substances (eg, alkylphenols and phenoxyethanol) remained low. This innovative e-learning module significantly improved residents’ knowledge and preventive behaviors related to EDCs. These findings support the integration of environmental health training into medical curricula and highlight the potential of scalable e-learning interventions to strengthen preventive competencies in primary care.

4. Behçet's syndrome incidence and prevalence in Sardinia: implications of a latent class analysis combining administrative and clinical data.

期刊: Clinical and experimental rheumatology 发表日期: 2026-May-28 链接: PubMed

摘要

To estimate the epidemiology of Behçet’s syndrome (BS) in Sardinia using a combined administrative and clinical data latent class analysis (LCA). Cases with a diagnosis of BS were retrieved from 2006-2016 in the Hospital Discharge Records (HDRs), 2006-2016 Rare Diseases Regional Register (RDRR), and 2014-2016 in the Specialist Outpatient Database (SOD). Medical records from regional rheumatology clinics were reviewed and classified by the International Criteria for Behçet’s Disease (ICBD) and International Study Group (ISG) criteria. Statistical analysis involved cross-referencing databases and applying LCA to estimate the probability of a BS diagnosis. Prevalence and incidence of BS in Sardinia were calculated, as well as the sensitivity and specificity of each database source. Administrative databases analysis retrieved 271 unique cases. A medical record review of 133 patients identified 116 BS cases, of which 107 matched administrative records and 9 were new. After excluding two deaths, 280 cases were considered for analysis (164 administrative-only, 107 mixed, 9 clinical-only). Using ICBD, the LCA confirmed 193 (68.9%) as BS cases (68.3% female, mean age 47). This yielded a 2016 Sardinian BS prevalence of 11.7 per 100,000 inhabitants (15.7) for women and 7.6 for men), with annual incidence rates ranging from 0.24 to 0.48 per 100,000 inhabitants (2014-2016). Prevalence and incidence were lower using the ISG criteria. Database sensitivity varies from 40.6% to 70.5%, while specificity ranges from 16.3% to 99.0%. BS in Sardinia is a rare disease. Relying on a single data source to estimate.

5. Speech-in-Noise Ability and Longitudinal Cortical Thinning in Speech-Processing Networks.

期刊: JAMA otolaryngology– head & neck surgery 发表日期: 2026-May-28 链接: PubMed

摘要

Age-related hearing loss is a major modifiable risk factor for dementia, yet the neural mechanisms linking auditory dysfunction to brain aging and cognitive decline remain unclear. In particular, it is unknown whether peripheral hearing loss, central auditory processing deficits, or hearing aid use best predict neurodegenerative change in older adults. To determine whether hearing thresholds, speech-in-noise ability, and hearing aid use are associated with longitudinal cortical atrophy and cognitive trajectories in cognitively normal older adults. This population-based, longitudinal cohort study with baseline and 3-year follow-up assessments was conducted among community-dwelling older adults in Australia. Participants were selected from the Aspirin in Reducing Events in the Elderly trial and categorized as having normal hearing, unaided hearing loss, or using hearing aids based on audiometry and self-reported hearing aid use. Structural magnetic resonance imaging, auditory, and cognitive data were collected between 2012 and 2017. Data were analyzed from August to October 2025. Peripheral hearing loss assessed using better-ear 4-frequency average thresholds, central auditory processing assessed using binaural speech-in-noise performance, and hearing aid use and duration of use. Longitudinal change in cortical thickness and regional brain volumes derived from T1-weighted magnetic resonance imaging, focusing on auditory and Alzheimer disease-vulnerable regions. Global cognition was assessed using the Modified Mini-Mental State Examination. A total of 312 adults (mean [SD] age, 73.5 [3.3] years; 167 [54%] female) without dementia at baseline were included. At baseline, hearing loss groups showed poorer audiometric and speech-in-noise performance but did not differ in global cognition. Over 3 years, widespread age-related cortical atrophy was observed, and poorer baseline speech-in-noise performance was associated with faster cortical thinning in inferior parietal (β = -0.002; 95% CI, -0.003 to 0.001), precuneus (β = -0.001; 95% CI, -0.002 to 0.000), middle temporal cortex (β = -0.001; 95% CI, -0.002 to -0.001), and superior temporal sulcus regions (β = -0.001; 95% CI, -0.002 to 0.000), independent of hearing thresholds and hearing aid use. There was not a statistically significant association between hearing loss/hearing aid use and longitudinal neurostructural change or cognitive decline. In this cohort study of cognitively normal older adults, central auditory processing impairment, not peripheral hearing loss or hearing aid use, was associated with accelerated cortical thinning in speech-processing networks. Speech-in-noise performance may represent an early behavioral marker of neural vulnerability preceding measurable cognitive decline.

6. When Measuring Potassium, Matrix Matters.

期刊: The journal of applied laboratory medicine 发表日期: 2026-May-28 链接: PubMed

摘要

7. Should Risk of Bias Be Assessed at the Outcome Level?

期刊: JAMA oncology 发表日期: 2026-May-28 链接: PubMed

摘要

8. Traffic and Industrial Pollutants and Chronic Rhinosinusitis.

期刊: JAMA otolaryngology– head & neck surgery 发表日期: 2026-May-28 链接: PubMed

摘要

Air pollution has been implicated in the pathogenesis of chronic rhinosinusitis (CRS). To investigate the association between long-term residential exposure to traffic-related and industry-related pollutants and CRS risk and sinonasal cytokine expression. This case-control study was conducted at a tertiary center and examined sinonasal epithelial specimens that were collected 2018 to 2021 from 92 human participants during endoscopic sinus surgery (62 CRS case patients) and skull base surgeries (30 controls). Data were analyzed from 2022 to 2025. Five-year average pollutant exposures were assigned to geocoded residential addresses using a validated land use regression model for nitrogen dioxide (NO2), benzene, 1,3-butadiene, chromium, lead, nickel, and zinc. Cytokine expression was quantified by flow cytometry and Luminex assays. CRS odds were estimated with a logistic regression, and cytokine levels were modeled with a generalized linear regression with a log link, using pollutant concentrations as predictors. Of 92 participants, 44 (47.8%) were female, 48 (52.2%) were male, and the mean (SD) age was 50 (15) years. Adjusting for demographic characteristics, smoking history, steroid use, and comorbidities, each SD increase in NO2 levels was independently associated with a 132% rise in odds of CRS (adjusted odds ratio [aOR], 2.32, 95% CI, 1.09-4.93). Benzene levels were associated with an 115% rise (aOR, 2.15; 95% CI, 1.05-4.38), and lead levels were associated with a 248% rise (aOR, 3.48; 95% CI, 1.36-8.88). Controlling for CRS status and copollutant levels, NO2 exposure was associated with elevated interleukin (IL)-4, IL-5, IL-13, and tumor necrosis factor α levels, benzene with suppressed IL-1 receptor agonist levels, and lead with elevated IL-8 and IL-1 receptor agonist levels. The results of this case-control study suggest that long-term residential exposure to traffic-related and industry-related pollutants was associated with increased CRS risk and distinct cytokine signatures. Traffic-related NO2 was associated with elevated type 2 cytokines, which was consistent with a barrier alarmin type 2 pattern. Benzene and lead levels were associated with non-type 2 cytokine profiles that were characterized by innate and neutrophilic markers.

9. A Clinically Relevant Threshold of Impaired Contrast Sensitivity Among Older US Adults.

期刊: JAMA ophthalmology 发表日期: 2026-May-28 链接: PubMed

摘要

Contrast sensitivity (CS) is a critical yet underused measure of visual function that reflects the ability to detect subtle differences in luminance between an object and its background. Although poor CS is associated with falls, cognitive decline, and reduced independence in older adults, existing thresholds lack functional relevance. To identify a CS threshold associated with functional visual disability. This longitudinal cohort study used data from rounds 12 (2022) and 13 (2023) of the National Health and Aging Trends Study (NHATS), a nationally representative cohort study of Medicare beneficiaries aged 65 years and older in the US. Analyses included 4475 community-dwelling participants with available binocular contrast sensitivity and self-reported vision data. Data were analyzed from September 2024 to January 2026. Logarithm-scaled, binocular-presenting CS (logCS). Self-reported visual disability (SRVD), defined by difficulty recognizing faces, reading newspaper print, or seeing the television across a room. Covariates include age, education, race, income, visual acuity, frailty, and multimorbidity. Multiple logistic regression models were used to examine the association between CS and SRVD, and survey-weighted receiver operating characteristic (ROC) curve analyses were performed to identify an optimal CS threshold using the Youden index. Weighted mean logCS (SE) among participants was 1.72 (<0.01). At baseline, the mean contrast sensitivity in individuals with SRVD was 1.49 (0.03) logCS compared with 1.73 (<0.01) logCS among those without SRVD. Participants who developed new SRVD at 1-year follow-up demonstrated a mean decline in logCS from 1.62 to 1.56 logCS. Each 0.1-unit decrease in baseline logCS was independently associated with 12% higher odds of incident SRVD (odds ratio, 1.12; 95% CI, 1.08-1.16). A threshold of 1.60 logCS maximized discrimination for functional visual disability (sensitivity, 67% [95% CI, 62%-71%]; specificity, 70% [95% CI, 69%-72%]). In this cohort study, a threshold of 1.60 logCS represented the functional threshold at which older adults began to experience SRVD. This functionally anchored cutoff provides a benchmark for interpreting CS measures, although sensitivity and specificity were moderate.

10. Adverse Effects and Treatment Discontinuation of Blood Pressure-Lowering Drugs and Combinations: A Network Meta-Analysis.

期刊: JAMA 发表日期: 2026-May-28 链接: PubMed

摘要

Adverse drug effects from blood pressure (BP)-lowering drugs contribute to significant undertreatment and poor overall BP control rates. To review adverse effects and discontinuation of BP-lowering drugs and their combinations from the 5 major classes in short-term clinical trials. Cochrane Central Register of Controlled Trials for randomized clinical trials, MEDLINE, and Epistemonikos were searched from the date of inception until December 31, 2024, for double-blind randomized clinical trials of angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers (ARBs), β-blockers, calcium channel blockers (CCBs), thiazide and thiazide-like diuretics, or their combinations, with follow-up durations between 4 and 26 weeks. Data extraction was performed by 2 independent reviewers. Synthesis was performed using fixed-effect network meta-analyses according to drug class, summarized using odds ratios (ORs) and 95% credible intervals (CrIs) and surface under the cumulative ranking curves. Final statistical analysis was conducted in April 2026. Treatment discontinuation due to adverse events (AEs), defined as discontinuation of randomized treatment due to an AE. Secondary outcomes included headache, dizziness, edema, and cough. A total of 716 trials were included, with mean (SD) follow-up of 8.6 (5) weeks, including 159 362 participants (mean [SD] age, 54.6 [7] years; 44% female; mean baseline BP, 158/100 mm Hg). Compared with placebo, treatment discontinuation due to AEs was significantly increased by CCBs (OR, 1.43 [95% CrI, 1.23-1.67]; risk difference [RD], 1.2% [95% CrI, 0.6%-2.0%]), angiotensin-converting enzyme inhibitors plus CCBs (OR, 1.46 [95% CrI, 1.13-1.87]; RD, 1.1% [95% CrI, 0.2%-2.4%]), and β-blockers plus thiazide diuretics (OR, 1.58 [95% CrI, 1.04-2.47]; RD, 1.7% [95% CrI, 0.1%-4.3%]). All ARB-containing regimens had fewer treatment discontinuations due to AEs than placebo, and these differences were statistically significant for ARB monotherapy (OR, 0.73 [95% CrI, 0.61-0.86]; RD, -0.8% [95% CrI, -1.3% to -0.4%]) and ARBs plus CCBs (OR, 0.61 [95% CrI, 0.47-0.79]; RD, -1.2% [95% CrI, -1.8% to -0.6%]). In network meta-analyses, 5 combination and 2 monotherapy regimens had higher surface under the cumulative ranking curve values than placebo for treatment discontinuation due to AEs, suggesting overall symptomatic improvement compared with placebo. All regimens significantly increased dizziness, and all but CCBs significantly decreased headache compared with placebo. This meta-analysis of short-term randomized clinical trials found that adverse drug effects that led to discontinuation of BP-lowering therapy varied by drug class and regimen, with several combination therapies being better tolerated than monotherapies. Some regimens were associated with fewer drug withdrawals than placebo, suggesting a net symptomatic improvement. These findings are based on trial-level results and rely on assumptions underlying the network meta-analysis; they may not apply to individual patients.

11. Global and temporal trends in neonatal and under-five mortality due to birth asphyxia/trauma and prematurity (2000-2021) with projections up to 2040.

期刊: World journal of pediatrics : WJP 发表日期: 2026-May-28 链接: PubMed

摘要

Despite substantial global progress in reducing neonatal mortality, the deceleration in neonatal mortality decline in many low- and middle-income countries threatens attainment of Sustainable Development Goal 3.2. Intrapartum-related events and complications of preterm birth remain the leading causes of neonatal deaths. Therefore, this study aimed to examine temporal trends in neonatal and under-five mortality due to birth asphyxia, trauma, and prematurity from 2000 to 2021, with projections to 2040. This study used the United Nations Inter-agency Group for Child Mortality Estimation (UN IGME) cause-of-death dataset, which provides standardized annual estimates of under-five and neonatal mortality from birth asphyxia/trauma and prematurity for 194 countries and territories between 2000 and 2021. Causes of death were defined according to the dataset’s standardized classification. Country-specific mortality trends were examined in relation to four country-level indicators (the Socio-demographic Index, Human Development Index, Universal Health Coverage service coverage index, and Healthcare Access and Quality Index) using regression analyses. Temporal trends in cause-specific mortality were quantified using the estimated annual percentage change, and future mortality through 2040 was projected under three scenarios: (1) current-trend; (2) regional best-performer; (3) high-income country convergence based on country-specific annual rates of reduction. Globally, neonatal mortality declined from 7.52 deaths per 1000 live births [90% uncertainty interval (90% UI): 7.13-7.88] to 4.18 (3.81-4.82) for birth asphyxia/trauma, and from 10.63 (10.05-11.33) to 6.49 (6.05-7.38) for prematurity between 2000 and 2021. West and Central Africa and Eastern and Southern Africa had the highest neonatal mortality in 2021 and achieved the slowest progress, whereas East Asia and Pacific and Eastern Europe and Central Asia had the most pronounced declines. Countries with lower sociodemographic and health system indicator values showed slower declines in mortality, while the greatest reductions were observed in those with intermediate-to-upper levels. Projections suggest that disparities could remain substantial by 2040 if current trends continue, although accelerated progress in high-burden regions could yield further reductions. Despite substantial progress since 2000, neonatal mortality from birth asphyxia/trauma and prematurity remains persistently high, particularly in Africa, but scenario analyses suggest that substantial reductions could be achieved if future declines follow trajectories observed in the best-performing settings.

12. Hepatitis C Virus Infection at the Start of Hemodialysis and During Early Follow-up: Evidence from Two Dialysis Centers.

期刊: Journal of epidemiology and global health 发表日期: 2026-May-28 链接: PubMed

摘要

Hepatitis C virus (HCV) remains a concern in patients undergoing maintenance hemodialysis due to repeated blood exposure and prolonged contact with dialysis environments. Although direct-acting antivirals have reduced HCV burden in many settings, uncertainty persists regarding early infection dynamics at dialysis initiation and during initial follow-up. This observational study was conducted in two hemodialysis facilities in northern Iran (2022-2023). All adult patients receiving maintenance hemodialysis were included using a census-based approach. HCV status was assessed by anti-HCV antibody testing at dialysis initiation and repeated after three months as part of routine surveillance. Demographic and clinical variables, including dialysis duration and transfusion history, were extracted from medical records. Analyses focused on prevalence and associations with clinical characteristics. Among 470 patients, six (1.28%) were anti-HCV positive at dialysis initiation. After three months, no new cases were identified; overall prevalence remained unchanged. No significant associations were observed between HCV status and demographic variables, transfusion history, or comorbidities. In contrast, dialysis duration showed a clear association with HCV positivity. Patients with more than ten years of dialysis had markedly higher prevalence than those with shorter durations (P < 0.001). In this cohort, HCV prevalence at the start of dialysis was low and remained stable during short-term follow-up. Longer dialysis duration was the only factor associated with HCV positivity, supporting its role as a cumulative exposure marker. These findings emphasize the importance of sustained infection-control practices and continued surveillance, even in low-prevalence settings.

13. Statistical methods for retrospective harmonization of longitudinal epidemiological data: a scoping review.

期刊: European journal of epidemiology 发表日期: 2026-May-28 链接: PubMed

摘要

Data harmonization is a prerequisite for joint cohort analyses. In this review, we aim to identify and contrast statistical methods for retrospective harmonization of longitudinal data. We performed a scoping review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. Studies were included if they described statistical methods for retrospectively harmonizing longitudinal data at the participant level. From 35 included papers out of 1,234 hits, we identified three types of statistical methods applicable to tabular data commonly collected in longitudinal epidemiological studies (e.g., questionnaires): (1) distribution-based methods, (2) the proportion score model, and (3) latent variable models. Our results suggest that the suitability of a statistical harmonization method mainly depends on the measurement scales of the original variables as well as on the type of target variable (directly measurable vs. latent). The chosen harmonization method influences how missing subsets of variables are addressed. None of the included studies applied more automated approaches such as machine learning-based procedures for deriving a harmonized dataset. Based on our findings, we present a roadmap that can guide researchers in selecting the most appropriate statistical method for a specific harmonization task and in handling variables collected only in a subset of studies. Data harmonization is still a demanding task that requires the development and application of novel tools for automating the procedures.

14. Seroprevalence of Orthoflaviviruses in horses in 3 different Algerian climatic zones between 2021 and 2023.

期刊: Tropical animal health and production 发表日期: 2026-May-28 链接: PubMed

摘要

Orthoflaviviruses are etiological agents of neurological diseases in equines. Horses are susceptible to equine Tick-borne encephalitis virus (TBEV), Usutu virus (USUV), and West Nile virus (WNV), although mostly WNV has been associated with clinical disease. The aim of the present study was to estimate the prevalence of TBEV, USUV and WNV in 289 healthy horses from nine provinces of Algeria. This study was conducted between March 2021 and December 2023. Sera that tested positive, doubtful, or negative close to the doubtful threshold in the Orthoflavivirus-ELISA were further tested by the virus neutralization test (VNT), using TBEV, USUV, and WNV strains. The prevalence of Orthoflaviviruses antibodies by ELISA was 23.18% (67/289) compared with 16.95% (49/289) and 0.69% (2/289) detected by WNV and USUV VNT, respectively. TBEV antibodies were not detected in any samples. WNV seroprevalence varied with age, breed, climatic zones and altitude of the horses’ locations. This is the first screening of horse sera for TBEV in Algeria. This study indicates that WNV and USUV have circulated/are circulating in the horse population in three Algerian climatic zones, unlike TBEV, which does not seem to be present.

15. Zinc deficiency and sarcopenia define a metabolic frailty phenotype predicting hepatic encephalopathy and early mortality in cirrhosis.

期刊: Metabolic brain disease 发表日期: 2026-May-28 链接: PubMed

摘要

Cirrhosis is characterized by progressive metabolic vulnerability, yet early indicators of clinical decompensation remain limited. Zinc, a key cofactor in ammonia detoxification and protein metabolism, may reflect and contribute to metabolic frailty when deficient. We aimed to determine whether zinc deficiency and sarcopenia jointly define a metabolic frailty phenotype that predicts overt hepatic encephalopathy (OHE) and mortality in cirrhosis. In this 12-month prospective cohort, 109 adults with cirrhosis were followed to evaluate OHE incidence and survival. Serum zinc, dietary intake, and nutritional parameters were assessed at baseline and 3, 6, and 12 months. Sarcopenia was defined by dual-energy X-ray absorptiometry and handgrip strength. Logistic regression identified independent predictors of OHE, and Kaplan-Meier analysis evaluated survival. OHE occurred in 27.5% of patients and was associated with lower zinc levels (50.3 ± 13.2 vs. 62.8 ± 18.9 µg/dL; p = 0.002) and higher sarcopenia prevalence (53.3% vs. 16.5%; p = 0.001). Zinc deficiency was associated with increased OHE risk (OR 3.9; 95% CI 1.5-10.1; p = 0.005), while multivariable analysis identified sarcopenia, age, and Child-Pugh class as independent predictors. The coexistence of zinc deficiency and sarcopenia identified a subgroup with the highest 1-year mortality (log-rank p = 0.001). Zinc deficiency and sarcopenia were associated with adverse clinical outcomes in cirrhosis and may reflect a broader state of metabolic vulnerability. Their coexistence defines a metabolic frailty phenotype in cirrhosis, associated with reduced metabolic reserve, OHE, and poor survival. Recognition of this phenotype provides a framework for targeted nutritional and metabolic interventions aimed at restoring functional reserve.

16. Implementation of patient-reported outcomes in personalized lung cancer care: a qualitative study from the perspective of patients and health care providers.

期刊: Journal of patient-reported outcomes 发表日期: 2026-May-28 链接: PubMed

摘要

Patient-Reported Outcomes (PROs) in personalized lung cancer care aim to facilitate a targeted therapeutic management approach. This study explores the implementation of PROs as an intervention component within a precision medicine program, with a focus on identifying facilitating factors and barriers from the perspectives of health care providers (HCPs) and patients with stage IV non-small-cell lung cancer (NSCLC). Semi-structured individual interviews were conducted with HCPs and NSCLC patients over two rounds in 2023 and 2024, respectively. Verbatim transcripts were analyzed using qualitative content analysis. The framework of Grol and Wensing was employed, which divides healthcare into six dimensions. The structured documentation of symptoms and quality of life constitutes a benefit in that it enables intervention by the treating physician. From the perspective of HCPs, incorporating PROs into daily clinical practice was associated with considerable organizational challenges and the need for logins into an additional system to access the results. This required a substantial investment of time and personnel, which resulted in a lack of acceptance. The predominant motivation of patients who participated in the PRO questionnaires was a desire to contribute to scientific research. In general, the regular administration of the questionnaire has proven unfeasible for the NSCLC cohort, given the high disease burden often experienced in stage IV. Despite implementation challenges, PROs can improve symptom monitoring, communication, and patient-centered care in advanced NSCLC when key barriers are addressed.

17. Longitudinal Risk for Suicidal Self-Directed Violence Among Veterans With Cancer.

期刊: JAMA oncology 发表日期: 2026-May-28 链接: PubMed

摘要

Patients with cancer experience significantly higher rates of suicidal self-directed violence (SSDV; defined as both fatal and nonfatal suicide attempts) than the general population. To assess longitudinal risks and methods for SSDV among veterans and identify associated risk factors to improve screening and prevention strategies. This national cohort study of veterans with cancer was conducted between January 2014 and December 2023. Data from established oncology and suicide registries and the Veterans Health Administration (VA) were used. Data were analyzed from January 2025 to February 2026. Diagnosis of invasive solid or hematologic cancer. The primary outcome was SSDV and rates per 100 000 person-years. Risk factors for SSDV were estimated as adjusted hazard ratios (aHRs) from multivariable Cox proportional hazards models. Among 292 271 veterans (mean [SD] age, 69.0 [9.4] years; 7108 female [2%]; 2664 American Indian or Alaska Native [1%]; 1365 Asian [1%]; 62 538 Black or African American [21%]; 13 965 Hispanic or Latino [5%]; 2306 Native Hawaiian or Other Pacific Islander [1%]; 219 205 White [75%]), there were 2400 SSDV events (1%; overall rate, 203 [95% CI, 195-211] per 100 000 person-years). The most common method used was poisoning (eg, opioids; 617 attempts [26%]). Estimated SSDV probabilities were highest for those with central nervous system (CNS), pancreas, head and neck, liver and biliary system, and thyroid cancer types. Veterans with severe frailty (544 [95% CI, 457-648] events per 100 000 person-years), advanced cancer (261 [95% CI, 233-293] events per 100 000 person-years), chronic mental illness (419 [95% CI, 399-439] events per 100 000 person-years), and high pain scores (236 [95% CI, 192-210] events per 100 000 person-years) had high SSDV rates compared with the overall cohort. Younger age (≤45 years; 643 [95% CI, 547-756] events per 100 000 person-years), female sex (369 [95% CI, 306-445] events per 100 000 person-years), American Indian or Alaska Native race (286 [95% CI, 201-407] events per 100 000 person-years), and CNS (394 [95% CI, 311-500] events per 100 000 person-years) and thyroid (359 [95% CI, 290-445] events per 100 000 person-years) cancers had high rates of nonfatal attempts. Increased SSDV hazards (6 months postdiagnosis) occurred among veterans of Asian compared with White race (aHR, 2.55; 95% CI, 1.12-5.76), unmarried veterans (aHR, 1.83; 95% CI, 1.47-2.27), veterans with CNS (aHR, 2.07; 95% CI, 1.13-3.80) or head and neck (aHR, 1.67; 95% CI, 1.13-2.48) compared with lung cancer, and veterans with advanced cancer (aHR, 1.30; 95% CI, 1.00-1.68). Risk for most veterans decreased over time after diagnosis; however, risk remained elevated 5 years postdiagnosis for younger veterans (aged ≤45 vs 46-64 years; aHR, 1.58; 95% CI, 1.29-1.94), unmarried veterans (aHR, 1.48; 95% CI, 1.35-1.62), veterans with CNS vs lung cancer (aHR, 1.63; 95% CI, 1.22-1.27), and veterans with advanced cancer (aHR, 1.30; 95% CI, 1.14-1.50). This study found that veterans with cancer were at risk for SSDV that persisted years into survivorship. Previously overlooked high risk, subgroups, such as younger veterans, Asian veterans, or veterans with thyroid cancer, stress the need to systematically track all suicidal behaviors, not just fatal attempts, to inform tailored screening and prevention strategies as a key component of cancer care.

18. Low-cost sensor network for wildfire monitoring and air quality measurements at remote community locations.

期刊: Journal of the Air & Waste Management Association (1995) 发表日期: 2026-May-28 链接: PubMed

摘要

A sensor‑based microsystem for monitoring air quality related to wildfire emissions has been developed for deployment in a distributed network in a remote community. The sensor microsystem is equipped with particulate matter (PM2.5), carbon monoxide, carbon dioxide, ozone, and total volatile organic compound (tVOC) sensors. Root-mean-squared error for PM2.5 of less than 5 ug/m3 has been estimated. An onboard microcontroller-based control system synchronizes sensor data acquisition and communications. The microsystem is designed for operations in forest locations surrounding a remote community where cellular or Wi-Fi signals are not available. Radio communication protocol in mesh networking has been developed and tested in the range of 1-5 km in urban areas with structural barriers and outdoor terrains with vegetation. The air monitoring microsystem is designed for standalone operation with solar power, with a panel size of 50 × 37 cm that can be mounted on treetop configurations. The microcontroller-based architecture is designed for smart monitoring of air quality for optimization of energy usage toward sustainable operations throughout spring to fall, and potentially through winter seasons. System architecture has been developed to integrate several air monitoring microsystems in a network deployment to provide real-time information on potential wildfire status within several tens of thousands of hectares of forest area surrounding a remote community.Implications: This manuscript reports an innovative technology that can be deployed in forest locations surrounding remote communities in the typical northwestern prairie region in Alberta, Canada. These sensor systems will provide real-time data for air quality and wildfire events based on sensor data acquisition from forestlands. The distributed low-cost sensor network will address large gaps in provincial and federal air quality monitoring networks and can potentially be integrated with national data warehouses. These systems will inform policy on public health risk mitigation, emissions monitoring, land use policy, forest management, and climate change policies.

19. Healthcare professionals' perspectives of pharmacist roles in residential aged care: a qualitative systematic review and meta-synthesis.

期刊: International journal of clinical pharmacy 发表日期: 2026-May-28 链接: PubMed

摘要

Aged care systems are under increasing pressures, demanding optimised interdisciplinary teams. Pharmacist roles are expanding into these teams, and successful integration requires an understanding of team member perspectives. This systematic review and meta-synthesis aimed to identify, analyse and present the published literature pertaining to healthcare professional perspectives of the roles of pharmacists working in residential aged care settings. A systematic search of literature published between 2000 and 2025, in English language only, was undertaken across Embase, Medline, CINAHL and Web of Science. Primary studies addressing the research aim were eligible for inclusion. The Mixed Methods Appraisal Tool was used to assess methodological quality of each paper; no papers were excluded based on quality. Two researchers independently reviewed and reached consensus agreement for all studies to include. Both researchers undertook a thematic synthesis of qualitative data to identify analytic themes. After removing duplicates, 1874 unique papers were identified through database searching and an additional two papers identified through citation searching. After screening, we included 39 papers for data extraction and analysis. Three overarching themes were identified. Theme 1: ‘Supporting the role’ describes how pharmacist roles in aged care are supported through building trust with the team, education and experience, access to information, specific attributes, organisational buy-in, favourable models of care, and role clarity. Theme 2: ‘Medicines expertise activities’ describes how pharmacists perform three key roles valued by healthcare staff: knowledge and communication brokers, filling existing gaps in care, and optimising quality use of medicines. Theme 3: ‘Helping the team’ illustrates health professionals’ perception of three distinct outcomes of pharmacist input (ie enhanced confidence, improved workforce capacity and capability, and improved person-centred care). This meta-synthesis of the evidence regarding the perceptions of healthcare professionals on the role of pharmacists in aged care provides contextual information for individuals, organisations and policy-makers for future implementation. Pharmacists are perceived to improve stakeholder confidence, staff capacity and capability, and overall person-centred care. Embedded roles that foster interdisciplinary collaboration are preferred to irregular visiting roles. These embedded roles are enabled through a range of mechanisms that policymakers, organisations and individuals may leverage for successful implementation in future iterations.

20. Animal production under climate change: a global scientometric analysis of research structure, thematic evolution, and knowledge gaps.

期刊: Tropical animal health and production 发表日期: 2026-May-28 链接: PubMed

摘要

Climate change is a major driver of transformation in livestock systems; however, existing reviews remain fragmented, often addressing environmental impacts or adaptation strategies in isolation, without systematically integrating the structure, evolution, and knowledge gaps of the field. This study addresses this limitation through a comprehensive bibliometric-scientometric analysis of global research on climate change and animal production. A total of 1,694 peer-reviewed articles and reviews indexed in Scopus (1974-2025) were retrieved using a structured search applied to titles, abstracts, and keywords. Data were processed through duplicate removal and keyword harmonization, and analyzed using Bibliometrix (R) and VOSviewer to perform co-occurrence network analysis, thematic clustering, and temporal trend evaluation. Results indicate a sustained annual growth rate of 9.47% and increasing international collaboration (35.71%), reflecting the rapid expansion of the field. The co-occurrence network reveals a highly interconnected structure, with “climate change” acting as the central organizing concept linking environmental, physiological, genetic, and production-related domains. Thematic analysis shows that research on greenhouse gas emissions and environmental impacts is well established, whereas emerging areas-such as climate-smart agriculture, One Health, and integrated sustainability frameworks-remain less connected to applied and policy-oriented research. Temporal trends highlight a shift, particularly after 2015, from impact-oriented studies toward more integrated approaches incorporating sustainability, animal welfare, resilience, and adaptive management, alongside increasing use of digital tools such as modeling and machine learning. In addition, life cycle modeling further indicates that the field remains in an early expansion stage, having reached approximately 11.6% of its estimated saturation level, with continued growth expected over the coming decades. Despite this progress, important gaps persist, particularly regarding the translation of scientific knowledge into practice and the uneven geographic distribution of research efforts. Strengthening region-specific and socially inclusive research, enhancing the integration between technological innovation and field-level application, and advancing interdisciplinary frameworks are key priorities to improve the adaptive capacity of livestock systems. By mapping the structure, evolution, and gaps of the field, this study provides a robust basis to inform future research agendas and support the transition toward more resilient and sustainable livestock systems under climate change.

21. Multi-city Elderly Health Examination Cohort Study (MEHECS) in China.

期刊: European journal of epidemiology 发表日期: 2026-May-28 链接: PubMed

摘要

Multi-city Elderly Health Examination Cohort Study (MEHECS) is an ongoing multicenter multistage prospective cohort study in China with yearly data available between 2012 and 2023, aiming to provide a reliable source of Chinese elderly health data and detailed multidimensional information. This study correlated elderly health management data from the Basic Public Health Services Project in China with mortality registration data from the China Population Death Information Registration System. Participants were entitled to an annual free health examination which was structured into three components: a face-to-face questionnaire interview, a medical examination, and health assessment summary. The standardized questionnaire was used to obtain information on the elderly’s personal information, lifestyles, current health problems, physical symptoms, healthcare utilization, current medications, and history of non-programmatic immunization. The medical examination covered general conditions, anthropometric measurements, physical examination, functional capacities, and auxiliary examinations. Since 2012, baseline data have been collected in 3,716,364 participants with a mean age of 70.9 years. The proportion of participants over 80 years old was 10.0%, and the proportion of men was 46.8%. By the end of 2023, a total of 412,869 death cases were identified during a median follow-up of 4.44 years. Baseline data collection and follow-up are ongoing. Research results are continuously produced, which can provide evidence to help policy-makers develop better policies to promote healthy aging in China.

22. Learning to dispatch volunteers to out-of-hospital cardiac arrests.

期刊: Health care management science 发表日期: 2026-May-28 链接: PubMed

摘要

Survival for out-of-hospital cardiac arrest can be significantly improved through volunteer efforts. To shorten the time to good-quality cardiopulmonary resuscitation, some emergency call centers use mobile phone technology to rapidly locate and alert nearby trained volunteers. Some such community first responder systems use phased alerts: notifying increasingly many volunteers with built-in time delays. The policy that defines the phasing of alerts affects both response times, which have a direct relation to survival, and the burden on volunteers. We aim to optimize this policy, which involves trading off these two metrics. The policy may depend on real-time information: where the volunteers are observed in relation to the patient and how long triage took. A direct approach using dynamic programming yields some insights, but is too slow for real-time use. Our contribution lies in recasting this problem as a multi-class classification problem and solving it using empirical data from Auckland, New Zealand’s community first response system. This case study shows that phasing the alerts based on real-time information provides important improvements relative to a competitive baseline that is indicative of current practice.

23. [The health insurers' perspective on defining and managing healthcare needs].

期刊: Innere Medizin (Heidelberg, Germany) 发表日期: 2026-May-28 链接: PubMed

摘要

The German healthcare system, despite its high performance, fails to achieve the goal of needs-based service provision. Supply-induced demand, regional disparities and misaligned financial incentives lead to overuse, underuse and misuse of healthcare services. Planning instruments are often based on data reflecting actual utilization rather than capturing the true healthcare needs of the population. The aim of this article is to analyze how needs orientation can be systematically achieved through new planning, financing and organizational frameworks. Drawing on current legislation, empirical data and sector-specific policy positions, the study examines which structural transformations are required. The analysis demonstrates that the existing legal framework does not enable needs-based service regulation. A shift away from a supply-driven system towards a planning approach that incorporates morbidity, demographic trends, accessibility and quality of care is essential. Central levers for reform include a quality-oriented hospital restructuring, appropriately designed cross-sectoral care facilities, a comprehensive primary care system, needs-oriented emergency care, consistent oitpatient substitution of inpatient cases, flexible regional decision-making capacities and cross-sectoral needs-based planning with unified service categories and quality requirements, involving regional stakeholders. A scientific instrument for needs assessment can align planning and financing, thereby enabling more reliable, efficient and patient-centered care. Only an integrated reform strategy will enable resources to be used efficiently, reduce excess capacities and align healthcare provision with the actual needs of the population. Das deutsche Gesundheitssystem verfehlt trotz hoher Leistungsfähigkeit das Ziel einer bedarfsgerechten Versorgung. Angebotsinduzierte Nachfrage, regionale Unterschiede sowie ökonomische Fehlanreize führen zu Über‑, Unter- und Fehlversorgung. Planungsinstrumente basieren oft auf Daten zur tatsächlichen Inanspruchnahme und bilden den eigentlichen Versorgungsbedarf unzureichend ab. Ziel des Beitrags ist, zu analysieren, wie Bedarfsgerechtigkeit durch neue planerische, finanzielle und organisatorische Rahmenbedingungen systematisch erreicht werden kann. Auf Basis aktueller Gesetzgebung, empirischer Daten und fachpolitischer Positionen wird untersucht, welche strukturellen Veränderungen notwendig sind. Die Analyse zeigt, dass der bestehende Rechtsrahmen keine bedarfsorientierte Versorgungssteuerung ermöglicht. Notwendig ist die Abkehr vom angebotsorientierten System hin zu einer Planung, die Morbidität, Demografie, Erreichbarkeit und Versorgungsqualität berücksichtigt. Zentrale Reformhebel sind eine qualitätsorientierte Krankenhausreform, sinnvoll ausgestaltete sektorenübergreifende Versorgungseinrichtungen, ein ganzheitliches Primärversorgungssystem, eine bedarfsorientierte Notfallversorgung, eine konsequente Ambulantisierung stationärer Fälle, flexible regionale Gestaltungsspielräume sowie eine sektorenübergreifende Bedarfsplanung mit einheitlichen Leistungsgruppen und Qualitätsanforderungen unter Beteiligung der regionalen Akteure. Ein wissenschaftliches Bedarfsbemessungsinstrument kann Planung und Finanzierung miteinander verzahnen sowie eine verlässlichere, wirtschaftlichere und patientenorientierte Versorgung ermöglichen. Nur durch ein integriertes Reformkonzept lassen sich Ressourcen effizient einsetzen, Überkapazitäten abbauen und Versorgungsangebote am realen Bedarf der Bevölkerung ausrichten.

24. Timely hospital discharge in TAVI patients: towards a patient-centered care pathway.

期刊: Clinical research in cardiology : official journal of the German Cardiac Society 发表日期: 2026-May-28 链接: PubMed

摘要

Transcatheter aortic valve implantation (TAVI) has evolved into the dominant therapeutic option for severe aortic stenosis, with procedural refinements and expanding indications increasingly supporting shorter post-procedural monitoring and discharge. International evidence from randomized trials, multi-center registries, and consensus guidelines demonstrates that reduced length of stay (LOS), including next-day or early discharge, can be safely achieved in selected patients when supported by standardized workflows, careful patient selection, and structured outpatient monitoring. In Germany, LOS remains among the longest in Europe, driven by structural, reimbursement, and cultural barriers. With increasing TAVI volumes, demographic pressures, and workforce constraints, these barriers inhibit health system sustainability, procedural capacity, and patient experience. Early discharge below the currently defined thresholds often results in financial disadvantages under the Diagnosis-Related Group (DRG) reimbursement mechanism, thereby disincentivizing standardized adoption and pathway innovation. Yet, a reduction in LOS would yield meaningful system-level advantages, including increased procedural capacity, improved resource allocation, and lower post-procedural bed occupancy costs, all leading to better and more efficient patient pathways. This narrative, practice- and policy-oriented critical perspective evaluates the current German landscape and outlines pragmatic strategies to enable safe early discharge. It synthesizes relevant international evidence, identifies system-level barriers specific to Germany, and proposes a structured roadmap including: (1) standardized eligibility criteria, (2) protocolized peri- and post-procedural pathways, (3) pilot implementation in carefully selected centers with outcome reporting, and (4) reimbursement realignment to avoid wrong financial incentives. Supported by professional medical societies and aligned with international standards, early discharge pathways could enhance efficiency and improve patient-centered care, offering Germany a timely opportunity to modernize TAVI experience and delivery.

25. Feasibility of a Monthly Morphine Milligram Equivalent Metric for Opioid Surveillance Using the National Claims Database of Japan: A Repeated Cross-Sectional Study in a Low-Consumption Setting.

期刊: Therapeutic innovation & regulatory science 发表日期: 2026-May-28 链接: PubMed

摘要

Japan has very low opioid consumption, yet national data on high-dose dispensing remain scarce. We assessed the feasibility of a monthly morphine milligram equivalent (MME) metric for opioid surveillance using claims data without days’ supply information and estimated high-dose dispensing for opioid analgesics potentially compatible with non-cancer pain treatment. Using a repeated cross-sectional analysis of Japan’s National Database Sampling Dataset (1% pharmacy claims, 2015-2019), we identified claims for a pre-specified set of strong (e.g., fentanyl, morphine) and weak (e.g., tramadol) opioids. Primary outcomes were proportions of opioid claims exceeding high-dose (≥ 1,800 MME/month, approximately 60 MME/day) and very-high-dose (≥ 2,700 MME/month, approximately 90 MME/day) thresholds. Among 204,159 opioid claims from 18.6 million pharmacy claims, 0.55% of opioid claims (95% confidence interval [CI], 0.52-0.58%; 0.0060% of all pharmacy claims) exceeded the high-dose threshold, and 0.30% of opioid claims (95% CI, 0.28-0.33%) exceeded the very-high-dose threshold. However, high-dose dispensing was highly concentrated among strong-opioid claims (n = 5,353), of which 20.8% and 11.5% exceeded the high-dose and very-high-dose thresholds, respectively; this pattern may partly reflect cancer-related prescribing because indications were unavailable. Weak-opioid monotherapy almost never exceeded thresholds (< 0.01%). Annual proportions showed little temporal change. High-dose opioid dispensing was rare overall in Japan but concentrated within strong-opioid claims. A monthly MME metric may provide a feasible and practical surveillance proxy for identifying high-risk dispensing events in claims databases with limited prescription metadata.

26. Impact of Unfractionated Heparin Use on Maternal Bone Mineral Density During Pregnancy: A Retrospective Study Using AI-Assisted Radiographic Analysis.

期刊: Reproductive sciences (Thousand Oaks, Calif.) 发表日期: 2026-May-28 链接: PubMed

摘要

This study aimed to evaluate the impact of unfractionated heparin (UFH) use during pregnancy on maternal bone mineral density (BMD) by assessing BMD in pregnant women with heparin exposure using an artificial intelligence (AI)-assisted analysis of chest radiographs. This retrospective cohort study was conducted between April 2013 and October 2023. Pregnant women who received UFH therapy and underwent cesarean section (CS) were compared, using preoperative chest radiographs, with a control group who underwent CS without medication. Estimated BMD (eBMD) values for the lumbar spine (LS) and femoral neck (FN) were obtained via an AI-assisted diagnostic system. Statistical analyses included univariate and multivariate methods, adjusted for covariates. Compared with the control group (n = 213), the UFH group (n = 86) exhibited significantly lower eBMD values at both LS and FN. Body mass index (BMI) correlated with eBMD in both groups, with underweight participants showing significantly lower eBMD, particularly in the UFH group. Multivariate analysis identified UFH as an independent factor associated with reduced eBMD in patients with LS. No significant correlation was found between the total UFH dose and eBMD. UFH administration during pregnancy may be associated with decreased maternal eBMD, especially in underweight women, with the LS appearing more susceptible to bone loss than the FN. The estimation system may provide a safe, accessible, and effective method for early detection and risk stratification of pregnancy-associated bone loss, supporting future clinical management in at-risk populations.

27. Current Advances in the Physiological Roles of the Thioredoxin-Like Family of Selenoproteins.

期刊: Biological trace element research 发表日期: 2026-May-28 链接: PubMed

摘要

Selenium (Se) is an essential trace element whose physiological functions in redox regulation, immunity, and metabolism are primarily executed by 25 distinct human selenoproteins. While systemic Se status is maintained through a tightly regulated hepatic distribution hierarchy and receptor-mediated transport to vital organs, recent research has significantly advanced our understanding of the specific roles of individual selenoproteins. This review focuses on the thioredoxin-like family, comprising SELENOT, SELENOV, SELENOW, and SELENOH, which share a conserved Rdx fold but perform diverse, tissue-specific functions. SELENOT has been implicated in the development and function of catecholaminergic circuits and may contribute to the regulation of calcium homeostasis, while SELENOV appears to play a role in modulating energy balance, adiposity, and hepatic responses to stress resistance. Emerging evidence suggests that SELENOW may play roles in muscle maintenance, bone remodeling, and inflammation resolution, with potential involvement in neuroprotection via regulation of tau homeostasis. Finally, the nuclear-localized SELENOH preserves genomic stability and is involved in cell cycle progression. By integrating findings from molecular pathways and physiological data from knockout mouse models, this review highlights the roles of these four proteins in supporting cellular viability and physiological homeostasis under conditions of oxidative and metabolic stress.

28. Developing Quality Criteria for Community-Based Loneliness Interventions in Older Adults: An Evidence-Informed Framework.

期刊: Journal of prevention (2022) 发表日期: 2026-May-28 链接: PubMed

摘要

Community-based interventions addressing social isolation among older adults lack systematic quality assessment frameworks despite their public health importance. This study developed evidence-informed quality criteria for complex community-based health promotion interventions using a transdisciplinary approach. We conducted systematic literature searches for guidelines and evidence syntheses on social isolation interventions, followed by quality assessment using the following standardised tools: the Appraisal of Guidelines for Research and Evaluation II (AGREE II) and A MeaSurement Tool to Assess systematic Reviews (AMSTAR 2). Quality criteria were categorised using a lifecycle-based framework and were supplemented with health promotion principles. A stakeholder panel (practitioners, funders, and target group representatives; n = 6) prioritised criteria through a two-round Delphi process including an intermediate workshop. We developed 39 evidence-informed quality criteria organised into four lifecycle domains: Programme Conditions (7 criteria), Programme Planning (17 criteria), Programme Implementation (12 criteria), and Programme Results (3 criteria). The framework integrates evidence from one clinical guideline, six systematic reviews, and established health promotion principles. This study demonstrates the systematic development of evidence-informed quality criteria through participatory stakeholder engagement. The framework provides practitioners and policymakers with a comprehensive tool for planning, implementing, and evaluating community-based interventions targeting social isolation among older adults, enhancing accountability and programme improvement capacity.

29. Tree-based and sparse logistic models for predicting one-month postoperative performance status after surgery for spinal metastases.

期刊: European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society 发表日期: 2026-May-28 链接: PubMed

摘要

We aimed to develop and internally validate prediction models for one-month postoperative performance status (PS) after surgery for spinal metastases and to identify patients likely to achieve PS 0-2 at one month. We performed a retrospective analysis of a prospectively collected spine surgery registry. We compared three tree-based models (Random Forest, XGBoost, and CatBoost) with two regularized logistic regression models (ridge-regularized logistic regression and a sparse elastic-net logistic regression model constrained to ≤ 15 predictors). Model development and hyperparameter tuning were performed using nested cross-validation. Missing data were handled using model-specific strategies within the cross-validation pipeline, and a sensitivity analysis excluded the predictor with the highest missingness. Performance was assessed using discrimination and calibration metrics, including the area under the receiver operating characteristic curve (AUC-ROC), accuracy, precision, recall, F1 score, Brier score, calibration intercept, and calibration slope. The primary analysis included 375 patients with available one-month PS out of 413 enrolled patients. Random Forest achieved the highest discrimination (AUC-ROC 0.811 ± 0.079) and showed calibration measures closest to the ideal among the evaluated models (Brier score 0.168; calibration intercept - 0.024; slope 1.121). The sparse elastic-net model showed good discrimination (AUC-ROC 0.796 ± 0.081) with a limited set of predictors, although its calibration metrics suggested less reliable absolute probability estimates (Brier score 0.217; intercept 0.612; slope 3.228). Excluding the predictor with the highest missingness yielded similar performance for the main models. Tree-based models, particularly Random Forest, provided the most favorable overall predictive performance for one-month postoperative PS after surgery for spinal metastases, whereas a sparse elastic-net logistic regression model preserved reasonable discrimination with a small predictor set and coefficient-based interpretability. These findings support clinically oriented prediction of early postoperative functional status while highlighting the need to assess calibration before clinical implementation.

30. From global to local: comparing the EAT-Lancet planetary health diets with the traditional Mediterranean Diet across Mediterranean countries.

期刊: International journal of food sciences and nutrition 发表日期: 2026-May-28 链接: PubMed

摘要

The planetary health diet proposed by the EAT-Lancet Commission provides a global framework to integrate human health and environmental sustainability through plant-based dietary patterns. Its 2025 update refined quantitative targets and emphasised the need for regional adaptation. This study compares the EAT-Lancet reference diets, the FAO/WHO Sustainable Healthy Diets, and Mediterranean dietary models represented by national guidelines from Italy, Spain, Greece, and Portugal, alongside the Italian Mediterranean Diet Pyramid proposed by the Italian Society of Human Nutrition. Quantitative recommendations were harmonised into weekly intakes, and qualitative features were systematically analysed. Overall, strong convergence was observed, particularly for whole grains, fruits, vegetables, and unsaturated fats. However, the EAT-Lancet model recommends higher intakes of legumes and nuts than the Mediterranean guidelines. Differences also emerged for dairy products and olive oil, reflecting regional adaptations. The Mediterranean Diet represents a culturally grounded and feasible model for translating planetary health principles into practice.

31. Promoting digital tool usability for supporting everyday life in reconstruction areas after the Fukushima Daiichi nuclear power station accident: Results of a pilot study.

期刊: Annals of the ICRP 发表日期: 2026-May-28 链接: PubMed

摘要

Comprehensive support for the everyday life of people in reconstruction areas around the Fukushima Daiichi nuclear power station should include access to specialists. This prompted the original development and recent user satisfaction survey of the ‘Mimamoru Health Application’ (MHApp), a digital tool connecting people to specialists and their expertise. To improve MHApp user satisfaction, user data from April 2021 to January 2023 were collected and analysed. Participants included affected populations (evacuees and returnees), unaffected residents, and local healthcare workers living in Fukushima Prefecture. Data included MHApp’s system usability on a 0-100 scale [system usability scale (SUS)], user background characteristics, and free-text comments about using MHApp. In total, 47 participants joined this study. The number of days participants used MHApp was 17.3 ± 14.7 (mean ± SD). The SUS mean ± SD was 57.4 ± 13.2. Age-specific SUS scores were higher among users 20-40 years old than among users 50 + years old (p = 0.03). These results, along with free-text comments, suggest that improving the visualisation of various data and addressing the needs of users aged 50 years and older were key to better usability of MHApp.

32. Pathologic Myopia Globe Shape and Long-Term Prognosis.

期刊: JAMA ophthalmology 发表日期: 2026-May-28 链接: PubMed

摘要

Three-dimensional (3D) eye shape may play a critical role in predicting long-term structural and functional outcomes in high myopia. To determine whether 3D eye shape subtypes defined by high-resolution magnetic resonance imaging (MRI) predict 15-year structural and functional outcomes in high myopia. This prospective cohort study involved a subsample of individuals with high myopia (spherical equivalent ≤-6.00 D in both eyes) enrolled in the Zhongshan High Myopia Cohort at a single center in China. Participants underwent biennial ophthalmic examinations over 15 years. Baseline assessments began in August 2011, with biennial follow-ups through September 2025. Data were analyzed from October 2025 through December 2025. Eye shape was classified into the following 6 categories: spheroidal, ellipsoidal, conical, nasally distorted, temporally distorted, and barrel shaped. Spheroidal and ellipsoidal types were defined as nondeformed and the others as deformed. The primary outcomes were annual axial elongation rate, rapid elongation (≥0.10 mm/y), macular choroidal thinning (subfoveal choroidal thickness <62 µm), progression of myopic macular degeneration (MMD), incidence of posterior staphyloma, visual impairment (best-corrected visual acuity ≤20/40), and visual field defects. Of 190 eyes from 95 participants, 152 eyes completed follow-up and were included in the analysis. Of the 152 eyes analyzed, 77 (50.7%) were from female participants, with an overall mean (SD) age of 32.3 (14.1) years. Baseline shapes included spheroidal (83 eyes [54.6%]), nasally distorted (25 [16.4%]), conical (23 [15.1%]), ellipsoidal (11 [7.2%]), temporally distorted (5 [3.3%]), and barrel shaped (5 [3.3%]). Axial elongation followed a morphology-dependent gradient, from slowest in spheroidal eyes (0.045 mm/y) to fastest in nasally distorted eyes (0.095 mm/y). After multivariable adjustment, nasally distorted eyes elongated by 0.050 mm/y (95% CI, 0.020-0.080 mm/y; P = .001) faster and had higher odds of rapid elongation (odds ratio, 5.74; 95% CI, 1.66-19.82; P = .006). Deformed eyes overall had a 7-fold higher risk of macular choroidal thinning (odds ratio, 7.24; 95% CI, 1.77-29.63; P = .006). Nasally distorted and conical eyes showed the greatest risks for both choroidal thinning and MMD progression. For visual field defects, risk was elevated in nasally distorted and conical eyes. Findings from this prospective cohort study suggest that 3D eye shape is an important determinant of long-term outcomes in high myopia. Nasally distorted and conical phenotypes conferred the greatest risks, highlighting the potential value of baseline eye shape stratification for personalized management, risk prediction, or early intervention. isrctn.org Identifier: ISRCTN56368396.

33. Psychological resilience predicts medication adherence in multiple sclerosis.

期刊: Acta neurologica Belgica 发表日期: 2026-May-28 链接: PubMed

摘要

Sustained adherence to disease-modifying therapies is essential for preventing relapses and long-term disability progression in people with relapsing-remitting-multiple sclerosis (PwRRMS). Although psychological distress is associated with poor adherence, the independent contribution of psychological resilience remains unclear. This study aimed to determine whether psychological resilience is independently associated with medication adherence (MA) in PwRRMS who are in remission after accounting for psychological distress, disability level, quality of life (QoL), and clinical factors. This study included 165 PwRRMS in clinical remission. MA was assessed using the Medication Adherence Report Scale. Psychological resilience, psychological distress, coping attitudes, and QoL were measured using validated scales, and neurological disability was evaluated using the Expanded Disability Status Scale (EDSS). A multivariate logistic regression analysis was conducted after adjusting for depression, anxiety, stress, coping strategies, QoL, EDSS, and disease duration. Compared with poorly adherent participants, those with good adherence reported (60%) significantly higher resilience, lower depression, anxiety and stress symptoms, and better QoL (all p ≤ .01). Adherence was positively associated with resilience and negatively associated with psychological distress. Regression analysis revealed psychological resilience was the only independent predictor of good adherence (p = .016), whereas psychological distress, QoL, and disability level were not retained. Psychological resilience appears to be a key psychological resource supporting sustained treatment adherence in RRMS, independent of emotional distress, disability severity, or QoL. Routine clinical care may benefit from screening for resilience and the incorporation of resilience-enhancing strategies to improve long-term adherence and optimize patient outcomes.

34. CircRNA based bi-antigen vaccines against mpox virus induce potent and durable cross-protection in mice.

期刊: Molecular biomedicine 发表日期: 2026-May-28 链接: PubMed

摘要

The ongoing epidemic of mpox highlights the urgency of developing novel and effective vaccines against mpox virus (MPXV). Circular RNA (circRNA) has emerged as a promising novel vaccine platform due to its high stability, resistance to exonuclease-mediated degradation, and potential to support prolonged antigen expression. Based on our lipid nanoparticle (LNP)-encapsulated circRNA vaccine platform, we developed two novel bi-antigen circRNA vaccines cirEV and cirMV, which respectively encode the combination of MPXV extracellular enveloped virion (EEV) antigens (A35R and B6R) or intracellular mature virion (IMV) antigens (A29L and M1R). The two MPXV circRNA vaccines alone or mixed as a combination vaccine successfully induce high levels of antigen-specific antibody responses and cellular immune responses against the MPXV antigens and protect mice from lethal vaccinia virus (VACV) challenge in a dose-dependent manner. Furthermore, both circRNA vaccines can provide complete long-term cross-protection against lethal VACV challenge at day 260 after first immunization, indicating the durability of vaccine-induced protective immunity. Notably, vaccine-induced cellular immune responses play a crucial role in immune protection and virus clearance in mice. Our study provides critical insights to understand the protective mechanisms underlying circRNA vaccines in an orthopoxvirus surrogate model, demonstrating that bi-antigen circRNA vaccines represent a promising multivalent vaccine platform.

35. EDTA enhances antimicrobial activity of PR-39 and Protegrin-1 antimicrobial peptides against carbapenem-resistant Pseudomonas aeruginosa in serum.

期刊: Folia microbiologica 发表日期: 2026-May-28 链接: PubMed

摘要

Carbapenem-resistant Pseudomonas aeruginosa represents a frequent and clinically challenging pathogen responsible for both acute and chronic infections. Antimicrobial peptides are emerging as a promising class of novel therapeutic agents due to their broad-spectrum activity, rapid bactericidal activity, and low potential to induce antimicrobial resistance. The antimicrobial efficacy of these peptides can be further enhanced by EDTA. However, their activity is often reduced in the presence of serum, which contains multiple inhibitory components. In this study, EDTA fully restored the antimicrobial activity of PR-39 and Protegrin-1 in serum. Moreover, incorporation of chitosan increased the antimicrobial efficacy of the PR-39/Protegrin-1/EDTA formulation. These findings demonstrate that PR-39, Protegrin-1, EDTA, and chitosan can act synergistically, supporting the feasibility of integrating these components into a unified therapeutic platform.

36. Predicting late radiation-associated neurocognitive and endocrine toxicity in patients with brain tumors.

期刊: Journal of neuro-oncology 发表日期: 2026-May-28 链接: PubMed

摘要

Neurocognitive and endocrine dysfunction are potential complications of cranial irradiation. However, risk factors are poorly understood, impeding accurate prognostication and exploration of potential preventive interventions. The objective of this study was to evaluate the prognostic value of various vascular and genotypic risk factors for the development of radiation-related toxicities. This single-institution retrospective cohort study included patients with metastatic and malignant primary brain tumors who received cranial irradiation as part of their initial tumor-directed therapy. Demographic and treatment characteristics were collected, as well as putative vascular and genotypic risk factors. Univariate, multivariate, and machine-learning analyses were performed using five pre-specified measures of radiation-related toxicity. The primary outcome was change in mini-mental status exam (MMSE). Eighty patients (53% male, mean age 55.7, 53% primary and 44% metastatic brain tumors) were included. Elevated homocysteine and ApOE4 genotype were the strongest predictors of MMSE decline in the multivariate model (OR 3.96 [6.5-200, p < 0.001 and 2.85 [1.92-27.6], p = 0.004). Elevated homocysteine was associated white matter change on MRI and both physician and patient assessment. ApoE4 allele was associated with new endocrine deficiency, and physician assessment. An online nomogram provides risk predictions for each of the five late toxicity outcomes: ( https://afranklin22.shinyapps.io/PRMMSERadiationRiskFactors/ ) CONCLUSION: Two pre-treatment laboratory values (elevated homocysteine and ApOE genotype) were strongly associated with post-radiation neurocognitive and endocrine dysfunction using a variety of domains. Our predictive algorithm can aid clinicians in stratifying baseline risk and should be validated in prospective trials and with additional metrics of ND.

37. Trends in Pancreatic Cancer Incidence, Mortality and Net Survival: A Population-Based Analysis in Zurich (Switzerland), 1981-2021.

期刊: Journal of gastrointestinal cancer 发表日期: 2026-May-28 链接: PubMed

摘要

Pancreatic cancer incidence is increasing worldwide while survival remains poor. The incidence varies significantly across different regions. The aim of the present study was to analyse incidence, mortality and survival of patients diagnosed with pancreatic cancer in the canton of Zurich, Switzerland. Population-based cancer registry data and cause of death statistics of the canton of Zurich from 1981 to 2021 were analysed. Age-standardised incidence and mortality rates per 100’000 person-years and net survival were calculated. Joinpoint regression analysis was conducted to identify significant changes in time trends while net survival was estimated using the Pohar-Perme method. Age-standardised incidence rate of pancreatic adenocarcinomas (PAC) remained stable between 1981 and 2000 and then increased from 2000 to 2021, while pancreatic neuroendocrine tumours (PNET) incidence increased throughout and pancreatic cancers non histologically or cytologically confirmed (PC Non-HC) decreased. Overall age-standardised mortality rate remained stable. Five-year net survival was moderate for PNET (54.8%), but poor for PAC (4.8%) and PC Non-HC (1.2%). Among patients with PAC, survival declined with increasing age, earlier diagnosis year and advanced stage. Over the past 40 years, PNET incidence slowly increased. In contrast, PAC incidence significantly increased within the last 20 years. The underlying causes of the observed increase in PAC incidence might be attributable to special risk factors, e.g. obesity, but other risk factors should also be considered. Mortality rates of pancreatic cancer were stable and net survival was poor.

38. Unveiling Hydrogen Fluoride Emission Mechanisms in Municipal Solid Waste Incineration Using a Machine Learning Approach.

期刊: Environmental science & technology 发表日期: 2026-May-28 链接: PubMed

摘要

Hydrogen fluoride (HF) emissions from municipal solid waste incineration (MSWI) pose significant environmental and health risks. However, their complex formation mechanisms remain poorly understood. This study presents an integrated machine learning framework combining XGBoost for HF prediction, SHAP for feature interpretation, structural equation modeling (SEM) for mechanistic analysis, generalized additive models (GAMs) for threshold identification, and self-adaptive nondominated sorting genetic algorithm II (SA-NSGA-II) for multiparameter optimization. Using over 150,000 high-frequency (5 s interval) sensor records from a waste-to-energy plant in Hainan Province, China (June 1-10, 2024), the XGBoost model showed the best performance among the evaluated models (R2 = 0.755, RMSE = 0.041 mg/m3, MAE = 0.031 mg/m3) via 5-fold cross-validation. SHAP analysis identified flue gas temperatures─especially the second flue right side (10.97%) and first flue top (10.19%)─as dominant factors. SEM confirmed the grate incineration zone as the primary HF source (path coefficient = 1.058, p < 0.001). GAM identified location-specific critical temperature thresholds for HF emission control, specifically 767 °C at the upper second flue gas pass, 875 °C at the first flue top, and 212 °C at the low-temperature economizer inlet. SA-NSGA-II optimization, validated with June 11 data, reduced HF emissions in 89.74% of cases, achieving a 17.61% average reduction (0.1176 mg/m3). This framework advances mechanistic understanding and provides data-driven strategies for sustainable MSWI operation and pollution mitigation.

39. Response of microbial community in the soil plastisphere of polypropylene microplastics to the stress of phenanthrene pollution: Microbial composition, function, and network.

期刊: World journal of microbiology & biotechnology 发表日期: 2026-May-28 链接: PubMed

摘要

Microplastics (MPs) accumulate in soils, forming microbial habitats termed the “plastisphere”, which can concentrate hydrophobic pollutants like phenanthrene (PHE). This study investigated how PHE stress influences the microbial community in the polypropylene-amended soil plastisphere compared to bulk soil, revealing its “microbial refuge” function. Significant differences in microbial composition were observed. Under PHE stress, the number of unique genera in the plastisphere increased from 4 (without PHE) to 9, and the composition of significantly enriched genera changed substantially, with only 1 out of 6 enriched genera shared between PHE-stressed and non-stressed conditions. In contrast, the depleted genera remained largely consistent. Functional prediction indicated that PHE stress was associated with reduced health risks in the plastisphere relative to bulk soil. Carbon and methane metabolism pathways were significantly enriched in the plastisphere regardless of PHE stress. In contrast, nitrogen metabolism, aromatic compound degradation, and PAH degradation pathways did not differ significantly between the plastisphere and soil. Although several pathways reached statistical significance, fewer than 8.33% exhibited an absolute log₂FC > 1. This discrepancy indicates that microplastics exert a limited biological impact on the overall metabolic potential of the soil microbiome, irrespective of PHE contamination. Microbial co-occurrence networks initially showed similar complexity between plastisphere and soil. However, PHE stress markedly reduced network complexity (degree) in the plastisphere and increased the proportion of negative correlations (indicating competition/antagonism) from ~ 60% to ~ 50% in both habitats. This study advances the mechanistic understanding of pollutant-driven microbial responses in soil plastispheres, with a focus on how this unique plastic-associated microbial niche mediates microbial composition, function, and network under PAH stress, thereby informing targeted bioremediation and ecological risk models for microplastic-organic co-contaminated environments.

40. Changes in milk yield, composition, and udder morphology during early lactation according to weaning management period in Sicilo-Sarde ewes.

期刊: Tropical animal health and production 发表日期: 2026-May-28 链接: PubMed

摘要

Seventy-two early-lactation Sicilo-Sarde ewes were used to evaluate the effect of weaning system (WS) on milk yield (milked and residual), milk composition, and mammary morphology. Lambs were weaned at 30-35, 45-50, and 60-70 days for early (EW), semi-early (SEW), and late weaning (LW), respectively. Ewes (4.28 ± 0.77 years old) were divided into three groups based on the WS. Four milk recordings were performed during the first 45 days of milking (at days 7, 15, 30, and 45). The residual milk (RM) fraction was collected following an oxytocin injection. Additionally, external mammary morphology was assessed using six linear measurements and three udder and teat scores.WS significantly affected (p < 0.05) milked yield (MM) and total milk yield (MY); however, RM was not affected (p > 0.05). SEW and LW ewes produced more MM and MY than EW ewes. Furthermore, MM, RM, and MY traits were influenced by the ewes’ overall milk production level. Milk composition for both MM and RM did not vary with WS (p > 0.05), except for the lactose percentage, which was higher (p < 0.05) in the RM of the SEW and LW groups. Regarding morphology, WS only influenced udder height, cistern height, and teat diameter at the base (p < 0.05). Sicilo-Sarde ewes generally exhibited deep udders and short, horizontally inclined teats. Udder traits and teat diameter showed significant moderate correlations with all milk traits (p < 0.05; r = 0.27-0.39). In conclusion, SEW increased milk production compared to EW and followed the same trend as LW during the study period, without compromising milk quality. These results suggest that SEW could help farmers increase the volume of marketable milk.

41. Paraprobiotics in Modern Broiler Production: Stability, Safety, and Multifunctional Benefits - a Comprehensive Review.

期刊: Probiotics and antimicrobial proteins 发表日期: 2026-May-28 链接: PubMed

摘要

The growing restrictions on in-feed antibiotics and the global rise of antimicrobial resistance have intensified the demand for safe and sustainable alternatives to support animal health and productivity. Paraprobiotics, defined as non-viable or inactivated bacterial cells, have recently emerged as a promising class of functional bioactives capable of conferring health benefits without the risks associated with live probiotics. Unlike conventional probiotics, paraprobiotics mediate their effects through intact cell structures and microbial metabolites that engage host pattern-recognition receptors, thereby modulating both innate and adaptive immune responses. This review critically examines the antimicrobial efficacy of paraprobiotics in poultry, emphasizing their mechanistic role in maintaining gut barrier integrity, regulating microbial ecology, and mitigating inflammation-induced oxidative stress. Evidence indicates that paraprobiotics suppress pathogenic colonization enhance epithelial function, stimulating antimicrobial peptide production, and improve nutrient utilization and growth performance. Moreover, their stability during feed processing, prolonged shelf-life, and minimal risk of horizontal gene transfer further enhance their suitability for large-scale, intensive production systems. Additionally, emerging inactivation technologies, optimized dosing strategies, and synergistic applications with prebiotics and phytobiotics offer avenues to maximize their functional potential. Collectively, paraprobiotics exemplify a paradigm shift in antimicrobial nutrition providing “dead cells with living functions” that combine safety, efficacy, and sustainability. Their integration into antibiotic-free poultry system hold significant promise for enhancing disease resilience, productive performance and overall sustainability of modern poultry production.

42. A Systematic Review of Functional Brain Imaging Studies in Neurofibromatosis 1.

期刊: Neuropsychology review 发表日期: 2026-May-28 链接: PubMed

摘要

Neurofibromatosis 1 (NF1) is a rare genetic condition, frequently associated with learning difficulties. Functional neuroimaging techniques have been used to investigate brain mechanisms underlying learning difficulties in NF1, but these remain poorly understood. We conducted a systematic review of functional neuroimaging studies in NF1 from 2000-2024 aiming to develop a neurobiological framework for understanding the NF1 cognitive phenotype. A total of 44 studies were identified as relevant across functional magnetic resonance imaging (fMRI), electroencephalography (EEG), magnetic resonance spectroscopy (MRS), positron emission topography (PET), transcranial magnetic stimulation (TMS) and arterial spin labelling (ASL) techniques. Findings suggest mechanisms underlying learning in NF1 may be characterised as excitation/inhibition (E/I) ratio imbalance, dysconnectivity between brain regions and perturbations in neural activation patterns. We suggest, disruptions in GABAergic signalling, beginning in early development, may alter the whole brain function, explaining the differential patterns of brain activity, connectivity, and brain chemistry. As most of the reviewed studies were cross-sectional in nature, future research should focus on longitudinal designs to better understand developmental changes in brain mechanisms and how these processes evolve over time. Finally, it is essential to explore environmental modifiers in shaping the cognitive phenotypes associated with NF1.

43. Digestate biochar effects on soil Pb bioaccessibility, crop Pb concentrations, and human health risk in urban vegetable agroecosystems.

期刊: Environmental geochemistry and health 发表日期: 2026-May-28 链接: PubMed

摘要

Biochar is an effective method of Potentially Toxic Element (PTE) remediation in urban agricultural systems; however, its remediation potential may be determined by the extent to which it alters soil properties. Where soil properties are minimally changed with biochar application, remediation potential may be minimally effective. A controlled experiment was used to compare the effects of 5%w/w digestate biochar in no-crop, lettuce, carrot, and garlic agrisystems with differing soil Pb concentrations, high soil pH and organic matter. Total soil and vegetable Pb and bioaccessible soil Pb were quantified using acid digestions and Unified BARGE Bioaccessibility Methodology (UBM). Risk indices (ADI, THQ, CR), were used to assess grower (soil), consumer (vegetable) and combined (soil and vegetable) Pb ingestion risks for each vegetable agrisystem, and were supported by Monte Carlo and sensitivity analyses. Digestate biochar significantly reduced soil-derived Pb ingestion risks (ADI/THQ/CR) in high Pb no-crop systems, high Pb and low Pb carrot systems, and low-Pb garlic systems, though had no effect on ingestion risk in low Pb no-crop and high Pb garlic agrisystems. Notably, biochar did not affect vegetable-derived Pb ingestion risks for any agrisystem. When soil and vegetable risk indices were combined, biochar only lowered overall Pb ingestion risks in high-Pb no-crop and low-Pb lettuce systems, with minimal or inconsistent effects elsewhere. Ultimately, biochar had limited and variable effects on reducing Pb ingestion risks in the studied vegetable agrisystems, which suggests that its remediation potential in urban agrisystems is context-dependent and may offer limited protection for growers and consumers in soils with elevated pH and organic matter.

44. High dietary protein and energy content does not alter hepatic and renal health blood markers in growing lambs.

期刊: Tropical animal health and production 发表日期: 2026-May-28 链接: PubMed

摘要

This study aimed to evaluate the effect of different concentrate levels and increasing crude protein content in the diet on blood markers of hepatic and renal health in growing lambs. Two experiments were conducted with 64 non-castrated male Santa Inês lambs, four months old, with an initial average weight of 20 ± 1 kg. The lambs were housed in individual pens and fed ad libitum during a 57-days experimental period, with 14-days adaptation period. In Experiment 1 (Exp1), four diets with different concentrate levels (400, 500, 600, and 700 g/kg of DM) were tested, and in Experiment 2 (Exp2), four diets with different crude protein levels (120, 140, 160, and 180 g CP/kg of DM) were evaluated. Blood samples were collected on the 54th day in both experiments for analysis of serum albumin, urea, cholesterol, creatinine, alkaline phosphatase (AP), alanine aminotransferase (ALT), aspartate aminotransferase (AST), and gamma-glutamyltransferase (GGT). The results indicated that the increase in digestible organic matter intake (dOM) did not affect the blood parameters analyzed (p > 0.05). However, serum urea was above the reference range (17-43 mg/dL) in Exp1, while creatinine was below the reference range (1.2-1.9 mg/dL). In Exp2, the increase in crude protein intake led to a linear increase in serum urea (p = 0.0002), although no changes were observed for AP, albumin, AST, ALT, GGT, creatinine, and cholesterol (p > 0.05). This study demonstrated that increasing intake of dOM and CP above the requirements in growing lambs raises serum urea without affecting liver or renal health.

45. Ruminal tannase-producing bacteria and their effects on growth performance, nutrient digestibility, blood parameters, and rumen bacterial populations in weaning Afshar-Kurdi lambs fed pomegranate peel.

期刊: Tropical animal health and production 发表日期: 2026-May-28 链接: PubMed

摘要

This study investigated the effects of ruminal tannase-producing bacteria (TPB) on growth performance, nutrient digestibility, blood parameters, and rumen bacterial populations in weaning Afshar-Kurdi lambs fed pomegranate peel (PP). Forty-nine strains representing the genera Klebsiella, Escherichia, Raoultella, Enterobacter, and Pectobacterium, used to formulate an oral feed additive (OFA). The OFA was administered to thirty-six lambs aged 1-70 days, which were randomly assigned to four treatments: T1 (basal diet), T2 (basal diet + 1 mL OFA), T3 (basal diet + 5% PP), and T4 (basal diet + 1 mL OFA + 5% PP). Growth performance was not affected by dietary treatments, as dry matter intake (DMI), body weight (BW), and average daily gain (ADG) remained unchanged (P > 0.05). However, birth weight significantly influenced DMI, BW, and ADG (P < 0.05). OFA reduced ruminal pH (P < 0.0001) and improved digestibility of fiber fractions, particularly ADF and cellulose (P < 0.01). In contrast, PP increased ruminal pH and NH₃-N concentration (P = 0.009) and decreased DM and CP digestibility (P < 0.05). Significant OFA × PP interactions were observed for DM, CP, CF, NDF, and ADF digestibility (P ≤ 0.01), indicating interactive effects on fiber utilization. Blood metabolites were largely unaffected; however, OFA reduced serum uric acid (UA) by 60.5% (0.58 vs. 1.47 mg/dL; P = 0.01) and increased albumin (ALB) and Glutamate oxaloacetate transaminase (GOT, P < 0.05, while creatinine (CRE) remained unchanged. DGGE analysis revealed treatment-dependent shifts in ruminal bacterial communities, with OFA-supplemented groups showing greater band richness (≈ 11-14 bands per lane) than control and PP-only groups (< 7 bands). Overall, OFA, particularly when combined with PP, enhanced ruminal microbial diversity and fiber digestion without affecting growth performance.

46. Effectiveness of a Mobile Health Exercise Program for Adults With Mobility Disabilities: A Randomised Controlled Trial.

期刊: American journal of physical medicine & rehabilitation 发表日期: 2026-May-28 链接: PubMed

摘要

People with mobility disabilities experience significant barriers to regular physical activity, increasing risks of chronic disease and reducing quality of life. Mobile health (mHealth) programs may help by offering accessible, home-based exercise options. This study compared a 24-week mHealth intervention-with and without social networking-to an attention control condition. In this type 1 hybrid randomized controlled trial, 459 adults with mobility disabilities were randomized to one of three groups: M2M (exercise videos), M2Mplus (exercise videos plus social networking and optional coaching), or attention control (health articles). The 24-week intervention was delivered via a tablet-based app with follow-up through 48 weeks. The primary outcome was the Godin Leisure-Time Exercise Questionnaire (GLTEQ) health contribution score, measured at baseline, 12, 24, and 48 weeks. At the 24-week primary endpoint, the M2Mplus group showed significantly greater increases in GLTEQ health contribution scores compared with attention control (LSM=4.8; 95% CI 1.7-7.8; P=.002). By 48 weeks, the difference was no longer statistically significant. This large hybrid trial shows that scalable mHealth exercise programs can increase short-term physical activity among adults with mobility disabilities, though sustaining activity after the intervention ends remains challenging.

47. Spirituality, religion, and meaning-making in suicide loss: an international overview of clinical responses and therapeutic approaches.

期刊: Journal of religion and health 发表日期: 2026-May-28 链接: PubMed

摘要

Suicide loss confronts individuals with significant existential challenges, positioning spirituality, religion, and meaning-making as central dimensions of post-suicide bereavement. This overview synthesizes findings from existing review studies to explore the complex mechanisms of these dimensions and identify corresponding clinical responses. A narrative synthesis of nine peer-reviewed review papers was conducted following PRISMA guidelines. The search covered a decade from 2015 to 2025, with an updated search in March 2026. Methodological quality was assessed using AMSTAR-2, SANRA, and PRISMA-ScR. Data were analyzed using qualitative software to identify and synthesize key thematic patterns. The synthesis revealed three critical, interlocking themes: (1) The Paradox of Spiritual Engagement, highlighting the tension between religious comfort and spiritual struggle; (2) Meaning Reconstruction as the Core Psychological Mechanism, emphasizing both cognitive-existential and behavioral-occupational pathways; and (3) The Imperative for Existentially Integrated Postvention, which calls for a systems-based approach involving first responders, clinicians, and chaplains. Findings confirm that spirituality and religion are core determinants of bereavement trajectories. Effective postvention requires a comprehensive, systems-based approach that integrates spiritual assessment and meaning-centered therapies to support survivors. Future research should prioritize culturally diverse, spiritually integrated interventions.

48. US Air Quality Index and respiratory health outcomes: background, knowledge gaps, and research prioritization.

期刊: American journal of respiratory and critical care medicine 发表日期: 2026-May-28 链接: PubMed

摘要

The U.S. Air Quality Index (AQI) is the most widely reported tool for public communication of air pollution health risks in the U.S., yet its effectiveness in protecting individuals with respiratory conditions remain poorly understood. The American Thoracic Society (ATS) convened an ad hoc multidisciplinary committee, including participation from relevant officials, to assess the current evidence and define research priorities related to the AQI and respiratory health. The committee conducted a systematic search of the peer-reviewed literature and held a full-day meeting to discuss key topics. Subsequent engagement refined the findings and established consensus on priority research questions. The systematic search indicated significant gaps in the literature, including limited evaluation of AQI effectiveness in changing behavior, few studies assessing health outcomes associated with AQI use, and minimal research on how people with respiratory disease interpret and respond to AQI messaging. Priority research areas span five key domains: AQI structure, sub-daily exposure estimation, communication strategies, clinical and community implementation, and evaluation of health and exposure reductions. Specific research recommendations include evaluating AQI structures that better reflect cumulative and multi-pollutant exposures, developing methods to assess how patients with respiratory conditions interpret and act on AQI messaging, and measuring whether AQI-informed behaviors result in meaningful reductions in exposure and improvements in health outcomes. This research statement outlines a framework for strengthening the scientific foundation of the AQI and improving its effectiveness as a respiratory health protection tool.

49. Association Between Loneliness, Stress, and Access to Healthcare in Older Adults: The Mediating Role of Social Determinants of Health.

期刊: Journal of aging & social policy 发表日期: 2026-May-28 链接: PubMed

摘要

Loneliness and stress are increasingly prevalent among aged 65 years and older and have been linked to poor health outcomes and limited access to care. These psychological factors often intersect with social determinants of health (SDH), yet little is known about how SDH mediate their effects on healthcare utilization. This study used 2023 Behavioral Risk Factor Surveillance System (BRFSS) data to examine the relationships between loneliness, stress, and healthcare access among U.S. adults aged 65 and older (N = 62,878). Key outcomes included having a personal healthcare provider and attending a routine checkup. Ten SDH indicators, including income, education, emotional support, and transportation stability, were examined as mediators using logistic regression and path analysis. Older adults without loneliness or stress were significantly more likely to report better healthcare access. However, higher income, education, and lack of food assistance exhibited suppressor effects, weakening the positive relationship between emotional well-being and provider access. In contrast, transportation stability enhanced this association. Emotional support and life satisfaction fully mediated the relationship between loneliness, stress, and routine checkups. These findings highlight the complex role of SDH in healthcare access, suggesting that both emotional and structural supports are needed to reduce disparities among aging populations.

50. Effect of non-invasive brain stimulation (NIBS) techniques on neuropathic pain in patients with peripheral neuropathies. A systematic review with meta-analysis.

期刊: Neuromodulation : journal of the International Neuromodulation Society 发表日期: 2026-May-07 链接: PubMed

摘要

Painful peripheral neuropathies (PN) are highly prevalent and often refractory to pharmacological treatment. Given the emerging evidence of central nervous system involvement in painful PN, noninvasive brain stimulation (NIBS) techniques have gained attention as potential treatment alternatives. However, findings in neuropathic pain (NP) remain inconsistent, with previous studies reporting small effect sizes and pooling heterogeneous stimulation techniques or NP conditions in single analyses, which could influence the results observed. To overcome these limitations, we aimed to systematically evaluate the efficacy of NIBS on NP in adults with painful PN using stratified analyses by pathology and stimulation modality. We conducted a systematic review and meta-analysis of randomized controlled trials. Searches were performed across seven data bases from inception to November 2025. Eligible trials included adults with painful PN receiving NIBS techniques compared with sham or usual care, with pain intensity as our primary outcome. Methodologic quality was assessed using risk-of-bias tool for randomized trials (RoB 2), and the certainty of evidence using Grading of Recommendations Assessment, Development and Evaluation. A total of 18 trials met inclusion criteria and 13 (n = 569 participants) were included in quantitative synthesis. For postherpetic neuralgia, repetitive transcranial magnetic stimulation (rTMS) over the motor cortex produced modest reductions in pain intensity from immediate post treatment [MD (95% CI): -1.96 (-2.96 to -0.97)] to three-month follow-up [MD (95% CI): -1.23 (-2.34 to -0.14)], with low to moderate certainty. Sensitivity analyses confirmed effects at two-week and one-month follow-ups. Conversely, evidence for rTMS or transcranial direct current stimulation (tDCS) in diabetic neuropathy, radiculopathies, brachial plexus injuries, and post cancer treatment neuropathies was nonsignificant, with low to very low certainty. Although rTMS could provide short-term analgesic effects in certain PN, heterogeneity in protocols and populations underscores the need for standardized, high-quality trials with longer follow-ups.

51. Operationalizing the Ottawa Charter for Health Promotion in Thailand: the role of ThaiHealth.

期刊: Health promotion international 发表日期: 2026-May-05 链接: PubMed

摘要

52. How to Minimize Avoidable Coverage Losses Under Medicaid Work Requirements.

期刊: JAMA health forum 发表日期: 2026-May-01 链接: PubMed

摘要

This JAMA Forum discusses system design, outreach efforts, and job training in the context of the Medicaid work requirements passed into law as part of the 2025 budget reconciliation package.

53. Patient Digital Engagement With After Visit Summary in Ambulatory Care.

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

摘要

The after visit summary (AVS) is believed to be a critical mechanism for postvisit communication, and health systems are widely adopting digital AVS systems to comply with federal regulations. However, little is known regarding the physician time cost of writing the AVS and whether patients routinely engage with the digital AVS. To assess patterns of patient digital AVS engagement following ambulatory care visits and the associated physician time cost. This cross-sectional study analyzed ambulatory care visits that occurred between June 1, 2018, and May 31, 2023, at a large, urban, academic health care system with multiple hospitals and outpatient clinics. All ambulatory visits by adults between the study period that were captured in the institutional electronic health record system were included. Data were analyzed in May 2025. The primary outcome was engagement with the digital AVS through the patient portal following an ambulatory visit. Secondary measures included patient demographic factors, visit variables (including clinic specialty [primary care, urgent care, medical specialties, surgical specialties] and visit type [video, nonvideo]), and physician-specific behaviors (including time spent writing patient instructions, using composition tools, and physically printing the AVS). A total of 6 262 623 ambulatory care visits were analyzed. Most visits were made by female patients (3 890 100 [62.1%]), and 51.0% of all patients were aged 55 years or older. Digital AVS engagement increased from 20.8% in 2018 to 37.6% in 2023. Physicians spent a median (IQR) duration of 1.38 (0.52-3.28) minutes per visit writing patient instructions, despite the AVS not being viewed in 62.4% of encounters. AVS composition varied by physician specialty, with surgeons using a greater percentage of templated text (63.6% of AVS text) and medical specialists entering more text manually (50.7% of AVS text). Patient engagement varied by demographic factors, with higher engagement among married vs single patients (AME, 6.6 [95% CI, 6.1-7.1] percentage points) and retired vs employed patients (AME, 5.1 [95% CI, 4.5-5.6] percentage points). Lower engagement with the digital AVS was found among males vs females (AME, -3.1 [95% CI, -3.7 to -2.5] percentage points), non-English speakers vs English speakers (AME, -15.0 [95% CI, -15.9 to -14.2] percentage points), and those with Medicare (AME, -3.3 [95% CI, -4.2 to -2.5] percentage points) or public insurance (AME, -3.6 [95% CI, -4.4 to -2.9] percentage points) compared with private insurance. Physician behavior was also associated with digital AVS engagement, with presence vs nonpresence of physician-written patient instructions associated with higher engagement (40.5% vs 34.3%) and printed vs nonprinted AVS associated with lower engagement (31.6% vs 38.8%). Compared with primary care, medical and surgical specialties were associated with lower digital AVS engagement (medical: AME, -4.3 [95% CI, -5.3 to -3.2] percentage points; surgical: AME, -2.9 [95% CI, -4.1 to -1.7] percentage points), while urgent care showed no significant difference (AME, -0.6 [95% CI, -2.2 to +1.0] percentage points). In this cross-sectional study of ambulatory visits, digital AVS engagement increased but remained low and was associated with a high time investment for physicians. This inefficiency in postvisit communication emphasizes the need to reconsider such communication, particularly with unmarried males, non-English-speaking populations, and publicly insured populations, and in specialty care settings.

54. Test-Retest Reliability of Standardized Diagnostic Interviews for Common Adult Psychiatric Disorders: A Systematic Review and Meta-Analysis.

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

摘要

Standardized diagnostic interviews (SDIs) are structured assessments based on established criteria to improve the consistency and reliability of diagnoses. The pooled test-retest reliability of SDIs for adult psychiatric disorders is unknown. To estimate the test-retest reliability of SDIs used to classify common adult psychiatric disorders, examine variations in test-retest reliability between disorders, and assess prespecified factors associated with between-study heterogeneity. MEDLINE, Embase, Emcare, PsycINFO, and Applied Social Sciences Index and Abstracts were searched without date or language limitations from inception until September 2025. References of eligible articles and relevant reviews were also screened. Primary studies that evaluated test-retest reliability of SDIs assessing adult psychiatric disorders were selected. Disorders were selected based on estimated prevalence in the general adult population, clinical relevance, and frequent appearance in SDIs. Data were extracted and study quality was assessed based on the Consensus-based Standards for the Selection of Health Measurement Instruments checklist. Multilevel random-effects meta-analysis and meta-regression were performed. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Test-retest reliability estimates (Cohen κ) of SDI-based adult psychiatric disorder diagnoses. Pooled estimates were calculated for 5 groups of mental disorders (anxiety, bipolar, depressive, personality, and nonaffective psychoses) and 8 groups of substance use disorders (SUDs; alcohol, cannabis, cocaine, hallucinogens, opioids, sedatives, stimulants, and tobacco). Fifty-seven studies were analyzed, 46 of which were included in the meta-analysis (535 κ estimates; N = 8146 participants [mean age range, 22.0-54.3 years]). The pooled estimate of SDI test-retest reliability was κ = 0.69 (95% CI, 0.66-0.72), with substantial between-study heterogeneity (Q534 = 23 578.7; P < .001; I2 = 93%). Reliability was higher for SUDs than for mental disorders (κ = 0.72 [95% CI, 0.69-0.72; 292 estimates] vs 0.65 [95% CI, 0.61-0.69; 243 estimates]; z = 3.74; P < .001) and varied among disorder types. Reliability for mental disorders ranged from κ = 0.55 (95% CI, 0.44-0.66) for nonaffective psychoses to κ = 0.74 (95% CI, 0.56-0.91) for bipolar disorders. Reliability for SUDs ranged from κ = 0.59 (95% CI, 0.49-0.70) for hallucinogens to κ = 0.81 (95% CI, 0.74-0.88) for opioids. Univariate meta-regression indicated that diagnostic criteria partially explained between-study variation in SUDs, whereas methodological quality indicators (eg, small sample size and retest interval) did not. In this systematic review and meta-analysis, SDIs showed moderate and heterogenous test-retest reliability that varied substantially across common adult psychiatric disorders. The findings indicated that structural standardization alone may not be sufficient to ensure consistent psychiatric diagnosis and highlighted the importance of considering contextual and phenomenological information into diagnostic assessment and research practice.

55. High-Deductible Health Plan Enrollment and Buprenorphine Dispensing.

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

摘要

Buprenorphine can prevent opioid overdose deaths among patients with opioid use disorder (OUD). Among privately insured patients using buprenorphine, it is unclear whether switching from a non-high-deductible health plan (HDHP) to an HDHP is associated with changes in buprenorphine dispensing or OUD-related health care visits. To evaluate the association between switching to an HDHP, buprenorphine dispensing, and OUD-related health care visits. Repeated cross-sectional difference-in-differences analysis of the 2010 to 2023 Optum Labs Data Warehouse, a longitudinal clinical database with deidentified claims. Analyses included privately insured adults who were continuously enrolled throughout a baseline and follow-up year and had buprenorphine dispensing in the baseline year. The treatment group included patients who switched from a non-HDHP to an HDHP. The control group included patients who remained in a non-HDHP. Data were analyzed from January 1, 2025, through February 1, 2026. Switching to an HDHP. Annual number of days with active buprenorphine prescriptions; annual number of OUD-related outpatient visits; annual number of OUD-related emergency department visits or hospitalizations. Linear models with patient fixed effects compared changes in outcomes among the treatment and control groups. In a subgroup analysis, the treatment group was limited to patients experiencing a deductible increase exceeding the median of $1250. Among 14 801 included patients (9419 [63.6%] male), switching to an HDHP was associated with a differential decrease in the number of days with active buprenorphine prescriptions (-29.0; 95% CI, -35.0 to -22.9) but not with changes in OUD-related outpatient visits (-0.5; 95% CI, -1.0 to 0.05) or OUD-related emergency department visits and hospitalizations (4.0 events per 100 patients; 95% CI, -0.5 to 8.4 events per 100 patients). In the subgroup analysis, switching to an HDHP was associated with a differential decrease in the number of OUD-related outpatient visits (-1.0; 95% CI, -1.8 to -0.3). Results for other outcomes were similar to the overall analysis. In this repeated cross-sectional study using difference-in-differences analysis of privately insured patients using buprenorphine, those who switched to an HDHP were more likely to decrease buprenorphine use. When deductible increases were large, patients who switched to an HDHP were also more likely to decrease the number of OUD-related outpatient visits. Findings suggest that switching to an HDHP may be associated with heightened barriers to OUD treatment.

56. Validation of a 2-Gene Blood Test for Kawasaki Disease in Febrile Children.

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

摘要

Kawasaki disease (KD) remains a clinical diagnosis without an objective molecular test. Early identification is critical to prevent coronary artery complications through timely intravenous immunoglobulin therapy. To validate a 2-gene whole-blood quantitative polymerase chain reaction (qPCR) assay measuring IFI27 and MCEMP1 expression for distinguishing KD from other pediatric febrile illnesses. This multicenter diagnostic study was conducted in Taiwan and Shanghai, China. Patient blood samples were collected prospectively between 2012 and 2023 in Taiwan and between 2022 and 2023 in Shanghai and analyzed retrospectively from children younger than 8 years with KD and febrile controls (FCs) with viral, bacterial, or mixed infections. Data were analyzed from January 2022 to August 2025. Diagnostic accuracy of a prespecified 2-gene KD score derived from change in cycle threshold values normalized to glyceraldehyde 3-phosphate dehydrogenase, assessed by area under the receiver operating characteristic curve (AUC), sensitivity, specificity, predictive values, and likelihood ratios. A total of 541 children (mean [SD] age, 3.7 [1.9] years; 300 [55.5%] male), including 243 children with KD and 298 febrile controls, were analyzed. The KD score achieved an AUC of 0.91 (95% CI, 0.88-0.94), with a sensitivity of 94% (95% CI, 93%-97%) and a specificity of 82% (95% CI, 78%-86%). The positive likelihood ratio was 5.12, and the negative likelihood ratio was 0.05. Performance was consistent across cohorts, including incomplete KD, diverse FC etiologies, and coronary artery phenotypes. The assay was implemented as a laboratory-developed test. Analytical validation demonstrated high linearity (R2 > 0.99), precision (coefficient of variation <5%), and sample stability for up to 6 days at 4 °C or for 24 hours at room temperature. This diagnostic study found that a 2-gene laboratory-developed whole-blood qPCR assay measuring IFI27 and MCEMP1 expression accurately distinguished KD from other febrile illnesses using standard molecular platforms. Prospective evaluation in broader populations is warranted to determine its clinical utility for reducing diagnostic delay and coronary complications.

57. Development and Validation of a Prediction Model for Cardiovascular Risk in Reproductive-Aged Women.

期刊: JACC. Advances 发表日期: 2026-May 链接: PubMed

摘要

Currently available risk scores for cardiovascular disease (CVD) were developed in older populations and do not incorporate sex-specific factors, which limits their ability to provide accurate estimates in younger women. The objective of the study was to develop and validate a prognostic model, including female-specific risk factors, that can identify women at high risk. We created a cohort of 262,891 women aged 15 to 45 years with 1 randomly selected delivery from 1999 to 2017 in the Clinical Practice Research Datalink database to develop models for screening women within the first-year postpartum. The primary outcome was incident CVD. The least absolute shrinkage and selection operator method and an accelerated failure time Weibull model were used to determine the inclusion of predictors and to estimate the final model. Internal validation via bootstrapping was used to estimate the optimism-corrected measures of model performance. A total of 943 women (0.81 per 1,000 person-years) experienced a cardiovascular event over a median follow-up of 3.8 years (Q1-Q3 1.5-7.9). Predictors in the final model included traditional CVD risk factors, along with social deprivation, polycystic ovary syndrome, prior use of oral contraceptives, depression, thyroid disorders, hypertensive disorders of pregnancy, gestational diabetes, preterm birth, small-for-gestational-age birthweight, parity, and history of pregnancy complications. Optimism-corrected performance median (Q1-Q3) measures showed modest discrimination (C-statistic: 0.637 [0.623-0.650]) and good calibration (slope: 0.919 [0.905-0.930]). Although the model showed modest predictive accuracy and performance, the findings highlight the importance of sex-specific risk factors for identifying women at high risk of CVD in the postpartum period.

58. Musculoskeletal disorders in ophthalmologists and ophthalmology residents in Brazil.

期刊: Arquivos brasileiros de oftalmologia 发表日期: 2026 链接: PubMed

摘要

To assess musculoskeletal symptoms, identify the most affected body areas, and investigate factors associated with the development of musculoskeletal disorders among ophthalmologists in Brazil. A survey was conducted using an online questionnaire and snowball sampling. Statistical analyses were performed using Jamovi version 2.3.28, and graphs were generated using RStudio version 2023.06.2 + 561. A total of 233 participants (42 ophthalmology residents and 191 ophthalmologists) were included, with a mean age of 40.4 years (standard deviation 11.3; range 25-73 years). Musculoskeletal symptoms were reported by 83% of participants. The cervical region (57.1%), upper back (54.5%), and lumbar region (53.6%) were the most frequently reported sites of pain. A high body mass index was identified in 54.9% of the sample, and 50.2% of participants reported using painkillers in the previous year for musculoskeletal symptoms. The mean duration of professional activity in ophthalmology was 13.5 years, and the mean weekly workload was 39 hours. A significant association was observed between weekly workload and the presence of musculoskeletal disorders (p=0.045). This study demonstrated a high prevalence of musculoskeletal disorders among ophthalmologists in Brazil, particularly involving the cervical, lumbar, and upper back regions, consistent with findings reported in international studies. Important contributing factors include long working hours, a high patient volume, and repetitive or awkward postures during examinations and procedures. Preventive strategies and improvements in working conditions are needed to protect the health and well-being of ophthalmologists.

59. The Impact of Sociodemographic Factors on Job Insecurity Among Obstetric Nurses Under the Low Fertility Background: A Linear Mixed-Effects Model Analysis and Targeted Intervention Strategies.

期刊: Journal of multidisciplinary healthcare 发表日期: 2026 链接: PubMed

摘要

With the continuous decline in fertility rates in China, the demand for obstetric care services has decreased, posing severe challenges to the occupational security and mental health of obstetric nurses. The purpose of this study is to explore the effects of demographic sociological variables of obstetrical nurses on sense of security under the background of low fertility rate, identify the key driving factors, and put forward intervention countermeasures based on the empirical results, in order to improve the professional survival status of obstetric nurses and stabilize the obstetric nursing team. From April to May 2025, 406 obstetric nurses were recruited as the research subjects by using the two-stage sampling method and surveyed using a general information questionnaire and Job Insecurity Scale. Q-Q plots assessed data normality; normally distributed data were expressed as M±SD, with t-tests/ANOVA (SNK-q for pairwise comparisons).Under the premise of controlling the hospital agglomeration effect, the factors influencing the hospital agglomeration effect were analyzed by using the linear mixed effect model. Obstetric nurses’ total job insecurity score was 76.07±22.80, with 69.21% above the median (62.5). Linear mixed-effects model analysis showed significant differences (all P<0.05): secondary hospital nurses had higher job insecurity scores than tertiary hospital ones (β=12.55, 95% CI: 6.66~18.43); contracted nurses scored higher than staffed nurses (β=18.832, 95% CI: 13.254~24.409); those with monthly salary ≤4,000 yuan scored higher than ≥6,001 yuan (β=10.002, 95% CI: 2.891~17.113); nurses with 6-10 years of experience scored higher than ≤5 years (β=7.741, 95% CI: 1.829~13.653); team leaders scored lower than general nurses (β=-9.457, 95% CI: -16.245~-2.669). The model explained 26% of individual and 23% of hospital-level variance in job insecurity scores. Obstetric nurses in Chongqing have relatively high job insecurity affected by hospital and individual factors. This study provides empirical support for a dual approach of “optimizing hospital environment and precise individual empowerment” to stabilize the team and ensure maternal-infant safety.

60. Handgrip Strength Thresholds to Detect Cardiometabolic Risk in Youth: Cross-Sectional Study and Meta-Analysis.

期刊: Journal of cachexia, sarcopenia and muscle 发表日期: 2025-Oct 链接: PubMed

摘要

Muscular fitness, particularly handgrip strength, is increasingly recognized as a robust marker of cardiometabolic risk (CMR) in children and adolescents. However, evidence-based diagnostic thresholds for identifying at-risk individuals remain scarce, particularly in children. This study aimed to (1) establish sex-specific diagnostic thresholds for handgrip strength normalized to body weight to identify elevated CMR in children aged 8-11 years, and (2) synthesize existing evidence through a systematic review and meta-analysis across pediatric age groups, integrating the new data with existing evidence. We analyzed cross-sectional data from 1124 Spanish children (49.7% girls) aged 8-11 years participating in the MOVI-2 study. Normalized handgrip strength was associated with a CMR index composed of waist circumference, triglyceride-to-HDL ratio, mean arterial pressure and fasting insulin. Diagnostic accuracy was assessed using receiver operating characteristic curves and optimized with the Youden Index. Results from the MOVI-2 study and other diagnostic accuracy studies were combined in a meta-analysis for identifying the optimal threshold for normalized handgrip strength to identify elevated CMR in youth. In the MOVI-2 study, thresholds were 0.38 for boys and 0.34 for girls, with area under the curve (AUC) of 0.77 (95% CI: 0.73-0.81) and 0.75 (95% CI: 0.70-0.79), respectively. The systematic review and meta-analysis followed PRISMA-DTA guidelines and included nine additional studies (n = 10 588). Meta-analytic thresholds for normalized handgrip strength were 0.30 for girls and 0.39 for boys in childhood (6-12 years), and 0.36 for girls and 0.42 for boys in adolescence (13-18 years), with the highest diagnostic accuracy observed in adolescent girls (AUC = 0.80, 95% CI: 0.77-0.83; Youden Index = 0.60). Children showed greater heterogeneity, particularly in specificity. Despite certain limitations, our findings provide clinically relevant, sex- and age-specific thresholds for normalized handgrip strength to identify elevated CMR in youth. These thresholds may serve as a valuable starting point for CMR screening in both boys and girls.