公共卫生研究摘要 (2026-06-03)

共收录 52 篇研究文章

1. HPV vaccination scenario and parental willingness to pay among girls aged 9-14 y in the Yangtze River Delta, China.

期刊: Human vaccines & immunotherapeutics 发表日期: 2026-Dec-31 链接: PubMed

摘要

Human papillomavirus (HPV) vaccine uptake remains suboptimal among adolescent girls in China. In November 2025, bivalent HPV vaccine was included in China’s National Immunization Program for girls aged 13. This study examined girls’ vaccination scenario and parental willingness to pay (WTP) for HPV vaccine. A cross-sectional survey was conducted among parents of girls aged 9-14 in the Yangtze River Delta, one of the socioeconomically developed regions in China, between March and August 2025. The survey investigated HPV vaccination scenarios among mothers and their daughters. Contingent valuation method was used to estimate parental WTP. A total of 4,595 parents participated. Overall, 62.6% intended to vaccinate their daughters (39.9% for themselves or their wives), and 8.1% had completed/scheduled HPV vaccination in daughters (35.5% in mothers). It remained inconsistent between mothers and daughters (Kappa = 0.38). Daughters receiving influenza vaccine, parents being informed through schools or community health centers, and greater HPV knowledge were associated with both HPV vaccine intent and uptake (each P < .05). HPV vaccine uptake in daughters was associated with parents endorsing teacher engagement (P = .004). The average WTP was CNY 2,373 for daughters; it was higher among higher-income parents and those with daughters who received influenza vaccine, but lower among parents expecting governmental funding or unwilling to vaccinate daughters (each P < .05). School-based settings are key drivers of HPV vaccine intent and uptake among girls in the Yangtze River Delta. Multi-channel communication and stakeholder engagement may enhance parental decision-making. Improving vaccine financing strategies may promote health equity as China expands HPV vaccination.

2. Liberation Playbook: Pain, Sedation, Sleep, and Mobility Led by Advanced Practice Registered Nurses.

期刊: AACN advanced critical care 发表日期: 2026-Jun-15 链接: PubMed

摘要

Mechanical ventilation is lifesaving yet harmful when paired with deep sedation and immobility. The ABCDEF, or intensive care unit liberation bundle (assessment and treatment of pain, spontaneous awakening and breathing trials, judicious choice of analgesia/sedation, delirium prevention/management, early mobility, and family engagement) mitigates these risks, improving survival, reducing delirium and coma, shortening time receiving ventilation, and promoting recovery. This article synthesizes evidence for the awake-and-walking intensive care unit, in which wakefulness and mobility are the default. We define the role of the advanced practice registered nurse in reliable implementation of this model: embedding bundle elements into workflows, aligning sedation and mobility targets, coordinating interprofessional teams, and driving culture change through measurement and feedback. A case example illustrates a patient’s trajectory under high versus low adherence. We close with pragmatic strategies to overcome workflow fragmentation, staffing variability, and safety concerns, mapping barriers to solutions such as protocol standardization, nurse-respiratory therapist coleadership, daily goal alignment, and data transparency.

3. Infection in Solid Organ Transplant: Prevention, Risk, and Treatment Strategies.

期刊: AACN advanced critical care 发表日期: 2026-Jun-15 链接: PubMed

摘要

Solid organ transplantation is a life-saving procedure for patients with end-stage organ disease. After transplant, recipients receive immunosuppressive therapy to preserve allograft function and prevent rejection. However, this therapy increases the risk of infections, which can cause increased morbidity and mortality. The transplant care team plays a crucial role in preventing, assessing, diagnosing, and managing infections in patients with solid organ transplantation. Preventive strategies include comprehensive infectious disease screening before transplant, vaccinations, and educating patients on infection risk mitigation in the pretransplant and posttransplant phase. After solid organ transplantation, transplant teams must closely monitor for a wide range of infections, from common pathogens to opportunistic infections. Early diagnosis and appropriate treatment are vital for reducing infection-related morbidity and mortality. Collaboration between infectious disease specialists and transplant teams is key to guiding appropriate monitoring and treatment strategies for recipients of solid organ transplantation.

4. Measles outbreak: Experience at a pediatric hospital in Buenos Aires City.

期刊: Archivos argentinos de pediatria 发表日期: 2026-Jun-04 链接: PubMed

摘要

Introduction. Measles is a potentially serious and highly contagious febrile exanthematous disease. In 2025, 36 cases of measles were confirmed in Argentina. The objective of this study is to describe the confirmed cases at a pediatric hospital during the outbreak from February to June 2025, as well as the control and containment measures implemented. Population and methods. A retrospective, descriptive study of confirmed measles cases at a pediatric hospital. Results. Of the 190 patients evaluated for febrile exanthematous illness, 8 cases of measles were confirmed in children aged 9 months to 10 years. Four cases were linked to exposure in a waiting room, and four required hospitalization; no deaths were reported. All patients were susceptible. None had a history of travel. Based on the 8 confirmed cases, 933 contacts were identified, among whom 6 secondary cases were detected. Contact tracing and containment measures were implemented. Conclusions. The outbreak involved 8 confirmed cases. Epidemiological surveillance enabled the identification of 6 secondary cases and the timely implementation of control and containment measures. Introducción. El sarampión es una enfermedad febril exantemática potencialmente grave y altamente contagiosa. Durante el 2025, se confirmaron en Argentina 36 casos de sarampión. El objetivo es describir los casos confirmados en un hospital pediátrico durante el brote de febrero a junio de 2025, y las acciones de control y bloqueo implementadas. Población y métodos. Trabajo retrospectivo, descriptivo, de casos confirmados de sarampión en un hospital pediátrico. Resultados. De 190 evaluados por enfermedad febril exantemática, se confirmaron 8 casos de sarampión, entre 9 meses y 10 años. Cuatro casos se asociaron a exposición en sala de espera y cuatro requirieron hospitalización; no se registraron fallecidos. Todos eran susceptibles. Ninguno tenía antecedente de viaje. A partir de los 8 casos confirmados, se identificaron 933 contactos, entre los cuales se detectaron 6 casos secundarios. Se realizó seguimiento y bloqueo de contactos. Conclusiones. El brote incluyó 8 casos confirmados. El seguimiento epidemiológico permitió identificar 6 casos secundarios y aplicar oportunamente medidas de control y bloqueo.

5. Patterns of adverse and positive childhood experiences on prenatal mental health outcomes in Chinese pregnant women: A latent class analysis.

期刊: Child abuse & neglect 发表日期: 2026-Jun-02 链接: PubMed

摘要

Early life experiences, including adverse childhood experiences (ACEs) and positive childhood experiences (PCEs), are established factors affecting prenatal mental health. But understandings remained unclear on the patterns and effects of the co-occurrence of ACEs and PCEs. To identify the latent classes of ACEs and PCEs and assess the association of the distinct classes with prenatal mental health outcomes. This was a cross-sectional study in 936 Chinese pregnant women (mean age 30.98 [SD 0.27] years). ACEs, PCEs, prenatal depression symptoms, and mental well-being were measured by ACE International Questionnaire, Benevolent Childhood Experiences Scale, Edinburgh Postnatal Depression Scale, and Short Warwick-Edinburgh Mental Well-being Scale, respectively. Latent class analysis was used to identify distinct latent classes. Multivariable linear regression examined the associations of different classes with prenatal mental health outcomes, adjusting for demographic, lifestyle, and pregnancy-related covariates. 4 classes of ACEs and PCEs were identified, including high adversity/low positivity (8.1%), high adversity/moderate positivity (30.1%), low adversity/low positivity (14.1%), and low adversity/high positivity (47.7%). Relative to low adversity/high positivity class, high adversity/low positivity class was associated with the highest level of prenatal depression symptoms (adjusted b = 3.72, 95%CI 2.34, 5.09) and poorest mental well-being (adjusted b = -4.70, 95%CI -5.73, -3.67), followed by high adversity/moderate positivity class. Low adversity/low positivity class was solely associated with mental well-being. Our results showed 4 classes of ACEs and PCEs and their different associations with prenatal mental health outcomes, which warranted studies using longitudinal design and larger sample sizes with representative samples to confirm.

6. Maltreatment, social support, and mental well-being: A longitudinal observation study of youth in five low- and middle-income countries.

期刊: Child abuse & neglect 发表日期: 2026-Jun-02 链接: PubMed

摘要

Addressing the growing child and adolescent mental health crisis is a global priority, particularly in low- and middle-income countries (LMICs). Although the literature demonstrates that experiencing maltreatment may negatively impact mental well-being and experiencing social support may positively impact mental well-being, the relationship between mental well-being and co-occurring maltreatment and social support is unknown. This study examined the relationship between maltreatment, social support, and mental well-being. Study data is from the longitudinal Positive Outcomes for Orphans (POFO) study of orphaned and separated children and youth/young adults (OSC) (n = 2535) from five LMICs (Cambodia, Ethiopia, India, Kenya, and Tanzania). We used bivariable analyses to calculate relationships between 1) mental well-being and maltreatment and 2) mental well-being and social support. Then, we used generalized linear models (GLMs) to examine relationships between 1) mental well-being and maltreatment, 2) mental well-being and social support, and 3) mental well-being, maltreatment, and social support. Models were controlled for age, gender, health, parental status and other traumas. Maltreatment was associated with increased well-being difficulties (Coeff = 2.068, SE = 0.249, CI = 1.579-2.559), while social support was associated with decreased well-being difficulties. In a GLM examining social support and maltreatment, social support reduced well-being difficulties (Coeff = -0.137, SE = 0.010, CI = -0.157- -0.119), even in the concurrent presence of maltreatment (Coeff = -0.131, SE = 0.010, CI = -0.151- -0.111). Three subtypes of social support were associated with reduced mental well-being difficulties: emotional support, tangible support, and positive social support. Findings indicate that measuring both maltreatment and social support may result in a more comprehensive understanding of youth emotional difficulties. Interventions that facilitate social support may promote emotional well-being and may be particularly useful in communities where trauma-informed mental health services are inaccessible.

7. Adipose cellularity and long-term development of impaired glucose metabolism: Swedish cohort study from 1988 through 2016.

期刊: EBioMedicine 发表日期: 2026-Jun-02 链接: PubMed

摘要

Adipocyte volume and number form adipose tissue cellularity, and adipocyte volume relates to impaired glucose metabolism (IGM). We studied how the cellularity relates to future long-term IGM development. We investigated 1014 participants living in Stockholm, Sweden 1986-2016 for abdominal subcutaneous adipocyte volume and number and IGM (impaired fasting glucose (≥6.1 mmol/l) and/or type 2 diabetes). A re-examination was conducted 2018-2022 on 241 participants (after on average 15 years); 127 remained without IGM, 47 had developed IGM and 43 remained as IGM. We compared baseline adipocyte volume and number for the three groups by analysis of variance and studied the odds ratio for future IGM as compared with always being healthy by logistic regression, correcting for relevant co-factors. Subcutaneous adipocytes were 20% larger in those having IGM from start or developed it later compared with those without IGM throughout (p = 0.005-0.03). Subcutaneous adipocyte number was similar in all three groups (p = 0.26). By comparing upper and lower tertiles for adipocyte volume/number the odds ratio for developing IGM was 2.8 (95% confidence interval CI; 1.2-6.5) for large adipocytes and 0.8 (0.4-2.0) for many adipocytes. Large adipocytes as a risk factor for future IGM was independent of sex, age, observation time, waist-to-hip ratio, body fat, physical activity or undergoing bariatric surgery, but not of insulin resistance measure, which strongly associated with adipocyte volume (r = 0.65). Adipocyte volume, but not number, associates with risk of long-term development of IGM. Large adipocytes confer this increased risk, maybe through insulin resistance. The Stockholm County Council (963296, 994175, 986118), the Centre for Innovative Medicine at Karolinska Institutet (986109), and the Swedish Society of Medicine (1001156). The Novo Nordisk Foundation supports the Novo Nordisk Foundation Center for Basic Metabolic Research (grants NNF18CC0034900 and NNF23SA0084103). None of the funding sources had any involvement in the study.

8. Occupational exposure to chlorine gas and ultrafine particles during surface disinfection: A comparative study of wiping versus spraying methods.

期刊: Journal of occupational and environmental hygiene 发表日期: 2026-Jun-02 链接: PubMed

摘要

Environmental surface disinfection is a fundamental component of infection prevention and control (IPC) in healthcare settings. Sodium hypochlorite remains widely used owing to its broad-spectrum efficacy, availability, and low cost. Concerns regarding occupational health risks associated with chlorine spraying have led public health authorities to revise existing guidance. The World Health Organization currently recommends wiping as the preferred chlorine-based surface disinfection method. This policy revision was based on very low certainty evidence, and quantitative data directly comparing exposure risks between methods remain limited. This study quantified and compared occupational exposure to chlorine gas (Cl2) and ultrafine particles (UFPs) generated during surface disinfection with sodium hypochlorite applied by spraying versus wiping and assessed the influence of task duration and environmental conditions on cumulative exposure. Under controlled conditions, UFP and Cl2 emission factors (EFs) were measured, and a randomized crossover simulation was conducted to determine disinfection duration per method in a mock clinical room. A well-mixed room model estimated airborne concentrations and inhaled doses across 0.1 to 12 air changes per hour (ACH), including under high temperature, with organic load and soap-with-ammonia interaction. Mean UFP EFs were comparable between methods (spraying 3.1 × 108 and wiping 1.95 × 108 particles·min-1·m-2), while Cl2 concentrations remained below detection limits. Spraying was significantly faster (9.4 ± 3.0 vs. 25.0 ± 7.1 min; p < 0.001) and consistently resulted in lower cumulative exposure: at 0.2 ACH, wiping produced a 4.3-fold higher inhaled UFP dose. Across the 0.1 to 12 ACH range, spraying reduced the inhaled dose by 50 to 75% (p < 0.001). Although environmental factors exerted a stronger influence on absolute exposures, spraying consistently yielded lower Cl2 and UFP concentrations and inhaled doses. These findings indicate that cumulative inhalation exposure is driven primarily by environmental conditions, task duration, and ventilation, rather than the application method’s intrinsic emission rate. Spraying shortened procedures consistently and reduced inhaled doses relative to wiping, supporting reconsideration of current IPC recommendations to incorporate duration-sensitive exposure-based assessments when selecting disinfection methods.

9. Evaluating the Swedish Occupational Fatigue Inventory (SOFI) Among Providers in a Pediatric Emergency Department.

期刊: IISE transactions on occupational ergonomics and human factors 发表日期: 2026-Jun-02 链接: PubMed

摘要

This study evaluated the Swedish Occupational Fatigue Inventory (SOFI) and its revised versions among pediatric emergency department providers (e.g., attendings, fellows, advanced practice providers). Findings show that the original SOFI is a valid tool for measuring occupational fatigue, but a shortened version—excluding physical exertion items—offers better fit and usability. Adding items from the Center for Epidemiologic Studies Depression Scale (CES-D) did not enhance fatigue measurement. For practitioners, the reduced SOFI provides a practical, reliable way to assess fatigue in physicians and advanced practice providers in fast-paced clinical environments. Its brevity supports frequent use without burdening staff, enabling timely identification of fatigue-related risks. This tool can inform interventions such as shift redesign, break scheduling, and technology usability testing, ultimately supporting clinician wellness and patient safety.

10. Long-term outcomes and cardiac mortality after radiotherapy for primary pulmonary mucosa-associated lymphoid tissue lymphoma.

期刊: Cancer radiotherapie : journal de la Societe francaise de radiotherapie oncologique 发表日期: 2026-Jun-02 链接: PubMed

摘要

Pulmonary mucosa-associated lymphoid tissue (MALT) lymphoma is a rare but indolent B-cell lymphoma, most often presenting as localized disease. Radiotherapy is a curative option, but its proximity to the heart raises concerns about long-term cardiac toxicity, which remains poorly documented. The purpose of this work was to evaluate the potential risk of cardiac toxicity following radiotherapy in patients with pulmonary MALT lymphoma. This retrospective, population-based study used Surveillance, Epidemiology, and End Results (SEER) data (17 registries, 2000-2022; November 2024 submission). We identified patients with primary pulmonary MALT lymphoma treated with radiation. Demographic and clinical characteristics, including age, sex, Ann Arbor stage, tumour laterality, lobe involvement, and treatment modality, were collected. Outcomes included overall survival, cancer-specific survival, cardiac-specific survival, and non-cancer/non-cardiac-specific survival. Survival estimates were generated using Kaplan-Meier methods; univariate and multivariate Cox models assessed factors associated with cardiac-specific mortality. Among 248 patients, the median age was 70 years; 54.0 % were women and 81.9 % Caucasian. Most had early-stage disease (90.3 %) and right-sided tumours (57.3 %). Radiotherapy alone was used in 86.7 %. With a median follow-up of 59 months, median overall survival was 120 months. At 20 years, overall survival rate was 28.9 %, cancer-specific survival rate 85.5 %, and cardiac-specific survival rate 85.0 %. In competing risk multivariate analysis, age greater than 70 years (hazard ratio [HR]: 10.51; 95 % confidence interval [CI]: 1.11-99.8; p=0.040) and stage III-IV (HR: 6.52; 95 % CI: 1.17-36.4; p=0.032) were independently associated with cardiac-specific mortality. Radiotherapy for pulmonary MALT lymphoma is associated with excellent long-term outcomes and low cardiac-specific mortality. Tumour location within the lung does not influence cardiac risk, supporting the absence of significant radiation-induced cardiotoxicity.

11. Immune checkpoint inhibitor-associated hepatitis and colitis: current understanding and clinical approaches.

期刊: Immunological medicine 发表日期: 2026-Jun-02 链接: PubMed

摘要

Immune checkpoint inhibitors (ICIs) have revolutionized cancer treatment by harnessing the immune system to target tumors. The introduction of ipilimumab, an anti-CTLA-4 monoclonal antibody, marked a major milestone in immuno-oncology when it was approved by the U.S. Food and Drug Administration (FDA) in 2011 for advanced melanoma. By blocking CTLA-4, ipilimumab enhances T-cell activation and promotes antitumor immunity. Subsequent development and approval of anti-PD-1 and anti-PD-L1 antibodies, such as nivolumab and pembrolizumab, since 2014 have broadened the scope of ICI therapy to various malignancies, often demonstrating improved tolerability relative to CTLA-4 inhibition. While these agents have significantly improved clinical outcomes, they also disrupt immune homeostasis, leading to immune-related adverse events (irAEs), in which healthy tissues are attacked by the immune system. Among these, gastrointestinal irAEs - including hepatitis and colitis - are frequently observed and may require intensive management. These toxicities are immunologically mediated and differ substantially from adverse effects associated with conventional cytotoxic chemotherapy. As ICIs gain broader indications clinicians must be prepared to identify and manage irAEs promptly. This review provides an in-depth discussion of ICI-associated gastrointestinal toxicities, emphasizing their epidemiology, immunopathogenesis, diagnostic strategies, and therapeutic management, in line with the latest clinical guidelines from major oncological societies such as ASCO and ESMO.

12. Predicting Change in Brief Treatment for BPD: The Role of Defensive Functioning and Pervasiveness in Relationship Patterns.

期刊: Journal of clinical psychology 发表日期: 2026-Jun-02 链接: PubMed

摘要

Borderline personality disorder (BPD) is marked by unstable relationships and maladaptive defense mechanisms. This study examined whether defensive functioning and the pervasiveness of core conflictual relationship themes (CCRT) predict symptom change following 10-session General Psychiatric Management (GPM) versus Treatment as Usual (TAU) in patients with BPD. Sixty patients with BPD (75% female, mean age 29.6) in a randomized controlled trial completed the Relationship Anecdote Paradigm at pretreatment. Interviews were coded using the Defense Mechanisms Rating Scale-Q-sort and the CCRT method. Symptom severity change was assessed using the Zanarini Rating Scale for BPD as post-pre score differences for total and subscale measures. Multiple linear regressions were used for analysis. Neither overall defensive functioning (ODF) (b = -1.59, p = 0.36) nor overall CCRT pervasiveness (OCP) (b = 2.10, p = 0.46) predicted change in borderline symptom severity. However, the interaction between OCP and treatment was significant for affective disturbance (b = 13.55, p = 0.03): patients with low OCP ( < 70%) improved more under GPM, while those with high OCP benefited more from TAU. In TAU, low OCP ( < 50%) was associated with worsening affective symptoms. Patients with BPD whose relational patterns were less pervasive and who primarily seek relief from affective distress may particularly benefit from GPM. The preliminary findings further suggest that heightened caution may be warranted when providing TAU to patients with low CCRT pervasiveness. ClinicalTrials.gov Identifier: NCT03717818.

13. COVID-19 Rebound in Nirmatrelvir Plus Ritonavir Treatment and Control Groups: Prospective Cohort Study.

期刊: Interactive journal of medical research 发表日期: 2026-Jun-02 链接: PubMed

摘要

Observation of COVID-19 rebound after nirmatrelvir plus ritonavir (NPR) has driven important questions surrounding one of the only direct-acting antiviral treatments for COVID-19. The objective of this study was to examine the epidemiology of COVID-19 rebound among COVID-19-positive outpatients in the United States who independently decided whether or not to take NPR. This prospective, decentralized observational cohort study was conducted from August 2022 through December 2023 and included frequent proctored COVID-19 rapid antigen tests and self-report symptom surveys for 15 days. The primary outcome was the incidence of viral and symptom rebound. Secondary outcomes included time to initial viral and symptom clearance, rebound probability among patients who cleared by day 15, and symptom frequency. Of 917 consenting participants, 669 (73%) were eligible for inclusion in the analysis (n=443, 66% in the NPR group; n=226, 34% in the control group). The mean age was 46.1 (SD 12.9) years, 62.6% (n=419) of participants were female, and 49.2% (n=329) had at least one preexisting condition. Overall, 15-day cumulative incidence was higher in the NPR group than the control group for both viral (70/443, 15.8% vs 12/226, 5.3%) and symptom (73/443, 16.5% vs 19/226, 8.4%) rebound. Time to initial viral and symptom clearance was similar between groups, and among those who experienced clearance by day 15, the probability of viral rebound (NPR: 19.1%, 95% CI 15.1%-24.0% vs control: 7%, 95% CI 4.0%-12.6%; P<.001) and symptom rebound (NPR: 47.7%, 95% CI 36.1%-60.8% vs control: 16.9%, 95% CI 10.9%-25.7%; P<.001) was higher in the NPR group than the control group. This study demonstrates that while COVID-19 rebound occurs in both NPR-treated and untreated outpatients, the incidence is higher in the NPR group.

14. Graft-Free Lateral Crural Rotation for External Nasal Valve Collapse and Nasal Tip Refinement: A Cartilage-Preserving Technique.

期刊: The Journal of craniofacial surgery 发表日期: 2026-Jun-02 链接: PubMed

摘要

External nasal valve collapse frequently coexists with nasal tip aesthetic deformities. Conventional correction relies on structural grafting, which may increase operative time, donor-site morbidity, and tip rigidity. We describe a cartilage-preserving, graft-free technique designed to restore external nasal valve competence and refine nasal tip definition. A retrospective clinical series of 30 patients with external nasal valve collapse who underwent graft-free lateral crural rotation between 2022 and 2025 was performed. Patients with a minimum follow-up of 6 months were included. The technique involves mobilization of the lateral crus and its insertion into a subdermal alar pocket without the use of additional cartilage grafts. Outcomes were assessed using physical examination, standardized photographic analysis evaluated by 2 independent observers, and the Rhinoplasty Outcome Evaluation (ROE) questionnaire at 6 months. The technique restored external nasal valve stability on physical examination and improved nasal tip contour on photographic analysis. Observer-based evaluation demonstrated consistent aesthetic improvement. Patients reported improvement in nasal airflow and high satisfaction based on ROE scores. No major complications were observed during the follow-up period. Graft-free lateral crural rotation is a cartilage-preserving technique that may improve external nasal valve support and nasal tip aesthetics while minimizing operative complexity and donor-site morbidity. These preliminary findings suggest favorable functional and aesthetic outcomes; however, further prospective studies with objective functional assessment are required.

15. Cannabis Use among People Receiving Maintenance Hemodialysis with Chronic Pain.

期刊: Kidney360 发表日期: 2026-Jun-02 链接: PubMed

摘要

Legalization of cannabis across several US states may increase its use by individuals on hemodialysis, particularly among those with chronic pain. Contemporary data on frequency or factors associated with cannabis use by this population are limited. We conducted a secondary analysis of the HOPE Consortium Trial to Reduce Pain and Opioid Use in Hemodialysis, a randomized trial that tested whether a cognitive behavioral therapy intervention lowered pain interference in people with chronic pain receiving hemodialysis at 103 US dialysis facilities. We analyzed baseline demographic characteristics, social and medical history, pain intensity, pain interference, and cannabis use. Multivariable logistic regression was used to examine associations of baseline data with cannabis use. Linear regression was used to examine whether cannabis use modified the response to the intervention. Among 643 participants, 102 (16%) reported current cannabis use, 133 (21%) reported former use, and 408 (63%) had never used. Current users were younger than never or past users combined (median age 54 vs. 63 years) and more likely to be disabled (79% vs. 66%), to have received dialysis for >5 years (40% vs. 30%), and to self-report depression (41% vs. 31%), anxiety (28% vs. 20%), or any psychological disorder (51% vs. 38%), and less likely to be married (16% vs. 34%). Current cigarette smoking (odds ratio [OR]=3.22, 95% confidence interval (CI) 1.61-6.46) and alcohol use (OR=2.82, 95% CI 1.37-5.80) were independently associated with cannabis use, as were age, relationship status, neighborhood segregation index, and cocaine/heroin use. Cannabis use did not modify response to the intervention. Current cannabis use was reported by 16% of HOPE participants and was more common among younger, unmarried individuals who use other substances, but did not alter response to our intervention. More research is needed on the consequences of cannabis use among people receiving hemodialysis.

16. Telehealth Use Among Older Adults Receiving Home- and Community-Based Services: Cross-Sectional Analysis Using the National Core Indicators-Aging and Disabilities Survey.

期刊: JMIR human factors 发表日期: 2026-Jun-02 链接: PubMed

摘要

Telehealth was essential for maintaining care continuity during the COVID-19 pandemic, leading to its rapid adoption across the United States. Telehealth has been heralded as a strategy for improving health care access and reducing health disparities, especially for community-dwelling older adults who face significant barriers to in-person care. However, data on telehealth use among socially and financially vulnerable older adults are limited, and little is known about characteristics associated with telehealth use in this population. Guided by the Systems Engineering Initiative for Patient Safety (SEIPS) 3.0 framework, this study examined factors associated with postpandemic telehealth use among older adults living at home and receiving publicly funded home- and community-based services (HCBS), considering HCBS receipt as an indicator of social and financial vulnerability. This cross-sectional study included older adults aged 65 years or older living at home with available telehealth use data who participated in the 2021-2022 survey wave of the National Core Indicators-Aging and Disabilities Adult Consumer Survey. We used complete-case multivariable logistic regression, adjusting for sociodemographic and health-related factors with state-level random intercepts, to examine associations between telehealth use and covariates of interest (age, sex, race/ethnicity, zip code, rural-urban commuting area code, internet access, self-perceived overall health, medical transportation access, living alone, number of known non-Alzheimer disease and related dementias [ADRD] diagnoses, known ADRD diagnosis, and HCBS program/payer type). Based on the regression results, we estimated bivariate associations between internet access and key sociodemographic variables (age, sex, race/ethnicity, and zip code rural-urban commuting area) using the Pearson chi-square test. Findings were organized and interpreted through the SEIPS 3.0 framework. Of the 3680 participants, 1467 (40%) were telehealth users and 2213 (60%) were nonusers. Significantly lower odds of telehealth were observed for older adults in older age groups, males, Black individuals, those living in nonmetropolitan areas, and recipients of Older Americans Act services (odds ratios [OR] between 0.66 and 0.80). Individuals with more than one known non-ADRD diagnosis (OR 1.49, 95% CI 1.02-2.17) and those with an ADRD diagnosis (OR 1.33, 95% CI 1.07-1.66) had higher odds of telehealth use. Internet access was strongly associated with telehealth use (OR 2.51, 95% CI 2.15-2.92). Follow-up bivariate analyses between internet access and sociodemographic characteristics revealed that those of younger age, females, and White individuals had higher levels of internet access. Differences in telehealth use among older HCBS recipients are associated with multiple individual, technological, and organizational factors. Interpreted through the SEIPS 3.0 framework, these findings underscore the importance of viewing telehealth use as the outcome of multiple features of the health care system. Future research should clarify the mechanisms driving variation in telehealth use to identify and address barriers to telehealth adoption among vulnerable older adults.

17. Creating a Dementia Caregiver Assessment Tool for Home Health: User-Centered Development, Refinement, and Content Validity Testing.

期刊: Dementia (London, England) 发表日期: 2026-Jun-02 链接: PubMed

摘要

In the United States, home health care (HH) provides skilled nursing, therapy, and aide services delivered in patients’ homes. One-third of HH patients have diagnosed dementia and these individuals rely heavily on support from family and unpaid caregivers during HH care. Yet, caregiving context is not systematically assessed in HH, presenting a barrier to high-quality care for patients with dementia. Partnering with a major HH agency, we developed a dementia caregiver assessment tool designed to fit within existing HH clinical workflows. We engaged HH administrators, frontline clinicians, and caregivers of HH patients with dementia in a participatory, user-centered approach to intervention development. This process included 3 stages leading to the final assessment instrument: (1) development, (2) refinement, and (3) content validity testing. Research activities included structured focus groups with HH clinicians (n = 18), recurring co-design workgroup with administrators and clinicians (n = 19), and cognitive interviews with clinicians (n = 10) and caregivers (n = 11). The final assessment tool includes 10 items across three domains: (1) “who” is helping the patient and “when” they are in the home (caregiver identity and availability), (2) “what” types of help they are providing (caregiving tasks), and (3) “how” they are coping (caregiver burden). The final assessment received a Scale-Content Validity Index score of 0.96 from clinicians and caregivers, indicating excellent content validity. This assessment instrument is now poised for evaluation within a “real-world” HH clinical context to assess its impact on care delivery and caregiver experiences.

18. Challenges, Strategies, and Explanatory Mechanisms in Clinical Skills Remediation Programs in Undergraduate and Postgraduate Medical Education in Low- and Middle-Income Countries: Realist Review Protocol.

期刊: JMIR research protocols 发表日期: 2026-Jun-02 链接: PubMed

摘要

Clinical skills deficits are a patient-safety concern, yet remediation remains underexamined, particularly in low- and middle-income countries, where faculty shortages, uneven access to simulation and supervised practice, inconsistent assessment, and stigma can hinder timely and effective support. The effects of trainee underperformance extend beyond the individual, with implications for patient care, supervisory workload, and team functioning. Although interest in remediation is increasing, the evidence base remains fragmented, dominated by high-income settings, and largely descriptive. A theory-driven review is therefore needed to explain how remediation works, for whom, and under what conditions. This realist review protocol aims to identify the main challenges and strategies reported in clinical skills remediation in undergraduate and postgraduate medical training, explain for whom these strategies work, in what contexts, and through which mechanisms, and develop an evidence-informed initial program theory for low- and middle-income country settings. Following the RAMESES (Realist and Meta-narrative Evidence Syntheses: Evolving Standards) for realist synthesis, this review will draw on a broad range of sources, including MEDLINE or PubMed, CINAHL, PsycINFO, ERIC, and Scopus, alongside gray literature such as dissertations, World Health Organization resources, medical education policy documents, and institutional reports. Sources published from January 2000 onward will be considered eligible, spanning empirical studies, program evaluations, and theory-informing documents focused on the remediation of clinical or procedural underperformance among medical learners at any training stage. Screening, extraction, and appraisal will be performed in duplicate. Extracted data will include learner characteristics, remediation triggers, intervention features, contextual conditions, candidate mechanisms, and outcomes related to competence, progression, and patient safety. Synthesis will apply retroductive reasoning to develop and refine context-mechanism-outcome configurations and a middle-range program theory. Funding was secured through Badan Riset dan Inovasi Nasional (National Research and Innovation Agency of Indonesia; 2023). The protocol was registered in PROSPERO (International Prospective Register of Systematic Reviews) (CRD42023447029). Protocol development, stakeholder-informed scoping, preliminary literature familiarization, and initial program theory construction were completed by April 2026. Formal database and gray-literature searching is planned for mid-2026, followed by duplicate screening, relevance and rigor appraisal, data extraction, and iterative realist synthesis through 2026-2027. The primary review manuscript is targeted for submission in 2027. This review aims to move remediation scholarship beyond description, toward a clearer understanding of what works, for whom, and why. By bridging evidence, theory, and real-world practice, it hopes to guide the design of remediation systems that are contextually grounded, educationally sound, and ultimately capable of restoring safe clinical performance across both undergraduate and postgraduate medical training.

19. "To Get the Patient the Best Care": A Qualitative Analysis of Community Health Worker Integration in North Carolina Federally Qualified Health Centers.

期刊: The Journal of ambulatory care management 发表日期: 2026-Jun-02 链接: PubMed

摘要

Research suggests that community health worker (CHW) integration within clinical care teams can improve chronic disease outcomes and address health-related social needs. However, the processes by which CHWs are integrated in Federally Qualified Health Centers (FQHCs) and organizational factors enabling their success remain incompletely understood. Within the context of a national initiative sponsored by the Centers for Disease Control and Prevention, this study assessed CHW integration across three North Carolina FQHCs with distinct patient populations, management systems, and levels of prior CHW experience to identify facilitators, barriers, and CHW impact. We conducted a qualitative evaluation using inductive thematic analysis of semistructured key informant interviews with CHWs, their managers, and clinicians at each FQHC. Transcripts were analyzed using reflexive thematic analysis to identify themes and extract representative quotes. Facilitators included collaboration, targeted training, management systems, prior CHW and clinician experience, and organizational support. Barriers included unclear CHW role definition, CHW capacity and community resource constraints, and inconsistent communication about integration strategies. CHWs supported care coordination, health-related social needs referrals, and chronic disease management, improving patient engagement and outcomes. Findings confirmed known enablers and barriers to CHW integration, including role definition, capacity constraints, resource availability, and supportive leadership. We additionally identified novel factors impacting CHW integration, including the influence of prior experience of CHWs and clinical staff, CHW leadership in workflow development, the role of peer-learning collaboratives, and the importance of inclusive communication and data practices. Integration was most successful when CHWs shaped workflows, clinicians and managers had foundational CHW understanding, and collaborative learning spaces enabled peer exchange. These findings highlight the importance of CHW-centered program design and implementation, and may enhance existing frameworks for clinical integration of CHWs in FQHCs and similar settings.

20. Functional tests associated with balance impairment in chronic obstructive pulmonary disease: Screening implications.

期刊: Rehabilitacion 发表日期: 2026-Jun-02 链接: PubMed

摘要

Chronic obstructive pulmonary disease (COPD) is a prevalent condition that affects functional capacity and quality of life. Balance impairment remains an underexplored aspect in this population. To identify factors associated with balance impairment in patients with COPD and to evaluate the utility of balance tests as screening tools in clinical practice. A cross-sectional study with blinded assessment was conducted, including 132 participants (93 with COPD and 39 healthy controls). The Berg Balance Scale, Timed Up and Go (TUG), and Functional Reach Test were applied, along with assessments of muscle strength, fatigue, and dizziness. Patients with COPD showed a significantly higher risk of balance impairment (OR 13.0; p<0.0001). The main associated factors were TUG >12s (OR 7.0; p<0.0001), Functional Reach <25cm (OR 14.7; p<0.0001), and history of falls (OR 2.7; p<0.0001). In multivariate analysis, reduced mobility (TUG, p=0.0003), decreased functional reach (p<0.0001), muscle fatigue (Chalder Fatigue Scale, p=0.02), and history of falls (p=0.003) remained significantly associated with balance impairment. The TUG and Functional Reach tests demonstrated good discriminative ability (AUC=0.86 and 0.88, respectively), with sensitivity of 81-85% and specificity of 78-82%. Balance impairment is frequent in patients with COPD and is associated with reduced mobility, decreased functional reach, fatigue, and history of falls. The TUG and Functional Reach tests showed good utility as screening tools for detecting balance deficits.

21. Effect of Fermented Papaya Preparation Intake on Fatigue Recovery, Useful Field of View and Oxidative Stress: A Pilot Interventional Study in Professional Bus and Motor Racing Drivers.

期刊: Journal of the American Nutrition Association 发表日期: 2026-Jun-02 链接: PubMed

摘要

Fermented Papaya Preparation (FPP) is a supplement with antioxidant, anti-inflammatory, and immune-modulatory effects. This study investigated the effects of one-month continuous FPP intake on health parameters related to driving performance, the useful field of view (UFOV) and post-work fatigue recovery in active bus drivers and the effect of FPP on elite performance motor racing drivers and elite motor racing drivers. This study examined the effects of one-month continuous intake of FPP on health outcomes, oxidative stress markers and useful field of view (UFOV) in active bus drivers and elite motor racing drivers. Significant reductions were observed in oxidative stress markers (urinary 8-hydroxy-2’-deoxyguanosine [8-OHdG]) and reaction times within the UFOV. Subjective health measures related to driving performance-including concentration, vitality, fatigue, and sleep quality-also showed significant improvements. Participants with improved UFOV demonstrated concurrent reductions in urinary 8-OHdG. In the health-related quality of life assessment using the short form health survey SF-12®, significant improvements were detected in “general health perception” (p < 0.01), “vitality” (p < 0.05), and “mental health” (p < 0.01) after intervention. In the performance of elite drivers’ assessment, the malondialdehyde (MDA) values in elite motor sport drivers were similar at the beginning of the race and at the 12 hr period, there were notable differences in the values at 24 hr following the endurance motor racing. The non-supplemented drivers had the highest level of MDA, and protein carbonyls with values of 1.26 µM and 0.411 µmoles/g protein respectively. The corresponding values for the FPP-supplemented drivers were 0.714 µM and 0.115 µmoles/g protein respectively. These findings suggest that FPP can be safely consumed by professional drivers and may serve as a complementary self-care strategy targeting fatigue recovery, thereby mitigating risk factors associated with driving accidents such as age-related decline in driving useful field of view, sleep quality, cognitive function, and accumulation. FPP may be applied as a “Driver Support Tool” contributing to fatigue reduction, health maintenance, and accident risk reduction in both professional and elderly drivers. FPP may hold significance in improving recovery and cognition in elite motor sports drivers and general auto drivers. Fermented Papaya Preparation significantly improved fatigue-related subjective health indicators in professional bus drivers, including sleepiness, concentration, sleep quality, post-work fatigue, and feeling refreshed upon awakening after just one month of intake.Fermented Papaya Preparation intake significantly reduced urinary 8-hydroxydeoxyguanosine (8-OHdG), a biomarker of oxidative stress, particularly in middle-aged and older drivers, suggesting antioxidant effects relevant to healthy aging and long-term driving performance.Fermented Papaya Preparation significantly improved Useful Field of View (UFOV), especially peripheral reaction time, indicating enhanced hazard perception and visuospatial cognitive performance related to safer driving behavior.The exploratory research and hypothesis-generating data from elite motor racing drivers during the 24 h of endurance motor racing indicate that supplementation with Fermented Papaya Preparation may be associated with lower oxidative stress and improved recovery under extreme conditions.Fermented Papaya Preparation intake may serve as a safe and practical preventive adjunct nutraceutical approach for occupational and senior drivers to support fatigue recovery, cognitive resilience, safe mobility, and extension of “driving longevity” in aging societies.Fermented Papaya Preparation may provide adjunct beneficial benefits in the management of disease characterized by inflammation including Parkinson’s disease, Alzheimer’s disease, cancer, diabetes and immunological deficienciesFermented Papaya Preparation has the propensity to improve health, wellbeing and cognitive integrity aligned with healthy aging.

22. Differential Modulation of Reciprocal Inhibition Between Wrist Extensors and Flexors by Repetitive Peripheral Magnetic Stimulation of the Wrist Extensors.

期刊: Journal of neurophysiology 发表日期: 2026-Jun-02 链接: PubMed

摘要

Repetitive peripheral magnetic stimulation (rPMS) can improve motor dysfunction and spasticity in individuals with central nervous system lesions. However, its underlying neural mechanisms remain poorly understood. This study investigated the effects of 15-min rPMS applied to the wrist extensor muscles on reciprocal inhibition between the wrist flexor and extensor muscles in healthy adults. First, to assess distinct inhibitory mechanisms, the effects of rPMS on reciprocal inhibition directed from extensor carpi radialis (ECR) to the flexor carpi radialis (FCR) were examined using the FCR H-reflex conditioned by radial nerve stimulation by assessing disynaptic Ia inhibition and D1 inhibition at conditioning-test intervals of -0.3 ± 0.2 ms and 13 ms, respectively. At an intensity sufficient to elicit muscle contraction, rPMS significantly enhanced disynaptic Ia inhibition, but had no significant effect on D1 inhibition. Next, we assessed the effects of rPMS on disynaptic Ia inhibition and D1 inhibition directed in the opposite direction from FCR to ECR. In this case, rPMS significantly reduced disynaptic Ia inhibition but had no significant effect on D1 inhibition. Furthermore, rPMS did not alter the excitability of monosynaptic reflex pathways in the stimulated ECR or its antagonist FCR. Taken together, these findings indicate that rPMS applied to the wrist extensor muscles enhances disynaptic Ia inhibition from the stimulated muscles to their antagonist motoneurons and attenuates disynaptic Ia inhibition in the opposite direction, suggesting that rPMS modulates disynaptic Ia inhibition in a direction-dependent manner.

23. Computer use duration and body mass index as risk factors for arm, neck, and shoulder complaints among regular computer-using workers: A systematic review and meta-analysis.

期刊: Work (Reading, Mass.) 发表日期: 2026-Jun-02 链接: PubMed

摘要

BackgroundA growing body of evidence suggests that a combination of physical, psychological, and environmental factors increases the likelihood of experiencing complaints related to the arm, neck, and/or shoulder (CANS), although the precise nature of these relationships and their potential long-term effects remain uncertain.ObjectiveTo synthesize evidence from prospective cohort studies investigating the risk factors associated with the development of CANS among workers who use computers.MethodsA systematic search was conducted in PubMed, ProQuest, Scopus, Cochrane Library, and Google Scholar to identify prospective cohort studies published between January 2010 and 2025. Eligible studies investigated risk factors of CANS among workers using computers, with a follow-up period of at least one year. Two reviewers independently screened studies, extracted data, and assessed methodological quality using the Newcastle-Ottawa Scale. Relative risks (RR) and 95% confidence intervals (CI) were pooled using a random-effects meta-analysis. Heterogeneity among studies was assessed using Cochran’s Q test and the I2 statistic.ResultsTwo studies indicated a low risk of bias, while the remaining studies were assessed as having a moderate risk. For overall exposures, the correlation with the prevalence of CANS was the duration of using computers or mouse >4 h/day and BMI, with RR = 1.25 (95% CI: 1.08-1.44) and 1.05 (95% CI: 1.02-1.08), respectively.ConclusionProlonged computer use and higher body mass index were significant predictors of CANS, and the findings highlight the importance of ergonomic interventions and health promotion strategies to reduce work-related musculoskeletal complaints in sedentary occupational environments.

24. [The Network of Schools of Health for Citizenship: health literacy as a strategy for equity and co-responsibility].

期刊: Revista espanola de salud publica 发表日期: 2026-Jun-02 链接: PubMed

摘要

25. Digital Health Apps and Web-Based Platforms to Support the Prevention and Management of Snakebite Envenoming: Scoping Review.

期刊: JMIR mHealth and uHealth 发表日期: 2026-Jun-02 链接: PubMed

摘要

Neglected tropical diseases disproportionately affect underserved populations, with snakebite envenoming (SBE) remaining one of the most overlooked, despite its significant global burden. Digital health applications (DHAs) offer potential to improve prevention, care, and resource management, especially when integrated into digital health interventions. However, despite growing interest, evidence and structured evaluations are limited, making it difficult to assess their impact without a clear overview of existing tools. This scoping review aims to provide the first comprehensive mapping of DHAs for SBE, highlighting their potential to strengthen the World Health Organization (WHO) strategy while underscoring the urgent need for structured evaluation, improved quality, and strategic integration to enhance prevention, treatment, and coordination efforts. This review followed the Joanna Briggs Institute and PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines, with a protocol registered on the Open Science Framework. We searched the PubMed database, app stores, and Google for DHAs between September 24 and 26, 2024, addressing snakebite prevention or treatment. To be included, the DHA had to be accessible via the recorded link, contain a description with snakebite-related features (eg, identification, first aid, and treatment), and allow user interaction. Descriptions had to appear in abstracts, app store listings, or website text. Results were grouped by type (mobile- or web-based) and by WHO region. Furthermore, we examined the 2 most common features: first aid and snake identification. First aid content was benchmarked against global guidelines, while identification methods were categorized, and selected artificial intelligence (AI)-based identification apps were exploratively tested using images of medically significant snakes. A total of 52 eligible results were included, of which 94.2% (49/52) were mobile apps and 5.8% (3/52) were web-based. Regional focus varied, with most apps targeting South-East Asia (n=11, 21.2%), the Americas (n=9, 17.3%), and the Western Pacific (n=5, 9.6%). However, these numbers largely reflect concentration in just a few countries, namely India (n=10, 19.2%), the United States (n=5, 9.6%), and Australia (n=5, 9.6%). The most frequent feature was snake identification support, for example, through photo upload and algorithm-based recognition. However, AI-driven identification often lacked clarity and performed inconsistently in testing. First aid guidance was also common, but only a handful of apps offered comprehensive, evidence-based advice, while others omitted key steps or recommended unsafe practices. This review provides the first structured evaluation of DHAs for SBE and offers a reproducible framework for assessing digital solutions across neglected tropical diseases. By highlighting key gaps and proposing a foundation for integration into national strategies, it supports the development of equitable, evidence-based digital health innovation in underserved areas.

26. The Wnt inhibitor Tiki2 maintains articular cartilage homeostasis and protects against osteoarthritis.

期刊: Science signaling 发表日期: 2026-Jun-02 链接: PubMed

摘要

Osteoarthritis (OA) is a common chronic joint disease with limited treatment options. Cartilage degeneration in OA is driven by increased matrix catabolism and decreased matrix production and is characterized by chondrocyte hypertrophy. Aberrant activation of both β-catenin-dependent and β-catenin-independent Wnt signaling is implicated in OA progression and represents a potential therapeutic target. Here, we investigated the role of Tiki2, a membrane-tethered proteolytic inhibitor of Wnt ligands, in OA. Expression of Tiki2 was reduced in a mouse model of OA induced by joint destabilization, and expression of TIKI2 was reduced across multiple independent human OA transcriptomic datasets. Tiki2 haploinsufficiency in mice led to spontaneous cartilage degeneration, and loss of Tiki2 accelerated the progression of instability-induced OA. Tiki2 suppressed Wnt3a-induced β-catenin signaling and Wnt5a-induced β-catenin-independent signaling in chondrocytes and promoted anabolic gene expression to preserve cartilage integrity. Intra-articular overexpression of human TIKI2 attenuated OA-associated cartilage degeneration in mice. In vitro, Tiki2 inhibited hypertrophic differentiation in primary mouse chondrocytes and ATDC5 cells, and overexpression of TIKI2 promoted chondrogenic differentiation in primary mouse and human chondrocytes. Together, these results identify Tiki2 as a regulator of articular cartilage homeostasis and OA susceptibility and suggest that enhancing Tiki2-mediated Wnt inhibition may be a potential disease-modifying strategy for OA.

27. Geographical disparities and programmatic determinants of hydrocele surgery and lymphoedema management coverage for lymphatic filariasis in the Democratic Republic of the Congo, 2018-2024: A national analysis of routine programme data.

期刊: PLoS neglected tropical diseases 发表日期: 2026-Jun-02 链接: PubMed

摘要

Lymphatic filariasis (LF) is a significant neglected tropical disease in the Democratic Republic of the Congo (DRC). Although progress has been made toward interrupting transmission through mass drug administration, LF-related morbidities-particularly hydrocele, lymphoedema, and recurrent acute dermatolymphangioadenitis-continue to cause substantial disability, comorbid infections, and reduced quality of life. National evidence on the burden of LF morbidities and factors associated with access to morbidity management remains limited. We conducted a national retrospective analysis of routinely collected programmatic data from the National Neglected Tropical Diseases Control Programme in the DRC between 2018 and 2024. Data included estimates and management of LF-related hydrocele and lymphoedema across endemic provinces. Descriptive analyses assessed morbidity burden, geographic distribution, and temporal trends. Care cascade analyses were performed to quantify attrition across key stages of morbidity management. Multivariable linear regression models at provincial level were used to identify programmatic and health-system factors associated with hydrocele surgery coverage and lymphoedema management coverage. A total of 8,471 hydrocele cases and 5,310 lymphoedema cases were identified nationwide. During the study period, 2,013 hydrocele surgeries (23.8%) were performed, while 877 lymphoedema patients (16.5%) received the essential package of care. Marked geographic disparities were observed, with several high-burden provinces exhibiting particularly low coverage. Care cascade analyses revealed substantial attrition between case identification and receipt of care for both conditions. In multivariable analyses, hydrocele surgery coverage was positively associated with external partner support and availability of trained surgical personnel, while higher caseloads, post-Transmission Assessment Survey (post-TAS) surveillance phase, and geographic inaccessibility were associated with lower coverage. Lymphoedema management coverage was strongly associated with community-based care activities, health worker training, and availability of basic hygiene supplies. LF-related morbidities remain a substantial and unevenly addressed public health burden in the DRC, including in provinces that have achieved or are approaching interruption of transmission. Strengthening and scaling up morbidity management and disability prevention services-particularly for lymphoedema and hydrocele-are essential to improve patient quality of life and to meet World Health Organization requirements for elimination of lymphatic filariasis as a public health problem.

28. Endophytic seed microorganisms in legumes: Natural bioinoculants for sustainable agriculture.

期刊: Journal of experimental botany 发表日期: 2026-Jun-02 链接: PubMed

摘要

As global food demand rises against the backdrop of environmental and health concerns from intensive agrochemical use, there is an urgent need for sustainable crop-management strategies. In this perspective, seed-borne endophytic microbes, including bacteria and fungi, in legumes offer a naturally inherited bioinoculant system. This review integrates 35 Scopus and Web of Science studies to examine the occurrence, transmission dynamics, and functional diversity of endophytes within seeds of key legume species. Seed endophytes contribute to plant development and productivity through multiple mechanisms: atmospheric nitrogen fixation; solubilization of phosphorus and potassium; synthesis of siderophores and indole-3-acetic acid; and modulation of rhizosphere microbial communities, collectively enhancing germination rate, biomass accumulation, and yield. Under abiotic stress conditions, such as drought, nutrient deficiency, or contaminant exposure (metals and pesticides), such beneficial microbes promote root architecture remodeling, exopolysaccharide secretion, and 1-aminocyclopropane-1-carboxylate (ACC) deaminase activity, thereby improving stress resilience. In biotic contexts, certain bacterial endophytes may contribute to biocontrol through antibiotic production, while fungal inoculants have been reported to synthesize alkaloids that can deter herbivores. By elucidating the multifaceted roles of legume seed endophytes, this review underscores their potential as a turnkey, eco-friendly bioinoculants, paving the way for greener agricultural practices without compromising crop performance.

29. Hydroxamate Siderophores Drive Persistent Free Radical Generation to Suppress Antibiotic Resistance Gene Dissemination and Enhance Humification during Composting.

期刊: Environmental science & technology 发表日期: 2026-Jun-02 链接: PubMed

摘要

Composting agricultural waste is a cornerstone of circular agriculture but carries the risk of disseminating antibiotic resistance genes (ARGs). While persistent free radicals (PFRs) are known to continuously suppress ARGs, their natural yield in compost is often insufficient. Here, we demonstrate that hydroxamate siderophores (HDS) can capture Fe(III) to form stable redox-active complexes that act as potent electron shuttles, driving the generation of semiquinone radicals (SQ•-) to inhibit ARG proliferation while promoting the humification process. In a 40 day cocomposting experiment with rice straw and pig manure, HDS amendment accelerated humification by 24.7% and enriched the quinone moieties within the humic matrix by 22.3%. HDS-Fe(III) complexes were predominantly reduced via microbial activity to HDS-Fe(II), which then served as a potent electron donor due to its significantly lowered redox potential. This drove spontaneous electron transfer to quinone moieties, increasing SQ•- production by 2.1-7.4 times. The sustained oxidative pressure imposed by SQ•- significantly inhibited plasmid-mediated conjugative transfer frequency by 65.3-84.4% via inducing membrane damage of critical host bacteria (such as Streptomyces). Consequently, mid- to high-risk ARGs in HDS-treated compost products were reduced by 11.6-26.6%. Application of HDS-treated compost products to paddy soil confirmed the persistent mitigation of ARG propagation risks. Overall, this HDS-based approach achieves the dual goals of compost valorization and biosafety, advancing the sustainability of circular agriculture within the “One Health” framework.

30. Environmental regulation of mucosal-associated invariant T cells: Adding food for thought.

期刊: Science signaling 发表日期: 2026-Jun-02 链接: PubMed

摘要

Mucosal-associated invariant T (MAIT) cells are a population of innate-like, unconventional T cells characterized by the expression of a semi-invariant, non-MHC-restricted T cell receptor (TCR), which play an important role in mediating innate immune responses to bacterial and viral pathogens. Emerging research continues to describe the many environmental signals that influence the types of responses elicited downstream of MAIT cell activation. In this Review, we highlight five key factors that determine the metabolic and functional responses of MAIT cells, including TCR engagement, costimulation, chemokine signaling, cytokine stimulation, and nutrient availability. We further define the importance of optimal nutrient availability as “signal 5” in promoting MAIT cell fitness and in governing their capacity to respond appropriately to challenge. In understanding the ways in which MAIT cells are influenced by their microenvironment, we can continue to identify the potential factors that drive dysregulated responses in hostile circumstances, enabling restoration of their protective nature in the context of infection or in the tumor microenvironment.

31. A Multi-Department Investigation of Occupational Well-Being, Systemic Features, and Organizational Outcomes in Anesthesiology Using the Well-Being Influencers Survey for Healthcare (WISH).

期刊: Anesthesiology 发表日期: 2026-Jun-02 链接: PubMed

摘要

High rates of distress and intention to leave (ITL) threaten workforce stability and patient care in anesthesiology. Meaningful action is believed to require evidence-based insight into the systemic origins of occupational well-being shaping these risks. However, the field has lacked large-scale insights into these systemic features and their influence on well-being and its consequences using validated tools. The Well-Being Influencers Survey for Healthcare (WISH) was developed to provide a framework and metric for understanding organizational foundations of well-being. This study evaluated WISH’s generalizability across a multicenter cohort, examined the relevance of system-oriented assessment, and characterized the current profile of well-being culture in anesthesiology. Participants across 11 academic anesthesiology departments completed WISH alongside occupational well-being correlates. Mediation models examined theoretical relationships among well-being influencers, cognitive-affective states, and organizational outcomes. ANOVA assessed differences in WISH by influencer, department, and professional role. Psychometric techniques were used to extend validity evaluation of WISH, pooling data for higher-power and using meta-analysis to assess generalizability. Newly collected responses from 1470 health workers were analyzed. Multidimensional psychometric models met fit criteria. In meta-analytic summaries of departmental-level estimates, WISH significantly predicted ITL (b = -0.45) and affective commitment (AC, b = 0.81), including after controlling for well-being correlates. Mediation results were consistent with a model in which WISH influencers are upstream of cognitive-affective states and, in turn, organizational outcomes; of the total association between WISH and organizational outcomes, most (53% for ITL, 64% for AC) was attributable to WISH directly. ANOVA identified significant differences between WISH influencers: organizational justice scored lowest, whereas perceived social support, psychological safety, and inclusion and belonging scored highest. WISH identifies systemic features associated with well-being and its consequences, including ITL. Multicenter findings extend validation evidence for WISH, clarify the relevance of system-oriented assessment, and characterize the profile of well-being culture in academic anesthesiology.

32. Effectiveness of a standardized patient simulation training programme on nursing students' skill in dementia screening in Malawi: A quasi-experimental study.

期刊: Nurse education in practice 发表日期: 2026-Jun-01 链接: PubMed

摘要

To evaluate the effectiveness of Standardized Patient Simulation (SPS) compared with lecture-based teaching in improving dementia knowledge, dementia screening skills and mild cognitive impairment (MCI) classification accuracy among nursing students in Malawi. Dementia is a growing public health concern, especially in low- and middle-income countries with limited geriatric care resources. Nurses play a central role in early cognitive assessment and dementia screening, yet nursing students often demonstrate limited skill. A quasi-experimental two-group parallel pretest-posttest study. Sixty-eight nursing students at St. John’s Institute for Health, Malawi, were assigned to either an SPS group (n = 34) or a lecture group (n = 34). The primary outcome was post-intervention OSCE performance in dementia screening, while secondary outcomes included dementia knowledge and MCI classification accuracy. Data were analyzed using ANCOVA and McNemar’s test. The SPS group demonstrated significantly greater improvement in OSCE performance compared with the lecture group after adjusting for baseline scores (F (1,65) = 56.39, p < 0.001, partial η² = 0.465), indicating a large effect size. MCI classification accuracy improved significantly (p = 0.001), whereas adjusted dementia knowledge scores did not differ significantly between groups (p = 0.361). SPS significantly improved dementia screening and MCI identification accuracy but did not enhance theoretical dementia knowledge beyond lecture-based teaching. Findings support SPS as an effective strategy for strengthening clinical assessment and decision-making skills in gerontological nursing education.

33. Proteomic signatures of early retinal neurodegeneration in type 2 diabetes mellitus.

期刊: PLoS medicine 发表日期: 2026-Jun 链接: PubMed

摘要

Retinal neurodegeneration is an early and independent feature of diabetic retinal disease and has been proposed as a window into the systemic neural consequences of diabetes, yet accessible molecular biomarkers and individualized prediction tools remain scarce. We aimed to identify circulating plasma protein signatures of diabetic retinal neurodegeneration (DRN) and to translate them into a clinically usable risk prediction system. In this multi-cohort prospective observational study, we integrated high-throughput plasma proteomics with longitudinal optical coherence tomography (OCT) in two independent populations. The discovery cohort comprised 1,492 participants had baseline plasma proteomics and OCT, and 1,218 were followed with repeated OCT over 6 years in Guangzhou Diabetic Eye Study (GDES). DRN was quantified by the annualized OCT-derived retinal nerve fiber layer thinning rate. In multivariable analyses adjusted for age, sex, smoking, systolic blood pressure, HbA1c, and diabetes duration, we identified 71 plasma proteins associated with development and progression of DRN. These proteins mapped onto pathways governing inflammatory immune recruitment, extracellular matrix remodeling, and microvascular homeostasis, providing a plausible biological basis for DRN. We developed a proteomics-based DRN model (Pro-DRN) using eight machine learning (ML) algorithms, including XGBoost and LightGBM. In the independent test set, Pro-DRN achieved a C-index of 0.860, rising to 0.908 when integrated with clinical variables. Compared with six conventional models, Pro-DRN improved discrimination (ΔC-index 0.137 to 0.159; all P < 0.001), reclassification (IDI 0.212 to 0.245; NRI 0.226 to 0.452; all P < 0.05). In the Hippisley model, the C-index increased from 0.739 (95% CI [0.670, 0.808]) to 0.898 (95% CI [0.858, 0.937]), with IDI 0.245 (95% CI [0.177, 0.318]), NRI 0.452 (95% CI [0.222, 0.673]) (both P < 0.001), and higher net benefit. The proteins most consistently driving model performance included ACTA2, COL6A3, and HSPG2. For clinical translation, we deployed the locked model as an interactive, web-based risk-assessment tool to support early DRN screening and longitudinal monitoring. Cross-ethnic external validation in UK Biobank (n = 502; recruited 2006-2010) reproduced core protein signals and consistent effect directions, confirming robustness across populations. Principal methodological limitation lies in single time point proteomic assessment. In this multi-cohort study, we present a proteomics- and ML-based precision prediction system for DRN. Pro-DRN substantially enhanced early risk stratification beyond conventional clinical factors and may support targeted screening and timely neuroprotective interventions, advancing molecularly guided strategies for diabetic eye disease prevention.

34. GeneScanner: profiling genetic variation across bacterial populations.

期刊: Microbial genomics 发表日期: 2026-Jun 链接: PubMed

摘要

Rapid, low-cost genome sequencing has transformed microbiology, advancing efforts to link genetic and phenotypic variation across diverse bacterial systems. Laboratory functional screens now uncover causal mechanisms underlying key traits in simplified systems, such as drug resistance, pathogenicity and metabolic adaptation, while population-scale comparative genomics reveal the immense natural diversity associated with these traits in real-world settings. Despite their complementary strengths, these approaches remain challenging to integrate, especially for researchers without advanced bioinformatics skills. This skills gap can constrain the capacity to reveal the mechanisms underlying microbial traits and evolutionary adaptations. We developed GeneScanner to aid user-friendly analyses of gene- and protein-level variation across large bacterial genome collections. GeneScanner detects genetic variants and amino acid substitutions in homologous sequences to improve functional interpretation of microbial variation. Using synthetic data and three case studies across different species and phenotypes, we show that GeneScanner reliably identifies nucleotide and protein-level variants associated with specific traits. The presented examples highlight the broad applicability of GeneScanner in microbial genomics, enabling research across diverse fields, such as antimicrobial resistance, host-pathogen interactions, microbial evolution, epidemiology and public health.

35. Digital exclusion and frailty among older adults: findings from four longitudinal cohort studies.

期刊: Age and ageing 发表日期: 2026-Jun-01 链接: PubMed

摘要

Digital exclusion has emerged as a critical determinant of health inequality among older adults. However, evidence on its association with frailty remains limited. This study aims to examine the relationships between digital exclusion and frailty. This study used data from four prospective cohorts: the China Health and Retirement Longitudinal Study (CHARLS), the Health and Retirement Study (HRS), the English Longitudinal Study of Ageing (ELSA) and the Mexican Health and Aging Study (MHAS). Digital exclusion was recorded as an absence from Internet use by self-reported data. Frailty status was assessed by the frailty index (FI) ranging from 0 to 1, and frailty was defined as FI ≥ 0.25. Generalised estimating equations were used to assess the associations between digital exclusion and frailty outcomes, adjusting for potential confounders. Linear mixed-effect models were applied to analyse the associations of digital exclusion with frailty progression. The associations between change in digital exclusion status and frailty were also analysed. A total of 9091 participants from CHARLS, 13 210 from HRS, 6065 from ELSA and 9067 from MHAS were included according to the inclusion and exclusion criteria. Digital exclusion was significantly associated with higher odds of frailty across most cohort studies: CHARLS (OR = 2.90, 95% CI = 1.58-5.32), HRS (OR = 1.37, 95% CI = 1.25-1.51) and ELSA (OR = 1.33, 95% CI = 1.14-1.55). Digital exclusion was also associated with faster frailty progression in CHARLS (β = 0.007, 95% CI = 0.001-0.013) and ELSA (β = 0.007, 95% CI = 0.006-0.008). Participants transitioning from digital exclusion to digital inclusion showed significantly lower odds of frailty compared with those persistently excluded. A considerable proportion of older adults still experienced digital exclusion. Digital exclusion was associated with a higher likelihood of frailty and faster frailty progression among older adults. Transitions from digital exclusion to digital inclusion were linked to lower odds of frailty. These findings highlight digital exclusion as a potential correlate of frailty in later life and underscore that promoting equitable digital access and literacy may be a relevant consideration for strategies aimed at supporting healthy ageing.

36. Climate Change and Cancer Care: Disruptions, Disparities, and Strategies for Resilient Oncology Systems.

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

摘要

Our global climate is changing-increasing the frequency, intensity, and duration of extreme-weather related disasters-with direct consequences on human health. These extreme weather-related events are not only environmental crises-they are health system crises. Cancer care-from prevention to diagnosis, treatment, survivorship, and end-of-life care-is particularly affected by extreme weather events because of complex, time-sensitive, infrastructure-dependent, multidisciplinary, and resource-intense care. Although these events affect us all, disruptions are particularly impactful on those who live in settings where underlying community and health resources are limited. Therefore, preparedness and resilience planning specific to cancer care is crucial. Existing evidence-informed strategies to prepare and enhance resilience across clinical, institutional, and policy domains include climate resilience integration in clinical training and practice, adaptation of care delivery infrastructure and operations, knowledge and review of local climate vulnerabilities, and strengthened partnerships with community organizations. As extreme weather events increasingly threaten cancer care delivery, proactive, coordinated efforts by oncology professionals, health systems, and policy are essential to ensure high-quality care delivery.

37. Conditional Medicaid Expansion and Mental Health Outcomes in Georgia.

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

摘要

The continuous Medicaid enrollment provision adopted during the COVID-19 pandemic ended in March 2023, after which approximately 24 million individuals were disenrolled. This unwinding was associated with worsening mental and behavioral health, an urgent public health concern in the US. On July 1, 2023, Georgia implemented Pathways to Coverage, a limited Medicaid expansion program that conditions eligibility on meeting monthly work or community engagement requirements. To evaluate changes in mental health outcomes following implementation of Georgia’s Pathways to Coverage program. This cross-sectional study with a difference-in-differences design used survey data from the national Behavioral Risk Factor Surveillance System. The analysis compared the survey responses of adults residing in Georgia with those of adults residing in neighboring non-Medicaid expansion states (Alabama, Mississippi, Tennessee, and South Carolina). The sample included adults aged 18 to 64 years with household income at or below 100% of the federal poverty level. The preintervention period spanned January 2, 2017, through March 28, 2023, and the postintervention period spanned July 11, 2023, through December 31, 2024. To account for potential confounding related to the end of pandemic-era continuous enrollment, observations from March 29 through July 10, 2023, were excluded. Implementation of Georgia’s Pathways to Coverage Medicaid expansion program. Self-reported number of days in the past 30 days when mental health was not good and self-report of ever having been told that one had a depressive disorder. The analytic sample ranged from 7071 to 7259 observations, depending on the outcome, with a total of 8138 observations in all 5 states. The mean respondent age was 46.4 years (95% CI, 46.1-46.7 years). Most respondents (6155 of 8084 [76.1%]) were single, and 1756 (21.6%) resided in Georgia. Among income-eligible adults, implementation of Pathways to Coverage was associated with an increase of 4.0 days per month (95% CI, 2.0-6.0 days per month; P < .001) when mental health was not good and an increase of 7.2 percentage points (95% CI, 2.4-12.0 percentage points; P = .003) in the probability of ever being told they had a depressive disorder, compared with adults in neighboring non-Medicaid expansion states. In this difference-in-differences analysis of national surveillance data, Georgia’s Pathways to Coverage program was associated with worsening mental health among low-income adults. These findings suggest that conditioning Medicaid eligibility on work or community engagement requirements may create additional barriers to coverage and mental health care access, with potential implications for population health and equity.

38. Comparing Care Coordination and Food Assistance Referrals to Improve Diabetes Outcomes: A Cohort Study.

期刊: Journal of general internal medicine 发表日期: 2026-Jun-01 链接: PubMed

摘要

Care coordination or food assistance referrals can both improve diabetes outcomes by addressing health-related social needs such as food insecurity. However, the evidence comparing these approaches is limited. To examine whether care coordination and food assistance referrals are differentially associated with diabetes outcomes. Longitudinal, observational cohort study. Adults with type 2 diabetes seen in community-based health centers referred for care coordination or food assistance. The primary outcome was hemoglobin A1c (HbA1c). Secondary outcomes were systolic and diastolic blood pressure (SBP and DBP) and low-density lipoprotein cholesterol (LDL). The primary time point was 6 months after referral; 12, 18, and 24 months were secondary time points. Targeted minimum loss estimation was used to adjust for age, sex, race and ethnicity, language, income, health insurance, comorbidities, body mass index, census tract social vulnerability index, food insecurity, housing instability, transportation barriers, and baseline outcome levels. In total, 2108 individuals were included (food assistance = 960; care coordination = 1148). The mean age was 55.2 years (SD, 12.4), 61.9% were female, and the mean baseline HbA1c was 7.6% (SD, 2.1%). Results did not suggest clinically meaningful differences in outcomes when comparing food assistance referrals to care coordination referrals. For example, the estimated 6-month difference comparing food assistance to care coordination was 0.01% (95% CI -0.15 to 0.18) for HbA1c; -0.20 mm Hg (95% CI -1.62 to 1.22) for SBP; 0.78 mm Hg (95% CI -0.14 to 1.69) for DBP; and 2.78 mg/dL (95% CI -2.30 to 7.86) for LDL. Results were similar at other time points. This study did not find clinically meaningful differences in diabetes outcomes between adults who received a referral for food assistance versus care coordination. Both interventions have been proven effective in other studies, so clinics might decide which intervention to offer based on factors such as feasibility and patient preference.

39. Experiencing geriatric rehabilitation through the older adult's eyes: a mixed methods evaluation study of a virtual reality intervention among healthcare professionals.

期刊: Age and ageing 发表日期: 2026-Jun-01 链接: PubMed

摘要

Geriatric rehabilitation (GR) aims to optimise functional capacity and social participation in older adults through multidisciplinary care. Healthcare professionals (HCPs) play a key role, and a deeper awareness of patients’ lived experiences may enhance the quality of care. Virtual Reality (VR) offers an innovative way for HCPs to step into the perspective of older adults and experience rehabilitation through their eyes. Recent studies increasingly highlight VR’s potential to foster empathy and communication skills. To explore whether a VR movie can enhance HCPs’ understanding and empathy regarding older adults’ experiences during GR. In a mixed-methods design we combined structured questionnaires and focus groups. HCPs from four GR organisations viewed a 15-minute VR movie showing the rehabilitation process from the viewpoint of an older adult which was scripted based on earlier studies on this topic. After viewing, participants completed a questionnaire or took part in focus groups discussing their experiences. In total, 160 HCPs completed the questionnaire and 18 participated in a total of three focus groups. Most participants (85%) reported increased awareness of older adults’ experiences, and 95% indicated that they would recommend the VR movie to colleagues. Thematic analysis identified three key themes reflecting how HCPs, when adopting the older adult’s perspective, perceived the rehabilitation experience: (1) feeling overwhelmed, (2) being dependent and vulnerable and (3) lack of clarity in staff routines. Participants additionally suggested practical improvements in daily care. The VR movie appears to be an effective educational tool in raising understanding and empathy among HCPs in GR.

40. Integrating liquid chromatography-high resolution mass spectrometry based suspect screening with ionization efficiency prediction to expand semi-quantitative coverage in wastewater-based epidemiology: application to environmental chemicals.

期刊: Environment international 发表日期: 2026-May-30 链接: PubMed

摘要

Wastewater-based epidemiology (WBE) is increasingly used to assess population-level chemical exposure, yet its analytical scope is often limited by target-based methods and the availability of reference standards. In this study, we developed an integrated analytical workflow that expanded the coverage of environmental chemicals and enabled standard-free semi-quantitative analysis under a realistic post hoc WBE scenario. Influent wastewater samples from nine wastewater treatment plants in Taiwan were re-examined using a single additional liquid chromatography-high resolution mass spectrometry (LC-HRMS) analysis in full-scan and data-dependent acquisition modes. A total of 189 environmental compound signals were structurally identified, representing 79 unique chemical structures. Semi-quantitative concentration estimation was achieved using a single-point calibration strategy based on isotope-labeled internal standards originally included for illicit drug analysis, combined with ionization efficiency (IE) prediction tools. Internal cross-validation yielded median prediction errors of 2.3-fold in positive ionization mode and 5.0-fold in negative ionization mode. Furthermore, cross-method validation against historical targeted datasets for six illicit drugs within the same sample cohort revealed a median underestimation of 6.7-fold. To evaluate accuracy under controlled conditions, an independent spiking experiment using authentic standards in groundwater demonstrated an overall median error of 4.3-fold, with 81.3 % of the quantified analytes falling within one order of magnitude of their nominal concentrations. Population-normalized mass load analysis revealed regional differences in chemical exposure profiles, with elevated mass loads of smoking-related biomarkers, including cotinine and nornicotine, observed in wastewater from southern Taiwan.

41. Still fearing the unknown: Development and initial validation of an ultra-brief intolerance of uncertainty scale.

期刊: Journal of anxiety disorders 发表日期: 2026-May-28 链接: PubMed

摘要

The 12-item Intolerance of Uncertainty Scale (IUS-12) is a widely used measure in anxiety disorders research and clinical practice, although recent research efforts have recommended the development of a briefer measure to reduce response burdens. The current study was designed to develop a short form of the IUS-12. We administered the IUS-12 to two samples (cross-sectional, n = 3952; longitudinal, n = 190) of Canadian Public Safety Personnel through an online self-report survey. Exploratory (EFA) and confirmatory (CFA) factor analyses assessed the factor structure of the IUS-12 and facilitated item reduction and optimization. Convergent and concurrent validity, as well as pre-post rank-order consistency were also assessed. The IUS-12 was reduced to a two-factor, six-item short form (i.e., IUS-6) that retains the factor structure of the IUS-12 with statistically comparable validity and consistency, which appears to retain the intended latent content for each subscale. Very strong statistically significant positive correlations were observed between IUS-6 and IUS-12 subscales (rs = .90-.94) and total scores (r = .95) for all samples, suggesting excellent construct validity. Moderate to strong statistically significant associations were also observed among the IUS-6 and IUS-12 total and subscales and measures of generalized anxiety, social anxiety, and anxiety sensitivity, suggesting good convergent validity (rs = .23-.64), with only small differences in correlation strengths (i.e., r < .14). The IUS-6 may be used as an ultra-short version of the IUS-12 for assessing self-reported intolerance of uncertainty in both cross-sectional and longitudinal research designs, potentiating reduced response burdens, which may be important in various research and clinical settings.

42. Early life social and environmental exposures and all-cause hospital visits among children under five in southern Mozambique.

期刊: Environment international 发表日期: 2026-May-27 链接: PubMed

摘要

Children in low- and middle-income countries (LMICs) face high burdens of morbidity shaped by complex and interacting early-life exposures. In this study, we assessed the early-life external exposome and its association with hospital visits in a population-based cohort of 17,145 children under five years of age in Manhiça, southern Mozambique. We evaluated 47 exposures across four domains (surrounding residential environment, household environment, socioeconomic adversity, and family instability) and linked these to prospective all-cause hospital visit records. Using three complementary analytical approaches (exposome-wide association studies, Elastic Net exposure selection, and clustering) we identified consistent predictors of increased hospital visits, including household mobile phone ownership, maternal education, access to electricity, and proximity to roads. In contrast, living without a father and increased exposure to artificial light at night were associated with fewer visits. Clustering revealed distinct exposome profiles reflecting gradients in urbanization, material assets, maternal education, electrification, and the proportion of children living with their fathers. Cluster membership was associated with frequency of hospital visits, suggesting that healthcare utilization is shaped by both health needs and differential access. Our novel application of the exposome approach in a LMIC context highlights the value of considering in an integrated way multiple exposure dimensions relevant to morbidity and health-seeking behavior in early life.

43. Plastic Versus Cotton Caps for Preventing Hypothermia in Very Preterm Infants: A Randomized Clinical Trial.

期刊: Turkish archives of pediatrics 发表日期: 2026-May-21 链接: PubMed

摘要

Preventing hypothermia in very preterm infants is difficult. This study aims to compare the effect of plastic versus cotton caps in combination with polyethylene body wrapping in the prevention of hypothermia in very preterm infants. A total of 95 newborns less than 32 weeks of gestation were enrolled in this randomized clinical trial. Immediately after birth, the infants were placed in polyethylene covers. In the intervention group (n=48), the heads of newborns were covered with plastic caps, while in the control group (n=47), the heads were covered with cotton caps. The primary outcomes were temperature at admission and 1 hour after admission in the neonatal intensive care unit, as well as the rate of hypothermia in both groups. Mean axillary temperature on admission was higher in the plastic cap group compared to the cotton cap group (P = .009). After adjusting for gestational age, the difference in mean admission temperature was higher in the plastic cap group in the 28-31 weeks’ gestation (P = .013); however, all babies born at 25-27 weeks’ gestation remained hypothermic at neonatal intensive care unit admission. The temperature 1 hour after admission was similar between the groups (P=.846). The rate of hypothermia showed no significant difference between groups. Although plastic caps were associated with higher admission temperatures compared with cotton caps, they did not reduce the frequency of hypothermia. This points to the need for newer and combined strategies, especially in extremely preterm infants (25-27 weeks). Plastic caps remain a cost-effective and hygienic option for resource-limited settings. Trial registration: The trial was prospectively registered in the Iranian Registry of Clinical Trials (IRCT) under the registration number IRCT20091201002801N5 on February 9, 2023. The registration can be accessed at the following URL: https://irct.behdasht.gov.ir/trial/68485.

44. Complications related to the routine use of feeding jejunostomy in esophageal cancer surgery within an enhanced recovery protocol.

期刊: Clinical nutrition (Edinburgh, Scotland) 发表日期: 2026-May-19 链接: PubMed

摘要

To evaluate the feasibility, safety, and impacts of routine surgically placed feeding jejunostomy (FJ) and early enteral feeding (EF) in patients undergoing esophagectomy for esophageal cancer within an Enhanced Recovery Protocol (ERP), focusing on adverse events (FJ-AE and EF-AE). This monocentric retrospective observational study analyzed 738 consecutive patients with resectable esophageal or gastroesophageal junction carcinoma treated at University Hospitals Leuven from May 2017 to December 2023. All followed an ERP with routine FJ placement during esophagectomy (or pre-neoadjuvant staging laparoscopy in select cases). Data from a prospective database and medical records were reviewed for demographics, weights/BMI, all recorded FJ-AE, EF intolerance during the postoperative course, up to five years after surgery, when available, or date of death. The mean age was 65 years (range 24-90), with a majority being male (81%). About 77.5% had adenocarcinoma and were at an advanced stage. Neoadjuvant therapy was performed before surgery in 71%. FJ-AE impacted 361 (48.9%) patients, increasing to 419 (58.5%) when including EF-AE. After categorizing AEs, 310 (42%) were deemed non-serious, while 109 (14.8%) were considered serious, with 7 (0.9%) contributing to mortality. Late, serious complications occurred in 33 (4.5%) patients. The mean EF usage and FJ lifespan varied based on several factors: longer for older patients, those with non-adenocarcinoma, and higher NRS2002 scores, but shorter in minimally invasive approaches and patients with higher BMIs. Patients who experienced an anastomotic leak after surgery or required adjuvant therapy had longer EF usage and FJ duration. Routine FJ placement in esophagectomy yields high AE rates, conflicting with ERP goals of complication reduction. Selective placement in malnourished/high-risk patients, guided by the latest ESPEN/ERAS guidelines, may minimize burdens while preserving nutritional benefits. Multicenter trials are warranted for tailored strategies.

45. Energy expenditure, physical activity and dietary intake among patients with newly diagnosed colorectal cancer.

期刊: Nutrition (Burbank, Los Angeles County, Calif.) 发表日期: 2026-May-03 链接: PubMed

摘要

Characterizing energy balance components such as total energy expenditure (TEE), energy intake (EI), and physical activity energy expenditure (PAEE) is crucial to assessing nutritional status and guiding interventions. This observational study explored these variables and their interrelationships in patients with colorectal cancer (CRC). In patients with newly diagnosed CRC, PAEE was evaluated as the difference between TEE (doubly labeled water) and resting energy expenditure (REE; indirect calorimetry). Activity monitors worn during the 2-wk doubly labeled water period captured steps/d and time spent in various activity intensities activity. Dietary intake was assessed using a 24-h dietary recall and compared to guidelines and energy expenditure and physical activity outcomes. Twenty patients were included (65% male; age: 56 ± 13 y; body mass index: 28.2 ± 5.0 kg/m2). TEE ranged from ∼1500 to 3600 kcal/d and correlated with REE (r = 0.60, P = 0.006) and PAEE (r = 0.56, P = 0.011); REE and PAEE were not correlated. The majority (87.9 ± 6.1%) of time was spent in sedentary behavior, and activity was lower on weekend days compared to weekdays. EI was 2290 ± 29 kcal/d, with only 20% meeting energy and 30% meeting protein intake guidelines. TEE and PAEE were positively associated with EI and negatively associated with protein intake. REE was unrelated to dietary intake, and no associations were found between dietary intake and device-based activity. TEE and PAEE-but not REE or activity monitor parameters-were associated with dietary intake. These findings emphasize the need for robust, low-burden approaches to assess PAEE to optimize nutrition care in patients with CRC.

46. [Maternal obesity and child outcome: A major prevention issue].

期刊: La Revue du praticien 发表日期: 2026-May 链接: PubMed

摘要

The prevalence of maternal obesity is steadily increasing, affecting a significant proportion of pregnancies. Beyond well-known obstetric complications, this condition exposes the newborn to immediate risks (perinatal mortality, congenital malformations, macrosomia) and the child to long-term consequences (obesity, metabolic disorders, and neurodevelopmental issues). Since lifestyle interventions during pregnancy show limited efficacy on child outcomes, prevention strategies must focus on the preconception period and the promotion of breastfeeding. This is an underestimated public health issue that requires collective action by health authorities and practitioners. La prévalence de l’obésité maternelle ne cesse de croître, concernant désormais une part significative des grossesses. Au-delà des complications obstétricales bien connues, cette situation expose le nouveau-né à des risques immédiats (mortalité périnatale, malformations, macrosomie) et l’enfant à des conséquences à long terme (obésité, troubles métaboliques et neurodéveloppementaux). Les interventions hygiéno-diététiques pendant la grossesse montrant une efficacité limitée sur le devenir de l’enfant, la prévention doit s’orienter vers la période préconceptionnelle et la promotion de l’allaitement maternel. Il s’agit d’un problème de santé publique sous-estimé nécessitant une mobilisation collective des politiques de santé et des professionnels.

47. Applying the ADAPT-ITT framework to adapt a lifestyle Redesign® occupational therapy intervention for diabetic foot ulcer self-management.

期刊: Translational behavioral medicine 发表日期: 2026-Jan-07 链接: PubMed

摘要

Diabetic foot ulcers (DFUs) affect approximately 25% of people with diabetes and are associated with decreased quality of life, high healthcare costs, recurrent wounds, and amputation risk. Standard DFU care emphasizes offloading to promote healing; however, adherence is often poor due to behavioral, psychosocial, and everyday life challenges. These gaps highlight the need for person-centered interventions that support DFU self-management within daily routines. To systematically adapt a Lifestyle Redesign® occupational therapy intervention (LR-OT) for DFU self-management using the ADAPT-ITT framework. An iterative, stakeholder-engaged adaptation process was conducted across the first seven ADAPT-ITT phases: Assessment, Decision, Administration, Production, Topical Experts, Integration, and Training. Activities included targeted literature synthesis, theater testing with individuals with DFUs and DFU care providers, iterative material development, and expert consultation. Adaptation efforts focused on refining intervention content, delivery, and training supports to DFU-specific care demands while retaining alignment with LR-OT core elements. The ADAPT-ITT process yielded an interventionist-ready, DFU-specific LR-OT package, including patient-facing materials, an interventionist resource guide, and a conceptual mapping linking LR-OT theoretical elements to DFU-targeted management activities. Stakeholder input informed coordinated refinements to content, session structure, and delivery to support feasibility within DFU care contexts. Application of the ADAPT-ITT framework supported a transparent, stakeholder-informed, and reproducible process for adapting an evidence-based occupational therapy intervention for a high-risk and medically complex population. This work illustrates how lifestyle-focused interventions can be systematically adapted for specialty care contexts, with subsequent testing needed to evaluate fidelity and effectiveness. #NCT06278935. Diabetic foot ulcers (DFUs) are a common and serious complication of diabetes. They can interfere with daily life, often return after healing, and may lead to amputation. A key part of DFU care is “offloading,” which involves special footwear or casts to reduce pressure on the foot. Many people find it hard to use these devices consistently because everyday responsibilities, discomfort, emotional stress, and limited support. This project focused on adapting an occupational therapy program called Lifestyle Redesign® to better support people managing DFU in their daily lives. Rather than creating a new program, the research team used a structured adaptation process called ADAPT-ITT to modify an existing evidence-based intervention so it better fit the realities of DFU care. The process involved gathering input from people with DFUs, healthcare providers, and clinical experts through focus groups, interviews, review of materials, and expert consultation. The adaptation process resulted in new patient materials and resources for occupational therapists that address offloading use, foot checks, emotional well-being, and integrating DFU care into daily routines. This work shows how occupational therapy interventions can be thoughtfully adapted and integrated into multidisciplinary teams to support DFU self-management in specialty care settings.

48. Examination of the Reliability and Responsiveness of a Japanese Version of the Movement Imagery Questionnaire for Children: Toward Application in Children With Developmental Coordination Disorder.

期刊: Occupational therapy international 发表日期: 2026 链接: PubMed

摘要

Developmental coordination disorder (DCD) is a neurodevelopmental condition marked by impaired motor coordination despite the absence of an underlying neurological condition affecting movement (e.g., cerebral palsy, muscular dystrophy, and degenerative disorder). Motor imagery training (MIT) has recently gained attention as a rehabilitation approach for children with DCD. Effective implementation of MIT requires accurate assessment of motor imagery (MI) abilities; however, no comprehensive evaluation tool for children exists in Japan. This study is aimed at developing a Japanese version of the Movement Imagery Questionnaire for Children (MIQ-C) and examining its reliability and responsiveness. Thirty-three children (18 males and 15 females; mean age 10 ± 0.9 years) participated. Internal consistency was assessed using Cronbach’s alpha. Test-retest and interrater reliability were examined using intraclass correlation coefficients. Responsiveness was evaluated by examining changes in MIQ-C scores before and after training tasks. The Japanese version of the MIQ-C demonstrated strong internal consistency (Cronbach’s α = 0.82). Test-retest and interrater reliability showed moderate to strong agreement. No significant changes were observed in response to specific tasks, supporting appropriate responsiveness. The Japanese version of the MIQ-C is a reliable and valid instrument for assessing MI abilities in Japanese children, providing a useful tool to support the implementation of MIT in clinical and educational settings.

49. HIV post-exposure prophylaxis (PEP) and PEP-in-pocket (PIP) for women: A rodgers' evolutionary concept analysis.

期刊: Women’s health (London, England) 发表日期: 2026 链接: PubMed

摘要

BackgroundHIV prevalence among cis and trans women is increasing, yet prevention medication uptake remains low. Despite extensive literature regarding pre-exposure prophylaxis (PrEP), less is known about post-exposure interventions for women. Among women, non-occupational post-exposure prophylaxis (PEP) is mainly used in sexual assault centres and rarely otherwise. PEP-in-Pocket (PIP) is a self-initiated PEP option for infrequent high-risk exposures (<4/year) and could offer women more agency over their sexual health. PIP, an evolution of PEP endorsed by international guidelines, may better address women’s diverse needs, yet remains understudied and underutilized.ObjectiveTo develop a clear contextual understanding of PEP and PIP in the context of women based on its current use in the literature.DesignRodgers’ Evolutionary Concept Analysis. Rodger’s methodology is a flexible, non-linear approach suited for evolving health concepts and involves three phases: conceptualizing the concept; identifying key attributes, antecedents, and consequences; and interpreting findings to inform future research.Data sourcesScholarly peer-reviewed literature.MethodsA systematic search (January 2012-May 2025) across Medline, Emcare, and Global Health identified 33 relevant studies. Two reviewers screened and extracted texts using Covidence. Rodgers’ evolutionary concept analysis was used to examine PEP and PIP among cis and trans women.ResultsPEP attributes include reactive use after exposure, clinical initiation, and time-sensitive access. Key attributes of PIP include self-initiation, episodic use, autonomy, and accessibility outside healthcare settings. Shared antecedents include barriers to access, and the need for alternative HIV prevention strategies. PIP-specific antecedents include infrequent high-risk exposures and a desire for greater individual control, especially among those who may not interact with healthcare providers. Consequences of both strategies include reduced HIV risk and expanded options. Overall, the literature on PIP was limited, but increased agency, empowerment, and potential to fill HIV prevention gaps were noted.ConclusionsPEP and PIP are promising, women-centered HIV prevention strategies that support autonomy and timely care but remain underutilized. This analysis identifies significant gaps in research and implementation for women, underscoring the need for further investigation to advance equitable HIV prevention. Rates of HIV are increasing among cis and trans women worldwide. Although there are effective medications that can prevent HIV, many women are either unaware of these options or not able to access them. To date, most research has focused on pre-exposure prophylaxis (PrEP), a proactive prevention approach using tablets or injectable agents in HIV-negative individuals to prevent infection, which may not meet all women’s needs. Far less is known about medications used after possible HIV exposure, especially among women. Post-Exposure Prophylaxis (PEP) is a 28-day course of medication started as soon as possible (and within a 72-hour window) following a potential exposure to HIV. PEP is typically started through a healthcare setting and must be accessed quickly, and among women, PEP is commonly used in sexual assault centres and is rarely used in other situations. A newer approach, called PEP-in-Pocket (PIP), allows individuals to receive a proactive prescription for guideline-approved PEP medications, and supports individuals to fill this prescription and have medication readily accessible such that people may self-initiate PEP quickly after a potential exposure to HIV with as few barriers as possible. This approach may be especially helpful for women who face additional barriers to healthcare or want more control and autonomy over their HIV prevention. This review includes published literature between 2012 and 2025 to better understand the concepts of PEP and PIP, and how it relates to women. Both PEP and PIP can reduce HIV risk, but PIP may offer women greater personal control over their own HIV prevention. However, research on PIP among women is limited and more research studies are needed to support women-centered HIV prevention options.

50. Hepatitis B vaccine uptake and associated factors among pregnant women attending antenatal care at Gulu Regional Referral Hospital, Northern Uganda.

期刊: PloS one 发表日期: 2026 链接: PubMed

摘要

Hepatitis B virus (HBV) infection is a global public health concern. Uganda has a high prevalence of HBV infection among pregnant mothers. This study aimed to determine HBV vaccine uptake and associated factors among pregnant women attending Antenatal Care (ANC) at Gulu Regional Referral Hospital (GRRH). This was a cross-sectional study. Data were collected from 430 participants who were selected by systematic sampling. Data were collected using an electronic questionnaire built on the Kobo Collect server and analyzed using STATA version 16.0. Prevalence ratios (PR) were calculated using a modified Poisson regression analysis to determine the association between HBV vaccine uptake and the predictors. More than half (53%:229/430) of the pregnant mothers had received at least a dose of the HBV vaccine. Factors statistically significantly associated with HBV vaccine uptake included age (APR = 1.10, 95% CI: 1.02-1.18), knowledge about HBV (APR = 1.06, 95% CI: 1.01-1.10), and healthcare worker communication (APR = 1.17, 95% CI: 1.04-1.32). More than half of pregnant mothers had received at least a dose of the HBV vaccination. Age, knowledge, and healthcare communication influenced vaccine uptake. There is a need to provide adequate health education regarding the importance of completing the HBV vaccine to pregnant women and community members to improve vaccine outcomes.

51. Burden of acute lymphoblastic leukemia in children and adolescents in low- and middle-income countries from 1990 to 2023 and projections to 2050: A systematic analysis from the global burden of disease study 2023.

期刊: PloS one 发表日期: 2026 链接: PubMed

摘要

Acute Lymphoblastic Leukemia (ALL) is the most common and curable malignancy in children and adolescents, yet it remains a significant health threat. Despite global survival improvements driven by new drugs and treatment protocols, comprehensive data on disease burdens and attributable risk factors across diverse socio-economic contexts remain limited. This study evaluated the epidemiological characteristics, temporal trends, and modeled attributable risk factors of ALL in LMICs from 1990 to 2023. Using GBD 2023 data, we analyzed ALL incidence, mortality, and DALYs in children and adolescents (0-19 years), stratified by World Bank income groups. We assessed temporal trends via Joinpoint regression, projected burdens to 2050 using the Bayesian Age-Period-Cohort (BAPC) model, and evaluated risk attribution for occupational benzene and formaldehyde exposure. In 2023, LMICs reported 64,477 new ALL cases and 30,909 deaths, with a higher burden in males. While the age-standardized incidence rate (ASIR) declined overall, absolute cases rose due to population growth. Although occupational benzene and formaldehyde exposure were the only modeled risk factors, their Population Attributable Fractions (PAFs) were negligible (<1%), indicating minimal contribution to the total burden. Projections suggest the age-standardized ALL burden will continue declining through 2050, with the sharpest decrease expected in low-income countries. Globally, childhood and adolescent ALL mortality and DALYs are declining, yet the burden remains substantial in many LMICs, with the smallest improvements observed in low-income countries from 1990 to 2023. Occupational benzene and formaldehyde exposure contributed minimally to the total burden (PAFs < 1%), indicating that direct occupational exposure is rare in children. These findings suggest that the persistent burden in LMICs is primarily driven by healthcare system factors rather than occupational environmental exposures. Therefore, efforts to further reduce ALL mortality and DALYs in high-burden regions should address gaps in healthcare access and treatment delivery.

52. Development of a Confined-Space Suitability Index (CSSI) using Least Absolute Shrinkage and Selection Operator (LASSO) regression: a pilot study for structured fitness-for-duty screening.

期刊: PloS one 发表日期: 2026 链接: PubMed

摘要

Confined space work exposes workers to complex risks, including oxygen deficiency, hazardous gases, and physical strain, requiring structured criteria for fitness-for-duty screening. This study aimed to develop a Confined-Space Suitability Index (CSSI) based on routinely available health examination and functional test data. A total of 111 workers were analyzed. Risk factors were classified into anthropometric and metabolic factors, functional and physiological factors, and lifestyle factors. Low cardiorespiratory fitness was defined using age- and sex-specific VO₂max reference thresholds from Korea Occupational Safety and Health Agency (KOSHA) H-43-2021 and Canadian Public Health Association reference values. Risk-factor weights were derived using LASSO regression, and internal validation was performed using leave-one-out cross-validation and bootstrap stability analysis. According to the revised CSSI criteria, 86 workers were classified as suitable, 19 as caution, and 6 as unsuitable. The independent specialist assessment classified 7 workers as unsuitable. In leave-one-out cross-validation, the CSSI showed an AUROC of 0.940 and an AUPRC of 0.567, with sensitivity of 0.833, specificity of 0.933, and negative predictive value of 0.990. In bootstrap stability analysis, dyslipidemia, low cardiorespiratory fitness, and hypertension were consistently selected. The CSSI may serve as a structured screening and referral-support index for identifying workers who require additional specialist evaluation before confined space work. However, it should be interpreted as an auxiliary index rather than a replacement for specialist fitness-for-duty judgment.