公共卫生研究摘要 (2026-06-01)

共收录 55 篇研究文章

1. Characterization of volatile organic compounds emissions and health risk assessment in coking industry: A case study in East China.

期刊: Journal of environmental sciences (China) 发表日期: 2026-Jul 链接: PubMed

摘要

Volatile organic compounds (VOCs) represent a critical category of air pollutants, and the emissions from anthropogenic sources are essential for understanding and managing VOC pollution and the resultant ozone (O3) pollution. Several research initiatives have evaluated VOC emissions from significant industrial sources in China; however, knowledge regarding VOC emissions in the coking industry is still insufficient. The investigation examines the characteristics of VOC emissions from the coking industry through detailed unit-based field sampling, constructs emission source profiles, identifies provincial VOC emission characteristics, and assesses potential health risks to workers. Experimental results indicate that the primary categories of VOC emissions in the coking section are alkanes and alkenes, whereas aromatics and oxygenated VOCs predominate in the gas purification and sewage treatment sections. The fingerprint VOC species in these sections are n-pentane, benzene, and i-propanol, respectively. The highest emission factor occurs in the coking oven unit. The ozone formation potential research indicated that the coking oven and the condensing and blasting units significantly influence O3 formation, with propene being the predominant contributor. Additionally, the health risks associated with different physical work intensities for occupational workers are examined, indicating that heavy physical labor can cause serious carcinogenic risks to workers. Benzene is a predominant carcinogenic hazard, whereas 1,1,2-trichloroethane is the primary non-carcinogenic VOC species in coking industry. This study provides a comprehensive understanding of the pollution profiles and environmental risks of VOCs discharged from the coking industry, informs the implementation of VOC regulations, and promotes cleaner production.

2. Liver Aging Index: A Noninvasive Score for Liver Biological Aging and Liver-Related Outcomes in Multicohorts.

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

摘要

Biological aging is a key determinant of liver disease and mortality, but there is little evidence on noninvasive index for assessment of liver biological aging. We developed the Liver Aging Index (LAI) in the China Kadoorie Biobank (CKB, N = 21,629) using Cox-Gompertz proportional hazards model. The LAI incorporated three clinical factors (body mass index, systolic and diastolic blood pressure), eight plasma biomarkers (glucose, total cholesterol, triglycerides, high- and low-density lipoprotein cholesterol, alanine aminotransferase, aspartate aminotransferase, and γ-glutamyl transpeptidase), and two imaging biomarkers (fat attenuation parameter and liver stiffness measurement). External validation was conducted in the National Health and Nutrition Examination Survey (NHANES; N = 3412) and the VCTE-Prognosis cohort (N = 12,170, 16 global centers). Across all cohorts, the LAI demonstrated strong discrimination for all-cause mortality (AUROC: 0.764 in NHANES; 0.759 in VCTE-Prognosis), outperforming chronological age (p < 0.05). Liver aging acceleration (LAA), defined as the difference between LAI and chronological age, was associated with substantially elevated risks: each 1-SD increase in LAA conferred a 22%-85% higher risk of all-cause mortality and a 34%-170% higher risk of liver-related event or mortality. Using genetic instruments identified in CKB, we found genetic predisposition to accelerated liver aging was associated with higher risks of cirrhosis and liver cancer (HR = 3.94 [3.20-4.86] and 7.82 [2.05-29.80]), further validated in Biobank Japan. Integrating genetics and proteomics revealed novel pathophysiological involvement of amyloid-beta clearance pathway and amyloid precursor protein in liver aging. These findings demonstrate the feasibility of a noninvasive, liver-specific biological aging index and provide new insights into mechanisms underlying liver aging.

3. Pragmatic measurement of mechanisms: Does use of coping strategies mediate the effects of a teacher stress intervention?

期刊: Journal of school psychology 发表日期: 2026-Jun 链接: PubMed

摘要

Supporting teachers to cope with occupational stress is an important area of research. Many studies have examined the initial efficacy of teacher stress interventions; however, none have tested potential causal mechanisms. A previous study of a bibliotherapy teacher stress intervention based in cognitive-behavioral therapy (CBT) revealed positive effects on stress, coping, depression, and anxiety (n = 52, Eddy et al., 2022). The purpose of the present study was to examine the use of coping strategies as a mediator of treatment effects in the previously reported randomized control trial study. Growth modeling analyses revealed that reported use of coping strategies increased throughout the course of the intervention with the slope favoring the treatment group (moderate growth treatment d = 0.43; and overall treatment effect of d = 0.88). Reported use of coping strategies mediated the intervention effects on stress (31% of the total treatment effect) and coping (69% of the total direct effect) but did not mediate the intervention effects on depression or anxiety. These findings suggest that participants’ reported use of coping strategies led to immediate benefits of stress reduction and improved coping but were not associated with distal effects on depression and anxiety. Future teacher stress studies should consider including repeated measures of theory driven mechanisms to examine changes over time and hypothesized causal pathways to intervention effects.

4. Food insecurity in New York City college students during the COVID-19 pandemic: a longitudinal analysis of predictors, correlates, and trajectories.

期刊: Journal of American college health : J of ACH 发表日期: 2026-May-31 链接: PubMed

摘要

To examine predictors, correlates, and trajectories of food insecurity (FI) among students during COVID-19. Undergraduates. Between 2020-2021, students completed quarterly (T1-T4) self-administered questionnaires. FI comprised food not lasting or not affording balanced meals. Trajectories were created using cumulative FI reports. Across time, FI varied (T1 = 21%, T2 = 25%, T3 = 17%, T4 = 19%). FI predictors included preexisting FI, need-based aid, low social support, alcohol use, COVID-19 care-seeking behaviors, violence experience, transgender/gender non-conforming [TGNC] identity, and unsafe home perceptions. FI trajectories spanned Never (69%), Rarely (12% FI once), Frequently (14% FI twice/thrice), and Persistently (5%). Along with low social support, Persistently FI students had high psychological distress, need-based aid, unsafe home perceptions, smoking/vaping, drug use, TGNC representation, violence experience, and COVID-19 care-seeking behaviors. FI was associated with sociodemographic, residential, interpersonal, psychosocial, behavioral, and healthcare-related factors. In routine campus operations and emergency situations, universities must develop multi-component interventions to address multi-factorial stressors.

5. Exploring associations between sexual orientation, substance use, loneliness, and sense of belonging in a large college sample.

期刊: Journal of American college health : J of ACH 发表日期: 2026-May-31 链接: PubMed

摘要

Objective: We examined illicit substance use (including and excluding marijuana), mental health, alcohol consumption, and binge-drinking among postsecondary institution students, by sexual orientation. Participants: Students that completed the 2022-2023 Healthy Minds Study (N = 76,406), with complete demographic, substance use, and mental health responses. Methods: Weighted logistic regression models assessed the relationship between sexual orientation and substance use and mental health. Results: Positive mental health and a sense of belonging were protective against past 30-day substance use reporting (excluding marijuana), but the same protection was not seen in past two-week alcohol consumption and binge-drinking behavior. Respondents older than 20 years old had significantly lower odds of binge-drinking. Conclusions: Campuses should continue devoting appropriate resources to programming geared toward underage students for the dangers of excessive alcohol consumption. Additional strategies bolstering students’ sense of belonging on campuses may also be protective against students’ use of illicit substances.

6. In the End, What Shall We Say?

期刊: Journal of pain & palliative care pharmacotherapy 发表日期: 2026-May-31 链接: PubMed

摘要

7. A log-adjusted t-statistic for large clinical laboratory datasets: a simulation study and real-world application.

期刊: Scandinavian journal of clinical and laboratory investigation 发表日期: 2026-May-31 链接: PubMed

摘要

In large datasets, conventional t-tests may identify statistically significant but practically trivial differences because statistical significance increases with sample size. A log-adjusted t-statistic, defined as an empirical sample-size-aware modification of the classical t-statistic, was evaluated to reduce this oversensitivity. Performance was assessed by Monte Carlo simulations of two-sample comparisons across sample sizes from 10 to 50,000 and effect sizes from δ = 0 to 1.0, and by application to a real clinical laboratory dataset comprising 464,145 participants. In simulations, the log10⁡(Df)-adjusted statistic showed null rejection rates close to 0.05 across sample sizes, whereas the classical t-test became increasingly oversized at very large n. The adjustment was more conservative for small effects (δ = 0.2-0.4) while high rejection rates were retained for larger effects (δ = 0.6-1.0). In the real-data analysis, several sex differences that were highly significant by the classical t-test had small effect sizes and yielded reference p-values above the conventional 0.05 threshold after adjustment; platelet count (Cohen’s d = 0.13) changed from p < 10-300 to reference p = 0.052, and potassium (d = 0.05) from p = 10-51 to reference p = 0.104. In contrast, larger effects such as hematocrit (d = 0.83) and HDL cholesterol (d = 0.77) continued to yield reference p-values below that threshold. These reference p-values were compared with the conventional α = 0.05 threshold for illustrative purposes only and were not intended to imply formal Type I error control. These findings suggest that the log-adjusted t-statistic may serve as a useful empirical decision aid for interpreting large clinical laboratory datasets by attenuating sample-size-driven significance while preserving detection of substantively meaningful effects.

8. An Evidence-Based Master of Public Health Curriculum.

期刊: Public health reports (Washington, D.C. : 1974) 发表日期: 2026-May-31 链接: PubMed

摘要

This evaluation describes an innovative approach to align a master of public health (MPH) core curriculum with the Evidence-Based Public Health (EBPH) framework and the 2016 revised Council on Education for Public Health (CEPH) competencies. We describe implementation of revised core courses during the COVID-19 pandemic and student evaluation of the novel curriculum. Faculty mapped competencies to the EBPH framework, developed courses, and implemented the curriculum using a cohort model. For early cohorts enrolled from fall 2020 through summer 2021, faculty evaluated the effectiveness of the core courses, student satisfaction, and self-reported competency achievement through pre- and postcourse surveys starting in fall 2020. Additional qualitative insights were gathered from 6 focus groups (n = 50 students) and 10 interviews conducted in spring 2022. The redesigned curriculum launched in fall 2020 and emphasized an interdisciplinary approach that incorporated vital domains: health equity, community engagement, and the essential public health services. Survey findings indicated increased student self-efficacy and achievement of CEPH competencies. High retention and positive qualitative feedback underscored this curriculum’s relevance for students with diverse backgrounds, including those who were new to public health, online learning, or US graduate education. Ongoing quality improvement and iterative curriculum refinement ensure that the evolving needs of public health practice are met. The lessons learned through developing and implementing this evidence-based curriculum across delivery modes serve as an opportunity for other institutions aiming to enhance public health education in diverse student populations and address workforce needs. Applying this framework ensures that students attain the competencies required for the 21st-century public health workforce.

9. Physical activity, but not sedentary behavior, affects bone mineral density: Insights from a comprehensive genome-wide cross-trait analysis.

期刊: Journal of sports sciences 发表日期: 2026-May-31 链接: PubMed

摘要

The shared genetic architecture linking physical activity, sedentary behavior, and osteoporosis risk remains unclear. We investigated the genetic basis, pleiotropic effects, and causal relationships between moderate-to-vigorous physical activity (MVPA), leisure screen time (LST), and heel estimated bone mineral density (eBMD). Leveraging summary statistics from genome-wide association studies of European individuals (MVPA: N = 606,820; LST: N = 526,725; eBMD: N = 426,824), we conducted a genome-wide cross-trait analysis. A significant global genetic correlation was observed for MVPA and eBMD (rg = 0.13, P = 7.97 × 10-11), but not for LST and eBMD (rg = - 0.02, P = 0.34). Two specific genomic regions showed evidence of local genetic correlation. Cross-trait meta-analysis identified 90 pleiotropic loci, of which 20 were novel. Transcriptome-wide association studies revealed 42 shared genes. Mendelian randomization suggested a causal relationship between genetically predicted MVPA and eBMD (beta = 0.07, 95%CIs = 0.01-0.14, P = 0.03), but not for LST (beta = 0.01, 95%CIs = - 0.04-0.05, P = 0.81). Our findings demonstrate a shared genetic basis and pleiotropic effects between MVPA and eBMD, highlighting their intrinsic link and supporting MVPA’s role in osteoporosis prevention.

10. [Artificial intelligence in diabetic retinopathy screening].

期刊: Orvosi hetilap 发表日期: 2026-May-31 链接: PubMed

摘要

Visual impairment and blindness continue to represent a substantial disease burden in Hungary. According to national epidemiological data, the combined prevalence of bilateral blindness and severe visual impairment among individuals aged 50 years and older is approximately 0.9%, and international estimates suggest that around 90% of vision loss cases could be prevented or treated with appropriate care. However, the coverage of ophthalmic screening remains low, primarily due to the lack of targeted financing, limited ophthalmology workforce capacity, and the absence of a unified national screening protocol. The aim of our study is to review the professional, organizational, financial, legal and ethical conditions for the implementation of artificial intelligence-supported ophthalmic screening in Hungary, with a particular focus on diabetic retinopathy. We conducted a targeted narrative literature review of national epidemiological, human resource, and cost data, as well as an analysis of international diabetic retinopathy screening models and the European Union regulatory frameworks for medical devices and artificial intelligence, using sources selected based on clinical and public health relevance. The level of Hungarian ophthalmological screening practice is insufficient to significantly reduce the burden of preventable vision impairment, primarily due to limited human resources and funding constraints. The current human resource capacity of the Hungarian ophthalmic care system is insufficient to provide the approximately one million diabetic fundus examinations required annually according to professional guidelines. Preventive and screening activities are not organized as dedicated services but are largely delivered as part of routine ophthalmic outpatient care, without separate financing. International experience indicates that the use of artificial intelligence as a decision-support or triage tool can reduce specialist workload while maintaining diagnostic accuracy. Artificial intelligence-supported fundus screening systems have the potential to improve access to screening, consistency, and efficiency. The introduction of artificial intelligence-based fundus screening in Hungary would require the establishment of appropriate financing mechanisms, regulation of task-sharing involving optometrists and allied health professionals, and compliance with relevant regulatory and ethical frameworks. A transitional hybrid model - combining the pilot use of an internationally validated artificial intelligence system in parallel with launch of domestic development - may offer a realistic pathway toward a structured national screening program and contribute to reducing the disease burden of preventable blindness. Orv Hetil. 2026; 167(22): 865-875. Bevezetés: A látásromlás és a vakság jelentős betegségterhet jelent Magyarországon. Hazai epidemiológiai adatok szerint az 50 év feletti lakosság körében a kétoldali vakság és a súlyos látásromlás együttes prevalenciája megközelíti a 0,9%-ot, és nemzetközi becslések szerint a látásvesztéssel járó esetek mintegy 90%-a megfelelő ellátással megelőzhető vagy kezelhető lenne. A szemészeti szűrés lefedettsége alacsony, amit a célzott finanszírozás hiánya, a szemész szakorvosi kapacitás korlátozottsága és az egységes országos protokoll hiánya magyaráz. Célkitűzés: Tanulmányunk célja a mesterséges intelligenciával támogatott szemészeti szűrés magyarországi bevezetésének szakmai, szervezeti, finanszírozási, jogi és etikai feltételeinek áttekintése, különös tekintettel a diabeteses retinopathiára. Módszer: Hazai epidemiológiai, humánerőforrás- és költségadatok, valamint a nemzetközi diabeteses retinopathia szűrési modellek, továbbá az európai uniós, orvostechnikai eszközökre és mesterséges intelligenciára vonatkozó szabályozási keretek célzott narratív irodalmi áttekintését végeztük, a klinikai és népegészségügyi relevancia alapján kiválasztott források felhasználásával. Eredmények: A hazai szemészeti szűrési gyakorlat elsősorban a szemészeti humánerőforrás korlátozott száma és finanszírozási korlátok miatt elmarad attól a szinttől, amely a megelőzhető látásromlásokból adódó betegségteher érdemi mérsékléséhez szükséges. Szemészeti humánerőforrás-kapacitásunk jelenleg nem elegendő a szakmai ajánlások szerint szükséges, évente mintegy egymillió diabeteses szemfenéki vizsgálat biztosításához. A preventív és szűrési tevékenység nem elkülönült kapacitásként, hanem döntően az általános szemészeti szakellátás részeként, önálló finanszírozási háttér nélkül valósul meg. Nemzetközi tapasztalatok alapján a mesterséges intelligencia döntéstámogató vagy triázsoló eszközként történő alkalmazása képes mérsékelni a szakemberterhelést, miközben a diagnosztikai pontosság megőrizhető. Következtetés: A mesterséges intelligenciával támogatott szemfenéki szűrési rendszer javíthatja a szűréshez történő hozzáférést, a következetességet, valamint a hatékonyságot. A mesterségesintelligencia-alapú szemfenéki szűrés hazai bevezetése szükségessé teszi annak finanszírozási hátterének biztosítását, a feladatmegosztás szabályozását optometristák és szakdolgozók bevonásával, valamint a jogi és etikai előírások betartását. Egy átmeneti, hibrid modell – amelyben egy nemzetközileg validált mesterségesintelligencia-rendszer pilotformában működik, párhuzamosan a hazai fejlesztés elindításával – reális utat kínálhat egy strukturált, országos szűrőprogram felé, amely hozzájárulhat a megelőzhető vakság betegségterhének csökkentéséhez. Orv Hetil. 2026; 167(22): 865–875.

11. Detection of Palm Lethal Yellowing Phytoplasma in the Salivary Glands of Nesomyndus maculatus and Asymptomatic Bismarck Palms from Madagascar.

期刊: Phytopathology 发表日期: 2026-May-31 链接: PubMed

摘要

Palm lethal yellowing phytoplasmas (PLYPs) are plant pathogens that cause fatal infections in various palm species in tropical regions. The only confirmed vector of these pathogens is Haplaxius crudus Van Duzee (Hemiptera: Cixiidae), a planthopper found in the Neotropics and parts of North America. The recent identification of a new PLYP in Madagascar, ‘Candidatus Phytoplasma katsepyensis’, was the impetus for vector studies. In 2024, an expedition was launched to document planthopper diversity on palms in Madagascar where phytoplasmas had previously been observed to identify putative vectors. Insect specimens belonging to the genus Nesomyndus were collected in relatively high abundance (n = 101) and later determined to represent three species: N. australis, N. maculatus and N. madagascarensis. Additionally, five coconut palms tested positive by qPCR for phytoplasma among the sites surveyed. Among all specimens of all three species, only nine out of 61 specimens of N. maculatus were positive for phytoplasma based on qPCR and high resolution melt curve analysis (HRMA) with four of these nine specimens having detectable levels of phytoplasma in the salivary glands by digital PCR. All positive specimens were collected from a single site. The detection of the phytoplasma in the salivary glands provides strong evidence that N. maculatus is a competent vector of a phytoplasma strain affecting coconuts in Madagascar. Future efforts will determine if the other species are also capable of acquiring the phytoplasma as well as evaluate critical details of the transmission cycle.

12. Wheat Diseases and Pests in Pakistan: A Nationwide Assessment.

期刊: Phytopathology 发表日期: 2026-May-31 链接: PubMed

摘要

Wheat production in Pakistan faces persistent threats from diseases and pests. However, limited geographic information exists on local risks, economic impacts, and management practices. We used expert knowledge elicitation to provide the first integrated assessment of wheat health in Pakistan. Experts mapped yield losses for major diseases and pests at the district level. We analyzed networks of seed and grain exchange and stakeholder interactions. Analysis of wheat cropland connectivity identified locations that are likely to play important epidemiological roles. Cumulative yield losses estimated by experts ranged from 4% to 16%, with hotspots in central Punjab and northern Sindh. Stripe rust, leaf rust, and aphids remained top threats, with increasingly favorable climates and pathogen population structure identified as likely major determinants of yield losses. Experts indicated that national networks included informal exchange of wheat seed and grain, highlighting key pathways for potential spread of seedborne pathogens. In stakeholder networks characterized by experts, farmer associations and seed dealers were strategic points for information sharing and seed health monitoring. Cropland connectivity analysis identified highly connected wheat areas along the Indus River, overlapping with national disease hotspots and facilitating pathogen proliferation. Pakistan has a moderate vulnerability to wheat blast introduction, yet climate change and informal seed movement could increase this potential. These findings provide farmer associations, researchers, and policymakers with actionable control points to enhance wheat health systems in Pakistan. This study establishes a rapid information baseline to support geographically targeted surveillance, spatial disease-resistance deployment, coordinated seed system interventions, and epidemic preparedness planning.

13. Impact of Population-Based Pathogenic Variant Testing on Risk-Based Breast Screening Recommendations: A Secondary Analysis of the WISDOM Study.

期刊: JAMA oncology 发表日期: 2026-May-31 链接: PubMed

摘要

Risk-based breast cancer screening has emerged as a viable alternative to annual mammography. To guide implementation, knowledge is needed on the contribution of testing for pathogenic variants (PVs) beyond clinical risk factors and common genetic variants for population-based risk stratification. To evaluate how many PV carriers in a risk-based breast cancer screening trial would have been recommended for high-risk screening based on clinical risk or clinical plus polygenic risk. This cohort study used retrospective data from the WISDOM Study, a national clinical trial of risk-based vs annual breast cancer screening, to compare screening assignments informed by PV status vs those based on a clinical risk model alone or a clinical risk model combined with a polygenic risk score. WISDOM participants aged 40 to 74 years who tested positive for a PV as part of risk-based screening were included. Data were collected from September 2016 to February 2023, with follow-up to September 2025. Data were analyzed from January to May 2026. Concordance between actual (considering participants’ PV status) and hypothetical screening assignments based on a clinical (Breast Cancer Surveillance Consortium) risk model or a clinical model plus polygenic risk score. Of 712 included women with a PV, the median (IQR) age was 53 (46-62) years. A total of 232 PVs (33%) were high penetrance, 278 (39%) were moderate penetrance, and 202 (28%) were CHEK2 low penetrance. There was little overlap between actual screening assignments based on PV status and hypothetical assignments based on a clinical model plus polygenic risk score. Among high-penetrance PV carriers (a group recommended high-risk screening with magnetic resonance imaging alternating with mammography every 6 months), 2 of 232 (0.9%) would have received the same screening assignment based on clinical plus polygenic risk. Overall, 178 of 279 PV carriers aged 40 to 49 years (63.8%) would have otherwise been recommended to defer screening until age 50 years based on clinical plus polygenic risk, whereas 385 of 433 carriers aged 50 to 74 years (88.9%) would have been recommended biennial mammography. Results were similar when comparing assignments based on a clinical model alone. In this cohort study, most participants with PVs in breast cancer genes would not have been recommended for high-risk screening based on their clinical or clinical plus polygenic risk. PV testing therefore may identify different subsets of high-risk women than clinical risk factors and polygenic risk scores. These findings highlight the importance of population-based PV testing in risk-based screening. ClinicalTrials.gov Identifier: NCT02620852.

14. The Prevalence and Risk Factors for at-Risk MASH and Advanced Liver Fibrosis in People With Metabolic Risk Factors in Primary Care.

期刊: Alimentary pharmacology & therapeutics 发表日期: 2026-May-31 链接: PubMed

摘要

The majority of the burden of metabolic dysfunction-associated steatohepatitis (MASH) exists in primary care; however, the prevalence of severe disease in patients with metabolic dysfunction remains poorly described. A cross-sectional study of 84 general practices located in Victoria, Australia identified patients with metabolic dysfunction over a 12 month period from the PATRON data repository. At-risk MASH was defined using the Fibrotic NASH Index (FNI) based on laboratory data. Patients needing further liver assessment were defined by FIB-4 ≥ 1.3 (≥ 2.0 if 65+ years) and = < 2.67. Advanced liver fibrosis was defined as a FIB-4 of > 2.67. 110,938 individuals were identified with metabolic dysfunction. Of those with a FNI available (n = 16,586), the prevalence of At-risk MASH was 24.3%. Among those with a FIB-4 available (n = 64,948), 16.3% required further liver assessment, while the prevalence of advanced fibrosis was 4.3%. On multivariate analysis, male sex, type 2 diabetes, and hypertension were associated with At-risk MASH, whereas male sex and type 2 diabetes were associated with advanced liver fibrosis. Socio-economic disadvantage was a risk factor for both At-risk MASH and advanced liver fibrosis. Significant liver disease was observed in a substantial proportion of patients with metabolic dysfunction within primary care, particularly among patients with type 2 diabetes, supporting the rationale for risk stratification. Associations with socio-economic disadvantage highlight the need for societal and public health policy change to improve liver outcomes.

15. Residential radon exposure and lung cancer histology and stage: a population-based ecological study in Central Germany.

期刊: Journal of cancer research and clinical oncology 发表日期: 2026-May-31 链接: PubMed

摘要

Residential radon exposure is recognised as one of the leading environmental risk factors for lung cancer and acts synergistically with tobacco smoking. Thuringia, Germany, exhibits high geogenic radon potential; however, population-level associations with lung cancer histology and stage at diagnosis remain insufficiently characterised. We conducted a retrospective ecological analysis of 893 lung cancer cases (2018-2022) from the Thuringian State Cancer Registry. Cases from 96 communities were classified as high- or low-radon exposure based on geogenic radon potential and soil radon activity. Demographics, histology and stage were compared between groups. Population-level lung cancer incidence did not differ significantly between low- and high-radon communities, consistent with age- and sex-adjusted Poisson regression showing no association with residential radon exposure (adjusted IRR 1.05, p = 0.473). However, all cases in women younger than 50 years occurred in high-radon communities. Adenocarcinoma was nominally more frequent (56% vs. 48%, p = 0.04), and among patients with small cell lung cancer (SCLC), extensive-stage disease was more common (64% vs. 49%, p = 0.04), with combined SCLC occurring exclusively; however, these findings were not significant after correction for multiple testing. In this ecological analysis, residential radon exposure was not associated with annual lung cancer incidence but was linked to tumour histology and stage at diagnosis. Given the ecological design and lack of smoking and occupational exposure data, these findings are hypothesis-generating and warrant further investigation to clarify radon’s role in lung cancer biology and prevention.

16. The effects of racial discrimination on Black STEM students' health: A daily diary study.

期刊: Journal of American college health : J of ACH 发表日期: 2026-May-31 链接: PubMed

摘要

Objective: Black STEM students at Predominantly White Institutions face unique challenges related to racial discrimination, which negatively affect health outcomes and academic achievement. Participants and Methods: This study employed a quantitative exploratory design using experience sampling to examine the daily-level associations between discrimination and mental health and substance use among n = 117 Black STEM students. Results: Students were more likely to engage in substance use on days where they experienced racial discrimination compared to days they did not, even after controlling for person-level covariates. While mental health was significantly worse on days with discrimination in bivariate analyses, these associations were not significant in multivariable models. Conclusions: Results highlight the daily toll of racism and call for policy and programming to address racism and support Black STEM students on college campuses.

17. The Relationship Between Sexual Assault Victimization and Academic Outcomes Among Sexual Minority College Students: The Role of Campus Climate and Social Support.

期刊: Journal of interpersonal violence 发表日期: 2026-May-31 链接: PubMed

摘要

Research has established that sexual assault is a persistent social problem among college students. Throughout the last decade, research has found that sexual minority college students disproportionately experience sexual assault in the college context, compared to heterosexual students. While potential mental and physical health consequences of sexual assault are well-documented in the literature, less is known about the academic outcomes. Further, few studies have accounted for other variables to better understand the nuances of this relationship. This cross-sectional study investigates how sexual assault victimization and other factors (i.e., campus climate, institutional response, and social support) are associated with academic outcomes. Participants were recruited via paid Facebook and Instagram social media advertisements. The sample included 241 sexual minority college students in the United States. Linear regression analysis was used to assess how different factors were associated with academic outcomes among this sample. Results from this study indicate that when accounting for other factors, the higher level of social support, a stronger sense of inclusion, and the more trust they felt in their campus’s ability to respond to a report of sexual assault in a fair and just way all uniquely predicted a stronger commitment to continue their education at their current college or university. Students who experienced sexual assault in college and lower levels of social support uniquely predicted lower levels of focus on their current academics. These findings have real-world implications for campus administrators, policy makers, and advocates. Campus investment in inclusive practices and programming, as well as support for sexual minority students, may significantly benefit academic outcomes for this population. Also, building trust in campus responses to sexual assault may positively influence the academic path of students. And finally, the well-being of survivors may be further supported through accessible academic supports and accommodations from staff who work in this area.

18. Distinct epidemiology and treatment outcomes between skeletal and extraskeletal Ewing sarcoma in Japan: a population-based study.

期刊: Japanese journal of clinical oncology 发表日期: 2026-May-31 链接: PubMed

摘要

Ewing sarcoma arises at both skeletal (SES) and extraskeletal (EES) sites; however, whether the anatomical origin influences outcomes in current practice remains uncertain. This study compared clinical characteristics, treatment, and survival rates of patients with SES and EES in a large nationwide Japanese cohort. We analyzed patients diagnosed with Ewing’s sarcoma between 2016 and 2019 in Japan, classified as having SES or EES, using a population-based cancer registry. Demographics, stage, treatment, hospital characteristics, and overall survival (OAS) were evaluated using chi-square tests, Kaplan-Meier estimates, and log-rank analyses. We identified 505 patients with ES: 211 with SES and 294 with EES. Patients with EES were significantly older than those with SES (P < .001). Chemotherapy (97.7% vs. 74.9%, P < .001) and radiotherapy (36.6% vs. 27.1%, P = .024) were administered more frequently in the SES group. Three-year OAS rate was 62.3%, 73.5% for SES, and 54.7% for EES, with significantly worse survival in EES group (P < .001). Favorable prognostic factors included younger age, localized stage, surgery, chemotherapy, treatment at certified institutions, higher hospital volume, and female sex among patients with EES. In this nationwide cohort, EES presented at older ages, received less chemotherapy, and demonstrated inferior survival compared to SES, despite a similar stage distribution. Patient background, hospital type, and volume influenced the outcomes. These findings underscore the need for equitable multimodal therapy delivery, particularly for patients with EES.

19. Structured exercise program following adjuvant chemotherapy for colon cancer: A cost-utility analysis of the CHALLENGE trial.

期刊: Journal of clinical oncology : official journal of the American Society of Clinical Oncology 发表日期: 2026-May-31 链接: PubMed

摘要

The phase III CHALLENGE trial (CCTG CO.21) demonstrated that a 3-year structured exercise program (SEP) improved disease-free and overall survival versus health education materials (HEM) in patients with stage III or high-risk stage II colon cancer after surgery and adjuvant chemotherapy. We assessed the cost-effectiveness of the SEP versus HEM. This pre-specified economic evaluation used prospectively collected data from all trial participants (n = 889). The base case adopted the Canadian public payer perspective and included direct healthcare costs over a 5-year time horizon with a 1.5% discount rate. 36-Item Short Form (SF-36) outcomes were mapped to Short-Form 6-Dimension (SF-6D) utilities using a validated algorithm. Mean costs (2024 CAD) and effects (life-years (LYs) and quality-adjusted life-years (QALYs)) per participant in each intervention group were used to estimate the incremental costs, incremental LYs/QALYs, incremental cost-effectiveness ratio (ICER, $/life-year gain (LYG)), and incremental cost-utility ratio (ICUR, $/QALY) when applicable. Uncertainty was assessed via bootstrapping (1,000 samples). Notable scenario analyses included a 10-year time horizon and a societal perspective incorporating lost wages due to missed work, measured through the Work Productivity and Activity Impairment questionnaire. In the base case, despite an up-front cost of $2,917 to provide the exercise sessions, the SEP ($31,957) was dominant over HEM ($33,546), being less costly (-$1,589) and more effective (+0.05 LYs; +0.10 QALYs). The SEP was dominant in 53% of bootstrap samples, and 80% fell below a $50,000 per QALY willingness-to-pay threshold. Major cost drivers were cancer recurrence or new malignancy and anticancer therapy. Scenario analyses were consistent with the base case. The SEP was less costly and more effective than HEM. This study can inform payers and health-systems with implementation of SEPs in routine care.

20. From Ideas to Curricula: Institutional Adoption of Lifestyle Medicine Through Student-Led Initiatives.

期刊: Health education & behavior : the official publication of the Society for Public Health Education 发表日期: 2026-May-31 链接: PubMed

摘要

Lifestyle medicine, an evidence-based approach to preventing and managing chronic disease through behavior change, remains underrepresented in health professional education. Limited institutional support and funding barriers often prevent students from engaging in experiential learning opportunities that reinforce lifestyle medicine competencies. This study examines how student-led initiatives supported by targeted grant funding can serve as an alternative to promote institutional curricular adoption of lifestyle medicine. Using the American College of Lifestyle Medicine’s (ACLM) project management platform, Asana, and a mixed-methods approach, we analyzed 178 reimbursement forms from the Taste of Lifestyle Medicine (TOLM) grant program. Descriptive analyses summarized the characteristics of Lifestyle Medicine Interest Group (LMIG) and non-LMIG events, while qualitative content analysis of open-ended feedback explored engagement outcomes and perceived value. Between September 2023 and May 2024, 178 funded events reached 6,278 participants across U.S. health professional institutions. More than half of these events were nutrition-focused, integrating plant-predominant meals and culinary demonstrations that generated enthusiasm and community engagement around lifestyle medicine principles. Findings illustrate how combining student advocacy with strategic grant mechanisms can overcome financial and institutional barriers to implementing lifestyle medicine education, especially events such as cooking demonstrations and culinary medicine demos. This case example shows the utilization of the Taba model in which student leadership and external funding drive curricular innovation via increasing student and faculty interest, as well as capacity building in preventive health. This model offers a scalable approach for embedding behavior change and health promotion training within the next generation of health professionals.

21. Building Power for Health: CARE's Community Health Leaders Program.

期刊: Health promotion practice 发表日期: 2026-May-31 链接: PubMed

摘要

Individuals who face the daily impact of health inequities and their social drivers have knowledge and invaluable insights about solutions that are feasible at the local level. Community organizing is a dynamic and proven approach for building power among residents to identify community priorities, advocate for change, and co-create solutions to community issues, which has been applied to advance community priorities in the public health field. To build on evidence and further cultivate a pathway to strengthen community power and capacity within a public health framework, the Community Alliance for Research and Engagement (CARE), a health equity-focused partnership among Southern Connecticut State University, Yale School of Public Health, and the New Haven community, developed and implemented a new initiative, the Community Health Leaders (CHL) Program. The CHL program provides a model for community-centered leadership development as a strategy for advancing health equity. By equipping residents with the skills and support needed to advocate for change, CHL contributes to strengthening community power. Ultimately, continued investment in programs like CHL has the potential to create responsive public health programs and policies, reduce health inequities, and improve health outcomes.

22. Neighborhood disadvantage and cognitive function in older adults: The moderating role of young adult general cognitive ability.

期刊: Health & place 发表日期: 2026-May-31 链接: PubMed

摘要

Neighborhood disadvantage in later life is associated with poorer cognition and increased vulnerability to dementia. Cognitive reserve (CR), an individual’s total cognitive resources, may foster cognitive resilience against dementia in the face of neighborhood disadvantage. However, whether the neighborhood disadvantage-cognition association varies across older adults remains understudied and its moderators remain underexplored. We examined associations between late midlife neighborhood disadvantage and five domain-specific cognitive functions as well as the moderating role of young adult CR on these associations. In 1149 community-dwelling men age 61-73 living across the United States, we assessed neighborhood-level socioeconomic disadvantage using the area deprivation index and cognitive performance in executive function, episodic memory, processing speed, verbal fluency, and visual-spatial ability. General cognitive ability assessed at average age 20 was used as a measure of young adult CR. Years of education was included as another potential moderator for comparison. Greater late midlife neighborhood disadvantage was associated with poorer executive function (β = -.09, p < .05) and processing speed (β = -.12, p < .05). Moreover, those with higher young adult CR showed a weaker association between neighborhood disadvantage and executive function (β = .07, p < .02). The same moderation effect was not observed for years of education. Findings are consistent with the idea that neighborhood disadvantage negatively associates with executive function, albeit less so among those with higher young adult CR. Fostering cognitive development to enhance CR earlier in life may buffer against environmental threats to later-life executive function, which is among the earliest cognitive functions affected in aging, and may, in turn, decrease vulnerability to dementia.

23. Deep learning-based monitoring and localization in autonomous underwater vehicle networks for aquatic ecosystem analysis.

期刊: Journal of environmental science and health. Part A, Toxic/hazardous substances & environmental engineering 发表日期: 2026-May-31 链接: PubMed

摘要

Monitoring the aquatic ecosystem is crucial for effective communication and issuing alerts regarding underwater environmental conditions. None of the existing studies have accounted for varying environmental conditions in underwater ecosystem monitoring and communication systems. In this work, sensor data from the Autonomous Underwater Vehicular Network are tuned using a Fuzzy Custom Convex-based Rule to monitor the aquatic ecosystem effectively. Underwater photos and sensor data are pre-processed, features are extracted, correlations are examined, sensor nodes and AUVs are initialized and grouped, cluster heads are chosen, and models are trained to precisely identify species and detect pollution. Finally, pollution is detected using the DSRCN method. The Disaster Management Model is also trained in the same way as the PDM. The DMM attained an accuracy of 98.91%. Thus, the control stations are based on the SMM, PDM, and DMM outputs. Hence, environmental protection is done based on the alert, and the resource is managed accordingly.

24. Value and Sustainability of Semi-reusable Patch Pump Therapy in Routine Care: A Prospective Multicentre Study.

期刊: Journal of diabetes science and technology 发表日期: 2026-May-31 链接: PubMed

摘要

Patch insulin pumps are often treated as a single class, although fully disposable and semi-reusable designs differ in cost and waste. We evaluated real-world clinical, pharmacoeconomic, and environmental outcomes of a semi-reusable tubeless insulin pump (Microtech Equil™, referred as SR-TIP). Prospective, multicentre, open-label real-world study in adults with type 1 or type 2 diabetes transitioning from continuous subcutaneous insulin infusion (CSII) or multiple daily injections (MDI). Follow-up was 3 months. Primary endpoints were HbA1c non-inferiority and change in hypoglycaemic event frequency. Secondary endpoints included safety, device deficiencies, patient-reported outcomes (Diabetes Treatment Satisfaction Questionnaire, Device Assessment Questionnaire), monthly disposable treatment costs, and waste based on disposable component counts and material composition. Ninety-seven participants completed follow-up (CSII n = 79; MDI n = 18). HbA1c changes met non-inferiority criteria in both groups. Hypoglycaemic events decreased by 45% in CSII users and 86% in MDI users. Device-related adverse events were infrequent and mainly mild. Among participants previously using fully disposable tubeless pumps, mean monthly disposable treatment costs decreased by €108.6 (p < 0.001). The semi-reusable architecture eliminated routine disposal of batteries/electronic components and reduced overall waste. In routine care, a semi-reusable tubeless pump maintained glycaemic control while reducing hypoglycaemia and disposable costs versus fully disposable patch pumps, with measurable reductions in electronic waste. These data support value-based, sustainable diabetes technology adoption.

25. Understanding the Defluorination Mechanism of Per- and Polyfluoroalkyl Substances in Wastewater: From Microscopic Process to Practical Application.

期刊: Small (Weinheim an der Bergstrasse, Germany) 发表日期: 2026-May-31 链接: PubMed

摘要

Per- and polyfluoroalkyl substances (PFAS) are called forever chemicals due to the extremely stable C─F bond (bond energy of 485 kJ·mol-1), which leads the persistent existence in the natural environment thus poses a threat to human health. Compared with simple removal without destruction, defluorination is a more meaningful and thorough way for the harmless disposal of PFAS. In this review, the relationship between the structural properties of PFAS and defluorination mechanism are concluded. Thereafter, we discussed the advantages and limitations of defluorination techniques and specific defluorination pathways of active substances (free radicals and electron). This will provide a comprehensive theoretical foundation for the selection and improvement of defluorination technologies. The influence of key factors on the practical application of defluorination technologies in wastewater treatment plants are assessed in detail from the perspectives of reaction solvents, homogeneous and heterogeneous systems, and reactor design. Importantly, the pilot-scale application of relevant PFAS defluorination technologies has also been discussed. Finally, we prospect for the future research direction of PFAS defluorination from the aspects of precise exploration of reaction pathways, fluorine balance, resource recovery, and life cycle assessment (LCA). This will provide a practical strategy for addressing the urgent issue of PFAS-contaminated wastewater.

26. A Policy Analysis of Pediatric-Focused APRN Integration of Developmental Behavioral Mental Health Into Primary Care.

期刊: Journal of pediatric health care : official publication of National Association of Pediatric Nurse Associates & Practitioners 发表日期: 2026-May-30 链接: PubMed

摘要

Youth referred to developmental behavioral mental health (DBMH) clinicians often encounter prolonged wait times for appointments, placing them at risk for symptom exacerbation. Integrating DBMH care into pediatric primary care can enhance access. This policy analysis explains the policy problem, delineates stakeholders, suggests implementation strategies, and offers recommendations for how pediatric-focused APRNs can provide leadership in integrating DBMH care into pediatric primary care settings.

27. Distribution of Gastrointestinal and Dietary Risk Factors Among U.S. Adults Classified as Having Iron Deficiency Anemia Across Diagnostic Thresholds.

期刊: American journal of hematology 发表日期: 2026-May-30 链接: PubMed

摘要

28. Mapping antimicrobial resistance interventions in ASEAN countries: a scoping review of implementation patterns, One Health integration, and evidence gaps.

期刊: Tropical medicine and health 发表日期: 2026-May-30 链接: PubMed

摘要

Antimicrobial resistance (AMR) is a critical and escalating public health threat globally, with Southeast Asia facing particularly high burdens due to elevated antimicrobial consumption, fragmented health systems, and uneven regulatory enforcement. Although member states of the Association of Southeast Asian Nations (ASEAN) have introduced AMR-related initiatives aligned with the Global Action Plan on AMR, the regional evidence base remains dispersed, fragmented across sectors, and insufficiently synthesized from a One Health perspective. This scoping review aimed to systematically map implemented AMR interventions across ASEAN countries, characterize their implementation patterns, assess the extent of One Health integration, and identify evidence gaps. We conducted a scoping review following PRISMA-ScR guidelines. PubMed/MEDLINE, Scopus, and ScienceDirect were searched for empirical studies published between January 1, 2018, and December 31, 2025, that reported the implementation of AMR-related programs, policies, or interventions in ASEAN member states. Data on country, sector, setting, intervention type, One Health pillar, study design, and outcomes were extracted and analyzed using narrative synthesis. Of 9,832 records screened, 57 studies met the inclusion criteria. Evidence was heavily concentrated in three countries: Thailand (n = 15, 26.3%), Singapore (n = 13, 22.8%), and Vietnam (n = 12, 21.1%), accounting for 70.2% of all studies. Critically, no eligible peer-reviewed studies were identified from Brunei Darussalam, while Laos and Cambodia were represented only through disaggregated data from one multi-country surveillance study. The human health sector dominated (86.0%), while only 8.8% of studies adopted integrated One Health approaches, and no studies addressed the environmental sector in isolation. Antimicrobial stewardship was the most common intervention (63.2% of studies), but explicit use of implementation science frameworks was rare. Fifteen studies (26.3%) evaluated multi-component interventions, indicating an emerging shift toward integrated strategies. Most studies employed observational designs (50.9%) and assessed short-term process outcomes rather than sustained resistance reduction. This comprehensive mapping of AMR interventions across all ten ASEAN countries reveals extreme geographical and sectoral inequities. The complete absence of evidence from three member states and the dominance of hospital-based human health interventions underscore the urgent need for targeted investment in underrepresented settings and genuinely integrated One Health approaches. Without such advances, antimicrobial resistance initiatives in ASEAN will remain fragmented and unable to achieve sustained population-level impact.

29. Spatial heterogeneity in the burden of respiratory syncytial virus infection attributable to low and high ambient temperature in Japan: a nationwide time-stratified case-crossover analysis.

期刊: Respiratory research 发表日期: 2026-May-30 链接: PubMed

摘要

Respiratory syncytial virus (RSV) infection poses a considerable disease burden worldwide. Although multiple studies have estimated the short-term effects of ambient temperature on mortality and morbidity, the burden of RSV attributable to temperature is poorly characterized. This nationwide study aimed to quantify the total burden of RSV infection in Japan attributable to non-optimum ambient temperature conditions, and to partition this burden into contributions from low and high temperatures and from moderate and extreme components of non-optimum temperature. We collected weekly time-series data on the number of reported RSV cases and meteorological variables (mean temperature, relative humidity, wind speed, and sunshine duration) for all 47 Japanese prefectures from 2006 to 2019. An extended two-stage approach was used: First, a time-stratified case-crossover design fitted with conditional quasi-Poisson regression was used to estimate prefecture-specific associations. Second, multivariate random-effects meta-analysis was used to obtain pooled estimates. The number of attributable cases were estimated for temperatures above and below the optimum minimum morbidity temperature (MMT) and further categorized as moderate or extreme using the 2.5th and 97.5th percentiles as cutpoints. Data on 1,227,012 RSV cases reported during the study period were analyzed. The pooled exposure-response relationship between temperature and RSV incidence was U-shaped, with a higher RSV incidence at both low and high temperature levels. In most prefectures the MMT was between the 40th to 50th percentiles of the local temperature distribution. Overall, 21.32% (95% empirical confidence interval [eCI] 18.93% to 22.78%) of cases were attributable to non-optimum temperature, with marked geographic heterogeneity: from 8.24% (95% eCI: - 9.06-21.12%) in Akita, to 32.63% (95% eCI: 27.86-41.78%) in Kagoshima. A greater share of temperature-attributable cases was due to moderate high temperatures (12.27%, 95% eCI: 10.95-13.19%) than to low temperatures (9.05%, 95% eCI: 7.12-10.36%), whereas the contributions of extremely high and extremely low temperatures were relatively small. High weekly mean ambient temperatures over lag 0-3 weeks were associated with a substantial attributable risk of RSV infection. Public health efforts to reduce the RSV burden should take ambient temperature into account, paying particular attention to the impact of sustained, moderately warm conditions.

30. Environmental reservoirs of carbapenem-resistant organisms in the intensive care unit: a multicenter longitudinal study in two middle-income country hospitals.

期刊: Antimicrobial resistance and infection control 发表日期: 2026-May-30 链接: PubMed

摘要

There is limited data regarding environmental reservoirs of carbapenem-resistant organisms (CRO) during non-outbreak settings in resource-limited hospitals, or the role of these reservoirs in healthcare transmission. Prospective longitudinal study in which sinks and high-touch surfaces (HTS) were sampled prior to room cleaning in intensive care units (ICUs) in two hospitals (hospital A, Argentina, and hospital B, India), July 2023-February 2024. Selective media was used to recover CROs. Whole genome sequencing (WGS) and single nucleotide polymorphism (SNP) pairwise analysis were performed on environmental and clinical isolates to evaluate bacterial transmission dynamics. Metagenomic sequencing was performed to evaluate bacterial diversity of environmental samples. Of 541 environmental samples collected, 47.9% in hospital A and 97.5% in hospital B grew at least one CRO. Most CROs tested for the presence of a carbapenemase were positive (63.9-91.0% for hospital A and B isolates, respectively). Carbapenemase producer (CP)-Acinetobacter baumannii and CP-Pseudomonas spp. predominated in HTS and sinks samples, respectively, in hospital A; while CP-Klebsiella pneumoniae predominated in hospital B samples. WGS of 113 CRO isolates and SNP analysis demonstrated certain lineages established enduring reservoirs in the ICUs environment (e.g., blaVIM-36 P. aeruginosa ST395 isolates with 2-9 SNP difference were detected in sinks over 7 months). Several clusters involving environmental and clinical isolates that shared an epidemiological link and displayed ≤ 10 SNP difference were identified (e.g., blaOXA-23 A. baumannii ST195 isolated from three unique patients who stayed in the same private room on sampling months 4, 5, 6 and 7, and from HTS of that room on sampling month 5 displayed 0-3 SNP difference). Metagenomic analysis identified additional AMR genes of clinical importance. CROs were abundant and persisted in the ICU environment in countries with high prevalence of MDROs. Our data suggests movement of clones between the environment and patients.

31. Suicide attempts, self-harm and suicidal ideation among Norwegian university students with eating disorders and disordered eating: the SHoT study 2018 and 2022.

期刊: BMC psychiatry 发表日期: 2026-May-30 链接: PubMed

摘要

Eating disorders (EDs) and disordered eating (DE) are associated with elevated risk for suicide attempts, self-harm and suicidal ideation. Still, gender-specific knowledge about the frequency and association of EDs and DE with these outcomes among university students is limited. This study examines gender-stratified frequencies and associations between EDs and DE, and suicide attempts, self-harm and suicidal ideation. We pooled data from the students` Health and Wellbeing Study (SHoT) collected in 2018 and 2022, including Norwegian fulltime students aged 18-35 (N: 98 925). Participants completed self-report measures assessing EDs (including subtypes) and symptoms of DE (EDS-5), suicide attempts, self-harm and suicidal ideation during the last 12 months. Statistical analyses included logistic regression to assess associations between EDs, DE and suicide attempts, self-harm, and suicidal ideation. Further, a single item analysis of the EDS-5 was performed for the same outcomes. We found that female, male and gender diverse students with EDs had substantially elevated odds of suicide attempts, self-harm and suicidal ideation, and for DE, moderately elevated odds, compared to students without these conditions. We found the strongest associations among males with EDs, but precision was limited in several subgroup analyses because of small cell counts. Particularly items “comfort eating” and “feeling guilty about eating” on EDS-5 were closely associated with reports of suicide attempts, self-harm and suicidal ideation. We found consistently high rates of suicide attempts, self-harm and suicidal ideation among students with EDs and DE across genders, and robust associations between EDs and DE, and suicide attempts, self-harm and suicidal ideation. These findings underscore the importance of considering gender-specific patterns and targeted items to enhance assessment practices in student health settings. Identifier: NCT05731102.

32. Nutritional status and attitudes toward overweight and obesity among health-science students in Vietnam.

期刊: BMC public health 发表日期: 2026-May-30 链接: PubMed

摘要

To assess nutritional status across different health-professional disciplines and to examine attitudes toward overweight and obesity and their associated factors among undergraduate health-science students in Vietnam. A cross-sectional analytical study was conducted among 764 undergraduate students from medicine, nursing, pharmacy, and other health programs at two universities in Hanoi. Stratified random sampling ensured representation by major and academic year. Nutritional status was classified by BMI using WHO Asian cutoffs. Attitudes toward obesity were measured using the 20-item Attitudes Toward Obese Persons Scale and analyzed in three domains identified by factor analysis. Physical activity, emotional well-being, and resilience were assessed using validated scales. Ordered logistic regression identified predictors of higher BMI category, and Tobit regression examined factors associated with attitude domain scores. Most students had normal BMI, while overweight and obesity were more common in males, in certain living situations, and in general medicine students. Female gender and pharmacy major were associated with lower odds of higher BMI, whereas higher depression scores were associated with higher BMI category. Attitudes toward obesity showed moderate negative stereotypes and relatively positive beliefs. BMI category was associated only with the psychological inferiority domain, with higher scores among students with overweight. Female gender, lower depression, higher happiness and resilience, and moderate physical activity were associated with more favorable attitude profiles. Among Vietnamese health-science students, nutritional status and attitudes toward obesity varied across demographic and psychosocial characteristics. Excess weight and weight-related attitudes appear partly independent but influenced by mental well-being and training context. Integrated health promotion and stigma-reduction strategies in health-professional education may improve both student health and future obesity care.

33. The COOL-AF 3-year prediction models for death, ischemic stroke, and major bleeding: a report from the COOL-AF registry.

期刊: Journal of thrombosis and thrombolysis 发表日期: 2026-May-30 链接: PubMed

摘要

Patients with atrial fibrillation (AF) are at increased risk of death, ischemic stroke/systemic embolism (SSE), and major bleeding. Most existing risk models focus on short-term outcomes and are derived mainly from Western populations. We aimed to develop and validate 3-year prediction models for these outcomes in an Asian AF cohort and to compare their performance with established risk scores. We analyzed the 3-year data from the prospective, nationwide COOL-AF registry, enrolling patients with non-valvular AF from 27 hospitals in Thailand. Multivariable Cox proportional hazards models were used to derive prediction models for death, SSE, and major bleeding. Model performance was assessed using discrimination (C-statistics), calibration, and reclassification metrics, and compared with GARFIELD, CHA₂DS₂-VASc, and HAS-BLED models. Among 3,405 patients, 380 deaths, 134 SSE events, and 199 major bleeding events occurred over a median follow-up of 35.9 months. The 3-year COOL-AF models showed good discrimination, with C-statistics of 0.728 (0.712-0.743) for death, 0.703 (0.687-0.718) for SSE, and 0.700 (0.685-0.716) for major bleeding, and demonstrated good calibration. Compared with existing scores, the COOL-AF models performed better than CHA₂DS₂-VASc for death and better than HAS-BLED for major bleeding, while showing comparable or superior performance to the GARFIELD models, particularly for bleeding risk. Reclassification indices further supported the incremental value of the COOL-AF models. In conclusion, the 3-year COOL-AF prediction models provide an acceptable levels of prediction, well-calibrated estimates of death, SSE, and major bleeding in Asian patients with AF and outperform commonly used clinical risk scores, supporting their use for long-term risk stratification and clinical decision-making.

34. Physical function impacts hearing without mediation from systolic blood pressure.

期刊: Scientific reports 发表日期: 2026-May-30 链接: PubMed

摘要

The common cause theory of age-related hearing loss and age-related disorders of cognition suggests that there are shared underlying physiological variables that may be modified with intervention. This study examined the interrelationships among physical function (PF), systolic blood pressure (SBP), hearing, and cognition in 150 adults aged 50-80 years old, utilizing a Bayesian generalized structural equation modeling approach. The findings suggest that every 10-point increase in PF results in a decrease of hearing threshold by 1.35 dB HL (95% CrI: -0.232, -0.038) independent of SBP, while every 10-year increase in age increases SBP by 7.5 mm Hg (95% CrI: 0.417, 1.098) and increases hearing threshold by 8.78 dB HL (95% CrI: 0.608, 1.152). This indicates a more active lifestyle is associated with better hearing and that while SBP increases with age, it does not mediate the relationship between PF and hearing. Sex differences were observed in hearing outcomes, with males exhibiting poorer hearing. Additionally, there was only a minimal effect of PF on cognition, and this modest improvement was not explained by systolic blood pressure in our analytical sample. These results underscore the complexity of the pathways linking cardiovascular health, sensory function, and cognitive aging. The lack of mediation by SBP highlights the importance of targeting PF directly, rather than relying solely on blood pressure management for preserving auditory and cognitive health.

35. Evaluating an Online Training Program for Child Sexual Abuse Prevention in Schools: The Role of Training, Leadership, and Policy in Educator Awareness and Reporting.

期刊: Journal of child sexual abuse 发表日期: 2026-May-30 链接: PubMed

摘要

The problem of school employee sexual misconduct or educator sexual misconduct remains persistent and largely taboo. Yet, organizational priorities and norms play a critical role in determining how effectively schools can prevent such misconduct. This paper examines the impact of Praesidium’s online training program by analyzing changes in school employee attitudes and beliefs across three time points: pre-training, immediately after the training, and two to three months after the training. It also incorporates perspectives from school administrators to gain a fuller understanding of what is happening in educational institutions regarding child sexual abuse (CSA) prevention. The educators in the sample come from 63 schools in 12 school districts from 9 states across the U.S. These schools include both independent and public institutions, and several had previously reported incidents of educator sexual abuse. The schools were selected using a purposive and outreach-based strategy aimed at engaging a diverse cross-section of K-12 institutions. By combining survey data with insights from administrator interviews, this paper captures factors that shape school employee preparedness to recognize and respond to sexual misconduct and boundary-crossing behaviors (BCB). The findings highlight the effectiveness of the training program in enhancing knowledge related to grooming, reporting responsibilities, and school culture. This research underscores the importance of equipping educators with practical tools to prevent CSA and emphasizes the need for clear policies and professional development that promote safer learning environments for all. In this paper, school employee sexual misconduct and educator sexual misconduct are used interchangeably.

36. Champions and early adopters in an implementation-effectiveness study of shared decision making: implications for interpersonal strategies.

期刊: Implementation science communications 发表日期: 2026-May-30 链接: PubMed

摘要

Although recommended, shared decision making (SDM) is not widely adopted for primary prevention of cardiovascular (CV) disease. Champions may influence peer adoption if they are enthusiastic and skilled. We describe adoption of an SDM conversation aid for CV risk reduction (CV Prevention Choice) by champions and early adopters in a pragmatic implementation trial and consider their influence on uptake in clinics. We embedded the SDM tool in the electronic health record in three U.S. health care systems. Eight of their 15 affiliated clinics deployed a champion implementation strategy. Adopters used the SDM tool in ≥ 2 routine clinical encounters. Superusers had ≥ 20 encounters. Penetration was the proportion of adopters among eligible clinicians. Adoption and penetration were assessed in the usual care (early adoption), active implementation, and maintenance implementation phases. Thematic analysis methods were used to analyze qualitative data from individual interviews and periodic reflections. Between May 2021 and January 2025, 37 interviews with clinicians and other staff and 65 periodic reflections were completed. Among 176 clinicians, 55% (n = 97) used CV Prevention Choice at least once and 42% (n = 76) adopted it. Champions and other opinion leaders gave presentations and demonstrated their practice, but targeted individual persuasion and group dialogue were less common, especially when champions appreciated peers’ preferences. Champions used the tool more frequently (median = 93, IQR 53-150) than non-champions (median = 16, IQR 4-50), although only 4 of the top 20 users were champions. Clinics with champions had higher penetration rates (50% vs 29%) and lower rates of one-time tool use than clinics without champions (17% vs 33%). Champions, superusers, and other opinions leaders may influence peer adoption of clinical innovations by sharing their experience, but group discourse may be needed to build the case for uptake of innovations. Superusers may be impactful in clinics without formal champions. The protocol described herein was registered with ClinicalTrials.gov on 22 June 2020 (No. NCT04450914).

37. Control of a hospital outbreak with methicillin-resistant Staphylococcus argenteus in The Netherlands, June-September 2023.

期刊: Antimicrobial resistance and infection control 发表日期: 2026-May-30 链接: PubMed

摘要

Staphylococcus argenteus belongs to the Staphylococcus aureus complex and causes similar disease. Methicillin-resistant S. argenteus (MRSArg) is rare in the Netherlands. We describe the first hospital outbreak and its management. After a healthcare worker linked to a patient with MRSArg bacteremia tested positive, cohort screening of healthcare workers, patients, and family members was performed. Carriers received eradication therapy. Whole-genome multilocus sequence typing (wgMLST) and antimicrobial susceptibility testing were used to characterize isolates and mupirocin resistance. Fifteen (2.6%) MRSArg carriers were detected: 9/317 (2.8%) healthcare workers, 4/238 (1.7%) patients, 2/16 (12.5%) family members; age range 22-88 years, median 55 years. Nine (60%) were complicated and six (40%) uncomplicated carriers. After transfer of one initially negative patient to a nursing home, subsequent positivity led to two carriers among nursing home staff. wgMLST confirmed a single outbreak cluster of 15 isolates, all MLST ST2250. The isolates carried mecA, dfrG, and blaZ, but not PVL. Eradication therapy was started in 13/15 (86.7%) persons, with 84.6% (11/13) successful eradication. Six isolates carried a V588F-mutated ileS gene and had mupirocin MICs of 2-32 mg/L; nine were sensitive. We report the first successfully controlled MRSArg hospital outbreak in the Netherlands. The outbreak strain was clonally related and showed low-level mupirocin resistance linked to a mutated ileS gene. This work supports the importance of infection prevention and control measures that are applied for MRSA are also effective for MRSArg.

38. Child Maltreatment and Trauma Symptoms Role in the Development of Intrusive Sexual Behaviors Among Children.

期刊: Journal of child sexual abuse 发表日期: 2026-May-30 链接: PubMed

摘要

Given the high rate of sexual victimization committed by youth, it is critical to identify the etiological pathways of intrusive sexual behavior (ISB) to prevent future acts. ISBs are sexual behaviors that are aggressive, forceful, or otherwise coercive. Previous research has suggested that child maltreatment experiences are key environmental risk factors for ISB. The specific mechanism requires further study, including the potential pathway of subsequent posttraumatic symptom clusters (PTSS) sequela and ISB. This paper investigated maltreatment type and PTSS as risk factors in the development of ISBs. Caregivers of 106 children aged 3-12 who were referred to a specialty outpatient clinic for problematic sexual behaviors completed measures of child trauma, PTSS (e.g. reexperiencing, hyperarousal), and PSB frequencies, including ISBs. Results demonstrated a significant association between traumatic events and PTSS. A direct effect between CPA and ISB was found (ß = 1.22, t = 2.54, p = .04), as well as a significant indirect effect of CPA through hyperarousal symptoms (ß = 0.26, CI = 0.015-0.634) to ISB. CSA did not exert a direct effect on ISB or through any PTSS symptoms. Lastly, no direct effect of reexperiencing or hyperarousal on ISB was found. These results are discussed through clinical implications and future research for the prevention of future sexual victimization among children. The pattern of results is consistent with etiological research on disruptive behaviors overall, supporting future longitudinal research examining environmental, developmental, and neurological risk and protective factors.

39. Motor control exercise program versus standard care in the treatment of lumbopelvic pain in pregnant women: a randomized controlled pilot trial.

期刊: Chiropractic & manual therapies 发表日期: 2026-May-30 链接: PubMed

摘要

Lumbopelvic pain is highly prevalent in pregnant women and although exercises are part of the strategies used to manage pregnancy-related lumbopelvic pain (PLBPP), available evidence regarding their effectiveness is inconclusive. The primary objective of this pilot study was to assess the feasibility of implementing a motor control exercise program for pregnant women presenting with a history of, or currently experiencing lumbopelvic pain. The secondary objective of the study was to explore the preliminary effectiveness of the program. Women aged 18-40 years with a singleton pregnancy at gestational age ≤ 20 were eligible if they had a history of lumbopelvic pain or were currently experiencing their first PLBPP episode. Participants were randomly allocated to an intervention group (n = 16) or a control group (n = 16). The intervention group received standard prenatal care and participated in three 40-minute exercise sessions per week (one supervised and two unsupervised) from gestational age ≤ 20 weeks through 34-36. The control group received only standard prenatal care. Primary outcomes were recruitment, retention, and adherence rates, safety and acceptability of the intervention, whereas secondary outcomes included PLBPP frequency and intensity, PLBPP-related disability and several other PLBPP-related outcomes. Descriptive statistics were used to assess the feasibility and the preliminary effectiveness of the intervention. Over a 15-month period, 32 participants were recruited (April 2021 to July 2022). Of these, 26 (11 in the intervention group and 15 in the control group) attended the post-intervention visit, yielding an 81.3% retention rate. The adherence rates were similar for supervised and unsupervised exercise sessions; however, acceptability was higher for supervised sessions than for unsupervised sessions. No adverse events were reported. At pre-intervention, participants’ characteristics were similar between both groups except for education levels (higher in the control group). Preliminary results showed no clear differences in PLBPP frequency, intensity or associated disability between groups. The motor control exercise program appears safe and feasible, with minor modifications. Optimization of recruitment strategies and participant adherence is warranted before proceeding to a full-scale randomized controlled trial. The study has been registered at the US National Institutes of Health Clinical trials registry (Clinicaltrials.gov) (05/02/2020) NCT04253717.

40. Trajectories of sickness absence in healthcare workers: a cohort study in a Spanish hospital between 2018 and 2023.

期刊: BMC health services research 发表日期: 2026-May-30 链接: PubMed

摘要

Sickness absence (SA) is a key indicator of health and job performance. The COVID-19 pandemic increased workload and stress, potentially affecting healthcare workers’ (HCWs) health and retention. This study aimed at identifying vulnerable HCW groups by analysing SA trajectories before and after the pandemic. A retrospective longitudinal study was conducted using administrative data from HCWs at Hospital del Mar, Barcelona, Spain, 2018-2023. SA was measured as cumulative days per semester. Latent Class Growth Analysis with zero-inflated Poisson models identified SA trajectories. The associations between socio-demographic and employment variables (occupation, shifts, care setting) and SA trajectories was analysed using bivariate analysis and multinomial logistic regression, yielding adjusted odds ratios (aOR) and 95% confidence intervals (95% CI). An overall increase in accumulated SA days per semester was observed among HCWs between 2018 and 2023. Five SA trajectories were identified: zero (7.8%), low (53.7%), degrowing (16.4%), growing (15%), and high (7%). Women were more likely to belong to growing (aOR: 1.54; 95% CI: 1.16-2.05) and high (aOR: 1.77; 95% CI: 1.14-2.74) trajectories. Aides were strongly associated with the high trajectory (aOR: 30.7; 95% CI: 9.55-98.7). Working in non-direct care areas was associated with the zero trajectory (aOR: 2.86; 95% CI: 1.79-4.58) and negatively to the high trajectory (aOR: 0.54; 95% CI: 0.31-0.93). Night shifts were associated with the high trajectory (aOR: 1.78; 95% CI: 1.21-2.60). SA among HCWs increased 2018-2023, following distinct trajectories related to gender, care level, and occupation. Persistent pandemic effects and key sociodemographic and work-related factors shape these patterns. Targeted occupational health interventions could mitigate SA in high-risk groups and enhance healthcare system resilience.

41. Use of virtual reality simulation in preparation for practical training in healthcare education - a mixed method study with students and educators.

期刊: BMC medical education 发表日期: 2026-May-30 链接: PubMed

摘要

Simulation-based education promotes active learning and reflective practice in healthcare education. With the advancement of immersive technologies, virtual reality (VR) enables simulation of complex clinical interactions in a safe and engaging environment. This study explored the experiences and perceptions of students and educators regarding the use of VR-based dialogue simulations as preparation for practical training in physiotherapy and occupational therapy education. A concurrent mixed-methods design was applied. Ninety-three second-year bachelor students participated in two short VR scenarios simulating communication with a child with cerebral palsy and her father. Data was collected through a post-simulation questionnaire for the students (n = 49) and a focus group interview with five educators. Questionnaires were analyzed descriptively, while reflexive thematic analysis was employed on the interviews. Students described VR simulation as a valuable and safe learning experience. They highlighted the importance of observing peers, engaging in structured reflection, and receiving feedback. The VR component contributed by providing brief but immersive encounters with the child and parent avatars, which enriched the subsequent reflections. Educators emphasized that the simulations triggered emotional engagement and promoted deep learning, particularly during the debriefing phase. Both explicit learning outcomes (e.g., practicing open-ended questions) and implicit outcomes (e.g., increased confidence, emotional resilience) were identified. Technical support and a structured pedagogical model were essential for successful implementation. VR-based simulations represent a promising pedagogical approach for developing communication skills in healthcare education. Their effectiveness depends on constructive alignment of learning objectives, structured facilitation, and reliable technical support. Future research should examine long-term skill transfer and optimize VR design for complex interpersonal interactions.

42. Temporomandibular joint disorders in dental students - a systematic review of the literature.

期刊: BMC oral health 发表日期: 2026-May-30 链接: PubMed

摘要

Temporomandibular disorders (TMD) are a group of musculoskeletal conditions that may affect quality of life and functional performance. Dental students represent a population potentially at increased risk due to academic demands, psychosocial stress, and occupational strain; however, reported prevalence estimates and associated factors vary across studies. This systematic review aimed to synthesize evidence published between 2010 and 2024 on the prevalence of TMD among dental students and to examine reported associations with psychological stress, gender, and stage of dental education. A systematic literature search was conducted in PubMed, Scopus, Web of Science, and Embase in accordance with PRISMA 2020 guidelines. The search strategy combined controlled vocabulary (MeSH and Emtree terms) and free-text terms. Original quantitative studies involving dental students were included. Data extraction included study characteristics, diagnostic methods, prevalence estimates (n/N, %), and reported associations. Methodological quality was assessed using an adapted Newcastle-Ottawa Scale, and the certainty of evidence was evaluated using the GRADE framework. Due to substantial heterogeneity in diagnostic criteria and outcome measures, a qualitative synthesis was performed, with studies grouped according to diagnostic approach. Missing data were coded as “NA”, and non-reportable prevalence values were indicated as “NR”. A total of 23 studies were included. Reported prevalence of TMD ranged from 15.0% to 82.3%, reflecting differences in diagnostic methods and study designs. Studies using standardized diagnostic criteria (RDC/TMD or DC/TMD) generally reported lower prevalence estimates compared to those using self-reported instruments. Psychological stress was assessed in 15 out of 23 studies; however, reported associations with TMD were not consistent. Associations with gender were also inconsistently reported. The overall certainty of evidence was rated as low. Temporomandibular disorders are frequently reported among dental students; however, prevalence estimates vary considerably due to methodological heterogeneity. Reported associations with psychological stress and gender are inconsistent, and the predominantly cross-sectional design of included studies precludes causal inference. Future research should prioritize standardized diagnostic criteria, validated assessment tools, and longitudinal designs to improve comparability and strengthen the evidence base.

43. Heat exposure and cardiovascular risk factors among migrant and seasonal farmworkers in the United States: data from the National Agricultural Workers Survey (1999-2020).

期刊: Journal of exposure science & environmental epidemiology 发表日期: 2026-May-30 链接: PubMed

摘要

The United States (U.S.) currently lacks a Federal occupational heat standard and hot weather threatens the safety and health of farmworkers who often work under extreme heat conditions. Chronic disease and related risk factors can enhance worker susceptibility, yet prior studies on heat vulnerability in farmworkers used small samples over short time periods, leaving knowledge gaps about the scope of the problem. To describe temperature exposures and characteristics, including cardiovascular disease (CVD) and risk factors (diabetes, high blood pressure, elevated cholesterol), of a U.S. national sample of farmworkers over a 21-year period. We obtained demographic and health data on farmworkers from the U.S. National Agricultural Workers Survey (NAWS) and publicly available temperature data from 1999 to 2020. We aggregated temperature datasets to six NAWS regions and calculated average daily mean temperature days above four absolute thresholds of 32.2-40.6 Celsius (°C) and seasonal average summertime temperatures to represent potential exposure of the survey population. We used joinpoint regression to describe temporal patterns in temperatures and the prevalence of CVD outcomes within the repeated cross-sectional NAWS data. Multivariate logistic regression analysis was used to explore patterns in CVD outcomes across farmworker characteristics. Farmworkers (n = 44,388) were predominantly Hispanic (81%) and male (73%) with 33% below the poverty level and 40% receiving benefits from needs-based government programs. Seasonal temperatures experienced overall increasing trends, and all regions experienced days over heat thresholds. Prevalence of diabetes, high blood pressure, and CVD generally increased over the study period, with some diminishing trends for diabetes and high blood pressure after 2017. Increasing prevalence of CVD and related risk factors, combined with the aging workforce and other social vulnerabilities, support targeted actions to mitigate heat-related health risks and ensure safety and health provisions for this essential workforce. Elevated temperatures pose a risk of morbidity and mortality for farmworkers and outdoor workers in general. We present evidence from a nationwide survey that U.S. farmworkers, while generally younger and healthier than the population as a whole, experience potential vulnerability to heat as their prevalence of cardiovascular disease, average age and risk factors have risen nationally over 21 years. These results highlight the need to pass and implement heat standards and policies to ensure the safety and health of this essential workforce, in light of the absence of such standards in all but five states.

44. Sensor wide association studies in digital medicine.

期刊: NPJ digital medicine 发表日期: 2026-May-30 链接: PubMed

摘要

Assoziation studies revolutionized genomics by rigorously screening large feature sets against health outcomes. Digital medicine now produces similarly high-dimensional, longitudinal sensor data from wearables, smartphones, and connected environments. We propose Sensor-Wide Association Studies (SWAS): structured, feature-wide, hypothesis-generating scans of a pre-specified library of sensor-derived features against one or more pre-defined clinical phenotypes, with transparent feature documentation, appropriate longitudinal modeling, and principled control of multiplicity. This perspective outlines minimal standards, common failure modes, and ethical considerations to help SWAS become a reproducible foundation for digital epidemiology and personalized medicine.

45. Development and Validation of the Vocal Health Literacy Scale (VHLS) for English-Medium Instruction Educators: A Sequential Mixed-Methods Study.

期刊: Journal of voice : official journal of the Voice Foundation 发表日期: 2026-May-30 链接: PubMed

摘要

English-medium instruction (EMI) educators perform sustained occupational voice use and may experience elevated vocal load and voice-related risk. Despite extensive research on teacher voice symptoms, tools to quantify educators’ competencies in accessing, understanding, appraising, and applying voice-health information and resources remain limited. This study developed and validated the Vocal Health Literacy Scale (VHLS) for EMI educators. A sequential exploratory mixed-methods design was used across five phases. Phase 1 involved semistructured interviews with EMI educators (N = 12) to elaborate domains and generate items using reflexive thematic analysis. Phase 2 employed a two-round Delphi process with a multidisciplinary expert panel (N = 15) to establish content validity (I-CVI; S-CVI/Ave) and refine the item pool. Phase 3 pilot testing with EMI educators (N = 52) evaluated feasibility, clarity, and preliminary item performance and informed item reduction. Phase 4 large-scale validation with EMI educators in Malaysia (N = 520) used split-sample EFA (n = 260) and CFA (n = 260), reliability estimation (McDonald’s ω; Cronbach’s α), convergent/discriminant validity (AVE; factor correlations), measurement invariance (gender, teaching context, EMI experience), and external validity testing (vocal hygiene behaviors, help-seeking intention, vocal fatigue). Phase 5 examined test-retest reliability over 14-28 days (N = 82; ICC [3,1]). Qualitative analysis yielded seven domains reflecting both core health literacy processes and occupational/EMI-specific demands. Delphi findings supported excellent content validity (final S-CVI/Ave: relevance = 0.92; clarity = 0.91; EMI-context fit = 0.93) and produced a 48-item draft. Pilot testing supported feasibility and guided refinement to a 38-item version. Large-scale validation supported a seven-factor model explaining 62.4% of variance, with acceptable CFA fit (CFI = 0.947; TLI = 0.941; RMSEA = 0.054; SRMR = 0.058) and high reliability (overall ω = 0.94). Measurement invariance was supported at full/partial scalar levels across subgroups. External validity patterns were theoretically coherent (higher VHLS associated with more frequent hygiene behaviors and stronger help-seeking; and with lower vocal fatigue). The final VHLS is a 35-item, seven-domain, literacy-grounded multidimensional instrument comprising core literacy competencies (access/navigation, understanding, appraisal, help-seeking), behavioral enactment (self-management), and contextual moderators (institutional barriers/supports, EMI-specific vocal load). Domain scores are re–ed as the primary basis for interpretation, whereas the total score should be understood as a broad composite profile of voice-health readiness/capacity rather than a narrow literacy index.

46. Integrating urban land-use characteristics and heavy metal exposure in assessing pediatric gut microbiota: Implications for environmental management.

期刊: Integrated environmental assessment and management 发表日期: 2026-May-29 链接: PubMed

摘要

Early-life exposure to environmental pollutants poses a critical risk to pediatric health, yet few studies have integrated chemical contaminants with urban land-use characteristics to assess their combined associations with the developing gut microbiome. In this study, we evaluated the associations between fecal heavy metal (HM) concentrations and residential land-use cover area (measured as area-based metrics within specific buffers), as well as gut microbial composition and predicted functional pathways, in 78 preschool children from the greater Taipei area. Using Bayesian kernel machine regression (BKMR), we characterized nonlinear and interactive exposure-response relationships. Elevated fecal cadmium (Cd) levels were significantly and positively associated with increased abundance of Bacteroides (q = 0.02), while nominal positive associations were observed with Klebsiella and Veillonella. Fecal lead (Pb) showed a suggestive positive association with Phocaeicola (q = 0.07). Crucially, residential land-use features modified these associations: increased gas station coverage was linked to lower Bacteroides and Veillonella levels but higher Klebsiella abundance, whereas green-space coverage was positively associated with Veillonella. The BKMR model highlighted synergistic negative associations between fecal Cd and gas station area coverage within a 1500-m residential buffer on Veillonella and Bacteroides, suggesting that the spatial distribution of physical urban infrastructure may be linked to the apparent effects of chemical contaminants on the gut microbiota. These environmental contaminants were further associated with alterations in predicted microbial functional pathways involved in energy metabolism, secondary metabolite biosynthesis, and genetic information processing. These findings suggest that children’s gut health may be associated with a complex interplay of urban chemical and structural factors. Our results underscore the need for science-informed urban management and health-protective zoning, which may inform strategies such as optimizing land-use cover area of gas stations near residential areas and increasing urban greenery to mitigate environmental risks during critical developmental windows.

47. Cluster Randomized Trial of Reablement Strategies Targeting Sarcopenia (ReStart-S) in Long-Term Care Settings.

期刊: The journals of gerontology. Series A, Biological sciences and medical sciences 发表日期: 2026-May-29 链接: PubMed

摘要

Sarcopenia prevalence is high in long-term care settings (LTCS), yet existing guidelines often overlook this population. The Reablement Strategies targeting Sarcopenia (ReStart-S) program was developed to address this gap. This study evaluated its effects on muscle outcomes, physical performance, quality of life (QoL), and a blood biomarker. A cluster-randomized trial was conducted in LTCS across Udupi and neighbouring districts. Sarcopenic older adults (≥60 years, Barthel Index ≥60, Mini-Cog ≥3, AWGS-2019 criteria) were recruited. LTCS were randomized into intervention (IG) and control (CG) groups. IG received a 6-week ReStart-S program, while CG continued usual activities. Outcomes at baseline, 6, 12, and 18 weeks included handgrip strength (HGS, primary outcome), skeletal muscle index, Short Physical Performance Battery (SPPB), SarQoL, and C-terminal Agrin Fragment (CAF; not assessed at 12 weeks). Linear mixed models evaluated grouptime interactions with Bonferroni correction. Of 12 LTCS screened, 7 were eligible; 78 participants enrolled (IG = 39; CG = 39). CG was older than IG (74.3 ± 9.4 vs. 67.9 ± 6.0; p < 0.001). Significant grouptime interaction was observed for HGS (F = 5.524; p = 0.001), improving at 12 (2.49; 95% CI: 1.16-3.82; p < 0.001) and 18 weeks (2.14; 0.79-3.48; p = 0.002). SPPB improved at 6, 12, and 18 weeks (all p < 0.001). SarQoL improved at all follow-ups (all p < 0.001). Skeletal muscle index improved at 18 weeks (0.20; p = 0.011). CAF decreased at 18 weeks (-61.77; p < 0.001). ReStart-S improved muscle strength, physical performance, and QoL, reduced CAF, and showed delayed muscle mass gains, supporting its role in sarcopenia care in LTCS.

48. Life's Essential 8 and the incidence and progression trajectory of chronic lung diseases: A multistate analysis of a prospective cohort study.

期刊: Chinese medical journal 发表日期: 2026-May-29 链接: PubMed

摘要

The association of Life’s Essential 8 (LE8) with the development of first chronic lung disease (FCLD), progression to chronic lung multimorbidity (CLM), and subsequent mortality remains inconclusive. In addition, the relative importance of individual LE8 components is unclear. We used data from the UK Biobank, including 391,384 participants free of chronic lung diseases (CLDs) at baseline. CLM was defined as the coexistence of two or more CLDs, including asthma, chronic obstructive pulmonary disease (COPD), idiopathic pulmonary fibrosis (IPF), and lung cancer. A multistate model was used to estimate the impact of LE8 score on the dynamic progression of CLDs. Component-specific contributions were assessed using Heller’s explained risk. During a median follow-up of 13.6 years, 27,934 participants developed FCLD, 4174 subsequently developed CLM, and 31,881 died. Higher LE8 scores were consistently associated with lower risks across all transition stages, with hazard ratios (95% confidence intervals) per 10-point increase of 0.75 (0.74-0.76) for transition from baseline to FCLD, 0.85 (0.83-0.87) from FCLD to CLM, 0.85 (0.84-0.86) from baseline to death, 0.92 (0.90-0.94) from FCLD to death, and 0.89 (0.85-0.92) from CLM to death. For CLD subtypes, LE8 scores showed heterogeneous associations with disease-specific transitions, even within the same transition stage. LE8 showed the strongest protective association with COPD incidence (a 36% risk reduction per 10-point increase), whereas its strongest protective association with disease progression was observed for asthma to CLM (a 27% risk reduction per 10-point increase). Among the component of LE8, smoking ranked highest in relative importance across nearly all transitions, while diet emerged as a comparably influential factor for the transition from CLM to death. Higher LE8 scores are associated with significant risk reductions for CLDs at all progression stages. Early LE8 optimization, particularly smoking avoidance, offers the greatest potential for CLDs prevention, while post-diagnosis benefits support lifelong adherence.

49. Voluntary intake of dry matter and water of sheep fed low dry matter forages and consequences for nitrogen excretion.

期刊: Journal of animal science 发表日期: 2026-May-29 链接: PubMed

摘要

Low dry matter (DM) forages (<16%) have been reported to restrict voluntary intake. However, New Zealand temperate grazing systems use a wide range of low DM% forages in high production systems. Interest in mitigating nitrogen (N) losses from farming systems has increased use of low DM% pasture forbs to dilute urine N concentrations. Voluntary DM intake (DMI), water and N intake, urine volume and N excretion were measured in young growing sheep fed a range of autumn-harvested, low DM% plantain, chicory, and ryegrass cultivars. Four diet-treatment groups of eight young male sheep were used in each of three consecutive runs, with 7 d total urine and faecal collection in metabolism crates. Feed, refusal, urine and faecal assessment of DM% and N% enabled DM, water and N intake, urine and faecal water, and N excretion to be calculated. The association of DM% and DMI, and both water intake and suspected phyto-diuretics with urine output, were also assessed. Voluntary DMI considered high (>25g/kg BW) were observed in all diet-treatments (DM%: 8.5-16.0%), was above 30g/kg BW in eight of ten diet-treatments (8.5-13.3%), and was lowest in the highest diet-treatment DM%. The association of DM% and DMI was negative, weak (r  2= 0.22) but significant (P < 0.05). Total water intakes were high across all diet-treatments (126-390 ml/ kg BW/ d), but least in a ryegrass diet-treatment. Urine volumes were high (3697-11654 ml/ d), and greatest in a chicory diet-treatment. The association of feed DM% with both total water intake (r  2=0.83) and urine output (r  2 >0.90) was negative, strong and significant (P<0.001), while that of forage concentrations of suspected phyto-diuretics with urine output was negative, weak (r  2 = 0.20-0.44), but significant (P < 0.01). Urine DM voided was high with greater volumes, suggesting higher costs. Total N output and urinary N output were greater in plantain diet-treatments, while the proportion of excreted N in urine was lower (P < 0.05) in all plantains compared to chicory and ryegrass diet-treatments, and the urine N% was greatest in ryegrass, and similar among the plantain and chicory diet-treatments. Conclusions: high DMI can be achieved with low DM% forages in young growing sheep, and the feed water intake, not phyto-diuretics, produces the observed high urine volume. Low DM% temperate forages are therefore suitable for N excretion mitigation via increased urine volume and urinary N% dilution, but urine energy and mineral costs may increase. There is increasing interest in reducing environmental impacts of grazing ruminants. Recently the use of high-water content forages to produce dilute urine, thereby mitigating nitrogen concentrations in excreta and reducing impacts on groundwater, has been encouraged in temperate grazing systems. Of these, some plantain varieties have been suggested to contain diuretic compounds that increase urine production. However, existing research consensus suggests high water content may reduce intake of forages, and therefore liveweight or milk production. In experiments using long adaptations to forages, the intake of a range of high-water content temperate forages was measured in pen feeding experiments, along with excreta and identified plant secondary metabolites. High intake was observed across forages, even those of unusually high-water content, and urine production was strongly positively associated with the resulting water intake, while compounds previously identified as diuretics had no apparent effect. However, there are potentially significant physiological costs in dramatically increased urine losses of carbon and minerals, which may reduce the energy value of diets. Diluted urine of reduced nitrogen concentrations can be achieved with numerous high water content forage species, and with appropriate adaptation, the effect on voluntary intake of high-water content in the temperate forages studied is limited.

50. High Adherence Over a Decade of Annual Lung Cancer Screening in an Occupational Cohort.

期刊: Clinical lung cancer 发表日期: 2026-May-09 链接: PubMed

摘要

Adherence to an annual low-dose chest CT (LDCT) scan regimen is essential to lung cancer screening success but has been scarcely studied beyond 2 annual CT scans. From 2014 to 2024, we conducted annual LDCT screening for 1,498 United States nuclear weapons workers based on age, smoking history, and occupational exposure to lung carcinogens. Labor unions co-sponsored the program in Department of Energy communities. Participants were eligible for up to 8 annual CT scans over a decade. Group adherence at each annual CT scan was calculated as the percentage who completed the next annual CT scan within 11 to 15 months (“on time”). We measured individual adherence by identifying the percentage of “on time” CT scans completed by each participant. Multivariable logistic regression was used to examine the relation between relevant risk factors and adherence. We achieved a mean year-to-year adherence of 88.5% among eligible participants for the first through eighth annual CT scan. Mean annual LDCT scan adherence score for all study participants was 68.1%; nearly one-third of participants (30.8%) were 100% adherent. All nodules suspicious for lung cancer received follow-up. 90.4% of 3- and 6-month follow-up scans for indeterminate nodules were completed within 11 months. Advanced age, non-White race, and Midwest or Western U.S. residence were associated with lower adherence. A high level of adherence is achievable in lung cancer screening implementation programs. Including occupational risk in lung cancer screening more completely addresses risk-related screening eligibility and may increase adherence.

51. StackAge: an ensemble-based clock for precise quantification of biological age using multi-omics data.

期刊: Briefings in bioinformatics 发表日期: 2026-May-04 链接: PubMed

摘要

Accurate quantification of biological age is essential for early risk stratification and intervention of chronic diseases. Here, we present StackAge, an ensemble-based biological aging clock that integrates large-scale plasma proteomic and metabolomic profiles from 30 376 participants in the UK Biobank. StackAge demonstrated high accuracy in age prediction (Pearson r ≈ 0.93 with chronological age) and substantially enhanced risk prediction for 12 chronic diseases, achieving AUCs exceeding 0.90 for type 2 diabetes, Alzheimer’s disease, and chronic kidney disease. Notably, the incorporation of estimated aging rates consistently improved disease prediction beyond conventional omics and demographic features. Feature interpretation and pathway enrichment analyses revealed that aging-associated biomarkers were enriched in inflammation, metabolic stress, and extracellular matrix remodeling pathways. Mediation analysis further indicated that modifiable lifestyle factors may accelerate biological aging, thereby increasing susceptibility to cardiovascular, neurological, immune, and musculoskeletal disorders. Together, these findings establish a robust multi-omics framework for quantifying individual aging trajectories and highlight biological age as a clinically actionable indicator for precision prevention and health management of age-related diseases.

52. AnnQ: reference-based quantification of cellular abnormality at single-cell resolution.

期刊: Briefings in bioinformatics 发表日期: 2026-May-04 链接: PubMed

摘要

Reference-based annotation tools have become standard for cell type assignment in single-cell RNA sequencing, leveraging large-scale atlases to transfer labels to new datasets. However, a substantial fraction of cells often receive uncertain or ambiguous annotations-low confidence scores, competing label probabilities, or high entropy across cell types. These cells are typically treated as technical artifacts and filtered out, yet in perturbation experiments they may represent the biologically interesting deviations that investigators seek to identify. We present AnnQ (Annotation Quantification of cellular identity uncertainty), a Python framework that repurposes annotation uncertainty as a quantitative measure of cellular abnormality. AnnQ extracts uncertainty-aware features from probabilistic cell type assignments-including confidence, confidence gap, admixture ratio, and entropy-and computes an out-of-reference (OOR) score measuring each cell’s deviation from a reference population in multivariate uncertainty space. Applying AnnQ to genetic perturbation and drug resistance datasets, we show that OOR scores detect aberrant cellular states that are not resolved by conventional clustering or differential abundance analyses. AnnQ provides a complementary approach for characterizing transitional and abnormal cell states at single-cell resolution. AnnQ is implemented in Python, and its source code and documentation are available on https://github.com/joonan-lab/AnnQ.git.

53. Institutional Special Needs Plans and End-of-Life Outcomes for Nursing Home Residents With Dementia.

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

摘要

Nursing home residents with dementia are often unnecessarily hospitalized at the end of life. Institutional Special Needs Plans (I-SNPs) are a type of Medicare Advantage plan for long-term nursing home residents that use advanced practice clinicians to manage care. Studies have demonstrated the effectiveness of the original and largest I-SNP operated by UnitedHealthcare (UHC), but there has been minimal evaluation of non-UHC I-SNPs, which have driven recent growth, nor specific focus on end-of-life outcomes. To examine the association of I-SNP enrollment with end-of-life outcomes for nursing home residents with dementia, separately for UHC and non-UHC I-SNPs. This retrospective cohort study used 2010 to 2022 Medicare data on 1.4 million long-stay nursing home residents with dementia who died between 2013 and 2022. Facility-level and patient-level selection bias were addressed with cross-temporal propensity score matching and difference-in-differences models. Both the direct effects of I-SNP enrollment, as well as the indirect (ie, spillover) effects on nonenrollees residing in nursing homes offering I-SNPs were assessed. Variation in these relationships by I-SNP maturity was also examined. Data were analyzed from November 2024 to April 2026. Four I-SNP exposure categories: UHC I-SNP enrollment and spillover; non-UHC I-SNP enrollment and spillover. Hospitalization and hospice use in the last month of life. The study cohort included 1 415 265 long-stay nursing home residents with dementia who died between 2013 and 2022. The unadjusted hospitalization rate in the last 30 days of life was 27.7%. UHC I-SNP enrollment was associated with a 9.0-percentage point (pp) reduction in hospitalization (95% CI, -10.3 pp to -7.7 pp) while non-UHC I-SNP enrollment was associated with a 5.9-pp reduction (95% CI, -8.4 pp to -3.5 pp). The spillover effect on nonenrollees in nursing homes offering a UHC I-SNP was a 1.7-pp (95% CI, -2.4 pp to -1.1 pp) decline in hospitalizations; the spillover effect in non-UHC nursing homes was not statistically significant. Similar trends appeared with hospitalization in the last 3 days of life, intensive care unit admission, and mechanical ventilation, but there was no association with hospice use. The reduction in hospitalizations increased in the 3 years after nursing home I-SNP adoption, then plateaued. In this retrospective cohort study, I-SNP enrollment was associated with significantly fewer hospitalizations for nursing home residents with dementia at the end of life, with effect sizes larger for UHC vs non-UHC I-SNPs. Plan maturity and volume are likely important factors impacting success.

54. Expert Opinions on Postoperative Complications in Breast Cancer Surgery After Neoadjuvant Chemotherapy: A Descriptive Study Through Structured Interviews With Surgeons in Austria.

期刊: The breast journal 发表日期: 2026 链接: PubMed

摘要

Neoadjuvant chemotherapy (NACT) is an important component in preparing breast cancer patients for surgery. Its impact on postoperative complications, such as wound infections and bleeding, remains unclear. While most studies show no increase in complication rates, factors such as smoking may elevate risk. Understanding surgeons’ perspectives on bleeding and related influences is therefore essential. This study used a questionnaire on bleeding and wound healing. After ethical approval in Vienna and Burgenland, 33 surgeons were recruited. Data were collected between July and December 2022 through interviews or self-administered questionnaires and analyzed descriptively. Overall, 63.6% of surgeons reported recognizing NACT-treated patients intraoperatively. Perceptions of blood loss varied, with some noting no difference and others reporting increased bleeding. The influence of tumor size and smoking was debated, with no clear consensus. Most surgeons did not observe prolonged operative times. Challenges in axillary dissection and sentinel lymph node identification were reported, particularly after NACT. Surgeons’ views on the impact of NACT in breast surgery vary considerably. These findings highlight the complexity of integrating NACT into surgical practice and the need for further research to improve training, patient counseling, and evidence-based guidelines.

55. Triple-stack geostatistical modeling for urban injury: Integrating grids, built environment, and Poisson kriging for pedestrian fatalities in Cali, Colombia.

期刊: Health informatics journal 发表日期: 2026 链接: PubMed

摘要

We introduce a novel geostatistical framework to map and predict pedestrian fatalities in Cali, Colombia (2008-2010), addressing critical gaps in research on built environment risk factors particularly in low- and middle-income countries. We triple stack: (1) a grid-based global moving window reducing the modifiable areal unit problem, redistributing events and population; (2) a Poisson-based land use regression incorporating built environment data; and (3) Poisson kriging addressing small number issues. Nine built environment variables were significant predictors of pedestrian fatalities. Health centers had the highest risk increase (54%), while parks and population density were protective. The triple-stack model markedly improved risk prediction, sharpening hotspot delineation and reducing background noise; at high population densities, predictive errors were as low as 0.26 deaths. The framework is a transferable tool for other urban contexts; thus, we provide method decision-making support helping users select between a simplified, codeless, GUI based platform or an advanced, custom-coded approach. Our results demonstrate gains in model predictive accuracy may be primarily attributable to the first two layers, the grid and LUR. Although, Poisson kriging is traditionally used to address the “small number problem,” the first two layers may substantially stabilize rates, resulting in more realistic, interpretable risk maps.