公共卫生研究摘要 (2026-06-11)

共收录 58 篇研究文章

1. Safety and immunogenicity of a booster dose of COVAC-2, a Sepivac SWE™ adjuvanted SARS-CoV-2 recombinant protein vaccine in previously vaccinated healthy adults; a randomized controlled multicentre trial.

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

摘要

This Phase 1 clinical trial evaluated the safety and immunogenicity of COVAC-2, a recombinant protein subunit vaccine as a heterologous booster in adults previously immunized with authorized COVID-19 vaccines (NCT05226702). COVAC-2 contains the SARS-CoV-2 S1 spike protein subunit adjuvanted with Sepivac SWE™, an open-access oil-in-water adjuvant. Sixty participants were randomized to receive a single intramuscular dose of COVAC-2 (10 µg or 25 µg) or placebo, with follow-up through Day 180. The vaccine was well tolerated, with most adverse events being mild or moderate; no serious adverse events were attributed to vaccination. Immunogenicity assessments included spike-binding antibody ELISA, pseudovirus neutralization assays (PNA), ELISpot, and flow cytometry. The 25 µg dose elicited the strongest humoral and cellular responses, with peak antibody titers observed 14 d after COVAC-2 vaccination. While titers waned, they were sustained above baseline through Day 180. ELISpot and flow cytometry revealed elevated IFN-γ and IL-2 responses indicating antigen-specific T-cell activation. Minimal IL-4 and IL-13 responses were demonstrated by flow cytometry. These findings support the safety and immunogenicity of COVAC-2 as a heterologous booster, particularly at the 25 µg dose level. The favorable safety profile, induction of immune responses, and thermal stability of the vaccine formulation suggest its potential utility in global vaccination strategies, especially in low- and middle-income countries. COVAC-2 may offer a scalable and accessible platform for enhancing protection against COVID-19.Clinicaltrials.gov: NCT05226702 - Registered 22 Jul 2022.

2. The course and management of symptom diagnoses in general practice.

期刊: Scandinavian journal of primary health care 发表日期: 2026-Dec 链接: PubMed

摘要

In general practice, symptom diagnoses are commonly used when patients seek care for symptoms in which no specific disease or disorder can be diagnosed. These diagnoses are prevalent, yet little is known about how they evolve or how General Practitioners (GPs) manage them in daily practice. To explore the course of symptom diagnoses and compare GPs’ management strategies, both for symptom diagnoses that persisted for more than a year or changed into disease diagnoses. A retrospective longitudinal cohort study was conducted using the Dutch Family Medicine Network (FaMe-Net) database. We included all episodes of care in which the diagnosis recorded at the first consultation was coded as a symptom diagnosis between 2008 and 2021. The course of each EoC was analyzed, comparing management strategies, such as GP contacts, interventions, referrals, and medication use, between symptom diagnoses that persisted and those that changed into disease diagnoses. Referrals to primary healthcare workers include referrals to nurses, social workers and therapists such as physiotherapists and occupational therapists. Out of the 12,532 EoC that started as symptom diagnoses, 9.4% changed into a disease diagnosis within a median of 22 days [2-239], 85.8% resolved within one year, and 4.3% persisted as symptom diagnoses. Within the course of the first year of care, a significantly higher number of management strategies were found for EoC that changed into a disease diagnosis. Referrals to primary healthcare workers were lower for EoC that changed into disease diagnoses (OR = 0.80, 95% CI [0.74, 0.87], p < 0.001). Symptom diagnoses are more likely to resolve within a year, and only a few will persist or change into disease diagnoses. GPs can rapidly diagnose diseases. Our findings highlight the importance of reassurance in patient care when discussing the prognosis of symptom diagnoses, as most of these symptoms tend to resolve.

3. Glucocorticoid Receptor Translational Isoforms Generate Unique Glucocorticoid Responses in the Mouse Brain.

期刊: FASEB journal : official publication of the Federation of American Societies for Experimental Biology 发表日期: 2026-Jun-30 链接: PubMed

摘要

Glucocorticoids are primary stress hormones necessary for life that act on nearly every tissue in the body to maintain homeostasis. These hormones and their synthetic derivatives are widely used in the clinic to combat disease but are limited by serious adverse effects. The actions of glucocorticoids are mediated by the glucocorticoid receptor (GR). In addition to the classic full-length receptor (GR-A), seven highly conserved receptor isoforms with progressively shorter N-terminal transactivation domains (NTD) (GR-B, GR-C1, GR-C2, GR-C3, GR-D1, GR-D2, GR-D3) are produced from the single GR gene by alternative translation initiation. To investigate the physiological function of these isoforms, we developed knockin mice that express GR-A but lack the GR NTD translational isoforms. Analyses of the hippocampal transcriptome from wild-type and GR-A knockin mice treated with dexamethasone (Dex) revealed three classes of Dex-regulated genes: genes dependent on GR-A alone, genes dependent on the GR NTD translational isoforms, and genes dependent on GR-A only under conditions of GR NTD isoform deficiency. The genes dependent on the GR NTD isoforms were preferentially associated with circadian rhythm signaling, synaptic function, and cognition. Consistent with these gene enrichment results, the GR-A knockin mice exhibited alterations in hypothalamic-pituitary-adrenal axis activity and fear-motivated contextual learning. The GR NTD translational isoforms formed distinct molecular complexes with GR-A and with each other, providing a mechanistic basis for their unique transcriptional signatures. These findings demonstrate that the GR NTD translational isoforms contribute to the actions of glucocorticoids in the brain by generating heterogeneity in glucocorticoid signaling.

4. Examining bidirectional longitudinal relationships between physical activity and physical function in older breast cancer survivors: The Thinking and Living with Cancer study.

期刊: Cancer 发表日期: 2026-Jun-15 链接: PubMed

摘要

Older breast cancer survivors are susceptible to cancer- and treatment-related losses in physical function that can negatively affect daily living activities, mobility, and independence. Although physical activity can improve physical function, few studies have focused on older survivors or explored interrelationships between physical activity and physical function. Longitudinal bidirectional relationships between physical activity and physical function in breast cancer survivors and noncancer controls aged 60+ years were evaluated. Survivors (aged 67 ± 7 years; n = 357) newly diagnosed with nonmetastatic breast cancer (stages 0-III) and noncancer controls (aged 67 ± 9 years; n = 254) were assessed at baseline (postsurgery and pre-systemic therapy among survivors) and annual visits for up to 36 months. Physical activity (steps per day) was assessed via actigraphy. The Timed Up and Go test (longer time indicates lower function) and 12-item Short Form Health Survey Physical Component Score evaluated physical function. Data were analyzed via random-intercepts cross-lagged panel models, with controlling for covariates; p values of ˂.05 were considered statistically significant. Starting from the 12-month visit, higher daily steps predicted better subsequent Timed Up and Go time among survivors and controls, and the magnitude of effect was stronger for survivors than controls at 24 months (post hoc comparison, p = .036; survivors: β = -0.420; p = .003; controls: β = -0.211; p = .032). Timed Up and Go time did not predict later daily steps. Associations between steps and the Physical Component Score showed similar patterns. Higher daily steps predicted better subsequent physical function, especially in survivors. These results highlight the importance of promoting physical activity during cancer survivorship care to maintain functional independence.

5. Global burden of non-communicable diseases attributable to ambient fine particulate matter pollution in adults aged 65 years and older from 1990 to 2021.

期刊: QJM : monthly journal of the Association of Physicians 发表日期: 2026-Jun-10 链接: PubMed

摘要

Older adults are an important group affected by both non-communicable diseases (NCDs) and ambient fine particulate matter pollution (ambient PM2.5). This study aimed to estimate the disease burden of NCDs attributable to ambient PM2.5 among adults aged 65 years and older from 1990 to 2021 globally, and forecast to 2031. The data were extracted from Global Burden of Disease Study (GBD) 2021 project. The estimated annual percentage change (EAPC) was used to measure the temporal trend. The Bayesian APC model was employed to predict the disease burden. In 2021, there were an estimated 3.32 million NCDs deaths and 56.30 million disability-adjusted life years (DALYs) attributable to ambient PM2.5 among older adults, globally, with cardiovascular diseases (CVDs) being the leading cause. From 1990 to 2021, the age-standardized mortality rate (ASMR) and age-standardized DALYs rate (ASDR) showed a downward trend, with EAPC of -0.33 (95% CI: -0.45-0.21) and -0.17 (95% CI: -0.2-0.15). But the numbers of deaths and DALYs increased by125.56% and 127.05%, respectively. Males, elderly and the middle the Socio-demographic Index (SDI) region had a greater burden. Finally, only despite a slight increase in both ASMR and ASDR in the next decade, the numbers of deaths and DALYs would increase by over 50%. The numbers of deaths and DALYs for NCDs attributable to ambient PM2.5 among older adults showed an upward trend globally in the past 31 years, and projected to increase in the next decade. Therefore, it is necessary to introduce targeted policies.

6. The Impact of Hidradenitis Suppurativa on Sexual Function: A Multicentered Cross-Sectional Study.

期刊: International journal of dermatology 发表日期: 2026-Jun-10 链接: PubMed

摘要

Hidradenitis suppurativa (HS) is a disease that impairs the quality of life (QoL), sexual functioning, and fertility of the patients. The relationship between disease characteristics and sexual function remains insufficiently characterized. The aim of this study is to evaluate the rate of sexual dysfunction among HS patients; and to evaluate its relationship to disease or patient characteristics. In this multi-centered cross-sectional study, patients were asked to complete a structured online questionnaire including demographics, disease characteristics, the Hidradenitis Suppurativa Self-Assessment Tool (HSSA), HS-specific Dermatology Life Quality Index (HS-DLQI), and validated sexual function instruments (International Index of Erectile Function-5 [IIEF-5] for males; Female Sexual Function Index [FSFI] for females). A total of 522 HS patients were included. Higher HSSA stages correlated positively with worse HS-DLQI scores (r = 0.258, p < 0.001). Lesions in the head/neck, inframammary, gluteal, and inguinal regions were associated with greater QoL impairment. Male patients had significantly lower IIEF scores and higher erectile dysfunction (ED) prevalence compared to controls; however, HS was not an independent risk factor for ED in multivariable analysis. Female patients had significantly lower total FSFI scores than controls, particularly in arousal, orgasm, satisfaction, and pain domains, whereas lubrication remained unaffected and desire scores were higher. Recall bias, the self-reported nature of questionnaires, and sociocultural barriers to discussing sexual health may have influenced results. HS significantly impairs quality of life, particularly with increasing disease severity and involvement of specific anatomical regions. HS is associated with impaired sexual function in both women and men, with a more pronounced and multifaceted impact observed in female patients. Effective pain and inflammation control may improve sexual outcomes, underscoring the importance of comprehensive, domain-specific assessment in HS management.

7. Disordered eating and vaping in athlete and non-athlete college students: Does sex matter?

期刊: Journal of American college health : J of ACH 发表日期: 2026-Jun-10 链接: PubMed

摘要

Vaping prevalence is rising among young adults, with linked evidence to disordered eating. Given the unique pressures of performance and body image in athletics, this study examines vaping-eating disorder (ED) risk associations comparing college athletes and non-athletes. Data was gathered from U.S. college students in the 2021-2022 Healthy Minds Study. Students reported past-30-day vaping and completed the SCOFF (Sick, Control, One, Fat, Food) questionnaire. Logistic regressions tested vaping-ED risk associations with athlete status as a covariate, adjusting for confounders. Overall, 18.1% of respondents reported vaping and 32.8% screened positive for ED risk. Vaping was associated with higher ED risk (adjusted OR = 1.45, p < .001). Athlete status did not independently predict ED risk or moderate the vaping-ED risk associations, while sex did moderate this association. Findings highlight the need for integrated mental health campus initiatives addressing substance use and disordered eating behaviors among athletes and non-athletes.

8. Associations of Accelerometry-Derived Time in Major Activity Intensities with Cognitive Outcomes: A Compositional Data Analysis Approach.

期刊: The journals of gerontology. Series A, Biological sciences and medical sciences 发表日期: 2026-Jun-10 链接: PubMed

摘要

Physical activity (PA), sedentary behavior (SB), and sleep are modifiable lifestyle factors linked to cognitive health. Prior research has largely relied on self-report to measure these constructs or ignored the compositional nature of these data. We applied compositional data analysis (CoDA) to quantify the association between accelerometry-derived measures of time in major activity domains and cognitive outcomes among older adults. Participants were 927 older adults (M age = 82.71 years, SD = 3.99, range = 76-95) from the Atherosclerosis Risk in Communities (ARIC) study who wore wrist-worn accelerometers and completed cognitive assessments. Major activity domains were time in bed and time out of bed, which were divided into four categories: sedentary behavior (SB), low-light (low-LIPA), high-light (high-LIPA), and moderate-to-vigorous physical activity (MVPA). Cognitive outcomes included global cognition, memory, executive function, and language performance. Across all cognitive domains, greater time spent in MVPA relative to other activity domains, including out-of-bed time, sedentary behavior, and low-LIPA, was associated with better cognitive performance. In contrast, greater time spent in low-LIPA relative to other activity domains was consistently associated with poorer performance across all cognitive domains, and these associations were attenuated, but remained statistically significant, after adjustment for gait speed. Sedentary behavior was negatively associated with executive function only. The trade-off between time spent in MVPA and in low-LIPA is the objectively measured physical activity that was most strongly associated with cognitive abilities. Time spent in low-LIPA may be an important biomarker of physical health and cognitive impairment.

9. UVB Light Activates an S Phase-Dependent DNA Damage Response in Human Keratinocytes Independent of Oxidative Stress.

期刊: Toxicological sciences : an official journal of the Society of Toxicology 发表日期: 2026-Jun-10 链接: PubMed

摘要

Ultraviolet B (UVB; 280-320 nm) radiation damages DNA in epidermal cells and contributes to the development of skin cancer. In response, keratinocytes activate a DNA damage response (DDR) that regulates DNA repair through signaling pathways involving the protein kinases ATR (ataxia telangiectasia and Rad3-related), ATM (ataxia telangiectasia mutated), and DNA-PKcs (DNA-dependent protein kinase catalytic subunit). Activation of these kinases promotes recruitment of DNA repair proteins, including phosphorylated H2AX and p53, to sites of DNA damage. Treatment of primary human neonatal foreskin epidermal keratinocytes and HaCaT keratinocytes with UVB (2.5-50 mJ/cm2) resulted in dose- and time-dependent activation of DDR proteins. In HaCaT cells, DDR signaling was most pronounced in S phase compared with cells in G0/G1 or G2/M, as determined by flow cytometry and cell cycle synchronization. Confocal microscopy revealed the accumulation of phosphorylated DNA-PKcs and phosphorylated H2AX in discrete subnuclear foci in S phase cells, consistent with recruitment to sites of DNA double-strand breaks. UVB also induced oxidative stress in HaCaT cells, as reflected by increased intracellular reactive oxygen species (ROS). Depletion of intracellular glutathione using buthionine sulfoximine significantly enhanced UVB-induced ROS production but had little or no effect on activation of DDR signaling. These findings demonstrate that UVB induces cell cycle-dependent DNA damage in human keratinocytes that are independent of oxidative stress. Understanding mechanisms of UVB activation of the DDR in keratinocytes will be important for elucidating molecular pathways contributing to skin carcinogenesis.

10. Associations between modifiable lifestyle choices and academic performance over the first year of university: A longitudinal cohort study.

期刊: Journal of American college health : J of ACH 发表日期: 2026-Jun-10 链接: PubMed

摘要

Objective: To examine associations between lifestyle choices and academic performance, considering differences by gender and the potential influence of psychopathology. Participants: 1,447 first-year Canadian undergraduates. Methods: Exposures from the Fall 2021 U-Flourish survey included substance use, exercise, sleep, self-care, and screen time. Multivariable linear regressions estimated associations between exposures and cumulative GPA at year-end. Results: Males more commonly reported weekly binge drinking (17.7 vs. 12.2%, p = 0.01) and ≥7 h/day of leisure screen time (19.1 vs. 14.7%, p = 0.05), while females more commonly reported smoking tobacco/vaping in the past month (29.2 vs. 22.4%, p = 0.01). Poor sleep, daily smoking, and leisure screen time were independently associated with a lower average GPA. Multiple unhealthy lifestyle choices showed a dose-response association with lower GPA, particularly among females; adjustment for depressive symptoms partially attenuated these associations. Conclusion: Clustering of unhealthy lifestyle choices cumulatively undermines academic performance, underscoring the need for proactive, integrated health promotion targeting undergraduates.

11. Slow Life Support for Imminently Dying Patients.

期刊: JAMA 发表日期: 2026-Jun-10 链接: PubMed

摘要

This Viewpoint discusses slow life support, a care strategy used when clinicians believe patient recovery is impossible but cannot negotiate full withdrawal of therapies, and provides ethical analysis and practical recommendations for such practices.

12. Population Skin Cancer Screening and Melanoma Mortality Rates.

期刊: JAMA dermatology 发表日期: 2026-Jun-10 链接: PubMed

摘要

In Germany, a population-based skin cancer screening (SCS) program was implemented in 2008. The benefit of the intervention is unclear. To determine whether the German SCS program was associated with reduced melanoma mortality. This population-based, ecological comparative effectiveness study compared trends in melanoma mortality from 2009 to 2022 in Germany with those in neighboring countries without population-based SCS using data on melanoma mortality from the official cause-of-death statistics. The total populations of 15 federal states of Germany and 9 neighboring countries were examined. The German federal state of Schleswig-Holstein was excluded from the analysis due to a potential lasting effect of a preceding pilot project, conducted in 2003 and 2004. Data were analyzed from November 7, 2025, to February 11, 2026. The German SCS program entitles men and women aged 35 years and older to a visual skin examination every 2 years, regardless of their individual skin cancer risk. The 2-year participation rate was estimated at approximately 32%. Pooled estimates of annual percentage changes (APCs) in age-standardized melanoma mortality rates in German and non-German control regions were calculated using a random-effects model. Data include a mean of 79.1 million inhabitants in Germany and 164.8 million inhabitants in 9 neighboring countries. Between 2009 and 2022, age-standardized melanoma mortality rates decreased in each included region. In Germany, APCs ranged from -3.8% (95% CI, -5.5% to -2.2%) to -0.1% (95% CI, -1.7% to 1.5%). In the control regions, mortality rates decreased between -3.8% (95% CI, -4.9% to -2.7%) and -1.0% (95% CI, -1.9% to -0.2%) per year. Pooled APC estimates are -1.8% (95% CI, -2.3% to -1.4%) for Germany and -2.2% (95% CI, -2.8% to -1.6%) for the non-German control regions; the difference was not statistically significant (P = .42). The findings of this ecological study are in line with previous studies that failed to show a melanoma mortality benefit associated with the German SCS program. To enable a well-founded decision on the future of the program, the causes of its poor performance should be investigated.

13. Cost-Effectiveness of Oral Nicotinamide for Keratinocyte Carcinoma Prevention.

期刊: JAMA dermatology 发表日期: 2026-Jun-10 链接: PubMed

摘要

Keratinocyte carcinoma (KC) is the most common cancer in the US, resulting in considerable clinical and economic burdens. Nicotinamide has been shown to reduce new KCs among high-risk patients. Despite growing clinical interest, the cost-effectiveness of nicotinamide for KC prevention has not been examined. To evaluate the cost-effectiveness of oral nicotinamide for KC prevention. This economic evaluation with a 1-year horizon included data from individuals within the Veterans Health Administration (VHA). Individuals with and without nicotinamide exposure for 30 or more days were included. Data were analyzed from September to October 2025. Oral nicotinamide use compared to no nicotinamide use. The primary outcome was the annual number of KC events prevented, translated into quality-adjusted life-years (QALYs) gained. Costs included annual nicotinamide expenses and weighted average treatment costs per KC episode. Incremental cost-effectiveness ratios were calculated as the differential cost divided by the differential QALYs gained, supplemented by probabilistic and 1-way sensitivity analyses, non-VHA cost assumptions, and symptom-related quality-of-life modeling. Among the 33 822 individuals included in the analysis and contributing 78 726 person-years of follow-up, the unexposed cohort had a mean (SD) age of 76.9 (8.7) years, compared with 77.2 (8.9) years in the exposed cohort, and 98.0% were male in both exposure groups. KC incidence was 0.204 per person-year in those exposed to nicotinamide and 0.255 in those who were not exposed, reflecting an absolute risk reduction of 0.051 and 624 annually prevented KCs among 12 287 users. Total nicotinamide cost was $161 451, with $526 032 in treatment cost savings, resulting in a net savings of $364 581. Assuming a 0.01-QALY decrement per KC, nicotinamide use yielded 6.24 QALYs gained per year across the cohort and a differential cost of -$58 426 per QALY gained. At the cohort level, this represented a 19.9% reduction in yearly KC treatment costs. Probabilistic, 1-way, and non-VHA cost analyses resulted in median (IQR; range) and scenario differential costs of -$57 700 (-$79 851 to -$38 836; -$116 853 to -$16 326) and $14 407 per QALY gained, respectively. Prevention of 624 KCs among those exposed to nicotinamide in the cohort preserved more than 8 Skindex-16 symptom points per KC in veterans and civilians. In this economic evaluation, oral nicotinamide was a cost-effective and patient-centric preventive approach for KC, particularly in individuals with KC history at high risk of multiple primary KC.

14. Machine learning for predicting liver metastasis in colorectal cancer.

期刊: Discover oncology 发表日期: 2026-Jun-10 链接: PubMed

摘要

To evaluate the performance of machine learning models in predicting liver metastasis in colorectal cancer (CRC) patients using the SEER database and external validation from Ningbo No.2 Hospital. The data on patients with colorectal cancer were obtained from Surveillance, Epidemiology, and End Results (SEER) database from 2010 to 2023. Patients were classified into training (n = 29017) and testing sets (n = 12437). The data were used to build eight machine learning models to predict liver metastasis in colorectal cancer patients. A total of 11 clinical variables were entered into these models. Model performance was measured with the area under the receiver operating characteristic curve (ROC) and area under precision-recall curve (AUPR). The models were visualized and interpreted using the SHAP method. In the SEER database cohort, the incidence of liver metastasis was 7.2% (2977/41,454). Of the eight machine learning models, Gradient Boosting (GB) had the best AUC (0.837) and AUPR (0.294). Upon external validation, the GB model achieved an AUC of 0.730 and an AUPR of 0.278. We explored the significance of features in the model through SHAP analysis. CEA, N stage and T stage were the heavily weighted factors used by the GB. An online calculator was developed for clinical use. The GB model demonstrates robust predictive performance for liver metastasis in CRC, validated internally and externally, and presents a potentially valuable tool for clinical decision-making.

15. [Pathological hoarding-A review of the disorder].

期刊: Der Nervenarzt 发表日期: 2026-Jun-10 链接: PubMed

摘要

Pathological hoarding is an independent psychological disorder characterized by persistent difficulties in discarding possessions, excessive accumulation and a functionally relevant impairment of living conditions and daily functioning. The prevalence is estimated at approximately 2-3%, with symptom onset often already occurring in childhood or adolescence. This article provides a structured overview of the epidemiology, etiopathogenesis, typical comorbidities and relevant differential diagnoses of pathological hoarding. A further focus is on evidence-based treatment approaches, in particular disorder-specific cognitive behavioral therapy and the relevance of pharmacotherapy for comorbid conditions. Finally, the substantial psychosocial of pathological hoarding as well as social law are discussed. Pathologisches Horten ist ein eigenständiges psychologisches Störungsbild, das durch anhaltende Schwierigkeiten beim Wegwerfen von Gegenständen, exzessives Ansammeln und eine funktionell relevante Beeinträchtigung der Wohn- und Lebenssituation gekennzeichnet ist. Die Prävalenz liegt bei etwa 2–3 %, wobei der Symptombeginn häufig bereits in der Kindheit oder Adoleszenz erfolgt. Der Beitrag vermittelt eine strukturierte Übersicht zu Epidemiologie, Ätiopathogenese, typischen Komorbiditäten und relevanten Differenzialdiagnosen des pathologischen Hortens. Ein weiterer Schwerpunkt liegt auf evidenzbasierten Behandlungsansätzen, insbesondere der störungsspezifischen kognitiven Verhaltenstherapie sowie der Bedeutung komorbider Pharmakotherapie. Abschließend werden die erheblichen psychosozialen Folgen des pathologischen Hortens sowie sozialrechtliche Implikationen diskutiert.

16. [Gender differences in children and adolescents with migraine].

期刊: Schmerz (Berlin, Germany) 发表日期: 2026-Jun-10 链接: PubMed

摘要

Migraine is a common neurological disorder that affects about 10% of children and adolescents and is associated with reduced school performance and participation in everyday life. The highest incidence of migraine occurs between 10-14 years. With the onset of puberty, girls are increasingly more likely to be affected. Generally, girls in all age groups show a higher prevalence and incidence of migraine, in contrast to tension-type headaches, where gender differences are less pronounced. Girls experience higher levels of migraine-related impairment than boys and are more likely to have comorbid mental health conditions. School-related stress and performance pressure are described primarily by girls as migraine triggers. Gender differences in epidemiology and clinical features have been widely studied in adulthood. Nevertheless, only a few studies deal with gender-specific treatment in childhood and adolescence. In addition to acute pain treatment while avoiding medication overuse, an individualized and multimodal headache therapy is the most important treatment component for recurrent headaches in childhood. Interdisciplinary group therapies enable individualized care for gender-specific circumstances. Mit einer Prävalenz von etwa 10 % leidet eine relevante Zahl an Kindern und Jugendlichen an Migräne, wobei diese häufig mit einer Beeinträchtigung sowohl der Schulleistungen als auch der Freizeitaktivitäten assoziiert ist. Dabei wird die höchste Inzidenz der Migräne im Alter zwischen 10 und 14 Jahren erreicht. Bereits ab dem Kindesalter zeigt sich ein zunehmend häufigeres Auftreten bei Mädchen, das sich mit Beginn der Pubertät noch verstärkt. Im Erwachsenenalter wurden Geschlechterunterschiede der Erkrankung bereits untersucht. Dagegen gibt es bisher kaum Untersuchungen, die sich mit einer geschlechtsspezifischen Präsentation und Behandlung der Migräne im Jugendalter befassen. Mädchen weisen im Vergleich zu Jungen eine höhere migränebedingte Beeinträchtigung auf und haben häufiger psychische Begleiterkrankungen. Schulstress und Leistungsdruck werden vor allem von Mädchen als Triggerfaktor der Migräne beschrieben. Neben einer adäquaten Akuttherapie ohne Schmerzmittelübergebrauch und der spezifischen Krankheitsedukation ist ein individualisierter und multimodaler Therapieansatz essenziell in der Behandlung von Migräne im Kindes- und Jugendalter. Generell weisen Mädchen in allen Altersgruppen eine höhere Prävalenz und Inzidenz von Migräne auf, im Unterschied zu Spannungskopfschmerzen, bei denen Geschlechterunterschiede weniger ausgeprägt sind.

17. Best Practices for Rural Surgical Health Services Research.

期刊: JAMA surgery 发表日期: 2026-Jun-10 链接: PubMed

摘要

This Viewpoint outlines key strategies for conducting high-quality quantitative rural surgical health services research to address disparities in access, timeliness, and clinical outcomes for rural surgical patients.

18. Prospective Associations Between Media Parenting Practices and Early Adolescent Screen Use: Findings From the Adolescent Brain Cognitive Development Study.

期刊: Acta paediatrica (Oslo, Norway : 1992) 发表日期: 2026-Jun-10 链接: PubMed

摘要

To assess prospective associations between media parenting practices and screen time and problematic screen use in early adolescents. We used data from the Adolescent Brain Cognitive Development Study, a prospective cohort of 7947 adolescents [Mage 12.9 years]. Media parenting practices from Year 3 (2019-2021) and adolescent-reported screen time, app-reported smartphone time (subsample N = 840), and problematic screen use from Year 4 were analyzed using linear regression models adjusted for potential confounders. Use of screens to control behaviour (e.g., as a reward or punishment) and adolescent bedroom screen use were associated with greater screen and smartphone time. Parental screen time modelling and family mealtime screen use were associated with greater screen time. Parental monitoring and limiting of screen time were associated with lower adolescent screen time. Parental monitoring was also associated with lower smartphone time. Parental screen time modelling and use of screens to control behaviour were associated with problematic social media use, while family mealtime screen use, adolescent bedroom screen use, and use of screens to control behaviour were associated with problematic mobile phone use. These findings suggest that counselling families on specific media parenting practices may help reduce adolescent screen exposure and problematic screen use.

19. Advancing cancer therapeutics: new perspectives on mechanisms, regulatory and policy challenges, and innovative multi-modality strategies for the early detection of cardiotoxicity.

期刊: Journal of thrombosis and thrombolysis 发表日期: 2026-Jun-10 链接: PubMed

摘要

Recent advances in cancer therapeutics, particularly targeted agents and tissue agnostic immunotherapies, have transformed care while introducing new challenges in cardiovascular safety. Although clinical guidelines have evolved, regulatory processes critical to ensuring safe innovation remain under-leveraged and often disconnected from real-world implementation. This gap is especially concerning amid federal downsizing, which has led to significant staff reductions at the United States Food and Drug Administration (FDA) and other health agencies. To meet growing needs in patient safety and therapeutic oversight, a new paradigm is emerging-one that is collaborative, adaptive, and inclusive of all stakeholders. Drug manufacturers, oncologists, cardiologists, clinical trialists, regulators, and technology developers must integrate around shared goals. Cardiovascular endpoints should be integrated into pre-new drug application (NDA) studies, with trial designs that include at-risk populations and robust cardiac monitoring. Early detection tools and mitigation strategies should be co-developed when feasible alongside therapeutics and considered part of the approval process.

20. Assessing long-term spatiotemporal patterns of PM2.5 using hybrid geostatistical modeling.

期刊: Environmental monitoring and assessment 发表日期: 2026-Jun-10 链接: PubMed

摘要

Air pollution and fine particulate matter (PM2.5) pose significant environmental and public health challenges, particularly in rapidly urbanizing regions. Long-term assessment of spatiotemporal patterns of PM2.5 is essential for effective air quality management and pollution mitigation. This study examines the long-term spatiotemporal distribution of PM2.5 concentrations across multiple decades using advanced geostatistical and hybrid modeling approaches. Pakistan, ranked as one of the most polluted countries worldwide according to recent global air quality assessments, is selected as the study region to investigate persistent patterns of particulate pollution. A hybrid spatial interpolation (HSI) framework integrating machine learning algorithms with regression kriging is employed to improve prediction accuracy and capture complex spatial trends. A decade-by-decade analysis was carried out to capture changes in PM2.5 patterns over successive decades. The results indicate that PM2.5 concentrations remained consistently elevated across most regions of Pakistan, frequently exceeding the WHO annual guideline of 5 μ g\,m - 3 and, in recent assessments, reaching levels multiple times higher than this threshold, with evidence of increasing extremes and spatial expansion rather than a uniform rise in average levels. Spatial analysis revealed a persistent southwest to northeast orientation along the Indus corridor, covering Karachi, Hyderabad, and Sukkur, and extending toward the central plains of Multan, Lahore, Faisalabad, and Gujranwala. The proposed HSI framework achieved improved interpolation performance and provided a more refined representation of spatial PM2.5 patterns. Overall, the findings highlight the persistence and spatial expansion of PM2.5 concentrations and provide a quantitative basis for improved air quality management and policy formulation.

21. Correction: Renalase knockdown inhibits proliferation of mouse satellite cells.

期刊: Molecular biology reports 发表日期: 2026-Jun-10 链接: PubMed

摘要

22. The protective effect of Schisandrin C against methicillin-resistant Staphylococcus aureus-induced otitis media.

期刊: Antimicrobial agents and chemotherapy 发表日期: 2026-Jun-10 链接: PubMed

摘要

Methicillin-resistant Staphylococcus aureus (MRSA) is a significant pathogen in otitis media (OM), including acute otitis media (AOM) and chronic suppurative otitis media (CSOM), presenting considerable therapeutic challenges due to its biofilm formation, host immune evasion, and promotion of persistent inflammation. This study evaluated the therapeutic potential of Schisandrin C (Sch C), a natural lignan derived from Schisandra chinensis, in mitigating MRSA-induced OM. In rat models of MRSA-induced AOM and CSOM, Sch C significantly reduced bacterial load and inflammatory responses by decreasing pro-inflammatory cytokine levels. By upregulating tight junction protein ZO-1 and downregulating mucin MUC5B, it also restored epithelial barrier integrity. In addition, Sch C treatment improved auditory function. Mechanistic studies revealed that Sch C directly inhibited sortase A (SrtA), a key enzyme responsible for anchoring surface virulence factors in MRSA, by binding to its active site and inhibiting its transpeptidase activity (fluorescence resonance energy transfer IC₅₀ = 38.68 µM). Through inhibiting SrtA, Sch C disrupted MRSA adhesion, invasion, and biofilm formation without exerting direct bactericidal effects. Furthermore, Sch C synergized with ofloxacin, enhancing its efficacy against MRSA otitis by reducing bacterial load, inflammation, and tissue damage. Collectively, these findings establish Sch C as a potent S. aureus SrtA inhibitor, highlighting its promise as a therapeutic strategy for MRSA-induced OM.

23. PM2.5 removal efficiency by an urban green landscape: Effect of planting design and environmental factors.

期刊: Journal of the Air & Waste Management Association (1995) 发表日期: 2026-Jun-10 链接: PubMed

摘要

Air pollution from fine dust (PM2.5) poses severe risks to urban environments and human health in many cities, particularly in roadside areas. Urban green spaces can help reduce this pollution, but there is still limited research on the best way to design plant layouts for maximum dust removal. This study evaluated the performance of a specially designed urban garden in Bangkok, Thailand, for PM2.5 removal. A three-layer planting design, featuring species with high PM2.5 removal capacity from a screening of 73 plant species, was implemented beside a major traffic road. Measurements conducted during high-pollution periods showed an average removal efficiency of 14.89%, increasing up to 35% under high PM2.5 conditions. The garden improved microclimatic conditions, reducing air temperature by 1-2°C and increasing relative humidity by approximately 9.9%. Environmental parameters such as wind speed and direction significantly affected removal efficiency. Wind speeds between 1-3 m/s optimized dust capture, reaching efficiency levels of 15-18%, while speeds above 3.6 m/s resulted in a drop in efficiency. The annual PM2.5 dry deposition rate was calculated at 1.33 g/m2 ·y. These results demonstrate that strategic planting design and species selection can enhance nature-based solutions for urban air quality improvement.Implications: This study demonstrated that a newly designed urban green space can significantly reduce roadside PM2.5, especially during high-pollution periods. Using a multi-layer planting structure and species with high PM2.5 removal capacity, the garden achieved up to 35% reduction and accumulated substantial annual particulate matter. Seasonal wind patterns were also key determinants of removal efficiency. These results provide practical guidance for municipalities and urban planners seeking cost-effective, nature-based solutions for air quality improvement. Integrating targeted green infrastructure into urban design can enhance public health protection and strengthen long-term air pollution management.

24. Promotion of hepatitis B virus infection by extracellular apolipoprotein E.

期刊: Journal of virology 发表日期: 2026-Jun-10 链接: PubMed

摘要

Chronic hepatitis B virus (HBV) infection remains a major burden to global health, affecting more than 250 million people worldwide. HBV and host interactions determine the HBV chronicity. Our previous studies have found that human apolipoprotein E (apoE) is incorporated in infectious HBV virions and plays important roles in HBV infection and morphogenesis. ApoE mediates HBV cell attachment through its interaction with cell surface receptors such as the low-density lipoprotein receptor (LDLR) family members and heparan sulfate proteoglycans (HSPGs). More importantly, both HBV-associated apoE and its expression in hepatocytes are critical for efficient HBV infection. However, the importance of extracellular apoE in HBV infection has not been examined. In the present study, we have determined the role of extracellular apoE in HBV infection in vitro. ApoE is an exchangeable apolipoprotein and was found to be efficiently transferred to HBV virions when mixed with an apoE-null HBV, as suggested by the results obtained from coimmunoprecipitation experiments. More significantly, extracellular apoE3 lipoproteins significantly promoted HBV infection in a dose-dependent manner when mixed with apoE-null HBV prior to infection. The cell culture supernatants obtained from apoE3-overexpressing HepG2 cells, sera derived from human apoE3-knockin mice, and a purified recombinant apoE expressed in E. coli were all able to significantly promote HBV infection. Additionally, extracellular apoE3 lipoproteins could dose-dependently enhance HBV attachment to HepG2NTCP cells. Collectively, these findings demonstrate that extracellular apoE3 plays a key role in HBV infection by exchangeable transfer to the HBV envelope and mediation of HBV cell attachment. Human apolipoprotein E (apoE) is implicated in the infection of different viruses as an entry-promoting factor. Our previous studies have demonstrated that apoE is enriched in the envelopes of hepatitis B virus (HBV) and hepatitis C virus (HCV)and promotes their infection and morphogenesis in vitro. In the present study, we have uncovered a previously unrecognized role of extracellular apoE3 in the promotion of HBV infection. Extracellular apoE3 was efficiently transferred to the HBV envelope when incubated with an apoE-deficient HBV. Strikingly, apoE-null HBV infection was proportionally enhanced by the increasing amounts of apoE3-containing mouse sera, as well as the supernatants of apoE3-overexpressing HepG2 cells. Likewise, a lipidated recombinant apoE3 significantly promoted HBV infection in a dose-dependent manner. Additionally, extracellular apoE3 promoted regular HBV infection. Moreover, extracellular apoE3 enhanced HBV cell attachment. These findings suggest that apoE3 lipoproteins with various densities in the plasma of chronic hepatitis B patients may play a key role in HBV infection and pathogenesis in vivo.

25. Factors Influencing Disaster Meal Provision Manual Development in Earthquake-Prone Food Service Facilities: Insights From Japan.

期刊: Disaster medicine and public health preparedness 发表日期: 2026-Jun-10 链接: PubMed

摘要

This study examines factors influencing the development of disaster meal provision manuals in food service facilities in earthquake-prone regions of Japan. Given the increasing frequency of natural disasters, ensuring meal service facilities’ preparedness is crucial to safeguarding vulnerable populations, including infants, pregnant women, the elderly, and individuals with chronic conditions. A survey of 866 meal service facilities in Mie Prefecture, Japan, was conducted to assess disaster preparedness measures. Key factors analyzed included the presence of registered dietitians, disaster preparedness drills, and stockpiling of balanced emergency food supplies. Logistic regression analysis was used to identify predictors of manual development. The presence of registered dietitians (OR = 2.82, 95% CI: 1.95-4.08), disaster preparedness training (OR = 3.15, 95% CI: 2.18-4.57), and balanced emergency food stockpiles (OR = 2.52, 95% CI: 1.66-3.83) were significant predictors of disaster meal provision manual development. Findings underscore the essential role of dietitians in disaster nutrition planning and highlight the need for proactive preparedness strategies to enhance food security and facility resilience. These insights can inform policy recommendations in Japan and other disaster-prone regions facing similar challenges.

26. Awareness and Self-Reported Effects of the Innovative Mexican Front-of-Package Nutrition Labeling Policy Among Mexican Americans Across Different US Regions, Health Literacy Levels, and Educational Attainment, 2021-2023.

期刊: American journal of health promotion : AJHP 发表日期: 2026-Jun-10 链接: PubMed

摘要

PurposeEvaluate trends and correlates of self-reported awareness of and responses to front-of-package warning labels (FoPWLs) on packaged Mexican foods among Mexican Americans (MAs) in the United States (US).DesignInternational Food Policy Study annual cross-sectional surveys (2021, 2022, 2023).SettingOnline survey.SampleMA adults in the US (n = 9662).MeasuresSelf-reported past-month frequency of buying food at Mexican-oriented stores (recoded: often/very often vs less often), awareness of Mexican FoPWLs (recoded: often/very often vs less often), and self-reported reductions in purchasing less healthy foods (yes vs no for eight foods) due to FoPWLs.AnalysisAdjusted logistic models regressed binary outcomes (above) on sociodemographics and survey year.ResultsMost participants bought food in Mexican-oriented stores (87.2%). Of those who noticed Mexican FoPWLs (67.6%), many reported that FoPWLs influenced them to reduce purchasing less healthy foods (range = 31.1% [snacks like chips] to 43.9% [cola]). In adjusted models, noticing FoPWLs often/very often (vs less often) increased over time (AOR2022 vs 2021 = 1.30; AOR2023 vs 2021 = 1.21), as did self-reported reductions in purchasing sweetened fruit drinks (AOR2022 vs 2021 = 1.27), and desserts (AOR2022 vs 2021 = 1.32). People with limited vs adequate health literacy reported higher awareness of FoPWLs (AOR = 1.21).ConclusionMAs’ awareness and reported effects of Mexican FoPWLs were high and stable or increased over time, with greater awareness among those with limited health literacy.

27. Validation of periprosthetic joint infection after total knee arthroplasty: a cohort study on 423 cases from the Norwegian Arthroplasty Register.

期刊: Acta orthopaedica 发表日期: 2026-Jun-10 链接: PubMed

摘要

Periprosthetic joint infection (PJI) is a serious complication following total knee arthroplasty (TKA). Accurate reporting is essential for quality development and research based on data in the Norwegian Arthroplasty Register (NAR). Our study aimed to validate Norwegian orthopedic surgeons’ reporting of reoperations for PJI.  We assessed detailed clinical, biochemical, and microbiological data on 423 patients reported to the NAR for reoperations after primary TKA performed in Western Norway in the period from 2010 to 2023. We used the Musculoskeletal Infection Society (MSIS) definition of PJI. For each cause of reoperation (including causes that could mimic PJI, such as aseptic loosening, prolonged wound drainage, and pain alone), we determined the sensitivity, specificity, negative and positive predictive values, and accuracy.  Of 423 reoperations, 170 were reported reoperations due to PJI. After validation, 94% (159 of 170) were confirmed to be due to PJI. Furthermore, 5% (13 of 253) of cases reported as reoperated due to causes other than deep infection were validated as PJI. The sensitivity, specificity, and accuracy for PJI reporting were 92%, 96%, and 94%, respectively. Accuracy for aseptic loosening, prolonged wound drainage, and pain alone was 97%, 94%, and 98%, respectively.  The accuracy of reporting of reoperations due to PJI is high, thereby affirming the quality of reoperation data concerning PJI submitted to the NAR. Our findings support the use of NAR data in quality development and research.

28. Neurological Manifestations in Adult Survivors of Ebola Virus Disease.

期刊: JAMA neurology 发表日期: 2026-Jun-10 链接: PubMed

摘要

Ebola virus disease (EVD) causes multiorgan damage and is highly fatal. EVD’s neurological impact among survivors remains poorly characterized due to limited neurological assessment capabilities in the remote regions where most outbreaks occur. To characterize neurological sequelae in EVD survivors over more than 7 years’ longitudinal follow-up. Under the Ebola Natural History Study (PREVAIL III; PIII), the Neurology Study of PIII was a prospective longitudinal cohort study in Liberia of adult Ebola survivors and control individuals conducted from September 2015 to March 2023 at the Partnership for Research on Vaccines and Infectious Diseases in Liberia (PREVAIL) site at John F. Kennedy Medical Center in Monrovia, Liberia. Data were analyzed from April 2023 to September 2025. Neurological evaluations were performed by trained neurologists biannually. Questionnaire and neurological examination data were collected on case report forms. Neurological symptom prevalence and neurological examination scores were compared to those of control individuals. Tests for differences between survivors and control individuals were conducted using generalized linear mixed-effects models controlling for age and sex. Overdispersed Poisson models were used to test for computed neurological examination score differences. Neurological examination scores were developed for this study, representing the cumulative abnormalities on neurological examinations, denoted on standardized case report forms, with the general neurological examination score representing all examination abnormalities and the central nervous system score representing the central nervous system-specific abnormalities on examination. Analysis after serologic testing included 148 Ebola antibody-positive survivors (mean [SD] age, 34.8 [10.5] years; 74 [50%] female) and 81 antibody-negative contacts (mean [SD] age, 35.8 [12.6] years; 41 [51%] female). During acute infection, survivors reported headaches, altered mental status, and strokelike symptoms or meningoencephalitis (rarely). Survivors had significant neurological sequelae involving the entire neuraxis: cognitive dysfunction (83 [56.1%]), persistent headaches (98 [66.2%]), sleep abnormalities (40 [27.0%]), depression (73 [49.3%]), sexual dysfunction (48 [32.4%]), tremor (18 [20.3%]), fatigue (71 [51.1%]), cranial nerve abnormalities (60 [40.5%]), and sensory abnormalities (45 [30.4%]). Over 7 years’ follow-up, most survivors demonstrated improvement in neurological status. The final visit included 115 survivors (77.7%) and 61 close contacts (75.3%). Persistent symptoms at final evaluation in survivors compared to contacts were memory loss (66 [57.4%] vs 16 [26.2%], respectively; P < .001), irritability (42 [36.5%] vs 9 [14.8%], respectively; P = .006), and trouble concentrating (34 [29.6%] vs 6 [9.8%], respectively; P = .002). The findings indicate that Ebola virus infection is associated with neurological complications in survivors, with increased health care burden and socioeconomic consequences. These neurological issues generally improved with time, but some persisted long-term. Close neurological follow-up of EVD survivors may be warranted.

29. Coronary Artery Calcium Progression-A Useful Outcome in Clinical Trials?

期刊: JAMA cardiology 发表日期: 2026-Jun-10 链接: PubMed

摘要

30. Illnesses, Violence, Forced Displacement and Differentiated Citizenship Among the Hitnü People from Arauca, Colombia.

期刊: Journal of racial and ethnic health disparities 发表日期: 2026-Jun-10 链接: PubMed

摘要

This article is an ethnography of the Hitnü, a nomadic Indigenous people who, due to killings and threats, sought refuge in the city of Arauca, on the border with Venezuela (northeastern Colombia). It examines the urban experience of poverty and exclusion in a context of Indigenous rights and differentiated policies offered to the displaced and Indigenous peoples and demonstrates how different forms of violence affect their health and limit effective responses to illness. A four-month ethnographic study (2023-2024) was carried out, during which one of the authors lived with 68 members (12 families) of the El Alcaraván settlement in Arauca, Colombia. The data provide insight into the settlement’s living conditions, the experience of illness in the urban context, the search for medical care, and the manifestations of violence. Respiratory infections and diarrhea are common among the Hitnü, and cases of tuberculosis and Chagas disease were also identified. So-called “mild illnesses” are managed through family-based self-care and treatment provided by the cacique, whereas “difficult illnesses” require biomedical intervention. Structural violence shapes both the burden of disease and the ways the Hitnü treat their ailments, particularly due to food insecurity, lack of drinking water, and inadequate sanitation. Venezuelan migrants, despite being foreigners, receive greater humanitarian assistance, generating tensions with the Hitnü. Physicians’ practices tend to be hegemonic, highly medicalized, and revictimizing. Health services must be grounded in the actual needs of the Hitnü and guided by an intercultural approach based on the findings of this study. Ensuring a safe territory would prevent the reproduction of direct, structural, and symbolic violence, and reduce health inequities.

31. From AKI to CKD mechanisms of maladaptive repair and disease progression.

期刊: International urology and nephrology 发表日期: 2026-Jun-10 链接: PubMed

摘要

Acute kidney injury (AKI) and chronic kidney disease (CKD) were traditionally regarded as distinct clinical entities, largely defined by the reversibility or irreversibility of renal dysfunction. However, growing clinical and experimental evidence now supports a continuum model in which AKI serves as a major initiating event for subsequent CKD development and progression. Even when conventional indices suggest functional recovery, persistent subclinical injury may drive long-term structural, metabolic, and transcriptional alterations that predispose the kidney to chronic damage. In this review, we synthesize current clinical, epidemiological, and mechanistic evidence linking AKI to CKD, with particular emphasis on maladaptive repair. We propose that maladaptive tubular epithelial repair represents the central coordinating event in this transition. Failed redifferentiation, sustained cell cycle arrest, partial epithelial reprogramming, and metabolic inflexibility convert injured tubular cells from targets of injury into active drivers of chronic remodeling. Persistent inflammation and immune dysregulation amplify tissue injury. Meanwhile, microvascular rarefaction and endothelial dysfunction reduce oxygen delivery and promote chronic hypoxia. Moreover, mitochondrial dysfunction, lipid accumulation, defective organelle quality control, and sustained cellular stress signaling reinforce tubular vulnerability and limit regenerative capacity. Emerging evidence also indicates that epigenetic and transcriptional memory may stabilize maladaptive cellular states, thereby lowering the threshold for re-injury and accelerating CKD progression. By integrating these interconnected pathways, we present a unified framework for the AKI-to-CKD continuum and discuss key translational opportunities, including time-sensitive intervention, mechanistic stratification, and biomarker-guided risk prediction. A more precise understanding of post-AKI remodeling may enable early and individualized strategies to prevent CKD progression.

32. Multi-omics insights into immunometabolic dysregulation in neonatal sepsis for precision medicine.

期刊: Molecular biology reports 发表日期: 2026-Jun-10 链接: PubMed

摘要

Neonatal sepsis remains a major global health challenge, contributing substantially to morbidity and mortality despite many advances. Conventional diagnostics often fail to capture the disease complexity and immune dysregulation, leading to delayed diagnosis and sub-optimal treatment. Recent advances in multiomics, including genomics, transcriptomics, proteomics, metabolomics and metagenomics are transforming molecular understanding by enabling a precise view of host-pathogen interactions. These approaches also provide critical insights into metainflammation, a state of chronic, low-grade immune and metabolic dysregulation, playing a pivotal role in neonatal immune vulnerability. Integrating multi-omics with meta-inflammatory profiling may support future risk stratification, biomarker discovery, and precision-oriented neonatal sepsis care. However, clinical translation requires further validation, platform standardization, and feasibility assessment in NICU settings. Such insights may establish the foundation of P4 medicine by emphasizing prediction, prevention, personalisation, and participation in neonatal care. Multi-omics integration may support endotype identification, and data-driven clinical communication after adequate validation. Overall, this review highlights how multiomics and metainflammation driven frameworks may improve mechanistic understanding of neonatal sepsis and guide future development of clinically feasible precision-medicine approaches.

33. Exploration of molecular mechanisms responsible for arthritis alleviating attributes of Calliandra haematocephala extracts.

期刊: Inflammopharmacology 发表日期: 2026-Jun-10 链接: PubMed

摘要

Inflammation and autoimmunity create a complex array of pathological parameters to induce rheumatoid arthritis (RA) that is primarily a disease of the musculoskeletal system. To date, there is no cure for RA. The purpose of the present study was to evaluate the antiarthritic effects of n-Hexane (CHnHE) and methanolic (CHME) extracts of Calliandra haematocephala in Complete Freund’s adjuvant-induced (CFA) arthritis. For this purpose, 30 mg/kg Naproxen and 3 doses of C. haematocephala extracts (250, 500 and 750 mg/kg) were administered to Wistar rats immunised with CFA. To evaluate the antiarthritic effects, the assessment parameters included paw swelling, arthritic index, changes in body and immune organ weights, haematological indices, biochemical markers, oxidative stress markers, radiographic and histopathological evaluation of paws, and mRNA expression analysis. Results of the study revealed significant (p < 0.05)  improvement in disease parameters in contrast to the arthritic control group. Both extracts attenuated paw inflammation and restored the whole body and immune organ weights. Haematological and biochemical derangements were significantly improved in the extract treated animals. Serum levelsof antioxidant enzymes were increased, whereas malondialdehyde (MDA) level was decreased in the extract treated animals. Radiographic and histopathological examination of paws revealed that both extracts prevented synovitis, pannus formation and bone erosion. RT-qPCR analysis revealed the downregulation of pro-inflammatory mediators and upregulation of anti-inflammatory cytokines in the extract treated rats. Phytochemical analysis exhibited the presence of phenolic acids, flavonoids, terpenoids, sterols and tannins in both extracts. On the basis of the findings of the present study, it is proposed that CHnHE  and CHME possess noticeable antiarthritic activity possibly via modulation of the immune system and antioxidant defense mechanisms.

34. Baseline Characteristics of Patients with Asthma Initiating Dupilumab in a Real-World Setting: The REVEAL Registry.

期刊: Advances in therapy 发表日期: 2026-Jun-10 链接: PubMed

摘要

Dupilumab, a fully human monoclonal antibody, blocks the receptors for interleukins 4/13, key and central drivers of type 2 inflammation. Clinical trials demonstrated the safety and efficacy of dupilumab in patients with moderate-to-severe asthma. Here, we aim to describe baseline characteristics of patients initiating dupilumab for asthma, to characterize its safety and effectiveness in real-world clinical practice. REVEAL (pRospEctiVe charactErization of asthma patients treated with dupilumAb in a reaL-world setting; NCT04550962) is a longitudinal, prospective, 3-year observational study of patients aged ≥12 years prescribed dupilumab for asthma in Latin America, the Middle East, Russian Federation, and Singapore per country-specific prescribing information. Of 376 patients enrolled, 374 were included in the effectiveness analysis set. Most were female (62.6%), white (50.3%), and non-Hispanic or Latino (51.3%). Mean (standard deviation [SD]) age was 47.8 (13.89) years. Tobacco use was rare; 312 (83.4%) patients were never smokers. Most were classified as Global Initiative for Asthma step 4 (17.8%) or 5 (69.5%). Mean (SD) number of prior-year severe exacerbations was 2.0 (4.53) (n = 374). Mean (SD) pre- and post-bronchodilator forced expiratory volume in 1 second (FEV1) was 2.2 L (0.83) (n = 306) and 2.3 L (0.86) (n = 212), respectively. Mean (SD) pre-bronchodilator FEV1/forced vital capacity (FVC) ratio was 0.7 (0.13) (n = 301). 242 (64.7%); 231 (61.8%) patients reported allergic rhinitis and chronic rhinosinusitis with nasal polyposis history. Median (Q1-Q3) blood eosinophil counts were 390.0 cells/µL (185.0-700.0) (n = 348) and fractional exhaled nitric oxide levels were 34.0 parts per billion (19.0-60.0) (n = 314). Patients prescribed dupilumab in routine clinical practice were predominantly adult women with severe asthma. Frequent severe exacerbations, high prevalence of coexisting type 2 inflammatory conditions, and elevated type 2 inflammatory biomarkers suggest disease burden is high among patients initiating dupilumab for asthma. ClinicalTrials.gov Identifier, NCT04550962. Standard asthma treatments do not always prevent asthma attacks or improve breathing. Dupilumab is a newer prescription medicine used to treat patients with moderate-to-severe asthma who have an overreaction of their immune system called type 2 inflammation. In clinical trials, dupilumab reduced asthma attacks and improved breathing in patients with moderate-to-severe asthma. The REVEAL registry is a study observing how patients with asthma in the Middle East, Latin America, Russian Federation, and Singapore respond to dupilumab outside of clinical trial settings. The average patient had uncontrolled, severe asthma on enrollment. We summarized the characteristics of 374 enrolled patients before they started dupilumab; 60% were from the Middle East, nearly 60% were women, and half were white. More than 80% reported no history of smoking and, on average, patients were overweight. In the year before REVEAL, despite taking their medicine, patients had an average of two severe asthma attacks. Breathing tests showed moderate asthma in most patients. Most (72%) had high numbers of blood eosinophils (an inflammatory white blood cell) and 55% had elevated fractional exhaled nitric oxide (FeNO; a marker of lung inflammation in breath), indicating presence of type 2 inflammation, common in many people with asthma. Several patients had other health problems related to type 2 inflammation, most commonly allergic rhinitis (runny nose, sneezing, and itchy eyes caused by allergies), seen in 65% of patients. Overall, patients starting dupilumab in the real world had features of uncontrolled, severe asthma, including frequent asthma attacks and type 2 inflammation.

35. Identifying the relationship between exosome genes and breast cancer risk using bioinformatics and machine learning methods.

期刊: Discover oncology 发表日期: 2026-Jun-10 链接: PubMed

摘要

Breast cancer (BC) is the most prevalent cancer among women globally, with a high mortality rate. The treatment and prevention of this disease are of utmost importance. Exosomes-nanovesicles derived from cells-play a vital role in intercellular communication and have profound implications for numerous physiological and pathological processes. However, relationships between exosomes and the development and prognosis of BC have not been fully elucidated. Using gene expression data obtained from the NCBI GEO database for BC and normal tissues, we analyzed differential gene expression. The intersection of differentially expressed genes and exosome-related genes was obtained, and a gene interaction network was established. Genes associated with BC were identified using the Least Absolute Shrinkage and Selection Operator (LASSO), Support Vector Machine-Recursive Feature Elimination (SVM-RFE), and Random Forest (RF) algorithms. Shared genes identified using the three algorithms were used to construct a nomogram for predicting the risk and prognosis of BC. Gene-drug, gene-RNA binding protein, and gene-transcription factor interaction networks were analyzed. Finally, we evaluated relationships between drugs and proteins using molecular docking analyses. We identified 595 differentially expressed genes and obtained 37 exosome-related genes. Five differentially expressed exosome-related genes associated with the risk of disease were identified using three machine learning methods. These genes were involved in the regulation of various biological processes and were associated with immune cell infiltration. Drugs targeting four of the five genes were identified. Exosome genes are related to the occurrence and prognosis of BC and can be used as targets for drug therapy.

36. Context-dependent telomere dynamics in wild fish populations under anthropogenic stress.

期刊: Environmental science and pollution research international 发表日期: 2026-Jun-10 链接: PubMed

摘要

Anthropogenic environmental change imposes severe physiological challenges on wild populations, often leading to accelerated cellular aging. In many vertebrate models, the ‘conventional expectation’ is that chronic exposure to stressors triggers oxidative damage and increases turnover, resulting in accelerated telomere shortening. However, the universality of this pattern remains poorly understood, particularly in high-biodiversity regions of the Southern Hemisphere. This study explores pollution-linked telomere dynamics in Cnesterodon decemmaculatus, a native Neotropical fish, along a steep anthropogenic gradient in the Suquía River Basin (Argentina). Age-related changes in RTL differed significantly among sampling sites. Fish from the most contaminated site (IP) showed a tendency toward increasing RTL within the analyzed age range, a pattern that stands in contrast to most findings from temperate-region fish. Meanwhile, a moderately contaminated site (LC) followed the classic pattern of age-related telomere loss. We suggest that these divergent RTL patterns reflect site-specific physiological or compensatory responses, potentially involving the up-regulation of cellular maintenance or the selective persistence of tolerant phenotypes under extreme chronic stress. These results highlight the complex and context-dependent nature of telomere dynamics in the wild. Our findings indicate that while RTL is a sensitive indicator of environmental impact, its application as a robust biomarker requires a multi-proxy framework -integrating oxidative stress and telomerase assays- to accurately interpret the diverse biological responses of native species to anthropogenic change.

37. Mapping Employability Assessments for Adults with Limitations of Functioning: A Scoping Review.

期刊: Journal of occupational rehabilitation 发表日期: 2026-Jun-10 链接: PubMed

摘要

Work is a fundamental life domain, providing income, social engagement, and a sense of identity. Despite evidence that employment can support recovery, rehabilitation, and well-being, adults with limitations of functioning continue to face barriers to labor market participation. Employability assessments are central for access to vocational services, income support, and workplace accommodations, yet little is known about how these assessments are conducted across contexts. This study aimed to explore practices used in assessing employability among individuals with limitations of functioning. A structured four-step scoping review drew on scientific and grey literature published since 2005 in English or French. It systematically identified, selected, analyzed, and extracted evidence on employability assessment among adults with functional limitations. The review identified 37 documents, revealing variation in assessment objectives, models, content, and methods. Assessments address individual factors (e.g., health, skills), environmental contexts (e.g., workplace, institutional settings), and activities and participation (e.g., job tasks, daily living). Data collection relies on interviews, observations, and standardized tools, often combined. Key challenges include overreliance on medical information, variability across assessors, administrative constraints, and assessment-related burden. This study identifies key components documented in employability assessments and highlights variation in assessment objectives and approaches, from standardized procedures to professional judgment, shaped by broader social and political contexts. These findings underscore the need for more reflective assessment practices.

38. Parental Companionship Shapes Children's Attentional Functions and Academic Achievement.

期刊: Child psychiatry and human development 发表日期: 2026-Jun-10 链接: PubMed

摘要

For elementary school students, parental companionship plays a complex role-potentially providing support while sometimes creating interference-resulting in dual impacts on academic achievement. We propose that effects on children’s attention may be a key underlying mechanism. This study examined this hypothesis through two complementary studies with Chinese elementary school students. Study 1 employed a questionnaire method with Chinese elementary school students (N = 871,mean age = 11.52 years-old). Questionnaire data confirmed that positive dimensions (communication/interaction, accompanying) and negative dimensions (neglect, interference) of parental companionship had dual impacts on academic achievement. Attention mediated these relationships differently: partially for communication/interaction, completely for accompanying and interference, with no mediation for neglect. Study 2 utilized the Attention Network Test to analyze specific attention functions, comparing children with high (N = 53) and low (N = 53) parental companionship groups. Children in the low companionship group exhibited a significantly larger alerting effect compared to those in the high companionship group, suggesting they develop compensatory mechanisms to detect environmental cues. These findings suggest that attention may represent a cognitive pathway linking different dimensions of parental companionship to academic outcomes and highlight the critical importance of balanced parental involvement that enhances attention development without causing interference.

39. Impact of the 2024 flood event on trace elements contamination in floodplain sediments at the mouth of the Nysa Kłodzka river into the Odra valley.

期刊: Environmental geochemistry and health 发表日期: 2026-Jun-10 链接: PubMed

摘要

This study investigates the impact of the September 2024 flood on the trace elements concentration in the floodplain sediments at the mouth of the Nysa Kłodzka River into the Odra Valley. The research integrated geological mapping, sediment sampling (112 samples from 56 locations), laboratory analyses of trace element concentrations (44 representative samples from 22 locations), statistical evaluation (Mann-Whitney U test), and calculation of the geochemical and ecotoxicological indices (Enrichment Factor, Geoaccumulation Index, Contamination Factor, Degree of Contamination, Single Index of Ecological Risk Factor, Potential Ecological Risk Index). The results indicate that the 2024 flood event caused an increase in the concentrations of trace elements in surface sediments compared to subsurface, pre-flood layers (significant increase of Pb and Cd). The applied geochemical and ecotoxicological indices confirmed that the 2024 flood event enhanced both contamination levels and ecological risk in floodplain sediments. Overall, the findings emphase the important role of flood events in the mobilization, transport, and redistribution of contaminants within river floodplains.

40. The impacts of common chronic disease on autophagy and cellular stress during exertional heat stress in peripheral blood mononuclear cells of older males.

期刊: American journal of physiology. Regulatory, integrative and comparative physiology 发表日期: 2026-Jun-10 链接: PubMed

摘要

Autophagy plays a key role in maintaining cellular function during acute physiological stress, including exercise and heat stress. While autophagic function declines with increasing age, the extent to which age-related chronic disease (e.g., hypertension, type 2 diabetes) influences autophagic responses during exertional heat stress remains unknown. Older males (mean [SD]: aged 70 [5] years) without (n=10) and with hypertension (n=10) or type 2 diabetes (n=10) performed high-intensity semi-recumbent cycling (70% of maximal oxygen consumption) in temperate (25°C, 15% relative humidity) or hot (40°C, 15% relative humidity) ambient conditions. Mean body temperature (rectal and skin) was measured throughout, while proteins associated with autophagy and cellular stress were assessed in peripheral blood mononuclear cells before and after exercise and following 6h of seated recovery via Western blot. Mean body temperature increased similarly across all groups at end-exercise in temperate (+0.40°C) and hot conditions (+0.84°C). Indices of autophagy, including LC3-II, were greater in the healthy compared to both chronic disease groups at end-exercise and throughout the 6h recovery in temperate conditions. However, between-group differences in LC3-II levels were less pronounced following heated exercise (p=0.03), and p62 content was lower in individuals with hypertension and type 2 diabetes. While apoptotic responses were similar across groups, disease-associated blunting of IL-6 responses may contribute to the observed differential levels in autophagic regulation in older males. Therefore, our findings reveal altered autophagic responses to exertional heat stress in older males with chronic health conditions, which may have implications for altered cellular vulnerability during exertional heat stress.

41. Long-term hearing threshold shifts from moderate noise exposure (< 85 dBA time-weighted average) in semiconductor silicon-wafer manufacturing process.

期刊: International archives of occupational and environmental health 发表日期: 2026-Jun-10 链接: PubMed

摘要

Long-term hearing effects of occupational noise exposure below 85 dBA TWA remain insufficiently characterized in semiconductor manufacturing environments. This study evaluated longitudinal hearing-threshold changes among silicon wafer manufacturing workers exposed to moderate workplace noise over approximately 20 years. This retrospective cohort study examined serial pure-tone air-conduction audiometry (0.5-6 kHz) in 71 male semiconductor workers exposed to process-specific noise levels ranging from 72.2 to 80.9 dBA TWA. Participants were classified into normal-hearing (n = 53) and hearing-impaired (n = 18) groups according to Korean special health examination criteria and further categorized by manufacturing process: Process A (utilities), Process B (ingot processing), and Process C (wafer slicing). Longitudinal hearing-threshold changes were analyzed using repeated-measures ANOVA and compared with ISO 1999:2013 reference predictions. Both groups demonstrated significant deterioration in high-frequency hearing thresholds, particularly at 4-6 kHz (p < 0.001). Workers with normal baseline hearing showed threshold shifts of approximately 6-8 dB at 4 kHz and 8-10 dB at 6 kHz during follow-up, whereas workers with pre-existing hearing impairment demonstrated substantially greater progression. Process C, which had the highest recent exposure levels, showed the most pronounced longitudinal deterioration. Observed high-frequency threshold shifts were greater than conservative ISO 1999 reference predictions despite exposure levels below 85 dBA. Prolonged exposure to moderate occupational noise below current regulatory limits was associated with progressive high-frequency hearing deterioration in semiconductor manufacturing workers. These findings suggest that cumulative exposure duration and process-specific exposure characteristics should be considered in occupational hearing conservation programs.

42. Retrospective analysis of guideline-based massage therapy in primary care for musculoskeletal disorders.

期刊: Advances in clinical and experimental medicine : official organ Wroclaw Medical University 发表日期: 2026-Jun-10 链接: PubMed

摘要

Musculoskeletal disorders (MSDs) impose a significant burden on primary healthcare systems and the economy. Massage therapy (MT) may represent a useful tool for addressing these issues. However, the lack of robust evidence confirming its effectiveness makes this therapy controversial. This study aimed to assess the feasibility of implementing guideline-based MT into routine primary care practice. In this retrospective study, records of 258 primary care patients (median (Me) = 51.5 years; 1st and 3rd quartiles (Q1-Q3) = 42-66) were analyzed. These patients had previously received MT according to guidelines recommended by the Polish Society of Physiotherapy, the Polish Society of Family Medicine, the College of Family Physicians in Poland, and the European Rural and Isolated Practitioners Association (EURIPA). The effectiveness of therapy was evaluated using the visual analogue scale (VAS) and the number of general practitioner (GP) appointments booked by patients (NA). The majority of patients who received MT suffered from low back pain (M54.5) (39.1%); soft tissue disorders related to use, overuse, and pressure (M70) (27.5%); unspecified spondylosis (M47.9) (9.3%); and osteoarthritis of the knee (M17.5 and M17.9) (4.3%). A Wilcoxon test revealed a significant reduction in NA for M54.5 (p < 0.001), M70 (p < 0.001), others (p < 0.001), M17 (p = 0.004), and M47.9 (p < 0.001), as well as in VAS scores for M54.5 (p < 0.001), M70 (p < 0.001), others (p < 0.001), M47.9 (p < 0.001), and M17 (p = 0.003) after MT. This study supports the potential benefits of integrating physiotherapy-led massage into routine primary care practice for the management of selected musculoskeletal disorders. When implemented in cooperation with family physicians, MT may reduce pain and decrease the need for additional GP visits.

43. Enhanced Environmental PFAS Characterization Using a Virtual High-Resolution Mass Spectral Library Generated by Transfer Learning-Based Neural Network.

期刊: Environmental science & technology 发表日期: 2026-Jun-10 链接: PubMed

摘要

Per- and polyfluoroalkyl substances (PFAS) represent a critical class of persistent environmental contaminants with significant ecological and human health implications. However, the rapid emergence of novel PFAS has far outpaced the development of reference mass spectral databases. Here, Neural Per- and Polyfluoroalkyl Substances Mass Spectrometry (NPFAS-MS), a transfer learning-based neural network model, was developed to predict PFAS-specific high-resolution mass spectra. NPFAS-MS was fine-tuned from a pretrained model using PFAS tandem mass (MS/MS) spectra. NPFAS-MS outperformed other in silico spectral prediction models for PFAS spectra prediction across multiple spectral similarity metrics. In library searching tasks, libraries generated by other spectral prediction models showed top-1 recall between 42.1% and 55.4%, while NPFAS-MS demonstrated 71.1%. Applying the virtual PFAS mass spectral library generated with NPFAS-MS using 10,553 PFAS structures from the U.S. EPA and NORMAN databases to groundwater and aqueous film-forming foam (AFFF) samples revealed more potential PFAS than other mass spectral databases. Specifically, 38 potential PFAS were annotated in AFFF products and 40 in groundwater samples. NPFAS-MS enabled characterization of emerging PFAS, including ultrashort-chain, unsaturated, and substituted derivatives in environmental matrices. This advancement enables comprehensive environmental monitoring of rapidly evolving PFAS contamination. NPFAS-MS and associated resources were deployed as a web-based tool at https://cosbi10.ee.ncku.edu.tw/NPFAS_MS/, enabling both structure-to-spectrum prediction and library searching against 31,659 predicted PFAS spectra.

44. Comparing prescribing practices of nurse practitioners and physicians in the United States: A scoping review.

期刊: Journal of the American Association of Nurse Practitioners 发表日期: 2026-Jun-10 链接: PubMed

摘要

Nurse practitioners (NPs) in the United States have an expanding role in medication prescribing and management as professional autonomy increases. To synthesize up-to-date, US-based evidence on NP and physician prescribing with respect to quality, patterns, and longitudinal trends. We searched Medline, Cumulative Index to Nursing and Allied Health Literature, PubMed, and PsycINFO (June 2024-December 2025) for US quantitative studies published since 2000 comparing NP and physician prescribing quality, patterns, or trends. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews framework, three reviewers screened 3,031 records with consensus resolution. A total of 17 studies were included. Prescribing quality was generally comparable between NPs and physicians, although findings related to opioid and antibiotic prescribing were mixed. Prescribing patterns varied by medication type and practice setting, with NPs accounting for a higher proportion of psychotropic and chronic disease medications and greater use of noncontrolled or over-the-counter medications in rural areas. Over time, NP prescribing increased, opioid prescribing declined, and adoption of newly approved medications was slower than physician prescribing. NP prescribing is generally comparable to physician prescribing across several quality indicators, with variation observed by medication type, outcome measure, and clinical context. The findings support the integration and expansion of NP-provided medication management as a means of meeting patient care needs without compromising quality. Variation in NP prescribing across medication types and practice settings highlights the importance of supporting NP prescribing roles with resources and clinical supports that are tailored to therapeutic area and practice setting.

45. Functional Motor Change Across Time and Phenotypes in Patients With Amyotrophic Lateral Sclerosis: A Descriptive Study.

期刊: Neurorehabilitation and neural repair 发表日期: 2026-Jun-10 链接: PubMed

摘要

Progressive disability occurs in persons with amyotrophic lateral sclerosis (pALS), but change over time across phenotypes remains understudied, limiting clinical decision-making. This descriptive study describes functional motor change with detailed measures across ALS phenotypes to enhance clinical decision making. Electronic health record data from an interdisciplinary ALS clinic (n = 109 pALS, 2018-2022) including demographics, disability (ALS Functional Rating Scale-[ALSFRS-R]), and functional motor scores (10 m Walk, Handheld dynamometry [grip and ankle]) was utilized. Phenotype groups were defined by site of onset (bulbar, limb onset; upper limb or lower limb). Analysis was conducted using R and included changes scores and measures of central tendency in 3-month intervals. PALS included n = 43 bulbar, n = 32 upper limb, n = 34 lower limb onset, age 65, 60 to 71 (median, interquartile range). ALFSRS-R decline was greatest in bulbar, and similar in upper and lower limb. Patterns of change within motor scores suggest greatest loss of grip strength in bulbar and upper limb, ankle strength in upper limb, walking speed in lower limb, and preservation of community ambulation in upper limb. While ALSFRS-R scores were similar in upper and lower limb, detailed functional motor measures indicated differences in groups. These patterns provide insight to guide clinical decision making and future research to enhance care in pALS.

46. MicroRNAs in exhaled breath condensate and plasma for diagnosis of asbestos-related interstitial lung diseases.

期刊: Expert review of respiratory medicine 发表日期: 2026-Jun-10 链接: PubMed

摘要

MicroRNAs (miRNAs) have been proposed as diagnostic biomarkers of asbestos-related cancers, but their role in asbestos-related interstitial lung diseases (ILDs) is unknown. We conducted a pilot study in 30 subjects: 11 unexposed population controls, 8 ILD-free asbestos-exposed subjects, and 11 asbestos-related ILD cases. We used the Receiver Operator Characteristic (ROC) Area Under the Curve (AUC) to estimate the diagnostic accuracy of miRNAs, and volcano plots to assess their differential expression between the study groups. miR-548h-5p was over-expressed in ILD-free asbestos-exposed subjects and demonstrated a 90% accuracy (95% CI: 0.75-1.00) in discriminating them from unexposed subjects, as well as a 96% diagnostic accuracy (95% CI: 0.88-1.00) in differentiating asbestos-related ILD cases from ILD-free asbestos-exposed subjects. miR-6127-3p was over-expressed and showed an accuracy of 85% (95% CI: 0.66-1.00) in discriminating asbestos-related ILD cases from unexposed subjects in plasma. let-7f-5p was over-expressed in the exhaled breath condensate (EBC) of ILD-free asbestos-exposed subjects and showed a 90% accuracy (95% CI: 0.76-1.00) in discriminating them from unexposed subjects. Our results suggest that the plasma and EBC miRNA profile might serve as a diagnostic biomarker of asbestos-related ILDs.

47. Sugar-Sweetened and Artificially Sweetened Beverages and Liver Cancer-A Hard Look at Soft Drinks.

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

摘要

48. Improving Empiric Antibiotic Selection for Patients With Cancer Hospitalized With Infection: Secondary Analysis of the INSPIRE Cluster Randomized Trials.

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

摘要

Patients with cancer are routinely prescribed extended-spectrum antibiotics despite overall low multidrug-resistant organism (MDRO) prevalence. Evidence for effective strategies to reduce antibiotic overuse in this population is limited. To evaluate the association of computerized provider order entry (CPOE) prompts providing patient- and pathogen-specific MDRO risk estimates with empiric extended-spectrum antibiotic use in patients with cancer. This secondary analysis of the 4 Intelligent Stewardship Prompts to Improve Real-Time Empiric Antibiotic Selection (INSPIRE) cluster randomized clinical trials identified non-critically ill hospitalized adults (aged ≥18 years) with discharge diagnosis codes for hematologic or solid organ malignant tumors in the INSPIRE pneumonia, urinary tract infection (UTI), abdominal, and skin and soft tissue infection (SSTI) trials. Each trial evaluated the effect of CPOE prompts that used real-time patient-specific electronic health record data to estimate MDRO infection risk for patients prescribed extended-spectrum antibiotics during the first 3 hospital days; the prompt recommended standard-spectrum antibiotics when the risk of antibiotic-resistant infection was less than 10%. Extended-spectrum antibiotic days of therapy were evaluated using as-randomized, adjusted difference-in-difference analyses with generalized linear mixed-effects models and clustering by patient, hospital, and period. Days to intensive care unit transfer, hospital length of stay, hospital readmissions, and in-hospital mortality were also assessed. In all trials, 36 861 patients (mean [SD] age, 69.0 [13.6] years; 19 076 [52%] female), including 18 272 baseline and 18 589 intervention patients, had cancer. Extended-spectrum antibiotic days of therapy decreased by 27% (rate ratio [RR], 0.73; 95% CI, 0.67-0.80; P < .001) in the pneumonia trial, 24% (RR, 0.76; 95% CI, 0.68-0.84; P < .001) in the UTI trial, 17% (RR, 0.83; 95% CI, 0.74-0.92; P < .001) in the SSTI trial, and 24% (RR, 0.76; 95% CI, 0.69-0.84; P < .001) in the abdominal infection trial. Pre-post changes in hospital length of stay, intensive care unit transfers, readmissions, and in-hospital mortality were similar in the 2 groups. In this secondary analysis of randomized clinical trials, an antibiotic stewardship bundle that included CPOE prompts recommending standard-spectrum antibiotics for patients at low risk for antimicrobial-resistant infections was associated with reduced extended-spectrum antibiotic use in non-critically ill patients with cancer who were hospitalized with community-acquired pneumonia, UTI, SSTI, or abdominal infection, without observed differences in safety outcomes. The findings support scalable, low-burden strategies to improve antimicrobial use in patients with cancer, a population with limited evidence to guide stewardship. ClinicalTrials.gov Identifiers: NCT05423756, NCT05423743, NCT03697070, NCT03697096.

49. Artificially Sweetened and Sugar-Sweetened Beverage Intake and Risk of Liver Cancer.

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

摘要

Artificially sweetened beverages (ASBs) and sugar-sweetened beverages (SSBs) are widely consumed worldwide and have been linked to metabolic disorders, including obesity and type 2 diabetes, which are established risk factors associated with liver cancer. However, prospective evidence examining beverage consumption and liver cancer subtypes remains limited and inconsistent. To examine associations between ASB and SSB consumption and risk of incident liver cancer overall and by subtype, including hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC). In this pooled analysis of 11 prospective cohort studies (10 US cohorts and 1 European cohort, comprising adults without a history of cancer at baseline), participants were enrolled across cohorts between 1980 and 2009 and followed up through end-of-study dates ranging from 2000 to 2019. The median (IQR) duration of follow-up was 11.4 (10.8-27.9) to 31.4 (27.6-31.5) years. This analysis was conducted between September 2024 and August 2025. Participants were followed up via linkage to state cancer registries or follow-up surveys for incident liver cancer. Self-reported intake of ASB and SSB assessed at baseline using validated food frequency questionnaires and analyzed per 1-beverage/day increment. Incident liver cancer overall and by subtype (HCC and ICC) identified through cancer registries or medical record review. Cox proportional hazards regression models were used to estimate multivariable hazard ratios (HRs) and 95% CIs for liver cancer incidence, adjusting for potential confounders, including demographics and lifestyle factors, and weighted-mean meta-analysis of estimates. A total of 1 518 411 participants (mean [SD] age, 57.8 [10.1] years; 883 832 female [58.2%]) were included in this analysis. During a median (IQR) of 17.8 (12.8-23.5) years of follow-up, 2811 incident liver cancer cases were identified, including 1699 HCC and 444 ICC cases. After multivariable adjustment, ASB intake per 1-beverage/day increase was not associated with liver cancer risk, HCC (10 cohorts), or ICC (6 cohorts). SSB intake per 1-beverage/day increase was not associated with overall liver cancer risk but was associated with increased risk of HCC (HR, 1.10; 95% CI, 1.03-1.18; 10 cohorts) and ICC (HR, 1.15; 95% CI, 1.00-1.32; 6 cohorts). There was no evidence of effect modification by diabetes status. In this study, increased SSB consumption was associated with increased risk of HCC and ICC. There was little evidence that ASB intake was associated with liver cancer risk overall or by subtype.

50. Vertical Integration-The Upside Potential.

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

摘要

51. Cold-Related Illness Among Older Adults Experiencing Homelessness.

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

摘要

This cohort study examines emergency department visits and hospitalizations for cold-related illness among older adults experiencing homelessness compared with socioeconomically disadvantaged adults with housing in Ontario, Canada.

52. The New Orleans Healthy Default Beverage Policy and Beverage Ordering Among Children.

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

摘要

Sugar-sweetened beverages (SSBs) are the leading source of added sugar in US children’s diets and are linked to increased obesity risk, and restaurants are critical settings for interventions to reduce SSB consumption. Local menu ordinances requiring default healthier beverages (HDB) are gaining in popularity, but to date, there has been no rigorous evaluation of their effectiveness. To evaluate the outcomes of an HDB ordinance on beverage ordering for children in restaurants. Difference-in-differences study using caregiver-reported survey data before and after policy implementation (September 2022 and 2024, respectively) in 2 urban parishes in Louisiana: New Orleans (intervention city) and Baton Rouge (comparison city). Parents and caregivers (≥18 years) of children aged 2 to 12 years who had ordered or eaten at a restaurant with their child in the past 30 days were surveyed. Implementation of the New Orleans Healthy Kids’ Meal Beverage Ordinance, which mandates that only water, unflavored or low-fat milk, or 100% juice be offered as default beverages with children’s meals. The primary outcome was ordering of a healthy default beverage with the most recent children’s restaurant meal. Secondary outcomes included beverage volume, sugar and calorie intake, and selection of beverage types. Models were weighted and adjusted for demographics, dining mode, and caregiver attitudes. A total of 1006 caregivers completed the baseline survey (736 [73.2%] female; 506 in New Orleans, 500 in Baton Rouge), and 1131 completed the postpolicy survey (548 [48.5%] female; 556 in New Orleans, 575 in Baton Rouge). Healthy beverage ordering decreased in both cities, but comparison of before-and-after differences between the 2 cities indicates the ordinance was associated with higher odds of ordering a healthy beverage (adjusted odds ratio [aOR], 2.10; 95% CI, 1.16 to 3.83; P = .02), attenuating the ordering decline in New Orleans. Sugar intake decreased by 5.6 g (95% CI, -9.6 to -1.5 g; P = .007), and calorie intake declined by 34.0 kcal (95% CI, -59.1 to -8.9 kcal; P = .008). The odds of ordering water increased (aOR, 2.08; 95% CI, 1.12 to 3.85), while the odds of ordering 100% juice decreased (aOR, 0.59; 95% CI, 0.36 to 0.96). No significant changes were observed for SSBs or beverage volume. In this survey study, the New Orleans HDB ordinance was associated with modest but meaningful improvements in children’s beverage ordering, supporting default-based policies as a tool for promoting healthier dietary behaviors.

53. Hospital System Acquisition of Physician Practices.

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

摘要

More than 50% of physicians currently work for hospital systems compared with 20% in 2010, a shift driven in large part by hospital acquisitions of physician practices. These acquisitions have been linked to higher prices for physician and hospital services, and the evidence regarding their impact on quality of care has been mixed; however, there is little research regarding the perspectives of key stakeholders regarding such acquisitions. To provide systematic evidence on the motivation for and impact of physician practice acquisitions from hospital system leaders and physicians who are directly involved in these transactions. A qualitative research design was used for the study. Data collection occurred between December 2024 and April 2025. A purposive sample of 3 hospital systems that each had experience with physician practice acquisitions was included. Interviews were conducted with hospital system leaders and employed physicians who had been members of an acquired practice. Semistructured interview guides were used covering motivations for acquisitions, implications for patient care, and operational challenges. Coded data were analyzed to identify major themes. A total of 37 interviews were conducted of 18 hospital system leaders and 19 employed physicians (26 male and 11 female). Both hospital leaders and physicians reported that practice acquisitions were most often initiated by physicians because of concerns about the financial viability of their practices. Hospital leaders and physicians also perceived that practice acquisitions improved care for patients, for example by uniting clinicians through a common electronic health record or colocating primary care and behavioral health services. Operationally, hospital leaders expressed frustration with employed physicians’ productivity, whereas employed physicians complained of being sidelined in decisions about practice support and work schedules. In this qualitative study of hospital acquisitions of physician practices, acquisitions were largely initiated by physicians seeking to leave independent practice. The acquisitions created opportunities to improve patient care, but efforts to integrate physicians after acquisition were impeded by ongoing tensions over physician productivity and autonomy. Physician practice acquisitions hold promise for improving patient care if various operational challenges on integrating acquired practices can be resolved.

54. Infant Growth After Mass Administration of Azithromycin: Secondary Outcomes of a Cluster Randomized Clinical Trial.

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

摘要

Mass administration of azithromycin reduced child mortality in parts of sub-Saharan Africa. Promotion of infant growth may be an additional benefit of azithromycin treatment. To investigate whether the provision of mass administration of azithromycin for infants aged 1 to 11 months improves growth outcomes. This cluster randomized clinical trial conducted from December 1, 2020, to December 31, 2024, included 1151 villages in southwestern Mali. Villages were randomized in a 3:4:2 ratio to placebo, twice-yearly azithromycin, or quarterly azithromycin. Participants and study personnel were masked. The prespecified growth substudy, conducted from August 31, 2022, to July 31, 2023, was conducted in 59 villages in the Kita region. Eligible participants were infants aged 1 to 11 months, weighing 3.0 kg or more, with no macrolide allergy or severe illness. Anthropometric data were collected cross-sectionally from children aged 6 to 8 months and 12 to 14 months at 15, 18, 21, and 24 months after village enrollment. Infants received a single oral dose of azithromycin, 20 mg/kg, at each quarterly visit: placebo at all rounds (control); azithromycin at 2 rounds from January to June and placebo at 2 rounds from July to December (twice-yearly azithromycin); or azithromycin at all rounds (quarterly azithromycin). Prespecified outcomes were weight and length; weight-for-age (WA), length-for-age (LA), weight-for-length (WL), and mid-upper-arm circumference (MUAC) z scores; and underweight, stunting, and wasting. Analysis was performed on an intention-to-treat basis. A total of 1205 infants (mean age, 5.7 months [95% CI, 5.6-5.9 months]; 633 boys [52.5%]) were included in the trial at baseline. Among 1789 children (923 boys [51.6%]) assessed for growth, the mean anthropometric indices did not differ between the placebo, twice-yearly azithromycin, and quarterly azithromycin groups: weight, 7.8 kg (95% CI, 7.7-7.9 kg), 7.8 kg (95% CI, 7.7-7.9 kg), and 7.8 kg (95% CI, 7.7-7.9 kg), respectively; length, 70.2 cm (95% CI, 69.9-70.8 cm), 70.6 cm (95% CI, 70.2-70.9 cm), and 70.6 cm (95% CI, 70.1-71.0 cm), respectively; WA z score, -1.12 (95% CI, -1.23 to -0.95), -1.10 (95% CI, -1.19 to -0.98), and -1.12 (95% CI, -1.27 to -1.01), respectively; LA z score, -0.86 (95% CI, -1.06 to -0.70), -0.79 (95% CI, -0.93 to -0.65), and -0.78 (95% CI, -0.98 to -0.63), respectively; WL z score, -0.87 (95% CI, -1.00 to -0.68), -0.89 (95% CI, -1.01 to -0.77), and -0.95 (95% CI, -1.12 to -0.81), respectively; and MUAC z score, -0.30 (95% CI, -0.43 to -0.10), -0.24 (95% CI, -0.37 to -0.12), and -0.26 (95% CI, -0.41 to -0.10), respectively. The proportions of underweight, stunting, and wasting did not differ between groups. In this prespecified analysis of secondary outcomes of a cluster randomized clinical trial of the provision of mass administration of azithromycin for infants aged 1 to 11 months, growth outcomes did not differ between azithromycin and placebo groups. These findings suggest that mass administration of azithromycin to infants is unlikely to promote growth. ClinicalTrials.gov Identifier: NCT04424511.

55. Influenza Vaccine and Associated Infection and Death in California, 2024 to 2025.

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

摘要

Effectiveness of seasonal influenza vaccine must be assessed annually as influenza viruses evolve, requiring updated vaccine components. Evidence is limited for direct vaccine benefit in lowering risk of death following influenza virus infection. To evaluate the association between current-season influenza vaccination and laboratory-confirmed influenza virus infection and, among persons with laboratory-confirmed influenza, the association with influenza-associated death. A case-control analysis of California residents aged 6 months or older with influenza diagnostic testing ordered between October 1, 2024, and May 31, 2025, with data on diagnostic test result and 2024 to 2025 influenza vaccination. Influenza-associated deaths within 30 days of testing among persons with laboratory-confirmed influenza were identified from vital statistics records. Influenza vaccination from October 1, 2024, to May 31, 2025. Associations were evaluated between 2024 to 2025 influenza vaccination and (1) laboratory-confirmed influenza, in which case individuals tested positive and control individuals tested negative for laboratory confirmed influenza; and (2) influenza-associated death, in which deaths were compared with surviving cases among persons with laboratory-confirmed influenza. Associations were assessed with mixed-effects logistic regression. Among 1 106 628 persons tested for laboratory-confirmed influenza (610 093 female participants [55.1%]), 234 715 were case individuals with laboratory-confirmed influenza (median [IQR] age, 28 [10-52] years) and 871 913 were control individuals (median [IQR] age, 42 [19-67] years); 45 441 influenza cases (19.4%) and 255 605 control individuals (29.3%) had received 2024 to 2025 influenza vaccination. Vaccination was significantly associated with decreased likelihood of laboratory-confirmed influenza (estimated vaccine effectiveness, 40%; 95% CI, 39%-41%). Among persons with laboratory confirmed influenza, there were 801 influenza-associated deaths. Influenza-associated death among persons aged 65 years or older was associated with lower likelihood of influenza vaccination (adjusted odds ratio, 0.71; 95% CI, 0.60-0.84) compared with persons with nonfatal infection. In this case-control study of estimated vaccine effectiveness, influenza vaccination was associated with decreased likelihood of laboratory-confirmed influenza and influenza-associated deaths among those with laboratory-confirmed influenza. Electronic laboratory reporting linked to immunization registry and vital statistics provide tools to assess vaccine effectiveness and risk of death, a rare influenza-associated outcome.

56. Factors Influencing Rural Hospitals to Participate and Remain in Accountable Care Organizations.

期刊: The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association 发表日期: 2026-Mar 链接: PubMed

摘要

Little is known about factors driving rural providers-who face unique challenges-to participate and remain in accountable care organization models. The purpose of this study was to investigate the specific factors that rural hospitals evaluate when weighing both initial and continued participation in Medicare as well as commercial ACO models. Furthermore, we explored policy implications to improve ACO models’ capacity to attract, retain, and promote success of rural providers. Semistructured, in-depth interviews were conducted with rural hospital executives with direct knowledge of ACO agreement terms and factors driving ACO participation. The interview guide contained seventeen open-ended questions. Interviews were recorded, transcribed, coded using codebooks informed by the interview guide, and analyzed using a thematic analysis approach. Interviewees identified five primary multi-faceted motivations for participation: (1) financial incentives-shared savings, upside-only risk initially, and upfront funding for some providers, (2) getting ahead of the curve of the move to value-based reimbursement, (3) importance placed on capacity to push toward improving population health or quality, (4) additional forms of resource gain, and (5) key outside factors. The specific ACO design affects rural providers’ decision-making on timing and selection of particular models. Importantly for future policy development, multiple respondents raised concerns about moving to risk in ACO models, leading them to consider dropping out. Findings from this qualitative study provide an in-depth understanding that is vital to achieving CMS’s goal of increasing participation in value-based care. In turn, this could further improve health care quality for countless lives.

57. Cultivating the Field of Rural Health Research: The Case for Rural Health Research Competencies.

期刊: The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association 发表日期: 2026-Mar 链接: PubMed

摘要

Rural Veterans face unique healthcare barriers and challenges despite an increased need for care. The U.S. Department of Veterans Affairs (VA) has long invested in research to improve Veteran health and healthcare delivery; however, rural Veterans remain underrepresented in research, limiting the equitable translation of evidence into rural settings. Rural-specific research is, therefore, essential in improving rural Veterans’ health. This commentary argues for the development of rural health research competencies and proposes possible competency domains to guide training, mentorship, and workforce development. Drawing on existing rural health scholarship, competency-based education, and implementation science, we outline illustrative domains of competence relevant to conducting rigorous, ethical, and impactful rural health research. There is currently no field-wide agreement on the knowledge, skills, and experiences that define a proficient rural health researcher. A core set of rural health research competencies is essential for defining effective rural health research practices, guiding the development, implementation, and evaluation of training efforts, and facilitating broader improvements in rural health research and healthcare. Establishing a flexible, evolving set of rural health research competencies, grounded in both academic rigor and community-embedded expertise, can strengthen the rural health research workforce, inform training and mentorship, and advance equitable healthcare for rural Veterans and rural populations more broadly.

58. TRENDS AND RESEARCH FRONTIERS ON GUT MICROBIOTA AND STUNTING: A BIBLIOMETRIC INSIGHT FROM 2009 TO 2025.

期刊: Arquivos de gastroenterologia 发表日期: 2026 链接: PubMed

摘要

Stunting, a chronic consequence of undernutrition, continues to affect millions of children under five years of age worldwide, particularly in developing countries, with long-term impacts on physical growth, cognitive development, and economic productivity. This study provides a bibliometric analysis of 172 publications indexed in Scopus from 2009 to 2025, aiming to identify trends, key contributors, core sources, thematic evolution, and future research directions in this emerging field. Results indicate a steady annual growth rate of 11.85%, with peak publication output in 2021, reflecting global attention. Influential contributions were led by Gordon JI, Barratt MJ, and Ahmed T, with the United States, France, Bangladesh, China, and Indonesia identified as the most active countries, and institutions such as Washington University and the International Centre for Diarrhoeal Disease Research (Bangladesh) playing pivotal roles. The most productive journals included PLOS ONE, Frontiers in Microbiology, Nutrients, and Gut Microbes, with Subramanian S serving as the foundational reference. Keyword analysis revealed a thematic shift from “malnutrition” and “stunting” toward mechanistic terms such as “dysbiosis,” “environmental enteric dysfunction,” and interventions including “probiotics” and “prebiotics.” Emerging themes highlight moderate acute malnutrition and microbiota-directed interventions as promising frontiers. This bibliometric analysis provides valuable insights into research trends, influential contributors, and emerging areas, offering a foundation for guiding future studies and supporting global strategies to address stunting as a critical public health challenge.