公共卫生研究摘要 (2026-06-10)

共收录 61 篇研究文章

1. Risk prediction of Helicobacter pylori strains across Correa's cascade via intelligent analysis of genome-wide SNPs.

期刊: Proceedings of the National Academy of Sciences of the United States of America 发表日期: 2026-Jun-16 链接: PubMed

摘要

Only a minority of Helicobacter pylori (H. pylori)-infected individuals progress along Correa’s cascade, and classical virulence markers do not fully explain this heterogeneity, motivating genome-wide approaches to quantify strain-level genomic risk associated with advanced lesions. We assembled 528 high-quality H. pylori whole-genome sequences spanning nonatrophic gastritis (NAG), atrophic gastritis (AG), intestinal metaplasia (IM), and gastric cancer (GC) and performed bacterial genome-wide association analyses with explicit adjustment for population structure. We then integrated advanced lesions-associated variants into a random forest model to derive an H. pylori Genomic Risk Score (HpRS), defined as the predicted probability that a strain is associated with advanced lesions (IM/GC) vs. nonadvanced lesions (NAG/AG). Despite phylogenetic analyses revealing that genome-wide clustering was primarily driven by geographic lineage rather than disease stage, HpRS achieved strong discrimination in repeated cross-validation (mean AUC = 0.902, 95% CI: 0.892 to 0.912), remained discriminatory in an internal held-out set (AUC = 0.780), and generalized to two independent cohorts (Bacterial and Viral Bioinformatics Resource Center (BV-BRC): AUC = 0.871; hospital cohort distinguishing IM vs. NAG/AG: AUC = 0.843). Predictive single-nucleotide polymorphisms mapped mainly to core functions (DNA repair, translation, and central and lipid metabolism) and often affected conserved domains, suggesting a polygenic architecture and generating testable functional hypotheses. HpRS provides a proof-of-principle framework for strain-aware risk stratification and may complement future gastric cancer prevention strategies.

2. Cell-Based Multisensor Array for Vapor-Phase Detection of Cancer-Related Compounds in Human Urine.

期刊: ACS sensors 发表日期: 2026-Jun-10 链接: PubMed

摘要

Detecting volatile biomarker candidates in complex biological samples is a key challenge in sensor science, particularly for noninvasive disease screening applications. Biohybrid sensors based on olfactory receptor-expressing cells offer high molecular selectivity; however, their use with physiological samples is often limited by weak fluorescence signals and variability in cellular responses. Here, we present a cell-based multisensor platform in which insect olfactory receptor-expressing cells are encapsulated in hydrogel and immobilized within slit-integrated microwells. This microstructural design enables dense three- dimensional cell loading and rapid, uniform exposure to target molecules, thereby enhancing fluorescence response sensitivity and reducing signal variability. The microwell architecture further allows simple and reproducible fabrication of multisensor arrays. Using this platform, multiple types of sensor cells on a single array enabled the selective and simultaneous detection of potential cancer-related volatile molecules, including acetophenone, phenol, and 6-methyl-5-hepten-2-one. By combining hexane extraction with vapor-phase exposure, we demonstrated reliable detection of acetophenone introduced into human urine samples at micromolar concentrations. The platform offers a compact, reproducible, and scalable strategy for cell-based detection of volatile molecules in complex biological samples.

3. A systematic review: Extended-spectrum beta-lactamase-producing Escherichia coli among cattle, companion animals, synanthropic species, and meat products in South America (2020-2024).

期刊: Revista Argentina de microbiologia 发表日期: 2026-Jun-09 链接: PubMed

摘要

The spread of ESBL-producing Escherichia coli strains among different hosts, including humans, domestic animals, and synanthropic animals, has become a current public health challenge. A comprehensive analysis of bacterial isolates in animals and meat products throughout South America is essential to improve the understanding of their distribution and the different mechanisms of resistance in developing countries. This review aims to evaluate the different studies on ESBL-producing E. coli in animals and meat products in South America, from 2020 to 2024. A systematic search was conducted in databases such as PubMed, SciELO, and Latindex from January 1, 2020 to May 1, 2024. Studies published in English, Spanish, and Portuguese on ESBL-producing E. coli from animal sources (dogs, cats, chickens, pigs, cows, rats, and meat products) were conducted across South America. Eighty percent of the included articles reported blaCTX-M genes, with the blaCTX-M-2 gene being the most common with 48.2%. This gene was found mainly in chickens, followed by dogs, cows and pigs. The ST10 clone was the most prevalent, reported in 40% of the included studies, while ST155 was evidenced in 30%. Other clones, such as ST117 and ST131, were identified in 20% of the studies. The increasing prevalence of blaCTX-M resistance genes in E. coli in South American countries highlights the need for effective surveillance and control measures in the animal environment. The inappropriate use of antibiotics in livestock requires multidisciplinary approaches, such as the One Health approach, to address this problem.

4. Digital Physiotherapeutic Elbow-Specific Training System for Patients After Arthroscopic Release of Elbow Contracture: Noninferiority Randomized Controlled Trial.

期刊: JMIR mHealth and uHealth 发表日期: 2026-Jun-09 链接: PubMed

摘要

The effectiveness of a digital training (DT) system in which patients receive individually tailored physiotherapeutic elbow-specific training (PEST) delivered via a digital platform remains unclear. This study determines the effectiveness of a DT system in which patients receive individually tailored PEST supervision and guidance via the Joymotion Intelligent Rehabilitation System and educational videos, compared with conventional training (CT) conducted by qualified physiotherapists at outpatient clinics and unsupervised home-based PEST in patients following arthroscopic release for posttraumatic elbow stiffness. This single-center, noninferiority randomized controlled trial was conducted at the Rehabilitation Department of Shanghai Sixth People’s Hospital between September 2020 and June 2024. Patients aged 16-65 years undergoing arthroscopic release for posttraumatic elbow stiffness were randomized to receive either a 12-week DT program or conventional outpatient clinic-based training. Outcome measures included elbow flexion-extension range of motion (primary outcome); forearm rotation; isometric and dynamic muscle strength; American Shoulder and Elbow Surgeons (ASES) and Disabilities of the Arm, Shoulder, and Hand (DASH) scores; EQ-5D-5L; cost-effectiveness; adherence; and adverse events, assessed at 4, 12, and 24 weeks postoperatively. At 12 weeks, the mean elbow flexion-extension range of motion improved similarly in the DT and CT groups (between-group difference -1.6°, 95% CI -8.2° to 4.9°; P=.53), confirming noninferiority. Forearm rotation gains were slightly greater with DT (difference 14.2°, 95% CI 2.9°-25.6°). Patient-reported outcomes were equivalent between groups: ASES function (difference 0.6, 95% CI -0.3 to 1.5; P=.39) and pain (difference 0, 95% CI -8.3 to 8.5; P=.68) subscores, DASH (difference 0.23, 95% CI -1.54 to 1.99; P=.68), and EQ-5D-5L index (difference 0.001, 95% CI -0.012 to 0.015; P=.56) showed no significant between-group differences. Nearly all patients completed the 12-week program in both arms (104/106, 98.1%, vs 101/102, 99%, adherence; odds ratio 0.52, 95% CI 0.05-5.77). Adverse events occurred in 29 out of 106 (27.4%) participants in the DT group and 32 out of 102 (31.4%) participants in the CT group (odds ratio 0.82, 95% CI 0.45-1.50). Total rehabilitation costs per patient were lower in the DT group by an average of CNY -7418.58, and incremental cost-effectiveness analysis indicated that DT provided comparable outcomes at lower cost. Individually tailored PEST delivered via a DT system is a viable, cost-effective, and safe alternative to conventional outpatient clinic-based training following arthroscopic release for posttraumatic elbow stiffness. These findings support its integration into routine postsurgical care, particularly for patients facing barriers to traditional therapy. Chinese Clinical Trial Registry Chictr2400093415; https://www.chictr.org.cn/showprojEN.html?proj=240693.

5. Evaluation of the Importance of Stopping Elderly Accidents, Deaths, and Injuries (STEADI)-Based Factors in Wearable Fall Risk Assessment: Secondary Data Analysis.

期刊: JMIR mHealth and uHealth 发表日期: 2026-Jun-09 链接: PubMed

摘要

Falls among older adults are a growing and costly public health problem that often leads to mobility decline and loss of independence. Although clinical frameworks such as the Centers for Disease Control and Prevention’s (CDC) Stopping Elderly Accidents, Deaths, and Injuries (STEADI) initiative recommend multifactor screening (gait, balance, strength, fear of falling, and fall history), most wearable fall risk assessment systems rely on a small set of risk factors (typically gait), which creates a gap between clinical practice and automated wearable assessment. This study aims to evaluate the importance of STEADI-based fall risk factors and provide design guidance for clinically compatible wearable fall risk assessment systems. We created a dataset of 24 older adults (10 low fall risk and 14 high fall risk) from a publicly available plantar pressure dataset of 48 participants by retaining only those with consistent fall risk labels based on both the Berg Balance Scale and the Timed Up and Go test. A total of 18 features were extracted to quantify gait, strength, balance, fear of falling, and fall history. Random forest (RF) models were trained with leave-one-subject-out cross-validation to assess fall risk. Importance of STEADI-based factors was assessed by two methods: (1) estimating Shapley Additive Explanations values based on a single RF model trained on all features; and (2) training 5 separate RF models, each on 1 STEADI factor category, and comparing their fall risk classification accuracies. In this secondary analysis, the RF model trained on all features achieved a subject-level accuracy of 87.53% (95% CI 75%-100%). Shapley Additive Explanations analysis identified the right foot flat phase ratio (fear of falling feature) as the highest-ranked feature, followed by maximum right forefoot ground reaction force (strength feature), whereas traditional gait features did not appear in the top 10. The 5 separate RF models trained on individual STEADI-based factor categories showed a similar trend in mean participant-level accuracy: fear of falling, 87.59% (95% CI 75%-100%); strength, 79.18% (95% CI 62.5%-95.83%); balance, 70.5% (95% CI 50%-87.5%); gait 70.81% (95% CI 54.17%-87.5%); and fall history 62.37% (95% CI 50%-75.1%). However, paired comparisons did not show statistically significant differences in accuracy between the gait model and the models trained on other factors. These preliminary results show that commonly overlooked nongait factors are potentially as informative as gait, although clear superiority was not demonstrated in this dataset. The novel foot flat phase ratio ranked higher than all other evaluated features, which showed the value of domain knowledge-informed feature engineering. These preliminary findings indicate that nongait STEADI factors merit consideration in the design of wearable fall risk assessment systems.

6. Cost-effectiveness Analysis of Xpert MTB/RIF Ultra for the Diagnosis of HIV-Associated Tuberculous Meningitis.

期刊: Clinical infectious diseases : an official publication of the Infectious Diseases Society of America 发表日期: 2026-Jun-09 链接: PubMed

摘要

HIV-associated tuberculous meningitis (TBM) is the most lethal form of extrapulmonary tuberculosis, with high mortality in sub-Saharan Africa. Due to the limited diagnostic performance of current testing, empiric treatment is frequently required as untreated TBM is almost universally fatal. Xpert MTB/RIF Ultra (Xpert Ultra) is the World Health Organization (WHO) recommended first line diagnostic test for TBM but is costly relative to standard of care. We performed a cost-effectiveness analysis of Xpert Ultra for HIV-associated TBM in Zambia. We developed a decision-analytic model comparing a diagnostic strategy guided by CSF Xpert Ultra plus standard of care (CSF biochemistry and clinical suspicion) versus standard of care alone in adults with HIV and suspected TBM. Costs were calculated from a healthcare perspective including medication, supplies, personnel, and overhead. The primary outcome was the incremental cost-effectiveness ratio (ICER) in US dollars per quality-adjusted life-year (QALY) gained. Sensitivity analyses and cost-effectiveness acceptability curves (CEAC) assessed robustness across a range of willingness-to-pay (WTP) thresholds. Xpert Ultra plus standard of care was cost-effective yielding an ICER of $242.76 per QALY gained. The number needed to test to prevent one TBM death was 125. Sensitivity analyses showed cost-effectiveness was most influenced by TBM prevalence, TBM mortality in treated patients, and the probability of empiric treatment. Xpert Ultra was approximately 88% likely to be cost-effective across a broad WTP range. Xpert Ultra is cost-effective for diagnosing HIV-associated TBM in Zambia. These findings support WHO guidelines recommending Xpert Ultra in high-burden, resource-limited settings.

7. Comprehensive Characterization of Metastatic Patterns and a Redefined Prognostic Framework in Metastatic Prostate Cancer.

期刊: The Prostate 发表日期: 2026-Jun-09 链接: PubMed

摘要

Metastatic prostate cancer (mPCa) exhibits highly complex metastatic patterns. Comprehensive evaluation of distinct metastatic patterns and their integrated prognostic impact remains lacking. Patients with mPCa were identified from the Surveillance, Epidemiology, and End Results (SEER) database, and metastatic patterns were systematically characterized. Cancer-specific survival (CSS) and overall survival (OS) were estimated using the Kaplan-Meier method and compared using multivariable Cox regression. Based on metastatic characteristics, patients were classified into seven pattern-based categories and subsequently consolidated into four risk groups (low, intermediate, high, and very high). Temporal robustness was assessed across diagnostic periods, and prognostic discrimination was compared with the conventional M classification using Harrell’s C-index and time-dependent area under the receiver operating characteristic curve (AUC). A total of 13,325 patients with mPCa were identified. Compared with M1b disease, liver-only and multiple visceral metastases were associated with significantly poorer survival (all HR > 1, p < 0.05), whereas lung-only and other single visceral metastases showed comparable outcomes (all p > 0.05). Concomitant distant lymph node involvement adversely affected survival primarily in M1b disease (all HR > 1, p < 0.05), while concomitant bone involvement worsened outcomes in most subgroups except those with multiple visceral sites. Integrating these findings, the four-tier risk stratification model demonstrated clear stepwise discrimination for both CSS (Low risk as reference; Intermediate: HR = 1.63, 95% CI, 1.45-1.84, p < 0.001; High: HR = 2.04, 95% CI, 1.76-2.37, p < 0.001; Very high: HR = 3.99, 95% CI, 3.39-4.71, p < 0.001) and OS (Low risk as reference; Intermediate: HR = 1.53, 95% CI, 1.38-1.70, p < 0.001; High: HR = 1.93, 95% CI, 1.70-2.19, p < 0.001; Very high: HR = 3.48, 95% CI, 2.99-4.06, p < 0.001). Temporal robustness analysis showed consistent stepwise survival gradients across both diagnostic periods. Compared with the conventional M classification, the four-tier risk model showed higher C-index values for CSS (0.695 vs 0.638) and OS (0.696 vs 0.639), with consistently higher time-dependent AUCs at 12, 36, and 60 months. Survival varies substantially across metastatic patterns in mPCa. A simplified four-tier risk stratification model integrating multidimensional metastatic features may provide incremental prognostic information beyond conventional M staging, although further external validation is required before clinical implementation.

8. Survival in low- and middle-income countries pediatric cancer: encouraging context expertise to inform conclusions in resource-constrained settings.

期刊: Journal of the National Cancer Institute 发表日期: 2026-Jun-09 链接: PubMed

摘要

9. Association Between Complications and Death Within 30 Days After Orthopedic Surgery: Vascular Events in Noncardiac Surgery Patients Cohort Evaluation (VISION) Substudy.

期刊: JMIR perioperative medicine 发表日期: 2026-Jun-09 链接: PubMed

摘要

The contemporary causes of postoperative mortality in orthopedic surgery are not well characterized. This study aimed to describe the epidemiology of postoperative complications among adult patients who underwent orthopedic surgery and inform their relationships with 30-day mortality. Vascular Events in Noncardiac Surgery Patients Cohort Evaluation (VISION) was a prospective cohort study involving 40,004 adult patients who underwent noncardiac surgery across 28 centers in 14 countries. For the subset of patients who underwent orthopedic surgery, a Cox proportional hazards model was used to determine time-dependent associations between various surgical complications and 30-day postoperative mortality. Analyses were adjusted for preoperative and surgical variables. Among 8385 patients who underwent an orthopedic surgery in VISION, 1.6% (n=132) died within 30 days of surgery. Of the 132 deaths, 63.6% (n=84) occurred in hospital during the index hospitalization, while 36.4% (n=48) occurred after discharge. The incidence of death across the subcategories of orthopedic surgery was above-knee amputation (30/221, 13.6%), internal fixation of femur (29/750, 3.9%), lower leg amputation (9/252, 3.6%), major hip or pelvic surgery (49/2898, 1.7%), major spine surgery (8/1405, 0.6%), and knee arthroplasty (7/2876, 0.2%). A total of 6 postoperative complications (myocardial injury after noncardiac surgery [MINS], major bleeding, infection without sepsis, sepsis, stroke, and atrial fibrillation) were associated with death in adjusted analyses. The greatest attributable fractions of postoperative mortality (ie, proportion of deaths in the cohort that can be attributed to each complication, if causality were established) were from MINS (1454/8385, 17.3%; hazard ratio [HR] 2.08, 95% CI 1.38-3.14; P<.001; attributable fraction=20.6%), major bleeding (2422/8385, 28.9%; HR 1.95, 95% CI 1.34-2.85; P<.001; attributable fraction=16.5%), and sepsis (318/8385, 3.8%; HR 6.24, 95% CI 3.85-10.12; P<.001; attributable fraction=9.7%). The complications most attributable to 30-day mortality following orthopedic surgery were MINS, major bleeding, and sepsis. These findings highlight areas for further study to mitigate perioperative mortality in orthopedic surgery. MINS demonstrated the highest attributable fraction for mortality (20.6%), emphasizing the importance of appropriate MINS screening, diagnosis, and management.

10. Cancer pharmacists and consultant credentialing in Great Britain: an analysis of influencing factors and the impact of a dedicated support initiative.

期刊: The International journal of pharmacy practice 发表日期: 2026-Jun-09 链接: PubMed

摘要

Portfolio-based credentialing is increasingly used internationally to recognize specialist pharmacy practice and support workforce development. In Great Britain (GB), the Royal Pharmaceutical Society (RPS), now the Royal College of Pharmacy (RCPharm), is the professional leadership body for pharmacists and leads a formalized credentialing framework across pharmacy practice. However, progression through portfolio-based assessment can be challenging, particularly in specialized fields such as cancer. To explore factors influencing cancer pharmacists’ ability to successfully submit and pass consultant-level credentialing portfolios, with particular emphasis on mentorship, support resources, and perceived impact of the British Oncology Pharmacy Association (BOPA) Cancer Consultant Pharmacist Credentialing Webinar Series (BCCPCWS). This cross-sectional survey, reported in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines, was conducted among cancer pharmacists intending to start, resubmit, or progress a consultant pharmacist portfolio. Quantitative and qualitative data were collected. Comparative analyses explored differences between pharmacists who attended the BCCPCWS and who did not, with free-text responses analysed thematically. Despite strong intention to pursue RPS/RCPharm consultant credentialing, most respondents had not submitted a portfolio. Key barriers included time constraints, limited organizational support, and lack of mentorship. Awareness and utilization of existing support resources was low. Pharmacists who attended BCCPCWS were more likely to report portfolio progression than non-attendees. There was demand for structured mentorship, peer support, and clearer guidance. Structured, accessible, specialty -led support may mitigate barriers to portfolio-based consultant credentialing within specialist pharmacy practice. These findings offer transferable insights to inform scalable credentialing support models across GB and international settings.

11. Virtual Reality for Pain Management During Repeated Pediatric Laser Procedures: Protocol for a Pilot Randomized Clinical Trial.

期刊: JMIR research protocols 发表日期: 2026-Jun-09 链接: PubMed

摘要

Lasers have wide applications in medicine but are associated with pain and anxiety, particularly in younger patients. Pain mitigation is often limited to topical anesthetics in the outpatient setting. Distraction techniques are limited by the need for ocular protection, which can include eye patches that completely occlude vision. Virtual reality (VR) is effective at managing procedural pain and anxiety during other short medical procedures and is a promising tool for this population. This trial aims to assess the safety, feasibility, and efficacy of the virtual reality pain alleviation therapeutic (VR-PAT) for pain management during outpatient laser procedures. A total of 40 patients requiring outpatient laser therapy for at least 2 sessions will be recruited from a pediatric hospital in the Midwestern United States for this crossover randomized, 2-arm clinical trial. During the first laser visit, the participants will be randomly assigned to either play the VR-PAT game during their procedure or wear the headset with a dark screen. Participants will answer questions about their pain (Numeric Rating Scale 0-10), anxiety (State-Trait Anxiety Inventory for Children, Numeric Rating Scale 0-10, and Modified Yale Preoperative Anxiety Scale), and pain medication usage. Those playing the VR-PAT will report simulator sickness symptoms and their experience playing the game. At their second laser visit, participants will cross over to the opposite intervention. The primary outcomes are the differences in self-reported pain and anxiety between the 2 interventions. Feasibility outcomes include the proportion of screened patients who were eligible, have given consent, and completed both visits, as well as adverse events reported. To evaluate the efficacy of pain reduction, composite pain scores, and pain medication usage will be calculated for each laser visit. To evaluate the efficacy of anxiety reduction, the change in Modified Yale Preoperative Anxiety Scale scores will be compared between control and VR groups at each visit using the Wilcoxon rank sum tests. All statistical analyses will follow the intention-to-treat principle with regard to intervention assignment at each visit. The study was funded in January 2023 and began enrollment at that time. A total of 44 participants were recruited, and data collection was completed in November 2025, with 40 participants completing both visits. The sample was balanced, with 40 participants using the intervention and participating in the control condition. The age range of the complete sample was 6 to 21 years at recruitment, and 22 (55%) were female. Data analysis is in progress with final results planned for June 2026. Findings from this innovative randomized clinical trial will provide early evidence on the efficacy of the VR-PAT in reducing self-reported pain and anxiety during outpatient laser procedures. The results from this trial will inform a large-scale, multisite study.

12. Exploring occupational therapists' perceptions of the use of functional electrical stimulation in adult stroke rehabilitation.

期刊: Disability and rehabilitation. Assistive technology 发表日期: 2026-Jun-09 链接: PubMed

摘要

Purpose: Stroke is one of the leading global causes of disability, with motor deficits, particularly in the upper limb, being among the most common and debilitating consequences. Occupational therapists are crucial members of the multidisciplinary team, working to enhance patients’ participation in daily activities by addressing motor impairments through interventions such as Functional Electrical Stimulation (FES). However, an evidence-practice gap exists in the application of FES. This study aimed to explore occupational therapists’ perceptions of using FES in adult stroke rehabilitation in Gauteng, South Africa. Materials and Methods: This study employed a descriptive qualitative research design. Twelve occupational therapists participated in semi-structured interviews conducted via an online platform. The research population included clinicians working in the neurorehabilitation field in Gauteng, South Africa from both public and private healthcare sectors. An inductive thematic analysis was used to analyse the data. Results: Three themes emerged from this qualitative study, namely, ‘A Tug of War’, ‘The Lost Leading the Lost’ and ‘A Puzzle of Practicality’. These themes unravel the perceptions of occupational therapists and explore the factors that influence the use of FES in stroke rehabilitation. Conclusion: Many identified perceptions and factors challenge the use of FES in adult stroke rehabilitation. Addressing these challenges is essential for improving evidence-based practices in occupational therapy, especially for motor impairments after stroke. Training on FES needs to be enhanced at an undergraduate and postgraduate level for improved application of the technology.Open-loop FES currently does not align with the complex movement patterns required for occupation-based intervention and is therefore best suited as a preparatory modality.Policy, protocol, and guideline development is needed for a unified approach to FES use in stroke rehabilitation.The commercial availability and access to closed-loop FES systems should be explored by rehabilitation technology manufacturers and sales representatives.

13. An Exploratory Study of Socioeconomic Status, Air Pollution, and 13 Other Variables as Predictors of U.S. State Autism Spectrum Disorder Rates.

期刊: Psychological reports 发表日期: 2026-Jun-09 链接: PubMed

摘要

This exploratory study determined which of 14 selected predictors of autism spectrum disorder (ASD) found in individual-level research are predictive of ASD prevalence rates in the 50 U.S. states without and with statistical control for socioeconomic status (SES). Analyses used 2017 state ASD rates and SES, race, Big Five personality, IQ, urban population percent, air pollution, health care providers per population, physician shortage, per pupil spending, PN-3 policy and strategy, percent without health insurance, Medicaid-CHIP enrollment, maternal age, prepregnant obesity, and low birth weight variables based on various samples largely from 2017. ASD rates correlated significantly with each of the 15 potential predictors except for percent uninsured, Medicaid-CHIP enrollment, and air pollution (p = .051). However, when each of the 14 potential predictors entered alone on the second step of a regression equation with SES controlled, only race, personality, urbanization, air pollution, PN-3 policy and strategy, and maternal age were significant predictors. Additionally, an equation with these six predictors entered simultaneously on a second step showed that only SES and air pollution were significant. In another equation with only SES and air pollution entered as predictors, they jointly accounted for 55.7% of the variance in state ASD prevalence rates. Both higher SES and greater air pollution were associated with higher ASD prevalence. There was no evidence of multicollinearity or spatial autocorrelation in the 15 regression equations. These results suggest that considering SES and air pollution could prove beneficial in aggregate-level or individual-level analysis of factors associated with an autism diagnosis.

14. Prediction of hospitalisation in young children with pneumonia in Malawi: A machine learning-based approach.

期刊: PLoS medicine 发表日期: 2026-Jun-09 链接: PubMed

摘要

Globally, pneumonia remains the single biggest cause of mortality in children under 5 years of age. This study sought to train and test a prediction model for hospitalisation within 7 days after initial presentation in 2- to 59-month-old Malawian children with WHO-defined pneumonia in primary care and compare its performance to existing risk prediction models. BIOTOPE is a cohort study of children with pneumonia in a primary healthcare setting in Malawi. The training cohort involved nine primary care centres and the testing cohort involved two primary care centres in Northern Malawi. The training cohort was recruited between December 2022 and April 2023 while the testing cohort was recruited in 2016. Participants were consecutive children aged 2-59 months presenting with cough and/or difficulty breathing and who were diagnosed as WHO-defined pneumonia in primary care of any severity. The training cohort was used to train and validate a machine learning model with a prespecified primary outcome defined as hospitalisation and/or death within 7 days as the outcome. This model was then further evaluated in the testing cohort. Median age was 15 months (interquartile range 8-27) in the training and 17 months (interquartile range 9-29) in the external testing cohort (52.1% and 54.4% male, respectively). Hospitalisation occurred in 14.3% (294) of the training cohort and 12.1% (55) of the testing cohort. There was one death in the training cohort only. WHO danger signs were present in 17.6% (360) and 15.9% (70) of children in the training and testing cohorts, respectively. The optimal machine learning model achieved an area under the receiver operating characteristic and precision recall curves of 0.87 and 0.57, respectively, in the testing cohort outperforming existing risk prediction models; furthermore, this model produced an expected calibration error of 0.16 (a logistic regression model using severity status as the response variable and the log odds of the machine learning model’s calibrated probabilities produced an intercept estimate of -0.32 and a slope estimate of 1.13). Key limitations include the use of hospitalisation and/or death as a severity outcome, which may reflect health system factors rather than true disease severity, that mortality-based comparisons were not possible due to low mortality in these primary care cohorts, and that comparator tools were developed for hospital populations rather than primary care populations. This machine learning score outperformed traditional pneumonia risk scores in predicting hospitalisation within 7 days in Malawian children presenting to primary care. Traditional pneumonia risk scores diminish in performance when externally applied to new datasets suggesting they may not generalise well beyond their original derivation settings. Mortality-related findings are not applicable as there was only one death in this cohort. Overall these findings support the potential of machine learning to meaningfully improve early identification of children at risk of severe pneumonia in low-resource primary care settings. Further external validation and clinical impact studies are needed to confirm these results.

15. Real-World Response and Super-Response to Eptinezumab over 48 Weeks in Migraine: The Prospective Multicenter EMBRACE III Study.

期刊: Neurology and therapy 发表日期: 2026-Jun-09 链接: PubMed

摘要

Long-term (> 24 weeks) real-world evidence of eptinezumab’s effectiveness is limited. We evaluated ≥ 50% and ≥ 75% response rates over 48 weeks in patients with high-frequency episodic migraine (HFEM) or chronic migraine (CM). EMBRACEIII (NCT05570149) is a prospective, multicenter, observational study. Adults with HFEM or CM who experienced ≥ 3 preventive treatment failures received eptinezumab 100 mg intravenously every 12 weeks, with optional 300 mg escalation after week 12 for inadequate response. Co-primary endpoints were ≥ 50% and ≥ 75% reductions in monthly migraine/headache days (MMD/MHD) at weeks 45-48 versus baseline. Secondary endpoints were changes in MMD/MHD, monthly analgesic intake (MAI), pain intensity (assessed using the numeric rating scale [NRS]), migraine-related disability and impact (assessed using the Headache Impact Test-6 [HIT-6], Migraine Disability Assessment [MIDAS], the Migraine Interictal Burden Scale-4 [MIBS-4]), patient-reported global treatment response (assessed using the Patient Global Impression of Change [PGI-C] questionnaire), and 100% response. Exploratory analyses assessed dose escalation, prior anti-calcitonin gene-related peptide monoclonal antibodies (CGRP mAbs) treatment failures, responders without adverse events, ≥ 30% reduction in the NRS during residual attacks, and clinically complex subgroups. Among the 261 patients (safety population) included in the study, 124 completed ≥ 48 weeks of treatment with eptinezumab. At week 48, the response rates for ≥ 50%, ≥ 75%, and 100% were 82.3%, 51.6%, and 9.7%, respectively. All secondary endpoints improved significantly (p < 0.001), with significant reductions from baseline: MMD/MHD, - 15.5; MAI, - 14.9; NRS, - 3.3; HIT-6, -  20.6; MIDAS, - 74; and MIBS-4, - 4.3. Also, 94.8% of patients reported PGI-C improvement. Dose escalation occurred in 69.4% of patients. Patients receiving ≥ 3 doses of 300 mg eptinezumab achieved outcomes comparable to responders receiving 100 mg. Among patients with prior anti-CGRP mAb treatment failures (51.6%), ≥ 50% and 100% responders were similar to mAb-naïve patients, whereas ≥ 75% response was lower (37.5%; p = 0.002). Response rates of ≥ 50%,  ≥ 75% and 100% were achieved by 81.2%, 50.4%, and 8.5%, respectively, in patients without adverse events; 85.7%, 51.4%, and 8.6% in patients with psychiatric comorbidities; 87.8%, 54.9%, and 7.3% in patients with CM with medication overuse; and 89.2%, 50.0%, and 7.1% in patients with CM with both conditions. Eptinezumab demonstrated sustained 48-week effectiveness, with high response rates of ≥ 75% and 100% in a difficult-to-treat population. Effectiveness was preserved in patients with prior anti-CGRP mAb failures after 300 mg escalation and in clinically complex subgroups. Many patients achieved ≥ 30% reduction in NRS during residual migraine attacks. ClinicalTrials.gov: NCT05570149.

16. Correction to: Improving aptamer binding affinity for HN protein of newcastle disease virus: molecular dynamics simulations and MM/GBSA calculations studies.

期刊: Molecular diversity 发表日期: 2026-Jun-09 链接: PubMed

摘要

17. Hospital-Level Variation in Early Tracheostomy and Withdrawal of Life-Sustaining Treatment in Severe Traumatic Brain Injury: A Nationwide Analysis.

期刊: Critical care medicine 发表日期: 2026-Jun-09 链接: PubMed

摘要

Early tracheostomy (ET) in severe traumatic brain injury (TBI) is often considered during periods of prognostic uncertainty and evolving goals of care. We aimed to evaluate the association between hospital-level tendency for ET and the frequency of withdrawal of life-sustaining treatment (WLST) following tracheostomy in patients with severe TBI. Retrospective cohort study. Trauma centers participating in the American College of Surgeons Trauma Quality Improvement Program (2016-2021). Adult patients 20-89 years old with severe TBI (head Abbreviated Injury Scale: 3-5 and Glasgow Coma Scale: 3-8), who received mechanical ventilation and underwent tracheostomy. None. A mixed-effects logistic regression model was developed to estimate each hospital’s unique risk-adjusted odds ratio (AOR) for ET (≤ 7 d after injury), and hospitals were stratified into low-, medium-, and high-tendency groups based on the AOR for ET. The association between hospital-level tendency for ET and WLST post-tracheostomy was assessed. Among 22,156 patients with severe TBI treated at 417 hospitals, the ET rates were 16.8%, 30.1%, and 47.7% in the low-, medium-, and high-tendency hospitals, respectively. WLST following tracheostomy occurred in 2.6%, 4.8%, and 9.6% of patients 20-39, 40-59, and 60-89 years old, respectively. After multilevel case-mix adjustments, a high hospital-level tendency for ET was associated with increased odds of WLST post-tracheostomy (AOR, 1.35; 95% CI, 1.10-1.66; p = 0.004), with the highest point estimate observed among patients 40-59 years old (AOR, 1.39; 95% CI, 1.01-1.91). Hospitals with a higher tendency to perform ET had a greater likelihood of WLST following tracheostomy. These findings highlight practice variability in tracheostomy timing that may occur in the setting of prognostic uncertainty early after severe TBI and may influence downstream care pathways.

18. Bridging Evidence and Policy: Reflections on the Economic Burden of Cancer Care in Ethiopia.

期刊: Value in health regional issues 发表日期: 2026-Jun-09 链接: PubMed

摘要

19. Development and Preclinical Evaluation of 68Ga-Labeled B7-H3-Specific Bicyclic Peptides as Immuno-PET Tracers for Oncology.

期刊: Journal of medicinal chemistry 发表日期: 2026-Jun-09 链接: PubMed

摘要

B7-H3 (CD276) is an emerging target for cancer theranostics, highlighting the need for imaging probes capable of noninvasively quantifying B7-H3 expression in tumors. Here, we developed three 68Ga-labeled B7-H3-targeting bicyclic peptide tracers with different PEG linker lengths. All tracers showed high radiochemical purity (>96%), favorable in vitro stability, and rapid blood clearance. Among them, [68Ga]Ga-B7H3-FZ1 exhibited the highest affinity (KD = 83.22 nM). Micro-PET/CT imaging demonstrated that tumor uptake of [68Ga]Ga-B7H3-FZ1 correlated positively with B7-H3 expression across multiple tumor models. In H1299 tumors. B7-H3 overexpression increased uptake from 1.09 ± 0.18 to 3.50 ± 0.97%ID/g at 30 min postinjection, confirming target specificity. Biosafety studies indicated no obvious toxicity. These results support [68Ga]Ga-B7H3-FZ1 as a promising PET tracer for noninvasive B7-H3 imaging.

20. Transmural healing is significantly associated with prevention of clinical relapse in Crohn's disease.

期刊: Inflammatory bowel diseases 发表日期: 2026-Jun-09 链接: PubMed

摘要

This multicenter, retrospective study assessed whether endoscopic, histologic, or radiologic remission best predicts outcomes in ileal Crohn’s disease (CD). Seventy-one patients who underwent paired colonoscopy with ileal biopsies and magnetic resonance enterography (MRE) were followed for 18 months. While remission by all modalities was associated with reduced relapse on univariate analysis, multivariable analysis showed that only radiologic remission (transmural healing) independently predicted reduced clinical relapse and longer relapse-free survival. Endoscopic and histologic remission showed non-significant trends. These findings suggest transmural healing provides superior prognostic value and may be a more meaningful treatment target in CD. Transmural healing has been suggested as a potential measure of evaluating the depth of CD remission in the latest consensus guidelines. We aimed to determine the significance of endoscopic, histologic, and radiologic assessment of ileal CD on longitudinal outcomes. Patients with ileal CD who underwent MRE and colonoscopy with ileal biopsies within a 6-month period were recruited. Rates of clinical relapse over the subsequent 18 months were calculated using pre-determined criteria. Objective histologic assessment was calculated, whilst blinded central radiologists determined the simplified MaRIA score. Multiple logistic regression was used to perform multi-variate analysis. Log-rank analysis was used to assess the time to clinical relapse and displayed using the Kaplan Meier method. 71 patients were included in the final analysis. The odds of clinical relapse in the subsequent 18 months were far lower for patients in remission, compared with disease activity, for each respective modality. Multivariate analysis determined that the only factor independently associated with avoidance of clinical relapse was radiologic remission (OR 0.12, P < .001). Correspondingly, only baseline radiologic remission (compared with radiologic disease activity) demonstrated significantly longer relapse-free survival (522 days vs 339 days, P = .005). Baseline disease remission was associated with avoidance of clinical relapse at 18 months, however, upon multivariable analysis only radiologic remission (transmural healing) was independently associated with prevention of clinical relapse. This adds to the current literature supporting the potential utility of targeting transmural healing in the management of CD.

21. 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines.

期刊: Circulation 发表日期: 2026-Jun-09 链接: PubMed

摘要

The “2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome” retires, replaces, and expands upon the “2013 AHA/ACC/TOS Guideline for the Management of Overweight and Obesity in Adults.” The primary intended audience for this guideline is clinicians who care for patients across the spectrum of cardiovascular-kidney-metabolic syndrome, an interrelated condition characterized by the interconnections among metabolic risk factors (including obesity and type 2 diabetes), chronic kidney disease, and cardiovascular disease. A comprehensive literature search was conducted from October 29, 2024, to April 14, 2025, to identify clinical studies, systematic reviews and meta-analyses, and other evidence conducted on human subjects that were published since 2015 in English from MEDLINE (through PubMed), EMBASE, the Cochrane Library, the Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. The focus of this clinical practice guideline is to create a living, working document that provides current knowledge in the field of cardiovascular-kidney-metabolic syndrome aimed at all practicing cardiologists, endocrinologists, nephrologists, and primary care and specialty clinicians who manage these patients.

22. Use of Predicted Risk and Expected Benefit to Guide Decision-Making in Cardiovascular-Kidney-Metabolic Syndrome for the Primary Prevention of Cardiovascular Disease: A Scientific Statement From the American Heart Association and American College of Cardiology.

期刊: Circulation 发表日期: 2026-Jun-09 链接: PubMed

摘要

Current clinical practice guidelines for the primary prevention of cardiovascular disease recommend risk assessment to align the type and intensity of preventive efforts with an individual’s risk. The 2025 American Heart Association/American College of Cardiology guideline for the prevention, detection, evaluation, and management of high blood pressure in adults and the 2026 American Heart Association/American College of Cardiology guideline on the management of dyslipidemia incorporate quantitative risk assessment, recommending the PREVENT (Predicting Risk of Cardiovascular Disease Events) equations to guide initiation and intensification of antihypertensive and lipid-lowering therapies, respectively. Given the growing awareness of the clustering of cardiovascular-kidney-metabolic risk factors along with the expanding armamentarium of cardioprotective therapies for obesity, diabetes, and chronic kidney disease, a harmonized approach that comprehensively assesses and addresses risk across these interconnected conditions is needed. The 2026 American Heart Association/American College of Cardiology guideline for the prevention, detection, evaluation, and management of cardiovascular-kidney-metabolic syndrome provides recommendations for the use of the PREVENT equations with outcome-specific risk thresholds for staging, detection of subclinical cardiovascular disease, and decision-making regarding initiation and intensification of cardiovascular-kidney-metabolic therapies. This approach integrates predicted risk (using PREVENT-CVD [cardiovascular disease], PREVENT-ASCVD [atherosclerotic cardiovascular disease], and PREVENT-HF [heart failure]) with the relative risk reduction expected from treatment for each outcome to estimate the expected benefit (ie, absolute risk reduction) from drug therapy. This scientific statement details the rationale for using outcome-specific PREVENT equations, the evidence base for selected risk thresholds, and the potential population-level impact of these recommendations. This scientific statement also offers practical guidance for applying risk assessment as the first step in shared decision-making and for addressing gaps in awareness, risk communication, and optimal implementation of evidence-based preventive therapies to improve outcomes in individuals with or at risk for cardiovascular-kidney-metabolic syndrome.

23. Characterization of non-O1 and non-O139 Vibrio cholerae from seafood in Atlantic Canada.

期刊: Canadian journal of microbiology 发表日期: 2026-Jun-09 链接: PubMed

摘要

This study reports on a comprehensive genomic analysis of Vibrio cholerae strains isolated from shellfish grown in Atlantic Canada, specifically the non-choleragenic non-O1/non-O139 serogroups - NOVC, with the aim to provide a baseline in research of these bacteria and inform risk characterization to human exposure. Seafood homogenates were enriched using both standard saline and modified salt free protocols, for recovery of V. cholerae. Isolates were identified by MALDI TOF MS, and relatedness was assessed using composite correlation index (CCI) analysis and multilocus sequence typing (MLST). Genomic characterization through whole genome sequencing revealed that Canadian NOVC isolates cluster with environmental strains previously reported from coastal New Hampshire, USA, while CCI and MLST analyses confirmed that the isolates are closely related to each other, with several representing novel sequence types. Bioinformatic screening identified gene clusters encoding secretion systems, adherence factors, and accessory toxins, although cholera toxin genes (ctx) and the toxin coregulated pilus (tcp) were absent. Antimicrobial susceptibility testing indicated that all isolates were sensitive to the antibiotics tested and exhibited β hemolysis. In light of the evidence of increase in sea surface water temperature, these findings provide the first comprehensive genomic and phenotypic baseline of NOVC strains from Canadian shellfish and underscore the importance of continued surveillance as a potential increase in NOVC prevalence and human exposure risk.

24. MFPD: A Multiple Fungal Pathogen Detection Pipeline Across Diverse Habitats.

期刊: Advanced science (Weinheim, Baden-Wurttemberg, Germany) 发表日期: 2026-Jun-09 链接: PubMed

摘要

Fungal pathogens threaten the health of humans, animals, and plants. ITS sequencing offers an effective approach for detecting fungal pathogens; however, a comprehensive pathogen database and associated tailored pipeline are still lacking. This study introduces the multiple fungal pathogen detection (MFPD) pipeline, which incorporates an accurate and high-speed sequence alignment algorithm for broad-habitat pathogen identification. The curated MFPD database includes 95 660 full-length ITS sequences from 4924 reported fungal pathogen species. In silico experiments show that the full-length ITS achieves the highest accuracy in pathogen detection (average 99.34%), outperforming both the ITS1 and ITS2 subregions. Benchmarking against existing tools, including FUNGuild, FungalTraits, and ISHAM-ITS, shows that MFPD achieves the highest F1 scores in mock communities (0.89 for both plant and human-animal pathogens) and detects the broadest spectrum of pathogenic taxa in real samples. In addition to identifying causal pathogens, MFPD can also detect coinfecting pathogens in biological and environmental samples. Together, our work supports pathogen surveillance across diverse sectors, including clinical, agricultural, and livestock systems within a One Health framework.

25. Nanocellulose Alleviates Intrahepatic Cholestasis of Pregnancy via Gut Microbiota-Mediated Bile Acid Homeostasis.

期刊: Advanced science (Weinheim, Baden-Wurttemberg, Germany) 发表日期: 2026-Jun-09 链接: PubMed

摘要

Intrahepatic cholestasis of pregnancy (ICP) is a pregnancy-specific disorder characterized by elevated maternal serum total bile acid (TBA) and increased risk of adverse fetal outcomes, yet current therapies and preventive strategies remain suboptimal. Here, we present a preclinical investigation of nanocellulose as a gut microbiota-targeted dietary intervention to restore bile acid homeostasis. We demonstrate that nanocellulose, particularly cellulose nanofibers (CNF), administered prophylactically, attenuated maternal TBA and improved offspring survival in a rat ICP model by enriching probiotic microbial taxa while suppressing bile acid-transforming bacteria. These microbial shifts promoted the accumulation of fecal primary bile acids and activation of gut-liver farnesoid X receptor (FXR) signaling. This cascade reduced intestinal reabsorption and hepatic synthesis of bile acids while promoting their excretion in feces. Collectively, pre-gestational CNF effectively lowered systemic bile acid burden and mitigated the ICP phenotype. Our findings identify CNF as a biosafe, microbiota-responsive dietary fiber with translational potential for early preventive management of bile acid-related disorders during pregnancy.

26. Free-living fungi in the Anthropocene and impacts on public health, food security, and biodiversity.

期刊: Mycologia 发表日期: 2026-Jun-09 链接: PubMed

摘要

Global environmental changes that characterize the Anthropocene, such as extreme weather events, increase in temperature, severe droughts, etc. are affecting soil fungi, the crucial roles they play in ecosystems, and therefore impacting our society. In the past two decades, many studies have investigated the effects of diverse environmental changes (i.e. global change drivers) in fungi, at the species, population, and community levels, in natural and managed ecosystems, as well as under laboratory conditions. In this review, we draw together these studies to examine overall impacts on fungi when exposed to global change drivers. In addition, we summarize how global change and impacts on fungi are affecting society through impacts on public health, food security, and biodiversity. In closing, we present ways forward for research in this area, as well as gaps in knowledge and emergent questions in the field of soil fungi in the Anthropocene.

27. Letter to the Editor Regarding "Is Persistence a Hazard?".

期刊: Environmental science & technology 发表日期: 2026-Jun-09 链接: PubMed

摘要

28. Patients seeking occupational health advice before and after COVID-19.

期刊: Occupational medicine (Oxford, England) 发表日期: 2026-Jun-09 链接: PubMed

摘要

The COVID-19 pandemic led to an increased prevalence of psychological disorder in population-based studies, but the effect on the ability to work has been less well studied, except in health workers. This study aimed to assess whether there has been an increase in the number of people seeking assistance for psychological problems from the Sheffield Occupational Health Advisory service in the UK since the COVID-19 pandemic. The study used routinely collected data at Sheffield Occupational Health Advisory Service (SOHAS) to compare the proportion of all new referrals presenting with psychological problems for 3 years prior to (2017-2019) and following the pandemic (2022-2024). Statistical differences were assessed using the chi-square test. Psychological problems were the most common health problem presenting among those seeking advice at SOHAS both before (57.9%) and after the pandemic (61.5%); this was a small, but significant, difference (P < 0.01). In the post-COVID period, phone consultations largely replaced face-to-face appointments, and the patients were slightly younger, less likely to be referred by a GP and less likely to be off work through illness. The advice given post-COVID was more likely to include employment law and disability discrimination. The observed increase in people seeking advice with psychological problems was minor and bore no resemblance to the reported increase in mental health problems in the UK population since the COVID-19 pandemic. There was no evidence that GPs are detecting and referring more patients with psychological problems affecting work performance.

29. The basis for recommending the selection of samplers in determining occupational exposures to aerosols.

期刊: Journal of occupational and environmental hygiene 发表日期: 2026-Jun-09 链接: PubMed

摘要

Measurements are considered to be the basis of exposure assessments used to determine risks to workers. Inhalation exposure poses the greatest risk for most airborne chemicals, and measurements are based on collecting (sampling) and analyzing air samples. Samplers have been developed for more than 120 years. Each new design has been intended to address flaws perceived in earlier designs. Users are faced with a varied array of samplers from which to choose. Comparisons are difficult to make because tests of sampler performance were not standardized until recently and have not been applied consistently. The existing large body of work does allow some conclusions to be drawn regarding performance. Many samplers have been shown to work effectively with test aerosols under controlled conditions in the laboratory. Further testing in the field has shown that not all samplers perform equally well in every situation; for example, under different wind speeds and directions or with aerosols that maintain unusual physical characteristics. There is not one aerosol sampler that can be used for all situations. Further, the design of a sampler and how the sampler needs to be handled can have an enormous influence on the result. Quality of manufacture, material of construction, cost, reusability, ease of use, setting of flow rates, transportation issues, and wearer acceptability all have an impact on selecting from among different samplers with similar performance. The range of available samplers constitutes a toolkit from which the most appropriate sampler could be selected for a given specific situation. Common inhalable and respirable aerosol samplers are considered in respect of their history of design and manufacture, validated performance studies, environmental factors, and practical use. However, the impact of these considerations on sampler selection is minimized through generalized industry-specific or task-specific recommendations. An online web-based Sampler Selection Tool is under development. It will use the information presented in this Commentary to provide a ranked list of appropriate samplers to be used in specific situations. In this commentary, the following definitions are used:Sampler: complete product for collecting the sample, including the collection substrate (filter or foam), which may be included in a capsule or cassette, size-separator (where applicable), and sampler body (where applicable).Cassette: product of multiple parts into which a collection substrate (filter or foam) can be placed. The cassette parts are typically sold separately from the collection substrate. Parts may be single-use or may be reused after cleaning. Cassettes may be the samplers themselves, e.g., closed-face cassettes (CFC), or may be placed in a sampler body (holder) to form the sampler, e.g., IOM cassettes.Capsule: filter including cowl or similar product sold as a single item, for single-use only. Capsules are always placed in other assemblies to form the sampler.Sampler body (holder): any additional device to support and/or orient the sampler in position for proper sampling performance.

30. A multicenter survey on BRAF screening for the implementation of perioperative cancer genomic medicine for resectable colorectal oligometastases.

期刊: International journal of clinical oncology 发表日期: 2026-Jun-09 链接: PubMed

摘要

Genomic screening is an essential, but potentially time-consuming procedure, especially in neoadjuvant settings. We evaluated the preoperative screening of the BRAF V600E mutation for recruitment to a clinical trial among patients with resectable colorectal oligometastases (CRM). In April 2022, an investigator-initiated trial was launched to investigate the efficacy and safety of perioperative use of the BEACON triplet regimen for BRAF V600E mutant resectable CRM. BRAF screening was retrospectively conducted in patients with resected colorectal liver metastases in 2019 for planning the trial and prospectively conducted in preoperative patients with resectable CRM from January 2022 to June 2025 for patient recruitment to the trial. BRAF V600E mutation was detected in 12 (3.2%) of 379 postoperative patients retrospectively and in 36 (1.7%) of 2140 preoperative patients prospectively, with 1840 patients (86.0%) carrying the wild-type and 264 patients (12.3%) classified as untested. The detection rate of the BRAF V600E mutation was significantly lower when the screening was performed prospectively in preoperative patients (P < 0.001). The untested rates varied across metastatic organs, with 10.3% in the liver, 18.1% in the lungs, 12.0% in the lymph nodes, 16.7% in the peritoneum, and 7.8% in other organs. The untested rates decreased consistently across semiannual comparisons: 28.5% in the first evaluation, followed by 15.0%, 12.0%, 8.4%, 9.1%, 7.3%, and 7.1% (P < 0.01 when compared with the first period). Raising physician awareness, as reflected by the untested rate, is a crucial factor in conducting clinical trials to implement perioperative cancer genomic medicine.

31. The association between pandemic-era unemployment rates and suicide rates in April 2020 among working-age adults in the United States.

期刊: Journal of occupational and environmental medicine 发表日期: 2026-Jun-09 链接: PubMed

摘要

This study seeks to assess whether April 2020 suicide rates were associated with unemployment during that month, the peak of the COVID-19 pandemic unemployment. Data on suicide deaths among working-age adults in April 2020 were obtained from the National Violent Death Reporting System and matched with unemployment rates for March and April 2020. Poisson regression was used to examine associations between suicide rates and unemployment rates and changes in unemployment rates. In April 2020, each 1-percentage-point increase in the unemployment rate was associated with a 3.3% higher suicide mortality rate (95% CI: 2.4%, 4.2%). A 1-percentage-point increase in the occupational unemployment rate from March to April 2020 was associated with a 2.5% higher suicide mortality rate (95% CI: 1.4%, 3.7%). Increases in unemployment rates in April 2020 may have contributed to elevated suicide mortality rates.

32. Comorbidities accompanying pneumoconiosis and their impact on the return to work: A clinical experience in occupational medicine department in Türkiye.

期刊: Journal of occupational and environmental medicine 发表日期: 2026-Jun-09 链接: PubMed

摘要

This study aimed to evaluate factors affecting return to work (RTW) after pneumoconiosis diagnosis and the impact of accompanying comorbidities. Demographic characteristics, occupational factors, disease stage, respiratory function, comorbidities, and other occupational diseases of patients diagnosed with pneumoconiosis were retrospectively analyzed. Their effects on RTW and continued exposure to dust after diagnosis were investigated. Among 617 pneumoconiosis cases, 65.2% returned to work and 29.3% continued working in dusty environments. Age, smoking, type of dust exposure, frequent job changes, delayed diagnosis, advanced disease category, symptoms, abnormal physical findings, reduced pulmonary function, additional occupational diseases, and comorbidities significantly affected RTW. The presence of comorbidity, particularly malignancy, increased the likelihood of not RTW. Pneumoconiosis and accompanying comorbidities substantially influence RTW outcomes, highlighting the need for stronger workplace protection and multidisciplinary occupational health management.

33. Hormonal influences on asthma phenotypes and endotypes during the menopausal transition.

期刊: American journal of physiology. Lung cellular and molecular physiology 发表日期: 2026-Jun-09 链接: PubMed

摘要

Asthma heterogeneity remains a defining challenge driven by multiple factors, including hormonal influences that contribute to distinct phenotypic and endotypic manifestations during the menopausal transition. Fluctuations in sex hormones such as estrogen and progesterone during this period do not merely alter reproductive physiology; they fundamentally modulate immune regulation, airway homeostasis, and inflammatory thresholds in ways that give rise to distinct clinically underrecognized asthma phenotypes and endotypes. This review examines how the hormonal milieu during the menopausal transition, defined as the period marked by changes in menstrual cycle regularity and ending 12 months after the final menstrual period (menopause), may influence the classical asthma subtypes. We highlight the hormonal dynamics, clinical features of asthma, asthma endotypes and phenotypes, and therapeutic modifiers of asthma during the menopausal transition. Collectively, this review underscores the need to reframe menopause-associated asthma as hormonally driven, biologically distinct subtypes while highlighting the critical gaps in knowledge that must be addressed to develop effective therapeutic strategies for this vulnerable and understudied population.

34. Enhanced Radiation Monitoring for Radiopharmacists: Quantification of Extremity Doses and Optimal Dosimeter Placement During 131I Dispensing.

期刊: Health physics 发表日期: 2026-Jun-09 链接: PubMed

摘要

Occupational radiation protection remains a fundamental concern in nuclear medicine practice, particularly when handling unsealed radiopharmaceuticals such as iodine-131 (131I). Personnel involved in dispensing are at elevated risk of significant extremity exposure, especially to the fingers, due to close contact with high-activity sources. This study was conducted to quantify extremity doses among radiopharmacists during routine 131I dispensing procedures and to determine the most suitable placement of dosimeters for accurate dose monitoring. Optically stimulated luminescent dosimeters were strategically placed at multiple anatomical sites on the fingers of three radiopharmacists to capture site-specific variations in dose distribution. Results demonstrated that the highest recorded dose per dispensing procedure was 2.386 ± 0.223 mSv, with the index and thumb fingers, particularly on the non-dominant hand, receiving the greatest exposure. This finding reflects the hand positioning typically adopted during manipulation of 131I vials and syringes. Considerable variability in dose patterns between individuals highlights the importance of standardized dosimeter positioning. Regression analysis was applied to estimate fingertip doses from base measurements, but a nonlinear relationship was identified, limiting predictive accuracy. Overall, the study underscores the limitations of current monitoring practices and support the recommendation of finger base dosimetry, standardized protocols, and optimization strategies such as automation and bilateral hand monitoring to improve radiation protection for nuclear medicine professionals.

35. Global disparities in hepatocellular carcinoma care: insights from the ESGAR Global Abdominal Imaging Forum.

期刊: European radiology 发表日期: 2026-Jun-09 链接: PubMed

摘要

To analyze the intercontinental differences and inequities in the management of hepatocellular carcinoma (HCC), including surveillance, diagnosis, and treatment, through the survey responses from the participants of the Global Abdominal Imaging Forum on HCC, organized by the European Society of Gastrointestinal and Abdominal Radiology (ESGAR). An online anonymous survey was distributed to the attendees of the Global Abdominal Imaging Forum on HCC. The survey consisted of 14 multiple-choice questions, covering demographic, epidemiological and occupational data, and information on the management of HCC. Global differences and differences between European and non-European countries were analyzed. Of 1963 attendees from 110 countries, 408 (20.8%) from 67 countries responded to the survey. Multidisciplinary HCC meetings were reported with the highest frequency in North America (83.3%) and the lowest in Africa (41.2%). The most commonly reported tools for HCC surveillance were ultrasound (86.8%) and serum alpha-fetoprotein (79.4%). Global inequities were reported for contrast-enhanced ultrasound (p < 0.001, lowest access in South America, Africa, and Asia), MRI (p < 0.001, lowest access in Africa) and PET/CT (p < 0.001, lowest access in Africa). LI-RADS was the most common algorithm used for HCC diagnosis (83.6%), with the highest use reported in North America (94.4%). Heterogeneity in treatment availability was observed, with respondents from Africa reporting limited availability of surgery (41.2%), locoregional treatments (23.5%), liver transplantation (0%), and immunotherapy (17.6%). Although the surveillance strategy for HCC is similar at a global level, disparities exist in access to CEUS, MRI, PET/CT, and treatments for HCC. Question What are the global disparities in hepatocellular carcinoma surveillance, diagnosis, and treatment reported by doctors working in different continents? Findings The survey from the Global Abdominal Imaging Forum on HCC revealed significant global variability with disparities regarding access to advanced imaging modalities and treatments, particularly affecting Africa. Clinical relevance Global efforts should focus on improving access to advanced imaging techniques (including MRI and PET/CT) and treatments (including transplantation and immunotherapy). Guidelines for the management of HCC should consider the existing regional disparities in healthcare infrastructure and resource availability to ensure more equitable HCC care worldwide.

36. Service Year-Dependent Disruption of Reproductive Hormones and Altered DNA Methylation in Male Firefighters.

期刊: Journal of occupational and environmental medicine 发表日期: 2026-Jun-09 链接: PubMed

摘要

Firefighters are routinely exposed to combustion-derived toxicants. This exploratory study examined associations between occupational exposure, DNA methylation, and reproductive hormones. Genome-wide methylome profiling using MIRA-seq was performed on pooled blood samples from six male firefighters and four matched controls. Candidate genes were validated by bisulfite sequencing. Jurkat and U937 cells were exposed to benzo[a]pyrene and a phthalate mixture to assess methylation and gene expression. Plasma reproductive hormones were measured in 17 firefighters and 17 matched controls. Firefighters showed 960 differentially methylated genes enriched in reproductive pathways. KLHL17 promoter hypomethylation and increased expression were reproduced in vitro. Hormone analyses demonstrated elevated anti-Müllerian hormone, service year-dependent increases in follicle-stimulating hormone, and reduced testosterone and estradiol. Occupational exposure in firefighters is associated with epigenetic and endocrine alterations potentially affecting reproductive health in firefighters.

37. Barriers to Accessing Urogynecologic Care: A Single-Site Survey Study.

期刊: Urogynecology (Philadelphia, Pa.) 发表日期: 2026-Jun-08 链接: PubMed

摘要

Disparities in urogynecologic care are well documented, but patient-reported barriers remain poorly characterized. The objective of this study was to evaluate how structural and informational barriers to urogynecologic care vary by race and neighborhood socioeconomic disadvantage, measured using the Area Deprivation Index (ADI). This cross-sectional study surveyed new urogynecology patients at a midwest academic medical center between January 2024 and May 2024 (IRB STUDY20231132). Participants completed a 23-item questionnaire adapted from the National Institutes of Health All of Us survey assessing access, symptom recognition, referral pathways, and perceived barriers. Demographic and clinical data were obtained by chart review. Zip code-linked ADI percentiles were analyzed using nonparametric tests and multivariable logistic regression, with ADI reported per 10-point increase. Among 219 participants, Black patients resided in more disadvantaged neighborhoods than White patients (mean ADI 80.0 vs 53.4; P<0.001). Higher ADI was independently associated with ≥1-hour round-trip travel (odds ratio [OR], 1.42; 95% CI, 1.15-1.79; P<0.001) and seeing ≥2 health care providers before referral (OR, 1.17; 95% CI, 1.03-1.35; P=0.020). The Black race was independently associated with reporting multiple barriers (OR, 4.79; 95% CI, 1.76-13.19; P=0.002) and time off work as a barrier (OR, 4.42; 95% CI, 1.24-15.3; P=0.023). Higher ADI was also associated with a lack of awareness of urogynecology (OR, 1.27; 95% CI, 1.04-1.59; P=0.020). Appointment wait time ≥1 month was not associated with ADI or race. Race and neighborhood disadvantage were independently associated with distinct barriers to urogynecologic care, supporting targeted, equity-focused interventions. The authors encourage institutions to assess barriers faced by their community patient populations.

38. Evaluating a Pediatric to Adult Care Transition Program for Adolescents and Young Adults With Sickle Cell Disease: A Program Assessment at Duke University.

期刊: Journal of pediatric hematology/oncology 发表日期: 2026-Jun-08 链接: PubMed

摘要

Only 33% to 53% of adolescents and young adults (AYAs) with sickle cell disease (SCD) complete the transition process to adult health systems. Examine transition-readiness practices in a pediatric SCD ambulatory clinic to identify strengths, gaps, and opportunities to enhance transition preparation for AYAs. A program evaluation using policy review and data from the American Society of Hematology (ASH) Transition Readiness Assessment Tool was analyzed, and current transition practices were evaluated using the Got Transition Framework. Findings from the ASH tool showed strong knowledge of disease (M=3.26/4) and medication (M=3.33/4) but low confidence in scheduling appointments (M=2.24/4) and understanding insurance (M=1.71/4). Variability in transition readiness across domains and gaps in standardized assessment frequency and documentation were identified. Policy review revealed strengths in early transition education but limited operational guidance for readiness tracking and patient feedback. Final program recommendations were (1) integration of the ASH tool into clinic policy with defined roles and assessment frequency; (2) development of age-based transition readiness benchmarks to support longitudinal monitoring and targeted interventions; and (3) implementation of voluntary exit interviews to capture patient-reported transition experiences and guide program improvement.

39. The importance of quality assurance in colposcopy in the elimination of cervical cancer: A position paper by the European Federation for Colposcopy.

期刊: European journal of obstetrics, gynecology, and reproductive biology 发表日期: 2026-Jun-07 链接: PubMed

摘要

The elimination of cervical cancer has been identified by the World Health Organisation as an achievable goal worldwide. An important component of cervical cancer prevention is the successful diagnosis and treatment of precancerous lesions with colposcopy in women with positive cervical screening tests. Colposcopy services should be of a high-quality with well trained staff delivering appropriate care using agreed clinical management protocols. Poor-quality services are associated with increased risk of both undertreatment and overtreatment for women which can significantly impair the reduction of cervical cancer in screened women. Organisational systems should be in place to ensure access to skilled colposcopy services where practice can be reviewed, measured and compared to improve performance. The current review provides guidance on how quality assurance for colposcopy services can be provided. The Quality and Standards Group of the European Federation for Colposcopy and Cervical Cancer Prevention comprised of senior colposcopists who reviewed the progress of quality assurance processes to date throughout Europe. There was considerable variation in the implementation of quality assurance programmes between countries and insight has been provided into how such variations can be rectified by implementation of best practice in colposcopy. A roadmap is described to implement the recommendations of the World Health Organisation and reduce the inequalities of colposcopy services to establish equity of access to quality diagnosis and treatment across Europe.

40. Cross-cultural drivers of satisfaction in digital public health services: evidence from India and the UK using text mining.

期刊: International journal of medical informatics 发表日期: 2026-Jun-06 链接: PubMed

摘要

Digital public health services (DPHS) succeed when three elements align: dependable operations, clear public-value benefits, and credible institutional trust. How these elements jointly shape user satisfaction across cultures remains unclear. Identify which user-voiced themes relate most to satisfaction, whether legitimacy and civic messages change how complaints affect ratings, and how these relationships vary across cultures. We analyzed app-store reviews for two DPHS apps (Indian/UK) using structural topic modeling aligned with Public Value Theory dimensions, public-value outcomes (PVO), operational capacity (OC), and the authorizing environment (AE). Ordered logit models estimated main effects of theme salience on ratings; interaction models tested whether AE cues (institutional legitimacy, prosocial messaging) moderate OC and PVO complaints; a cross-country sensitivity analysis compared India and the UK. OC problems, access, verification, updates, stability, are the most consistent drivers of dissatisfaction. PVO features lift satisfaction only when they deliver end-to-end in real conditions (reliable booking, trustworthy exposure logic, seamless results integration); ambiguous signals or broken data flows quickly erode confidence. Legitimacy and civic cues matter, but not as substitutes for reliability: pairing “trust in government” or solidarity appeals with unresolved core faults typically worsens perceptions; the same cues help when problems are peripheral or visibly being fixed. Cultural differences reshape these effects. In more collectivist, higher power-distance settings, stewardship and shared-purpose framing contribute more to satisfaction once basics work. In more individualist, egalitarian settings, users weigh demonstrable privacy safeguards, transparent evidence, and precise remediation over patriotic messaging. Make reliability non-negotiable, verify public-value features in live conditions before promotion, and tailor legitimacy strategies to culture. Use civic appeals to amplify, not replace, operational excellence; lead with privacy, transparency, and proof where autonomy expectations are higher. This framework turns Public Value Theory into an actionable playbook for DPHS design, communication, and rollout.

41. Brief cognitive behavioral therapy for chronic pain rapidly improves pain interference: a randomized controlled trial.

期刊: Pain 发表日期: 2026-Jun-05 链接: PubMed

摘要

Abbreviated psychotherapies for chronic pain improve access to care by reducing length of treatment and reaching patients outside of chronic pain clinics, such as primary care. However, the evidence for these approaches is limited. We conducted a randomized controlled trial of brief cognitive behavioral therapy for chronic pain (ie, 6, 30-minute sessions of psychoeducation, behavioral and cognitive skills, and relapse prevention delivered individually) with 184 primary care patients with moderate to severe chronic musculoskeletal pain from a Veterans Health Administration medical center. Mean age of the sample was 59 years (SD = 13.3), 84.8% were male, and 77.2% were White. Following baseline, patients were randomized to either brief cognitive behavioral therapy for chronic pain plus usual pain care or usual pain care alone. Assessments were conducted at baseline plus 6 weeks (mid-treatment), 12 weeks (treatment completion), and 24 weeks (3 month post-treatment follow-up) to gather information regarding pain interference (primary outcome), pain intensity, mental health symptoms, quality of life, and social role participation. Results indicated that relative to usual pain care alone, participants who also received behavioral treatment showed statistically greater improvement in pain interference at each time point. Clinically significant improvement in pain interference was reached by mid-treatment with continued improvement at treatment completion and 3-month follow-up among the behavioral treatment group but not the usual pain care group. Behavioral treatment was also associated with improved physical quality of life and sleep quality. This significantly abbreviated behavioral treatment designed for scalability can lead to rapid and sustained improvements in pain outcomes.

42. Orthopedic Injuries in Youth Ice Hockey Athletes During Peak Height Velocity: A Review.

期刊: Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine 发表日期: 2026-Jun-05 链接: PubMed

摘要

Youth ice hockey is a popular sport worldwide. Because of its high physical demand and full contact nature of the game, injuries are common. Adolescent athletes, specifically those nearing the peak height velocity (PHV), represent a vulnerable subset of patients with particular susceptibility to musculoskeletal injuries. Despite the concerns for athlete health, the overall incidence of injuries continues to rise. To review current literature on common orthopedic injuries in youth ice hockey athletes with particular emphasis on mechanisms and pathology related to those during PHV. Current literature was surveyed focusing on epidemiology, injury mechanisms, and pathology of orthopedic injuries observed commonly in youth ice hockey athletes. Special attention was given to injuries related to skeletal immaturity, physeal injuries, apophysitis/overuse injuries, and size mismatch among similarly aged cohorts. Extremity injuries remain common with upper extremity involvement occurring more often than lower extremity injuries. During PHV, changes in limb length result in muscle imbalance and altered neuromuscular control. In addition, the open physis remains weakened. These developmental changes, combined with high collision forces, size mismatch in similarly aged cohorts, and increased skating volume, amplify injury risk. Adolescents during PHV represent a vulnerable subset of patients with increased risk of orthopedic injuries. Understanding growth-related risk factors-physeal susceptibility, size mismatch, and sport demand-is essential to developing injury prevention strategies and directing future research on athlete safety during development.

43. Mobile health (mHealth) applications for community health workers in low- and middle-income countries: A scoping review.

期刊: International journal of medical informatics 发表日期: 2026-Jun-04 链接: PubMed

摘要

Mobile health (mHealth) applications are increasingly used to support community health workers (CHWs) in delivering primary care services in low- and middle-income countries (LMICs); however, evidence remains fragmented regarding how technical configuration intersects with the sociotechnical experience of the workforce. This scoping review aimed to characterize the technological and sociotechnical landscape of smartphone- and tablet-based mHealth applications used by CHWs in LMIC primary care settings. Following the PRISMA-ScR framework, systematic searches were conducted in PubMed, CINAHL, Cochrane, and Global Index Medicus to identify peer-reviewed and regionally diverse literature published between 2013 and 2025. Eligible studies reported on smartphone- or tablet-based applications designed to support CHWs working in LMIC primary care settings. Data were synthesized using a three-dimensional architecture framework (functions, connectivity, and interoperability) and thematic synthesis across five neutral sociotechnical domains: the Tool, Workflow, Worker, Client, and Health System. Thirty studies met the inclusion criteria. Evidence was geographically concentrated in Sub-Saharan Africa and South Asia, with notable gaps in upper-middle-income economies, including regions of Latin America and East Asia. While 25 of 30 applications utilized offline-first architecture, 29 lacked full interoperability with national health information systems. Thematic synthesis identified inherent tensions: while digital protocols (WHO function A3) enhanced clinical confidence and professional status, they simultaneously introduced dual-entry workload friction and managerial monitoring. Sustainability was consistently hindered by a digital island effect resulting from a lack of comprehensive back-end interoperability (functions D2, D6). The potential of mHealth applications for CHWs in LMICs is undermined by an architectural-systemic mismatch. Long-term success requires a shift from pilot-centric hardware deployment toward interoperability-first strategies that prioritize technical interoperability and clinical empowerment over top-down monitoring. Governments and partners should mandate architectural alignment with national health infrastructures to transition CHWs from isolated data-entry clerks to connected digital clinicians.

44. Socioeconomic inequalities and determinants of postpartum family planning utilization among Millennial and Generation Z women in Indonesia.

期刊: Midwifery 发表日期: 2026-Jun-03 链接: PubMed

摘要

Postpartum family planning (PPFP) within 12 months after childbirth is crucial to prevent unintended pregnancies and ensure healthy birth spacing for better maternal and child health outcomes. As Millennials and Generation Z dominate the reproductive-age population, understanding how generational identity intersects with socioeconomic factors is critical to designing equitable reproductive health interventions. To assess socioeconomic inequality and identify key determinants of PPFP utilization among Millennial and Generation Z women in Indonesia. We conducted a cross-sectional analysis using data from the 2023 Indonesia Health Survey, a nationally representative dataset. The sample included women aged 15-49 who had given birth in the past five years. Respondents were grouped into two cohorts: Millennials (born 1981-1996) and Generation Z (born 1997-2012). Logistic regression identified determinants of PPFP use, while socioeconomic inequality was assessed using the concentration index and decomposition analysis. Among Millennial women, PPFP utilization was significantly associated with maternal and partner education, employment status, household wealth, parity, pregnancy intention, delivery-related factors, and access to maternal health services. In contrast, among Generation Z women, PPFP utilization was mainly associated with partner’s education, employment status, household wealth, delivery complications, and service access, while parity and pregnancy intention were not significant. Socioeconomic inequality in PPFP use was more pronounced among Millennials (CI = -0.069, p<0.001) than Generation Z (CI = -0.024, p=0.313). Generational differences were associated with differences in PPFP determinants and equity patterns, underscoring the potential value of generation-sensitive approaches to promote more equitable access.

45. Dukan diet, ketogenic diet and low glycemic index diet: Biochemical basis and metabolic consequences.

期刊: Nutrition (Burbank, Los Angeles County, Calif.) 发表日期: 2026-May-12 链接: PubMed

摘要

Obesity and its consequences have been a serious public health problem for many years, both in developing and developed countries. Due to the dangers associated with being overweight, the topic of diet is constantly one of the most frequently discussed in society. Effective weight loss without feeling hunger and the yo-yo effect are among the most common phrases entered into search engines. Our work aimed to present three popular diets’ biochemical basis and metabolic consequences, each based on consuming a different macronutrient. Additionally, our work explores the epigenetic impact of these diets, examining how changes in dietary patterns can influence gene expression and potentially lead to long-term health effects. This aspect is crucial in understanding the immediate metabolic responses and the lasting genetic modifications that can arise from adhering to these dietary regimes.

46. Attitudes, Practices, and Perspectives of Oncology Nurses in Promoting Exercise Is Medicine Among Patients With Cancer in China: A Mixed-Methods Study.

期刊: Cancer nursing 发表日期: 2026-May-11 链接: PubMed

摘要

The exercise is medicine (EIM) initiative, promoted as routine care for cancer populations, is inadequately integrated into oncology practice. While barriers to and facilitators of physical activity (PA) promotion are well documented, oncology nurses’ perspectives on EIM remain underexplored. This mixed-methods study examined oncology nurses’ current PA promotion practice and perspectives on implementing the EIM initiative in China. A total of 155 oncology nurses across Hong Kong and Shenzhen in China participated in an online survey (including a 3-min EIM introductory video) assessing current PA promotion practices, personal PA habits, and attitudes toward PA and EIM, among which 14 were subsequently interviewed. The results revealed infrequent PA discussions with patients and relatively low confidence in PA promotion. After watching an EIM introductory video, participants’ attitudes toward PA promotion improved slightly, with most expressing average interest and preparedness to integrate EIM in practice. Qualitative analysis revealed 5 key themes influencing EIM implementation: confidence in PA promotion, perceived priority of promoting PA in practice, perceived appropriateness of promoting PA for patients, organizational infrastructure (trainings, guidelines, collaborations, resources), and societal support. Oncology EIM implementation requires systematic organizational support, necessitating a multifaceted approach encompassing competency development, standardized procedural guidelines, cross-sector collaborations, and strategic resource allocation. Integrating EIM in oncology care requires enhanced organizational support, including training, guidelines, collaboration and resources. Implementation assessment and research are essential to ensure successful and sustainable integration and to evaluate applicability, effectiveness, and sustainability of EIM in real-world oncology settings.

47. Discourses on children and health in National Public Health Policy documents: examples from Sweden and Norway.

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

摘要

Promoting the health of children remains a global and national priority, as reflected in the proliferation of public health policies, strategies, and guidelines over the past decade. While these documents aim to improve health outcomes, they also play a critical role in shaping how children and young people are constructed as health subjects. This study critically examines recent national public health policy documents from Sweden and Norway through a health promotion lens, focusing on the discursive positioning of children. Drawing on theoretical insights from critical childhood studies and public health policy research to frame our discourse analysis, we identify dominant narratives that frame children primarily as passive, dependent, and vulnerable. These adult-centric discourses, rooted in risk and knowledge paradigms, offer limited space for agency, participation, or rights-based approaches. Despite strong rhetorical commitments to equality and child health, the policies risk reinforcing hierarchical power relations and deficit-based views of childhood. We argue that aligning public health policy with health promotion principles requires reframing children not merely as future investments, but as present rights-holders and active contributors to their own health. Embedding participatory mechanisms and expanding comparative research across welfare contexts may foster more inclusive and empowering policy development. This study contributes to ongoing debates on child agency, policy framing, and the role of discourse in shaping health promotion practice.

48. Enduring strengths and a critical gap, the Ottawa Charter and animal rescue fostering in Aotearoa-New Zealand.

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

摘要

According to the Ottawa Charter, both care for others and a supportive environment promote health. Although the Ottawa charter focuses on the human context, animal rescue organizations can be conceptualized as providing supportive environments as part of their work to rehome animals. Animal fosterers also build care relationships with the animals they foster. Therefore, the Ottawa Charter provides a foundation for viewing animal fostering as health promotion. This mixed-methods study analysed animal rescue cat fostering programmes in Aotearoa-New Zealand from the perspective of the Ottawa Charter. Data was collected using a quantitative survey of 40 cat rescue organizations with foster programmes, and semistructured interviews (n = 14) with foster programme co-ordinators across Aotearoa-New Zealand. Template analysis was used to apply principles from the Ottawa Charter to the interview data, revealing (i) fostering as care to create health, and (ii) Ottawa charter strategies in action. Key findings were that fostering involved multiple, sometimes challenging aspects of care for others. Some co-ordinators described using strategies aligned with Ottawa Charter action areas to structure their service (strengthening community action, creating supportive environments, developing skills, and reorienting from institutional to community-based services). These strategies supported their ability to care for themselves, and animals. We argue the Ottawa Charter’s framing of care for others can be expanded to include human-animal relationships and that cat fostering programmes demonstrate health promotion in action. This case study demonstrates the Ottawa Charter’s enduring contribution while highlighting the need for public health to evolve to maintain relevance in our multispecies world.

49. Leveraging Natural Language Processing for Symptom Identification in Acute Myeloid Leukemia Using Clinical Notes from Electronic Health Records.

期刊: Cancer nursing 发表日期: 2026-May-04 链接: PubMed

摘要

Patients with acute myeloid leukemia (AML) experience severe, co-occurring, and fluctuating symptoms during treatment. Accurate identification is critical but often limited by under documentation and unstructured electronic health record notes. To develop and validate a natural language processing (NLP) system to extract symptoms from inpatient clinical notes, characterize prevalence and co-occurrence of documented symptoms, and examine whether documentation patterns vary by patient- and note-level factors. We analyzed 78,392 clinical notes from 812 AML patients admitted between 2006 and 2021. Ten symptom categories were defined (pain, gastrointestinal, myelosuppression, cardiopulmonary, skin, fatigue, anxiety/anger, central nervous system, depression, and sleep). The NLP system was validated against 240 manually annotated notes, with performance assessed by precision, recall, and F1 score. Exploratory analyses using generalized estimating equations estimated odds of documentation by sex, age, and author type. The NLP system achieved high performance across all symptom categories (average F1 = 0.90). Gastrointestinal (97.3%), pain (95.9%), and myelosuppression (95.7%) were most frequently documented, with extensive co-occurrence across encounters. Fatigue and depression were less common. Men had lower odds of depression documentation than women, and older patients had lower odds across multiple domains. Compared with physicians, advanced practice registered nurses more often documented cardiopulmonary symptoms, while other provider groups documented fewer symptoms overall. NLP enables accurate, scalable extraction of symptom data from unstructured notes, supporting large-scale surveillance and predictive modeling in AML. Findings highlight the need for standardized documentation and tailored interventions to address symptom risks across patient groups.

50. Percutaneous Intradiscal Hydrogel Implantation Versus Sham Control for Chronic Discogenic Low Back Pain: A Randomized Controlled Double-Blind Trial.

期刊: Pain physician 发表日期: 2026-May 链接: PubMed

摘要

Degenerative disc disease is a leading cause of low back pain. Conservative treatments like pain medication and exercise therapy have shown mixed results, while procedures like fusion surgery carry risks such as adjacent segment disorder and surgical morbidity. Therefore, there is a critical need for treatments that bridge the gap between conservative care and surgery. To assess the efficacy of intradiscal hydrogel implantation compared with sham treatment of intradiscal injection of saline in patients with chronic discogenic low back pain. Prospective, double-blind, randomized, controlled, multicenter trial. Two tertiary interventional pain care centers in Switzerland and in the Netherlands. Forty-nine patients with chronic discogenic low back pain unresponsive to conservative treatment were randomized to receive either intradiscal hydrogel implantation or a sham treatment. Control Group patients could cross over to hydrogel treatment after 6 months. The primary outcome was pain improvement at 6 months. Secondary outcomes included disability, quality of life, employment status, Patient Global Impression of Change score, analgesic use, disc space height, and disc degeneration. Adverse events were continually assessed. At 6 months postprocedure, the Hydrogel Group patients had improved pain scores compared to Control Group patients, though not statistically significant (P = 0.070). Six out of 24 patients in the Hydrogel Group reported much improvement on their Patient Global Impression of Change scores, compared to 0 out of 25 in the Control Group (P = 0.008). Within-group disability improvements were statistically significant in the Hydrogel Group but not in the Control Group. No significant differences were found between groups in disability, quality of life, or employment status. Only one serious adverse event was reported-a patient from the Hydrogel Group was hospitalized due to a possible exacerbation of low back pain 6 days postprocedure. This trial’s limitations include strict eligibility criteria and questions about the validity of intradiscal saline as a placebo. This trial suggests that percutaneous intradiscal hydrogel implantation may reduce chronic discogenic pain and disability, with significant Patient Global Impression of Change improvements, though larger trials are needed to confirm efficacy.

51. Updated Analysis of Continued Decline of Utilization Patterns of Facet Joint Interventions in Managing Spinal Pain in the Traditional Medicare Population: From 2000 to 2024.

期刊: Pain physician 发表日期: 2026-May 链接: PubMed

摘要

The use of facet joint interventions for spinal pain management increased rapidly between 2000 and 2010, followed by slower growth from 2010 to 2019. Post-COVID analyses demonstrated a marked decline in facet joint interventions despite an increasing prevalence of chronic pain among traditional Medicare beneficiaries after 2019, together with multiple contributing factors over time, including enactment of the Affordable Care Act, COVID-19, the Inflation Reduction Act, and other influences. This study aims to update and analyze utilization patterns of facet joint interventions for chronic pain management in the U.S. traditional Medicare population across multiple periods from 2000 to 2024. A retrospective cohort study evaluating utilization trends and influencing factors for facet joint interventions in the fee-for-service (FFS) traditional Medicare population in the United States from 2000 to 2024. Data were derived from the Centers for Medicare & Medicaid Services (CMS) physician/supplier procedure summary database (2000-2024). Utilization rates per 100,000 Medicare beneficiaries, percentage of change, and geometric average changes were calculated. Facet joint intervention utilization increased rapidly from 2000 to 2010 (15.5% annually), slowed from 2010 to 2019 (4.2% annually), and declined from 2019 to 2024 (-6.1% annually). Episodes followed similar patterns but declined less steeply than procedures (-6.7% vs. -27.1%). By 2024, service rates had returned to approximately 2012 levels (5,016 vs 5,046 per 100,000 beneficiaries). From 2000 to 2010, lumbar and cervical/thoracic facet joint blocks and radiofrequency ablation procedures increased substantially (13.5%-24.6% annually), followed by slower growth from 2010 to 2019 (2.8%-11.0%), a sharp pandemic-related decline from 2019 to 2020 (10.6%-17.4%), and partial recovery with modest growth or stabilization through 2024. Between 2019 and 2024, the episode ratio of facet joint nerve blocks to radiofrequency ablation declined from 1.9 to 1.7 for lumbar procedures and from 2.4 to 2.0 for cervical procedures, attributed to the mandatory radiofrequency policy. Interventional pain-related specialties accounted for the majority of facet joint procedures, increasing their share from 87.3% in 2010 to 95% by 2024, while surgical specialties declined from 4.8% to 2.0%. During the same period, the site of service shifted modestly from office settings (50.7% to 48.8%) and hospital outpatient departments (HOPD) (declining to 20.5%) toward ambulatory surgery centers (ASCs) (25.6% to 30.6%). These findings reflect increasing specialization, recent reductions in treatment intensity, and the influence of policy changes, Medicare Advantage shifts, and broader system pressures on pain management. The analysis was limited to the FFS traditional Medicare population and data availability through 2024, excluding utilization patterns for Medicare Advantage Plans, which covered 54% of Medicare enrollees in 2024. As with other retrospective claims-based studies, inherent limitations related to coding and administrative data apply. This retrospective analysis demonstrates a substantial decline in facet joint intervention episodes, with an overall reduction of 6.7% per 100,000 Medicare beneficiaries and an annual decline rate of 1.4% for episodes from 2019 to 2024. In contrast, services or procedures declined more markedly, with an overall reduction of 27.1% and an annual decline rate of 6.1% per 100,000 Medicare beneficiaries.

52. Risk Factors of Chemotherapy-Induced Painful Peripheral Neuropathy: A Retrospective Study from A Single Cancer Center.

期刊: Pain physician 发表日期: 2026-May 链接: PubMed

摘要

Chemotherapy-induced peripheral neuropathy (CIPN) affects approximately 50% of patients who receive chemotherapy. CIPN often results in dose reductions, therapy discontinuation, and long-term neurological impairment. Despite existing studies, identifying high-risk populations remains challenging, particularly in patients with diabetes, diabetic neuropathy, and those undergoing corticosteroid therapy. We sought to evaluate the key risk factors associated with CIPN by analyzing patient demographics, comorbidities, and chemotherapy regimens, with a specific focus on diabetes-related variables in order to inform early identification and prevention strategies. Retrospective, single-center, observational cohort study. Academic tertiary care cancer center. Adult patients who received chemotherapy between January 2016 and December 2023 were identified through electronic medical records. Patients with CIPN were defined by the International Classification of Disease, Tenth Revision G62.0 diagnosis code (drug-induced polyneuropathy) and an associated diagnosis of “painful peripheral neuropathy.” Extracted data included demographics (age, body mass index [kg/m2], race/ethnicity), clinical variables (alcohol use, corticosteroid use, diabetes-related factors), and chemotherapy regimen details. Descriptive statistics, Wilcoxon rank sum, c2/Fisher’s exact tests, and multivariable logistic regression were performed. Institutional review board (IRB) approval was obtained (IRB exemption #2024-0139). Among 36,949 patients, significant CIPN risk factors included older age (40-80 years, P < 0.0001), women (odds ratio [OR] 1.89; P < 0.0001), non-Hispanic/non-Latino ethnicity (OR 1.29; P < 0.0001), and corticosteroid use (OR 2.01; P < 0.0001). African American patients had lower odds of CIPN than White patients (OR 0.78; P < 0.0001). Diabetic neuropathy was strongly associated with increased CIPN risk (OR 5.35; P < 0.0001). Alcohol use was inversely associated with CIPN (OR 0.75; P < 0.0001). Several chemotherapy agents also showed significant associations. Our study is limited by its retrospective design, potential misclassification bias in CIPN diagnosis, and reliance on electronic medical records. Alcohol use data were frequently missing or unspecified, limiting interpretation. Key CIPN risk factors include age, race/ethnicity, corticosteroid use, and diabetic neuropathy. Alcohol use appeared inversely associated with CIPN, though causality remains unclear. Individualized patient assessments and proactive management strategies may help reduce CIPN incidence and improve outcomes in patients with cancer who are receiving chemotherapy.

53. Comment on "Diagnostic Guidance for Chronic Complex Regional Pain Syndrome Type I and Type II from The American Society of Interventional Physicians (ASIPP)".

期刊: Pain physician 发表日期: 2026-May 链接: PubMed

摘要

54. A feasibility study to examine the link between lifestyle and environmental exposures and endometriotic phenotype.

期刊: Reproductive biomedicine online 发表日期: 2026-Jan-22 链接: PubMed

摘要

Are there differences in lifestyle and environmental exposures, and clinical characteristics between patients with histologically confirmed endometriosis residing in regional and metropolitan locations in Australia, and their impact on phenotype and disease severity? A retrospective study of patients with histologically confirmed endometriosis and detailed phenotypic mapping willing to participate in a Lifestyle and Environmental Risk Factor questionnaire. Demographic, lifestyle, environmental and clinical factors were compared between patients residing in regional and metropolitan locations in Australia, and between patients presenting with different lesion types. Body mass index (BMI; mean ± SD 27.16 ± 5.39 and 25.22 ± 4.93, respectively) and exposure to animal and plant toxins (14.0% and 3.0%, respectively; P = 0.0020) and pesticides (20.0% and 6.0%, respectively; P = 0.0059) were higher in regional participants compared with metropolitan participants. Increasing age (mean ± SD 36.26 ± 8.09, 40.84 ± 7.81 and 33.88 ± 8.39, respectively; P < 0.0001), leiomyomata (16.4%, 19.5 and 6.8%, respectively; P = 0.03) and infertility (63.9%, 63.4% and 40.9%, respectively; P = 0.04) were associated with higher rates of deep infiltrating endometriosis (DIE) and ovarian endometrioma (OMA) compared with superficial disease (SUP). Mental and behavioural problems were reported more often in patients with SUP and DIE than OMA (52.4%, 59.2% and 38.1%, respectively; P = 0.01). This study suggests significant differences in environmental exposures and lifestyle factors between patients with endometriosis living in regional areas of Australia compared with patients with endometriosis living in metropolitan areas of Australia. These findings emphasize the importance of environmental and lifestyle considerations in understanding the clinical variability of endometriosis.

55. Spatial distribution and risk assessment of dengue incidence at district level across major climatic zones in India.

期刊: PloS one 发表日期: 2026 链接: PubMed

摘要

Over the past decade, dengue incidence has been steadily increasing across the different climatic zones of India. The role of climatic variability in the spatial and temporal distribution of dengue at the district level across India is to be determined. District-level dengue incidence data from 2010 to 2022 were obtained from the National Centre for Vector-Borne Disease Control. Indian districts were categorized into eleven climatic zones based on the Köppen-Geiger climate classification scheme and subsequently grouped into three significant climatic zones (tropical, temperate and arid). Temporal trends were assessed using the Prais-Winsten regression model that accounted for serial autocorrelation, while climate zonal differences in annual incidence were evaluated using Kruskal-Wallis tests and pairwise comparisons. The global Moran’s I test was used to assess overall spatial autocorrelation, followed by Anselin’s local Moran’s I test to identify clustering and hotspots of dengue incidences at the district level. There is significant heterogeneity in dengue distribution across the districts in India. Prais-Winsten regression analysis shows the strongest upward trend in dengue incidence in polar tundra (ET) zone [AIR = 126.9%; p = 0.01], temperate, no dry season, hot summer (Cfa) zone [AIR: 94.8%; p = 0.01], and cold, no dry season, warm summer (Dfb) zone [AIR = 85.1%; p < 0.001], indicating a substantial intensification of dengue transmission even in cooler climatic regions. Kruskal-Wallis tests confirmed persistent and significant disparities between tropical, temperate, and arid regions. Spatial analysis revealed clustering (Global Moran’s I = 0.06, p < 0.001), with 31 high-incidence clusters concentrated primarily in the semi-arid regions of Punjab and Haryana, and humid regions of Tamil Nadu and Kerala. Overall, the identified clustering of high-incidence districts in semi-arid and humid regions, along with the upward trends in multiple climatic zones, highlights an urgent need to embed climate-sensitive planning, early warning systems, and geographically targeted vector-control measures into India’s dengue prevention framework.

56. Study on the safety evaluation of latent tuberculosis treatment in high‑risk groups for tuberculosis development: Study protocol for a multi‑center prospective observational cohort study in Korea (STEP-TB).

期刊: PloS one 发表日期: 2026 链接: PubMed

摘要

Tuberculosis preventive treatment (TPT) is essential for tuberculosis elimination; however, evidence on its safety and feasibility in medically complex, high-risk populations is limited. Concerns regarding adverse events frequently hinder treatment initiation and completion in routine clinical practice. The Safety of Preventive Treatment in People at Risk for Tuberculosis (STEP-TB) study aims to generate real-world evidence on the safety of TPT among individuals at high risk of developing active tuberculosis disease and to identify factors associated with adverse events, treatment initiation, adherence, and completion. STEP-TB is a multicenter, prospective observational cohort study conducted at four university-affiliated hospitals in the Republic of Korea. Adults aged ≥19 years who are eligible for latent tuberculosis infection (LTBI) testing or TPT according to national guidelines will be enrolled, including individuals with chronic kidney disease, chronic lung disease, diabetes mellitus, immunosuppressive conditions, malignancy, or occupational risk. LTBI testing will be performed using interferon-gamma release assays, and TPT regimens will follow national guidelines. Participants initiating TPT will be followed for up to 12 months from treatment initiation. Those with negative LTBI results or without TPT will be also followed for up to 12 months. Adverse events, treatment adherence, and completion will be systematically assessed. Blood samples, including volumetric absorptive microsampling, will be collected in a subset of participants for pharmacokinetic and pharmacogenetic analyses. The primary outcome is the occurrence of adverse events during TPT. Secondary outcomes include TPT completion rates, predictors of non-initiation and discontinuation, and progression to active TB. STEP-TB will provide condition-specific, real-world evidence on TPT safety and implementation, informing clinical decision-making, patient-centered care, and national TB control policies to support the safe expansion of LTBI treatment strategies in Korea. CRIS Registration Number: KCT0011063.

57. Prevalence of diphtheria and antimicrobial-resistant wound infections among asylum seekers in Heidelberg, Germany, August-October 2024.

期刊: PloS one 发表日期: 2026 链接: PubMed

摘要

In the second half of 2022 and 2023, an increase of diphtheria cases among asylum seekers was observed in Europe, with 120 cases reported in the state of Baden-Wuerttemberg, Germany. We aimed to determine prevalence of infection or colonization with toxigenic Corynebacterium among asylum seekers arriving between August and October 2024 in Heidelberg, Germany. In addition, we assessed antimicrobial-resistant wound infections and diphtheria immunity levels in this population. We conducted a cross-sectional study with a random sample of 1073 newly arrived asylum seekers. Consenting participants received a throat and, if applicable, wound swabs. Demographic, clinical and migration-related information was collected to identify potential risk groups. Throat swabs were tested for toxigenic Corynebacterium species, while wound swabs were additionally tested for other antimicrobial-resistant pathogens with relevance to therapeutic management. IgG antibody levels against diphtheria toxoid were quantified in serum samples of a random sub-sample. Of the participants, 75% were male (n = 804), and ages ranged from 15 to 60 years (median = 27 years). The most common nationalities were Syrian (n = 281), Turkish (n = 189) and Afghan (n = 117). No toxigenic Corynebacterium was identified. Thirty-seven participants carried inflamed wounds, of whom 18 (49%) had wounds infected with methicillin-resistant Staphylococcus aureus (MRSA), corresponding to 1.7% (95% CI 1.0-2.6%) of the entire study population. Overall, 38.0% (95% CI 33.3-44.8%) showed non-protective diphtheria antibody titers, while acceptance of the on-site diphtheria vaccination was high at 93% (n = 998). While no toxigenic Corynebacterium was detected, low immunity levels and antimicrobial resistance findings underline the importance of early diagnosis, treatment and vaccination options in displaced populations.

58. Indirect state-level estimation of sexual minority adolescent populations by sex, age, and race/ethnicity using random forests.

期刊: PloS one 发表日期: 2026 链接: PubMed

摘要

Estimating population sizes of adolescents who identify as lesbian, gay, or bisexual (LGB) is important for addressing health needs and disparities. Most states have Youth Risk Behavior Surveys (YRBS) among high school students, but not all include an item about sexual identity. This study’s aim was to estimate the percentages of students identifying as LGB stratified by sex, age, and race and ethnicity where state data is incomplete. States where 2021 YRBS data are not available are outside the scope of this study. We developed two random forests trained separately for each sex and evaluated the models’ performance in predicting percentages of respondents identifying as LGB by state and demographic strata. We then estimated percentages for states that did not include or have responses to the LGB identity question available in 2021. The random forests outperformed benchmark comparison models based on a simple logistic regression approach. Estimates of students who identify as LGB across demographic strata and states ranged 5%-30%. The estimated percentages for states that did not ask students about sexual identity fell within the same range. Our approach to deriving state-level estimates of LGB students by sex, race and ethnicity, and age performs well and can be used to inform efforts to improve health and well-being of LGB youth.

59. What do youth need to know about puberty? A scoping review protocol to identify puberty education competencies.

期刊: PloS one 发表日期: 2026 链接: PubMed

摘要

Puberty is a key transition point in adolescents’ lives that plays a foundational role in shaping health behaviors and outcomes across one’s life course. This period holds significant potential to empower adolescents and support autonomy in health and well-being, but limited puberty education curricula exist for early adolescents (age 8-14), and those that do exist vary in content. There is a paucity of evaluations of puberty competencies and limited consensus on what competencies should be measured to assess effectiveness or even how to measure these competencies. The objective of this scoping review is to systematically map and characterize the outcomes, domains, and instruments used to evaluate puberty education curricula for early adolescents aged 8-14 years. In accordance with PRISMA-ScR and JBI scoping review guidance, this review does not synthesize effect sizes or assess intervention efficacy, but maps the breadth of evidence to identify conceptual gaps and inform future framework development. The review protocol is registered with the Open Science Framework (OSF). We will search PubMed, CINAHL, PsycInfo, ERIC, Education Source, Scopus, Web of Science Core Collection, ProQuest Dissertations and Theses Global, and OpenAlex for relevant sources. Two reviewers will independently screen and extract studies that meet inclusion criteria using our data extraction tool. Findings from the scoping review will be synthesized to create an overarching framework that can guide approaches to the development and evaluation of puberty curricula targeted to early adolescents. Focus group discussions with adolescents, parents, and school representatives will be conducted to assess the applicability and appropriateness of identified competencies and evaluation measures prior to broader dissemination. Insights from this scoping review will ultimately be used to inform the implementation and evaluation of puberty education.

60. Compounded environmental health risks in mountain communities upstream of Bhumibol Dam, Thailand.

期刊: PloS one 发表日期: 2026 链接: PubMed

摘要

Indigenous, mountain communities residing upstream of Bhumibol Dam, Thailand, rely on vulnerable natural water sources for their water supply, yet remain unaware of the associated health risks. This study assessed the water quality, usage patterns, and contamination pathways across six villages upstream of Bhumibol Dam to shed light on the obstacles to sustainable water security. Samples from 38 water sources of drinking and/or non-drinking water, soil, and the edible parts of crops were subjected to analyses of physical, chemical (NO3-N, pH), and qualitative pesticide-related variables, alongside a 6-month assessment of a community water filter system. Principal component analysis identified a “at-risk group” of preferred drinking water sources all exhibiting high NO3-N, highly alkaline pH, and substantial pesticide contamination, which was found to likely be caused by agricultural run-off. This was reinforced by the detection of pesticide residues in all soil samples and, critically, in the below-ground edible parts of crops (taro, lemongrass, arrowroot), confirming dietary exposure in the local communities. Further compounding the risks posed by the unsafe water supply, the community water filter was found to be ineffective throughout the 6-month analysis with there being no significant difference in water quality between before and after filtration. The residents’ paradoxical preference for high-risk, still water (from sand-filtered puddles) for drinking, rather than water from flowing sources, which they used only for cooking and cleaning. Overall, these findings reveal compounded environmental health risks emerging from the convergence of mineral-rich hydrogeology, agrochemical runoff, and vulnerable water-collection behaviours. To mitigate these threats, the study suggests that decentralized water management strategies must prioritize both the implementation of advanced filtration technologies capable of mineral and chemical removal and targeted public health education to shift community reliance away from high-risk, stagnant water sources.

61. Can heat stress affect the psychophysiological responses and locomotor demands of young soccer players during small-sided soccer games?

期刊: PloS one 发表日期: 2026 链接: PubMed

摘要

The study compared the effects of three different heat stress conditions on the psycho-physiological responses and locomotor demands of young players in different small-sided soccer games (SSGs). Sixteen soccer players (age: 16.5 ± 0.5 years) performed 2-a-side and 4-a-side SSGs under three environmental heat stress conditions: low environmental heat (LEH) ≤ 23.9°C, moderate environmental heat (MEH) 24.0-27.9°C, and high environmental heat (HEH) 28.0-32.9°C. Players’ heart rate (HR) responses and total distance covered (TDC) were continuously monitored for all SSGs; the rating of perceived exertion (RPE) and visual analog scale (VAS) were used after each bout. Tympanic temperature (TT) was recorded daily before and after the SSGs. The results demonstrated that for both 2-a-side and 4-a-side SSGs, significant main effects of temperature were observed for HR, %HRmax, RPE, and VAS responses (all p < 0.05), indicating progressively increased cardiovascular strain and perceptual load under higher heat stress conditions. In contrast, no significant main effects of temperature were found for TDC and TT responses in either game format. Interaction analyses revealed significant temperature × bout effects for most psychophysiological variables in both SSG formats, including HR, %HRmax, RPE, and VAS responses (all p < 0.05), suggesting that responses to heat stress varied across repeated bouts. However, no significant interaction effects were observed for TDC or TT in the 4-a-side SSGs, while only limited interaction effects emerged for TDC in the 2-a-side SSGs format. Overall, the findings indicate that heat stress substantially amplifies cardiovascular and perceptual responses during SSGs, with effects modulated by game format and bout structure. In contrast, TDC and TT appear less sensitive to these conditions. Coaches may use this evidence to manage players’ internal and external load and optimize their team’s performance across various heat-stress conditions.