公共卫生研究摘要 (2026-06-13)

共收录 60 篇研究文章

1. Race and Ethnicity, Hypertension, and Neuroimaging Markers of Brain Aging: A Causal Mediation Analysis in the HABS-HD Study.

期刊: Neurology 发表日期: 2026-Jul-14 链接: PubMed

摘要

The mechanisms underlying racial/ethnic differences in dementia incidence and pathology are multifactorial, and hypertension represents an actionable target for reducing these differences. We aimed to estimate the extent to which controlling for hypertension mediates racial/ethnic inequities in neuroimaging markers of brain aging. The Health and Aging Brain Study-Health Disparities cohort is a highly phenotyped, racially and ethnically diverse cohort of cognitive aging. We used marginal structural models with inverse probability weights to estimate total and controlled direct effects of race/ethnicity, hypertension, and systolic blood pressure (SBP) at baseline, with neuroimaging markers measured on average 2 years later. Neuroimaging markers of brain aging were measured at the 2-year follow-up. Among Black and Hispanic participants with any neuroimaging data at the second visit (overall N = 1,347), 68% and 71% were women, 75% and 67% had hypertension, and the mean age was 61 and 63 years, respectively. Black and Hispanic participants had greater white matter hyperintensity volume (WMHV) compared with non-Hispanic White (NHW) participants (n = 1,333, β [95% CI]: Black 2.08 [1.68-2.59], Hispanic 0.99 [0.91-1.08]). After analytically setting hypertension status to absent, Black-NHW inequities in WMHV were attenuated (β [95% CI]: 1.3 [1.01-1.65]). Black participants had lower amyloid deposition compared with NHW participants (n = 679, β [95% CI]: -0.29 [-0.46 to -0.12]), but analytically controlling for hypertension did not appreciably change estimates. Compared with NHW participants, Hispanic participants had lower Alzheimer disease meta-region of interest cortical thickness (n = 1,005, β [95% CI]: -0.20 [-0.34 to -0.07]), but neither hypertension nor SBP significantly mediated this difference. Medial temporal lobe tau-PET standardized uptake value ratio did not significantly differ in Black or Hispanic participants compared with NHW participants (n = 408). Black-NHW inequities in subclinical cerebral small vessel disease may be mitigated by population-level efforts to reduce hypertension prevalence. Future studies should extend this work to examine clinical outcomes.

2. Application of the 2024 McDonald Criteria in Individuals With Nonspecific Symptoms or Incidental Imaging Findings in a Multicenter Study.

期刊: Neurology 发表日期: 2026-Jul-14 链接: PubMed

摘要

The 2024 McDonald criteria allow diagnosis of multiple sclerosis (MS) in individuals presenting with symptoms not specific for MS or incidental imaging findings suggestive of demyelination when supported by biomarker evidence, reflecting a shift toward diagnostic definitions increasingly grounded in biological mechanisms of disease. The diagnostic yield of these criteria in such populations has not been evaluated in multicenter cohorts. We aimed to determine the proportion of individuals with nonspecific or incidental imaging presentations who meet the 2024 McDonald criteria and describe the contribution of central vein sign and CSF oligoclonal bands (OCBs) to diagnostic classification. This cross-sectional post hoc analysis used data from the Central Vein Sign in Multiple Sclerosis study, a multicenter observational cohort. Adults aged 18-65 years referred for diagnostic evaluation of possible MS were adjudicated by an expert panel. This analysis focused on participants with symptoms not specific for MS or incidental imaging findings suggestive of demyelination. Dissemination in space (DIS) and dissemination in time (DIT) were assessed using 2017 MRI criteria. Fulfillment of the 2024 McDonald criteria at baseline-the primary outcome-was determined using the Select-6 CVS and CSF OCBs. Select-6 assessment was available for all participants, whereas OCB data were available for a subset based on prior clinical evaluation. Of 420 participants enrolled, 191 (45%) presented with either nonspecific symptoms (n = 166) or incidental imaging findings (n = 25). The mean age was 42 years, and 78% were female. Thirty-six (19%) met the 2024 McDonald criteria at baseline, including 28 (17%) in the nonspecific symptom cohort and 8 (32%) in the incidental imaging cohort. Among 51 participants meeting 2017 DIS, 22 (43%) were Select-6 positive, 17 (33%) had positive OCBs, and 4 (8%) met 2017 DIT. Nonspecific sensory symptoms, visual disturbances, and subacute cognitive decline were most associated with a diagnosis of MS. Application of the 2024 McDonald criteria identified nearly one-fifth of individuals without typical presentations as meeting diagnostic criteria for MS at baseline. Biomarker incorporation-particularly the CVS-accounted for a substantial proportion of diagnostic yield. Interpretation is limited by availability of CSF data and absence of longitudinal follow-up.

3. Plasma CGRP Levels in Migraine: A Registry for Migraine Study.

期刊: Neurology 发表日期: 2026-Jul-14 链接: PubMed

摘要

Calcitonin gene-related peptide (CGRP) plays a central mechanistic role in migraine and is an established drug target. However, it remains unclear whether peripheral plasma CGRP levels meaningfully reflect disease activity. We investigated whether circulating plasma CGRP differs between individuals with migraine and healthy controls and whether concentrations vary across migraine subtypes, clinical status, and preventive treatment use. This cross-sectional observational study enrolled adults (≥18 years) with migraine with aura, migraine without aura, or chronic migraine primarily from specialized care. Healthy controls without personal or first-degree family history of primary headache disorders were mainly recruited through web-based advertisement. Venous blood was obtained by antecubital phlebotomy, and plasma CGRP was quantified in duplicate using a validated high-affinity radioimmunoassay. Controls were matched 1:4 to participants with migraine on age, sex, body mass index, and storage duration. The primary outcome was between-group difference in plasma CGRP concentrations. Group comparisons were performed using Mann-Whitney U tests. Regression models were performed to assess associations with clinical variables. A total of 588 participants with migraine and 147 matched controls were analyzed (mean age 43.1 ± 11.9 vs 41.5 ± 11.5 years; 88.8% vs 85.7% female). The median (interquartile range) plasma CGRP concentrations were lower in participants with migraine compared with controls (125 [68-173] vs 151 [118-199] pmol/L; p < 0.001). Subgroup analyses revealed no significant differences across subtypes (episodic vs chronic, with aura vs without aura), ictal vs interictal status, or preventive medication use (all p > 0.05). Sensitivity analyses restricted to headache-free participants confirmed the principal findings, demonstrating lower plasma CGRP concentrations across all migraine subgroups compared with controls (all p < 0.001). Multivariable models identified no clinical predictors of plasma CGRP levels. Sample storage duration did not correlate with measured levels (Spearman ρ = -0.032; p = 0.37). Plasma CGRP concentrations were modestly lower in migraine and did not vary by clinical subtype or disease state. These findings challenge the assumption that migraine is characterized by elevated circulating CGRP and suggest limited utility of plasma CGRP as a disease biomarker.

4. Capitalising experiential knowledge in health promotion: An approach to investigate intervention's implementation.

期刊: Public health 发表日期: 2026-Jun-12 链接: PubMed

摘要

To improve the quality of complex health promotion interventions, it is essential to better understand how they are implemented and how they interact with their context. In addition to research-based knowledge, the experiential knowledge of the professionals who implement these interventions should be explored and shared more extensively. The article describes a new qualitative approach and set of tools developed by a committee to collect and document intervention experiences. This project adopted a participatory, practice-oriented knowledge translation approach within a national, interdisciplinary and inter-organisational governance framework. A French national committee was established to promote experiential knowledge in health promotion. This committee developed an approach for Capitalising on Experiential Knowledge in Health Promotion: the CEKHP approach. A multi-stage process was followed, which included: reviewing the literature on experiential knowledge, benchmarking existing capitalisation approaches from other sectors and elaborating tools to broadly diffuse the approach to health promotion practitioners. The CEKHP approach consists of five steps to collect experiences from project managers and implementers about intervention implementation, key functions, stakeholders, and strategies. A guide and a toolkit have been created to support the adoption of CEKHP and ensure proper usage. The data resulting from this capitalisation process, consisting of a short and analytic narrative, is disseminated through a dedicated website, and is intended to inform intervention implementation for practitioners, decision-makers, and researchers alike. The CEKHP approach enables the collection, analysis, and sharing of professional knowledge about lessons learned from intervention implementation. It contributes to the generation of practice-based evidence, which is crucial for the development of high-quality health promotion interventions.

5. Comment on 'The illusion of healthy drinking: Methodological bias and selective reporting of effects shape evidence on alcohol and cardiovascular health'.

期刊: Public health 发表日期: 2026-Jun-12 链接: PubMed

摘要

6. Radiographic repeat analysis in four public hospital radiology departments in the Souss-Massa region, Morocco: A cross-sectional study.

期刊: Radiography (London, England : 1995) 发表日期: 2026-Jun-12 链接: PubMed

摘要

This study presents a radiographic repeat analysis conducted in public hospitals in the Souss-Massa region of Morocco. It aimed to assess repeat rates, identify the most frequent causes of image repetition and the most affected anatomical regions, and examine variations in recurrence rates. A cross-sectional study was conducted during March and April 2025 in four public hospitals in the Souss-Massa region of Morocco. The number of acquired and repeated images was recorded using a standardized observation grid, supplemented by repeated image extraction for retrospective analysis. Descriptive statistics and chi-square tests were used to assess repeat rates, associated causes, anatomical regions involved, and variations by hospital and day of the week. Of the 15,493 radiographic images analyzed, 1063 were repeated, resulting in an overall repeat rate of 6.86%, which falls within the acceptable range recommended by the American Association of Physicists in Medicine (AAPM). The highest specific repeat rate was observed at Hospital 2 (11.94%), followed by Hospital 1 (4.63%), Hospital 4 (4.33%), and Hospital 3 (3.92%). The most frequently repeated examinations were chest, pelvis, abdomen, lumbar spine, and shoulder. Across all examination types, the main causes included positioning errors, metallic artifacts, collimation errors, and under- or over-exposure. Daily variability in repeat rates was also observed. Although the repeat rate was within acceptable limits, indicating reasonably adequate radiographic image production, variations between hospitals and the predominance of preventable professional errors highlight the need for improved technical consistency. Implementing standardized protocols, extending repeat-rate assessment and regular monitoring, establishing a reference threshold, improving understanding of human and organizational factors, and harmonizing image acceptance criteria would help reduce repetition and strengthen consistency in assessments across professionals.

7. Action Planning for Reducing Sugar-Sweetened Beverage Intake in Appalachian Adults: Longitudinal Process Evaluation of a Digital Behavioral Health Intervention.

期刊: JMIR mHealth and uHealth 发表日期: 2026-Jun-12 链接: PubMed

摘要

Digital health interventions show promise for promoting behavior change, but how they incorporate action planning strategies is underreported. This oversight limits understanding of how to implement behavior change techniques. iSIPsmarter is a digital health intervention aimed at reducing sugar-sweetened beverage (SSB) consumption among Appalachian adults. This study aimed to examine the digital action planning process in the iSIPsmarter intervention, specifically by (1) assessing the frequency of action plan engagement, (2) evaluating participants’ perceived difficulty implementing their action plans and examining progress toward achieving SSB reduction and weight goals, and (3) exploring the selection of barriers and strategies. The digital action planning process is embedded within 5 of iSIPsmarter’s 6 behavioral content modules (Cores) and paired with self-monitoring of SSB intake via SMS text messaging and weight via a cellular-enabled scale. Participants first self-select program goals for SSB intake (in ounces) and weight (loss or maintenance). Then, in Cores 2-6, they complete action plans using personalized tracking feedback, recommendations, and goal progress updates. Participants identify barriers and strategies using preprogrammed or write-in responses. Summary statistics described the aims. Participants (n=119) were predominately White (Caucasian), female, aged between 18 and 44 years, college-educated, and from rural counties. On average, participants completed 4.5 (SD 1.1) of 5 possible SSB action plans, with 80% (95/119) completing all 5. Across all Cores, perceived difficulty implementing action plans and achieving goals remained relatively stable, with an average of 48% rating the tasks as impossible or hard, 29% as neither hard nor easy, and 24% as easy or very easy. Nearly half achieved their self-selected weekly SSB goals, and one-third made progress toward them. At Core 6, 57% (54/95) of participants met their self-selected SSB program goal, while 46% (44/95) met the recommended SSB intake of less than 8 ounces per day. Of 119 participants, 53 (45%) modified their SSB barriers, and 63 (53%) selected new strategies during action planning. Top reported SSB barriers included (1) caffeine, (2) taste, and (3) habit. Among those with a program weight loss goal (n=94), the average weight loss was -1.3% (SD 2.6) at the 9-week follow-up, with 61% (57/94) achieving their goal. By 6 months, weight loss increased to -2.1% (SD 5.6), with 54% (49/90) achieving their goal. Of those completing weight action plans, 62% (69/112) modified their barriers. Top weight barriers included (1) sweets, (2) portion sizes, and (3) eating healthy foods. Findings underscore the value of digital action planning as a central behavior change technique within a nutrition-focused digital intervention. High action plan completion and consistent strategy adaptation suggest that structured, digitally personalized goal setting and action planning processes can effectively support behavior change, particularly among underserved populations with limited access to preventative care.

8. Digital Health Center App for Community and National Malaria Surveillance in Cambodia: Implementation Case Study.

期刊: JMIR public health and surveillance 发表日期: 2026-Jun-12 链接: PubMed

摘要

By 2015, the emergence and dissemination of multidrug-resistant Plasmodium falciparum in the Greater Mekong Subregion threatened regional and global malaria control efforts. In response, Greater Mekong Subregion countries committed to malaria elimination by 2030, with strengthened surveillance as a strategic pillar. In 2017, Cambodia introduced an elimination-oriented digital Malaria Information System (MIS). Its health center app enables real-time, geo-located, case-based malaria reporting across primary health centers, and is fully integrated with the MIS. This study aimed to evaluate the real-world national implementation of Cambodia’s Android-based health center app, considering coverage, fidelity, timeliness, and data use, and their effects on malaria surveillance performance, case management, programmatic response, and public health outcomes. System performance and public health use were assessed using system-generated metadata, national surveillance data, and user surveys. Operational indicators included technical performance, data completeness, and reporting timeliness, alongside surveillance outcomes such as case notification, classification, reactive case detection, and foci investigation. Nationwide user experience was measured via a survey of 761 health centers across 21 provinces, with in-depth structured surveys at 9 health centers in 3 provinces. Descriptive analyses evaluated system functionality, contribution to malaria surveillance and response, and usability among frontline health workers. The health center app demonstrated strong technical performance, with rapid loading and resilient data transmission under low-bandwidth conditions, supporting reliable reporting in resource-constrained settings. Integrated real-time dashboards provided analytics for case management, surveillance monitoring, risk stratification, and targeted public health interventions. Data completeness remained high (99%, 89/90 fields in 2024), demonstrating consistent routine use even as case incidence declined. Between January 1, 2025, and July 31, 2025, 69 malaria cases were reported nationally (23 locally acquired, 7 domestically imported, and 39 internationally imported). Of these, 95.7% (66/69) were notified and classified within 1 day. Reactive case detection was completed within 3 days for all 21 eligible cases, and 16 of 19 eligible foci received a response within 7 days, indicating strong operational responsiveness. User surveys showed 96.3% (733/761) of health centers were satisfied or very satisfied, 90.1% (686/761) reported rare or no technical issues, and 91.7% (698/761) found the app easy to navigate. Operational challenges included limited internet connectivity, transport to remote areas, and electricity interruptions. In-depth surveys confirmed high uptake, confidence in reporting, and routine use of surveillance data, although gaps in local analytical capacity were identified. Developed and managed locally to enhance sustainability, the MIS drove significant reductions in malaria case incidence, with the health center app contributing timely, complete, structured reporting at the point of care. Public health responses were facilitated by real-time analysis, targeted interventions, and decentralized decision-making. User engagement was sustained as malaria cases declined, and further enhancements are planned to ensure seamless transition to postelimination surveillance, reducing the risk of malaria reestablishment in Cambodia.

9. Occupational Fatigue and Multidimensional Traffic Risk Outcomes Among Motorcycle-Based Food Delivery Workers: Cross-Sectional Study.

期刊: JMIR public health and surveillance 发表日期: 2026-Jun-12 链接: PubMed

摘要

Although motorcycle-based food delivery workers face a significant risk of accidents, previous research has primarily focused on traffic accidents, neglecting the multidimensional nature of safety, which includes perceived accident risk, near-miss experiences, and accident-related anxiety. This study addresses this gap by investigating how occupational fatigue and health behaviors are associated with the Traffic Accident Risk Index (TARI) and its subdomains (near-miss experiences, self-rated accident anxiety, and other-rated accident anxiety). A cross-sectional study was conducted. Data were collected from South Korean delivery workers via an online survey and analyzed using multiple linear regression. In total, 336 workers were included in the analysis. Occupational fatigue was positively associated with the overall risk index (B=0.017, 95% CI 0.012 to 0.021; P<.001) and all subdomains, including near-miss experiences (B=0.016, 95% CI 0.011 to 0.021; P<.001), other-rated accident anxiety (B=0.019, 95% CI 0.013 to 0.024; P<.001), and self-rated accident anxiety (B=0.016, 95% CI 0.011 to 0.021; P<.001). Inconsistent helmet use was associated with a higher TARI (B=0.413, 95% CI 0.030 to 0.796; P=.04), other-rated accident anxiety (B=0.495, 95% CI 0.025 to 0.966; P=.04), and self-rated accident anxiety (B=0.493, 95% CI 0.036 to 0.949; P=.04). Insufficient physical activity was associated with a higher TARI (B=0.368, 95% CI 0.016 to 0.719; P=.04) and self-rated accident anxiety (B=0.586, 95% CI 0.168 to 1.005; P=.006). Current smoking was associated with near-miss experiences (B=0.298, 95% CI 0.041 to 0.555; P=.02). Conversely, shorter break times were associated with lower accident risk (30 min to 1 h: B=-0.329, 95% CI -0.650 to -0.007; P=.045) and near-miss experiences (<30 min: B=-0.474, 95% CI -0.936 to -0.011; P=.045; 30 min to 1 h: B=-0.470, 95% CI -0.846 to -0.095; P=.01) than breaks exceeding 2 hours. Occupational fatigue was associated with a higher overall perceived accident risk, more near-miss experiences, and greater accident-related anxiety. Modifiable health behaviors showed additional domain-specific associations. Prevention efforts may benefit from combining fatigue management with strategies to improve helmet use, increase physical activity, and support smoking cessation. Future research should refine the measurement of break time and establish evidence-based rest guidance for motorcycle-based delivery workers.

10. Using a Virtual Reality CAVE-Based Mindfulness Intervention to Promote Mental Well-Being in Adolescents With Anxiety Symptoms: Pre-Post Mixed Methods Pilot Study.

期刊: JMIR formative research 发表日期: 2026-Jun-12 链接: PubMed

摘要

Adolescent anxiety is a growing public health concern associated with significant social and emotional impairment. Mindfulness-based interventions (MBIs) have shown promise in reducing anxiety and improving well-being; however, engagement remains challenging. Virtual reality (VR)-based delivery may enhance immersion and attention, potentially addressing barriers of traditional mindfulness formats. Evidence on VR-based mindfulness interventions for adolescents, particularly in Hong Kong, remains limited. This study aimed to evaluate the feasibility and acceptability of a VR-MBI delivered via a CAVE, an enclosed VR environment with three projected walls displaying immersive natural scenes and ambient sounds, for adolescents with mild-to-moderate anxiety symptoms in Hong Kong. Secondary aims were to explore preliminary effects on psychological outcomes and physiological stress regulation and to identify facilitators and barriers to engagement. A mixed methods, single-group pre-post study was conducted with adolescents experiencing mild-to-moderate anxiety symptoms, recruited from secondary schools and youth service organizations in Hong Kong. Participants completed an 8-week group-based VR-MBI. Feasibility and acceptability were assessed using recruitment, attendance, retention, homework practice frequency, dropouts, and adverse events. Psychological outcomes were measured using the Depression Anxiety Stress Scale-21 and the Mindful Attention Awareness Scale. Heart rate variability indices, including the standard deviation of normal-to-normal intervals and root-mean-square of successive differences, were collected at baseline and postintervention using a wearable device. Focus group interviews explored participants’ experiences. Paired-sample t tests and Wilcoxon signed rank tests examined pre-post changes, and qualitative data were analyzed using thematic analysis, with findings integrated through triangulation. A total of 42 participants (mean age 14.88, SD 1.90 years; 20/42, 47.6% female; 22/42, 52.4% male) enrolled and completed both assessments. Attendance was high, with 73.8% (31/42) of participants attending at least 80% (8/10) sessions, and participants engaged in regular homework practice. No dropouts or adverse events were reported. No significant pre-post changes were observed in self-reported distress, anxiety, depression, stress, or trait mindfulness (all P>.05). However, significant improvements were observed in both heart rate variability indices, standard deviation of normal-to-normal intervals (mean difference 17.6 ms, 95% CI -33.88 to -1.32; P=.04; Cohen d=0.38) and root-mean-square of successive differences (mean difference 20.20 ms, 95% CI -38.76 to -1.65; P=.03; Cohen d=0.39), which may suggest preliminary enhancements in physiological stress regulation. Qualitative findings suggested perceived benefits in emotional regulation, stress reduction, focus, and sleep, with the immersive environment and group-based format identified as key facilitators. The CAVE-based VR-MBI was feasible and acceptable for adolescents with mild-to-moderate anxiety symptoms in Hong Kong. Despite no significant changes in self-reported outcomes, physiological improvements and positive qualitative feedback suggest early benefits not captured by self-report measures. These findings support further investigation of using controlled designs and longer follow-up periods.

11. Perceptions of acceptability and preferences surrounding a hypothetical syphilis vaccine in Lima, Peru.

期刊: International journal of STD & AIDS 发表日期: 2026-Jun-12 链接: PubMed

摘要

BackgroundNo vaccine is currently available for syphilis. Research efforts to inform vaccine development are underway. In parallel, understanding factors that would influence willingness to receive a future vaccine can provide useful information for vaccine design and future implementation. This study explored attributes of interest in a hypothetical syphilis vaccine using focus group discussions in Lima, Peru.MethodsIn early 2025, we conducted ten virtual focus group discussions, among five population groups in Lima, Peru: health professionals, sexual/gender minorities, general population, cisgender female sex workers, and parents of minors. Semi-structured guides explored barriers and facilitators to preventive care, attitudes toward vaccines, syphilis knowledge, and desired attributes of a potential syphilis vaccine. Audio recordings were analyzed thematically.ResultsEighty-five participants took part in the discussions. Despite limited syphilis knowledge among many participants, there was interest in a hypothetical vaccine. Acceptability was shaped by three factors including, vaccine attributes, structural conditions and the healthcare provider-user relationship. In vaccine attributes, participants desired high effectiveness, safety, and a single-dose schedule, while expressing concerns about vaccine-induced persistent seropositivity related to stigma about STI prevention. Structural conditions: free vaccination, endorsement from respected health institutions, information environment and health education were viewed as essential for uptake. Third, the healthcare provider-user relationship emerged as a central mediator influencing how individuals interpreted vaccine information and navigated structural barriers.ConclusionsAcceptability of a future syphilis vaccine depends not only on its attributes, but also on structural enablers and the quality of provider-user interactions. Strengthening provider communication, addressing structural barriers, and ensuring transparent information dissemination will be essential for equitable implementation.

12. The phases of Clostridioides difficile infection in the United States: the history and epidemiology of CDI from 1935 to present.

期刊: Clinical infectious diseases : an official publication of the Infectious Diseases Society of America 发表日期: 2026-Jun-12 链接: PubMed

摘要

This review combines historical reports and surveillance data to contextualize Clostridioides difficile infection (CDI) in the U.S. as a phased epidemic, currently in the deceleration phase. C. difficile was first isolated in 1935. During a prolonged emergence phase, the organism attracted limited clinical attention. In 1978, C. difficile was established as the cause of antibiotic-associated pseudomembranous colitis and from 1978 to a peak in 2010, CDI was in an acceleration phase characterized by fluoroquinolone-resistant, toxin-overproducing strains, large hospital outbreaks, and incidence rates over 150 per 100,000 population. Beginning around 2010, CDI incidence decreased, with a shift from healthcare-associated to community-acquired CDI. Changes in diagnostics complicate incidence comparison between phases; only recently is it apparent that CDI has entered a deceleration phase characterized by infectious reservoirs and possible increases in immunity. It may behoove us to prepare for a different kind of CDI: community-based and insidious rather than hospital-predominant and explosive.

13. Plasma proteomics maps molecular bridges from depression to incident CHD: 15-year proteomic trajectories and enhanced prediction.

期刊: Cardiovascular research 发表日期: 2026-Jun-12 链接: PubMed

摘要

14. Integrated evaluation of antibody responses to mosquitoes and mosquito-borne pathogens using highly multiplexed serology.

期刊: Science advances 发表日期: 2026-Jun-12 链接: PubMed

摘要

Vector-borne diseases (VBDs) are a leading cause of morbidity and mortality worldwide. Antigens driving host immune responses to pathogens and vectors can serve as vaccine candidates and biomarkers of previous exposure, but the immunogenicity of relevant proteomes remains undercharacterized. To comprehensively profile antibody responses to VBDs and the vectors themselves, we developed a highly multiplexed phage display library, VectorScan, containing more than 250,000 peptides derived from diverse arthropod vectors and prevalent vector-borne pathogens. We used phage immunoprecipitation sequencing to screen VectorScan against blood samples with experimental and natural exposures to arboviruses, malaria parasites, and mosquitoes. We analyzed quantitative measurements of peptide seroreactivity to identify epitopes driving viral serotype-level exposure signatures and mosquito sialome antigens. Mosquito-directed antibody responses were quantitatively associated with natural viral and parasite exposure. We leverage VectorScan to define the relationship between the intensity of mosquito exposure and the rate of malaria infection in children, demonstrating the public health utility of a tool for paired vector and pathogen serosurveillance.

15. Graduate education and competency development in advanced practice provider roles: A scoping review.

期刊: Journal of medical imaging and radiation sciences 发表日期: 2026-Jun-12 链接: PubMed

摘要

The evidence base supporting the relationship between graduate education and the quality of advanced practice (AP) in healthcare remains limited and often fragmented across professional contexts. This project sought to understand more fully what evidence can provide insight to guide AP education and training in radiation therapy and other professions. The protocol was registered with the Open Science Framework, https://doi.org/10.17605/OSF.IO/37J4S. Professions such as nursing, radiation therapy, medical imaging, and physician assistants were included. The review focused on graduate-level education, with the outcome assessed in terms of competency development, scope of practice, or professional role advancement. Multiple databases in OvidSP and Clarivate were searched from 2005 onwards, and records were imported into Covidence. Multiple reviewers reviewed the title and abstract and then the full-text records, and performed templated data extraction. Charted data included profession, type of study, study comparator and outcome. Duplicates were removed from the 11,346 initially identified, leaving 6417 unique records. Based on initial screening, 111 were advanced to full-text review. Eleven articles were subsequently included, and three more were identified through manual reference searching, for a total of 14 articles from multiple countries. All were in the context of nursing, and 12 (85.7%) relied on survey data. Ten (71.4%) articles demonstrated significant benefit in graduate-level preparation for AP, though four of these were explicitly focused on doctoral-level education. None demonstrated a negative impact of a graduate degree. The majority of the evidence assessed is at least weakly supportive of the role of graduate education in building necessary advanced competence. Such evidence is important to inform policy and standards and to avoid unjustified credential creep. There is more work needed to strengthen evidence, especially outside of nursing in aligned professions with advanced classes of practice. Advanced practice roles in healthcare often require higher levels of education, but their benefits are not always clearly understood. This study reviewed research studies to understand how graduate education supports advanced practice roles. This study found that most evidence shows benefits in building skills and career development, mainly in nursing, with no negative effects reported. This matters because better evidence can help guide training, policy, and fair use of qualifications in healthcare.

16. Work-related musculoskeletal disorders among airport employees: a systematic literature review of prevalence, risks and interventions.

期刊: International journal of occupational safety and ergonomics : JOSE 发表日期: 2026-Jun-12 链接: PubMed

摘要

Objectives. Work-related musculoskeletal disorders (WMSDs) are a major occupational health concern and may affect airport employees due to diverse physical, ergonomic and psychosocial work demands. This systematic review synthesized evidence on WMSD prevalence, associated risk factors, interventions and regulatory gaps across airport occupational groups. Methods. The review followed Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020 guidelines and was prospectively registered in the Open Science Framework. Searches of Scopus, PubMed and Web of Science (WoS) identified 3616 records published between 2000 and 2025; 39 studies met the inclusion criteria. Results. Baggage handlers were the most frequently studied group, while many airport occupations remain under-researched. The lower back, shoulders and neck were the most commonly affected body regions, with prevalence varying across occupational groups and tasks. Physical and ergonomic exposures were the most consistently reported risk factors, while psychosocial, organizational and individual factors were also associated with WMSDs. Reported interventions were limited and focused mainly on ergonomic adjustments, training and organizational strategies, with little evidence of effectiveness. Conclusions. WMSDs are a significant occupational health concern in airport environments, highlighting the need for stronger preventive strategies and more tailored regulatory and policy frameworks.

17. Epidemiological Shifts and Trends From 2009 to 2023 in Hospital Admissions for Ruptured Aortic Aneurysms and Aortic Dissections in Austria: Retrospective, Population-Wide Study.

期刊: JMIR public health and surveillance 发表日期: 2026-Jun-12 链接: PubMed

摘要

Aortic pathologies in general and acute aortic syndromes in particular are persistent public health concerns worldwide. Continuous efforts to monitor and update incidence rates are necessary for guided public health interventions and health care policy adaptation. This study aims to evaluate temporal patterns in the incidence and outcomes of hospital admissions for ruptured aortic aneurysms (rAAs) and aortic dissections (ADs) in Austria over a 15-year period, with a focus on population-wide trends. This study provides a retrospective, population-wide analysis of aortic syndromes using national health care data from 2009 to 2023. The data were provided by a federal data warehouse that stores all recorded in-hospital services in Austria. We analyzed annual and population-adjusted hospital admissions, in-hospital mortality, comorbidities, complications, and demographic characteristics for rAA and AD cases. Temporal patterns were assessed for annual variations. Exploratory forecasts were made until 2030 using exponential smoothing time series models. Subgroup analyses by sex and age strata were incorporated to contextualize epidemiological shifts and assess differential trends across population segments. Corresponding to worldwide trends, the proportion of individuals aged 65 years and older slightly increased in Austria, from 17.4% in 2009 to 19.6% in 2023. Hospital admissions for rAA decreased from 357 in 2009 to 292 in 2023 (-18.2%), with admission rates falling from 4.3 to 3.2 per 100,000 (-25.2%) over the study period. In-hospital mortality among patients with rAA declined from 38.7% (138/357) to 34.6% (101/292), accompanied by a decrease in major comorbidities and recorded in-hospital complications. The incidence of hospital admissions for AD, however, showed a significant increase from 430 to 872 (+102.8%), with population-adjusted incidence rates rising from 5.2 to 9.6 per 100,000 (+85.6%). In-hospital mortality for aggregated AD cases decreased slightly, from 12.1% to 11.0%. Forecasting analyses suggest a continued rise in AD incidence through 2030, whereas rAA rates are expected to remain comparatively stable. While rAA incidence and mortality declined, AD cases showed a substantial increase, potentially due to improved detection, diagnostic advances, or a true epidemiological shift that warrants further investigation. These diverging trends highlight the need for updated surveillance strategies, improved risk stratification, and adaptation of health care resources to a potentially increasing burden of AD.

18. Understanding mental health service provision at community colleges: Findings from a statewide landscape analysis.

期刊: Journal of American college health : J of ACH 发表日期: 2026-Jun-12 链接: PubMed

摘要

Evaluate the availability and accessibility of mental health care at Michigan’s community colleges (CCs). Michigan’s 31 CCs. We employed quantitative data collection supplemented with qualitative validation: first conducting an analysis of CC websites, followed by interviews with CC providers and decision-makers to validate and contextualize findings. The integrated data were examined using univariate analyses to capture heterogeneity of models of mental health provision at CCs. Of 31 CCs, all were analyzed and 23 completed confirmation interviews. N = 5 CCs (16%) had no mental health providers; N = 16 CCs (52%) had mental health providers with additional roles beyond counseling (i.e., academic advisors). Referrals, teletherapy, and behavioral intervention teams were also common mental health supports. Most CC websites (N = 23; 74%) had navigability and/or content challenges for accessing mental health service information. In the face of resource constraints, CCs are pursuing numerous approaches to the provision, promotion, and structuring of mental health services.

19. Correction: Barriers and Facilitators in the Implementation of the Systematic Medical Appraisal, Referral, and Treatment (SMART) Mental Health Digital Intervention in Rural India: Mixed Methods Process Evaluation Study.

期刊: JMIR mental health 发表日期: 2026-Jun-12 链接: PubMed

摘要

[This corrects the article DOI: 10.2196/89164.].

20. Queering tenure: Broadening metrics to assess the impact, innovation, and independence of LGBTQ+ health researchers.

期刊: Nursing outlook 发表日期: 2026-Jun-12 链接: PubMed

摘要

Faculty focusing on LGBTQ+ communities often face structural challenges within academic institutions. These include limited access to research funding, difficulties publishing in some academic journals, and increased oversight from Institutional Review Boards. Typically, traditional promotion and tenure systems emphasize narrow definitions of scholarly output, overlooking the diverse contributions of researchers in LGBTQ+ health. The purpose of this paper is to examine how LGBTQ+ focused research is evaluated during the tenure process. Developed through iterative synthesis of conference working-group discussions from the 2025 National Nursing Summit on Sexual and Gender Minority (SGM) Health, this paper introduces a comprehensive evaluation framework designed for LGBTQ+ health researchers, with potential relevance to other marginalized groups. Rooted in discussions among researchers, students, and administrators, we outline 11 domains of scholarly contribution, each supported by rationale and examples, to help institutions value community-engaged, justice-driven scholarship. Addressing these structural gaps is vital for fostering a more equitable and inclusive academic culture.

21. Main Recommendations for Developing Education and Awareness Strategies for Rare Diseases: Scoping Review.

期刊: JMIR medical education 发表日期: 2026-Jun-12 链接: PubMed

摘要

According to the World Health Organization, education and awareness are essential components of public health promotion strategies. In the context of rare diseases (RDs), these actions are particularly critical because of persistent stigma, fragmented knowledge, and the frequent absence of consolidated clinical and organizational protocols. These gaps often result in inappropriate referrals, inefficient care pathways, unnecessary procedures, and delays in diagnosis, negatively affecting health outcomes and quality of life. This study aimed to identify and systematize the main recommendations for health education and awareness in the field of RDs, supporting the development of health care programs, public policies, and strategic initiatives. We formulated the research question using the Population, Concept, and Context framework. This scoping review followed the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines to ensure methodological transparency. Eligible records included peer-reviewed research articles of any design and official documents published in Portuguese, English, or Spanish, with no time restrictions. Records that did not address the research question, lacked sufficient rigor, or focused exclusively on specific subgroups of RDs were excluded. Searches were performed in PubMed/MEDLINE, Scopus, Embase, Web of Science, as well as gray literature. Study selection and data extraction were conducted by the research team, with disagreements resolved and the included sources reviewed by an RDs expert. Data were thematically categorized by consensus, and descriptive statistics were used to summarize findings. A total of 58 sources of evidence were included. Among the identified recommendations related to education and awareness, most sources focused on professional education and training (49/58, 84.4%), followed by public policies and intersectoral integration (36/58, 62%), education and awareness for the general population (28/58, 48.2%), digital technologies (27/58, 46.5%), emotional support and experience sharing (20/58, 34.4%), and awareness events and dates (8/58, 13.7%). Percentages exceed 100% because individual sources could report multiple recommendations. Overall, the literature emphasizes integrating RDs content into educational initiatives and strengthening professional competencies, intersectoral collaboration, digital technologies, and broader awareness strategies. This scoping review systematically mapped and organized recommendations from diverse sources of evidence on strategies for health education and awareness related to RDs. It synthesizes heterogeneous evidence using a structured approach to provide a comprehensive overview of strategies in this field, consolidating dispersed knowledge into a coherent body of evidence. The findings may inform improvements in health services, as well as professional and managerial practices, and initiatives aimed at supporting patients, families, and advocacy groups involved in RDs, with potential implications for strengthening diagnostic processes, referral coordination, and more equitable access to information and care.

22. Embodied Intelligence Applications in Health Care Populations: Scoping Review.

期刊: Journal of medical Internet research 发表日期: 2026-Jun-12 链接: PubMed

摘要

Embodied intelligence-artificial intelligence instantiated in physical or virtual bodies that can perceive, communicate, and interact with users and their environments-has been increasingly applied in health care. However, the evidence base remains fragmented because of inconsistent terminology, diverse embodiment forms, and limited synthesis of application domains, target populations, care settings, acceptability, and effectiveness. This fragmentation constrains conceptual clarity and translation into routine health care practice. This scoping review aimed to systematically map the applications of embodied intelligence in health care by classifying embodiment forms, identifying major functional domains, describing target populations and implementation settings, and synthesizing the available evidence on acceptability and effectiveness. This scoping review followed the Arksey and O’Malley framework, with enhancements by Levac et al, and was reported in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) and PRISMA-S (Preferred Reporting Items for Systematic Reviews and Meta-Analyses literature search extension) guidelines. Seven electronic databases were searched from database inception to December 2025, supplemented by gray literature searches and backward citation screening. Eligible studies were primary empirical studies published in English or Chinese that examined embodied intelligence in health care contexts. Two reviewers independently screened records and charted data using a pilot-tested standardized form. Descriptive statistics and thematic synthesis were applied. No formal critical appraisal was conducted because the aim was to map the breadth and characteristics of the evidence base. A total of 83 studies were included. Five embodiment forms were identified: virtual humanoid agents (32/83, 38.6%), physical humanoid robots (32/83, 38.6%), virtual animal-shaped agents (1/83, 1.2%), physical animal robots (13/83, 15.7%), and mechanical robots (5/83, 6%). Applications clustered into 3 functional domains: health management and health education (40/83, 48.2%), mental health promotion (37/83, 44.6%), and physiological health promotion (6/83, 7.2%). Older adults were the most frequently targeted population (45/83, 54.3%). Interventions were mainly implemented in home settings, care homes, laboratories, and hospitals. Twenty-two randomized controlled trials reported generally beneficial effects on health behaviors, mental health outcomes, or cognitive function, although outcome measures were heterogeneous. Twelve studies examined acceptability and generally reported favorable user acceptance. This scoping review provides the first comprehensive synthesis of embodied intelligence in health care using a unified classification of forms, functional domains, populations, and application settings. The findings indicate that embodied intelligence is most mature in “health management and health education” and “mental health promotion,” with increasing real-world deployment in home and care home settings. By consolidating fragmented evidence and standardizing terminology, this review offers a practical foundation for clinicians, nurses, and policymakers to support the implementation of embodied intelligence in routine health care. Evidence is limited by heterogeneous outcome measures, many lab-based evaluations, and the absence of formal quality appraisal, underscoring the need for standardized outcome measures, rigorous randomized controlled trials, and longitudinal evaluations to enable scalable and ethically grounded real-world adoption.

23. From social media to body image distress: Problematic internet use, exercise addiction, and enhancement drugs use across countries.

期刊: Journal of behavioral addictions 发表日期: 2026-Jun-12 链接: PubMed

摘要

Social media increasingly shapes body image by promoting often unattainable beauty ideals. Concurrently, targeted online marketing of image- and performance-enhancing drugs (IPEDs) exploits these vulnerabilities, intensifying anxiety and fostering maladaptive behaviours such as problematic usage of the internet (PUI), compulsive exercise, and IPEDs consumption. This study explores these behaviours across nine countries and examines how PUI, excessive exercise, and IPEDs use predict appearance anxiety, aiming to inform targeted prevention strategies for at-risk populations. A total of 3,514 participants from nine countries completed a web-based survey assessing sociodemographic data, appearance anxiety (AAI), problematic internet use (PIUQ-9), excessive exercise (EAI-R), and IPEDs intake. Appearance-related anxiety was observed in 12% of the participants, with the highest prevalence in Mexico (20.7%), Japan (13.8%) and Italy (13.6%). Median PUI scores were highest in Mexico (22.57) and Singapore (21.59). Excessive exercise was reported by 3.6% with no significant country differences. IPEDs use was reported by 28.3% of the sample, with the highest rates in Japan (60.6%). Logistic regression analyses revealed that PUI, excessive exercise and IPEDs use were significant predictors of appearance-related anxiety. The strong associations between PUI, excessive exercise, IPEDs use, and appearance anxiety underscore the complex interplay between online exposure, body image concerns and mental health. Cross-country differences suggest that socio-cultural factors influence appearance-related anxiety. These findings highlight the need for culturally sensitive interventions and policy measures that address the impact of digital media on body image, particularly to protect vulnerable populations.

24. Immediate Icing Disrupts the Very Early MCP-1/CCR2 Recruitment Window and Delays Muscle Regeneration in Rats.

期刊: American journal of physiology. Cell physiology 发表日期: 2026-Jun-12 链接: PubMed

摘要

Icing is a widely used initial intervention for skeletal muscle injury in sports settings. However, accumulating evidence suggests that icing impairs muscle regeneration, potentially via delayed monocyte/macrophage accumulation. To elucidate the mechanisms underlying this icing-induced delay, we investigated whether icing modulates the monocyte chemoattractant protein 1 (MCP-1)/CC chemokine receptor 2 (CCR2) axis governing monocyte/macrophage recruitment. We comprehensively characterized inflammatory cell dynamics in a rodent crush-injury model using immunostaining and flow cytometry. During the very early phase (up to 5 h postinjury), neutrophils were the dominant inflammatory cell population within the lesion. Subsequently, MCP-1 concentrations and CCR2+ monocytes/macrophages increased and became prominent within 24 h, suggesting that MCP-1/CCR2 signaling prominently contributes to monocyte/macrophage recruitment during this early phase. Consistently, CD68midCD163lo monocytes/macrophages, which exhibited the highest Ccr2 expression, predominated during the first 24 h. Immediate icing transiently suppressed MCP-1 production by neutrophils and monocytes/macrophages during this very early phase and was associated with attenuated subsequent recruitment of circulating monocytes. Consequently, monocyte/macrophage accumulation peaked at 48 h in the non-icing group but was delayed until 72 h in the immediate icing group. Notably, the late-icing model demonstrated that withholding icing during the early phase preserved normal monocyte/macrophage dynamics. Collectively, these results show that immediate icing disrupts the early MCP-1/CCR2-associated recruitment phase, likely by reducing the number of inflammatory cells and their production of MCP-1, thereby contributing to delayed monocyte/macrophage accumulation. These findings provide a crucial mechanistic basis for reconsidering and optimizing the timing of cryotherapy in clinical and sports settings.

25. Predicting accumulation and age at onset of amyloid-β from genetic risk and resilience for Alzheimer's disease.

期刊: EBioMedicine 发表日期: 2026-Jun-12 链接: PubMed

摘要

Accumulation of brain amyloid beta (Aβ), a key pathological hallmark of Alzheimer’s disease (AD), begins decades before cognitive symptoms. Being able to predict the risk of Aβ accumulation, or the age at which Aβ exceeds a critical threshold, may enable intervention to delay or prevent onset of AD. Using published genome-wide association studies (GWASs), we developed polygenic scores (PGS) for AD risk (PGSrisk) and resilience (PGSresilience), and tested whether these predicted (i) if an individual is an Aβ accumulator (‘Accumulator Status’), and (ii) in accumulators, the age at which brain Aβ exceeds a 20 centiloid (CL) threshold (‘Age at onset of Aβ’; AAO-Aβ) in 2175 participants (1158 with AAO-Aβ) from the Alzheimer’s Dementia Onset and Progression in International Cohorts (ADOPIC) study. We also performed GWASs on these traits to develop phenotype-specific PGSs. Higher genetic risk of AD predicted increased odds of Aβ accumulation (OR = 1.16; 95% CI = 1.05-1.29; p = 0.003) and younger AAO-Aβ (β = -1.32; SE = 0.31; p = 1.63 × 10-5). Higher genetic resilience to AD predicted later AAO-Aβ (β = 0.91; SE = 0.29; p = 0.002) but did not predict Aβ accumulation. These associations were independent of APOE ε4 status, the strongest genetic risk factor for AD. Phenotype-specific PGSs were not significantly associated with either trait. Polygenic scores, alongside other risk factors, may help identify individuals at risk of accumulating Aβ, and predict the age at which this exceeds a critical threshold. This could provide a window for administering disease-modifying treatment or lifestyle interventions to prevent or delay the onset of AD. National Institutes of Health (R01-AG058676-01A1) and Australian National Health and Medical Research Council (GNT1161706; GNT2001320).

26. Emerging Role of Sodium-Glucose Cotransporter-2 Inhibitors in Aortic Stenosis.

期刊: JACC. Basic to translational science 发表日期: 2026-Jun-12 链接: PubMed

摘要

Sodium-glucose cotransporter 2 (SGLT2) inhibitors have emerged as a key drug class in the management of heart failure, expanding far beyond their original use in type 2 diabetes mellitus. Aortic stenosis (AS), the most common valvular heart disease in the aging population, is characterized by progressive valve calcification and chronic left ventricular pressure overload. No disease-modifying pharmacologic treatment has yet been found to slow AS progression or to prevent myocardial remodeling in AS. The authors review the mechanistic rationale for SGLT2 inhibition in the pressure-overloaded heart and summarize the emerging evidence in AS. The authors propose that SGLT2 inhibition may represent a promising strategy targeting both myocardial remodeling and valvular disease biology in AS, warranting further investigation in dedicated trials.

27. Exercise Snacks in Adults Living With Obesity: Protocol for a Randomized Feasibility Trial.

期刊: JMIR research protocols 发表日期: 2026-Jun-12 链接: PubMed

摘要

Rates of obesity worldwide continue to increase and are associated with myriad health risks and socioeconomic burdens. Exercise is a traditional treatment for adults with obesity to increase physical activity levels, improve cardiorespiratory fitness, and reduce cardiometabolic risk. However, many people living with obesity do not engage in enough physical activity to achieve health benefits and often cite a perceived lack of time, lack of access to equipment, and stigma as barriers. “Exercise snacks” are short (~1 min) isolated bouts of vigorous exercise performed sporadically throughout the day that may be a viable strategy to improve fitness and cardiometabolic health. It is unknown whether exercise snacks are a feasible option in the real world for people living with obesity. This study aims to conduct a pilot randomized clinical trial (RCT) to determine the feasibility and preliminary efficacy of a 12-week smartphone app-supported exercise snacks intervention with behavior change counseling for improving cardiorespiratory fitness and other indices of cardiometabolic health in previously inactive adults living with obesity. A 2-site, parallel arm, RCT will be conducted in Kelowna and Hamilton, Canada. Eighty inactive adults living with obesity will be randomized to an exercise snacks or stretching/mobility exercise comparator group for 12 weeks. The former will complete 4 × 1-minute bouts of vigorous exercise at least 5 days per week, and the latter will perform mobility or stretching exercises using the same schedule. Interventions will be delivered through a customized smartphone mobile app and will be tailored to the participants’ schedules via onboarding counseling sessions, with ongoing telephone check-in call support at weeks 1, 2, 4, and 8. This pilot RCT will focus on feasibility as reflected by rates of recruitment, adherence, and dropout. We will also assess cardiorespiratory fitness, anthropometric markers, and routine blood health markers (eg, glucose, insulin) at baseline and postintervention. This study is funded through the Heart & Stroke Foundation of Canada Grants-in-Aid program (2024/2025). Recruitment began on July 18, 2025 (Kelowna) and in November 2025 (Hamilton). As of March 31, 2026, we have enrolled 65 participants (University of British Columbia Okanagan, n=51; McMaster University, n=14). Data analysis will begin once all enrolled participants have completed the trial, and we expect to publish the results of the trial in winter 2027. This study will test an RCT protocol, provide evidence on the feasibility of exercise snacks in inactive adults living with obesity, and report preliminary effect size estimates for their ability to improve cardiometabolic health.

28. Factors associated with lifestyle practices for preventing cardiovascular disease in adults aware of metabolic syndrome.

期刊: Archives of endocrinology and metabolism 发表日期: 2026-Jun-12 链接: PubMed

摘要

The global increase in metabolic syndrome (MetS) highlights the need for effective lifestyle interventions to reduce cardiovascular disease (CVD) risk. This study aimed to identify factors associated with lifestyle behaviors for preventing CVD complications among adults aware of MetS. A cross-sectional online survey was conducted from January to February 2023 among 1,000 South Korean adults aged 20-69 years. After excluding 212 participants unaware of MetS, 788 respondents were included, of whom 710 engaged in at least three of nine recommended lifestyle behaviors: smoking cessation, alcohol abstinence, body weight monitoring, waist circumference measurement, blood pressure monitoring, regular hospital visits, adequate sleep, adherence to a low-salt diet, and regular physical activity. Participants were categorized into those with one or more MetS risk factors (META) and those without (Non-META). participants with MetS risk factors were predominantly male and aged 50-69 years, while those without were more likely female and aged 20-39 years. Abdominal obesity was the most common risk factor, whereas waist circumference monitoring was the least practiced behavior. The META group showed higher rates of blood pressure monitoring and hospital visits, while the Non-META group reported more frequent smoking cessation and alcohol abstinence. Engagement in healthy lifestyle behaviors was positively associated with female sex, older age, and higher awareness of MetS-related complications. The limited practice of waist circumference monitoring underscores the need for targeted education and personalized preventive strategies to enhance CVD risk reduction among individual aware of MetS.

29. Targeting TMED4 enhances CD8+ T cell function and CAR T cell efficacy in solid tumors through the IRE1α-autophagy axis.

期刊: Science advances 发表日期: 2026-Jun-12 链接: PubMed

摘要

Endoplasmic reticulum stress (ERS) and autophagy regulate tumor-infiltrating T cell function and exhaustion, but the underlying mechanisms remain unclear. Here, we identified the ERS-related transmembrane protein TMED4 (transmembrane emp24 domain-containing 4) as a critical regulator of CD8+ T cell antitumor immunity. Tmed4 deletion in T cells enhanced antitumor responses by promoting CD8+ T proliferation, infiltration, and killing capacity, while reducing terminal exhaustion. Mechanistically, Tmed4 deficiency hyperactivated the inositol-requiring enzyme 1α (IRE1α)-X-box binding protein 1 (XBP1) axis and induced autophagy flux in an IRE1α-dependent manner. Genetic deletion of Ern1 (IRE1α) or Becn1 (Beclin1) impaired the antitumor effects of Tmed4 deficiency, underscoring the role of ERS and autophagy in CD8+ T cell function. Moreover, Tmed4-deficient chimeric antigen receptor T cells (CAR T cells) displayed improved antitumor immunity. Pharmacological inhibition of Tmed4 using antisense oligonucleotide also enhanced CD8+ T cell-mediated tumor control. In summary, our study reveals that TMED4 governs CD8+ T cell effector function and limits terminal exhaustion through IRE1α-driven autophagy, establishing TMED4 as a promising immunotherapeutic target for improving CAR T cell efficacy.

30. Corrigendum to 'Cytogenotoxic effects of polycyclic aromatic hydrocarbons complex mixture in human peripheral blood, lung A549 and liver HepG2 cells: Translation of a real-scenario exposure to in vitro' [Environ. Res. 298 (2026) 124252].

期刊: Environmental research 发表日期: 2026-Jun-12 链接: PubMed

摘要

31. Disentangling shared and divergent life histories with age-based eye lens isotope records in a coastal shark.

期刊: Isotopes in environmental and health studies 发表日期: 2026-Jun-12 链接: PubMed

摘要

Documenting lifetime diet preference and habitat use is critical for understanding how long-lived, mobile species respond to ecological change, yet such data remain sparse - particularly for comparisons within and among individuals, species, and populations. Eye lens layers (laminae) provide a biochemical archive that records these ecological signals sequentially through time, creating a unique opportunity to reconstruct entire life histories. This approach is especially valuable for elusive chondrichthyans (sharks, skates, rays, and chimeras), whose ecological importance as meso- to apex predators contrasts with the logistical challenges of tracking their movements and resource use. Stable isotope analysis (SIA) of vertebral growth bands is the established method for aging and reconstructing isotopic life histories in chondrichthyans, but eye lens laminae represent a promising yet under-verified alternative. We compared δ13C and δ15N values derived from eye lens laminae and vertebral bands of wild leopard sharks (Triakis semifasciata) to evaluate the ecological utility of eye lenses. Eye lens diameter increased linearly with total length (R2  =  0.95); however, because older laminar cells become progressively compacted, we incorporated a compaction index derived from attenuated total reflectance Fourier transform infrared (ATR-FTIR) spectroscopy into aging models. This integration yielded age-specific δ13C and δ15N patterns that closely mirrored those observed in vertebral centra. Across ages, δ13C offsets between eye lens laminae and vertebrae were inconsistent, whereas δ15N values were largely concordant, with only modest increases in the outer laminae. To further verify eye lens isotopic records, we compared δ13C and δ15N values from the terminal eye lens lamina and muscle tissue, enabling estimation of age-specific tissue discrimination factors for both isotopes. Finally, eye lens isotope profiles revealed shared and divergent life history patterns across four Central California estuaries. Collectively, our results highlight eye lens laminae as a robust isotopic substrate for reconstructing lifetime ecological context in chondrichthyans.

32. Breaking Barriers in Student Mental Health Care With AI-Enhanced Group Cognitive Behavioral Therapy: Pilot Feasibility Study.

期刊: JMIR formative research 发表日期: 2026-Jun-12 链接: PubMed

摘要

University students experience elevated psychological distress, with limited access to mental health services. While cognitive behavioral therapy (CBT) demonstrates efficacy for anxiety and depression, treatment gaps persist due to access barriers and insufficient between-session support. Large language model (LLM) chatbots could improve and scale CBT delivery. However, the scientific evaluation of chatbot-enhanced protocols is just emerging. This pilot study aimed to assess the feasibility, acceptability, and preliminary efficacy of an LLM-based ChatBot as an adjunct to group Unified Protocol (UP) therapy for between-session support in university students with subclinical anxiety and depression symptoms. A single-arm feasibility trial recruited university students aged 18 years and older with moderate subclinical symptoms (Social Phobia Inventory: 21-40, Patient Health Questionnaire-9: 5-14, or Generalized Anxiety Disorder-7: 5-14), excluding those with current psychiatric disorders, suicidal ideation, or psychotropic medication use. The intervention comprised 4 weekly group UP counseling sessions complemented by an adjunctive Claude 3.7-Sonnet LLM ChatBot programmed with UP-based therapeutic prompts for between-session support rather than a stand-alone therapeutic agent. Primary feasibility outcomes included treatment adherence, chatbot engagement metrics, and system usability (System Usability Scale). Secondary outcomes assessed changes in generalized anxiety (Generalized Anxiety Disorder-7 Scale), social anxiety (Social Phobia Inventory), depression (Patient Health Questionnaire-9), and well-being (Short Warwick-Edinburgh Mental Wellbeing Scale) using paired t tests. Qualitative feedback was collected through focus group interviews and analyzed using thematic analysis. Of 72 screened participants, 37 met eligibility criteria and 19 initiated treatment (mean age 22.06, SD 1.78 years; 70.6% female). Retention was high with 17 completers (10.5% dropout rate). Among completers, 94.1% (16/17) attended ≥3 group sessions. The engagement with the CBT ChatBot was substantial: participants were active on a median of 23 days during the 34-day study period and exchanged a median of 15 messages in total. System usability was rated as excellent (mean 84.94, SD 10.98 out of 100). Pre-to-post comparisons revealed significant improvements in generalized anxiety (mean change -3.00, SD 3.46; t16=3.01, P=.004; Cohen d=0.71) and mental well-being (mean change +2.29, SD 3.65; t16=-2.17, P=.02; Cohen d=0.69). Social anxiety and depression showed nonsignificant trends toward improvement. Qualitative feedback highlighted the CBT ChatBot’s accessibility and nonjudgmental support while noting limitations in personalization. No adverse events or inappropriate chatbot interactions occurred. Augmenting a group UP therapy with an LLM ChatBot demonstrated high feasibility, acceptability, and preliminary efficacy signals for university students with subclinical symptoms. The hybrid intervention package achieved strong retention and engagement while maintaining safety. These findings support progression to a randomized controlled trial to definitively evaluate this technology-enhanced approach for expanding access to evidence-based mental health interventions.

33. Hot-water extract of defatted Perilla frutescens seed residue suppresses osteoclast differentiation and improves bone-related parameters in ovariectomized mice.

期刊: Bioscience, biotechnology, and biochemistry 发表日期: 2026-Jun-12 链接: PubMed

摘要

The defatted residue of Perilla frutescens seeds, a by-product of edible oil production, remains largely underutilized in food applications. This study investigated the effects of a hot-water extract derived from this residue on osteoclast differentiation and bone-related changes. In bone marrow-derived macrophages, the extract inhibited receptor activator of nuclear factor-κB ligand-induced osteoclast differentiation, as evidenced by the reduced formation of tartrate-resistant acid phosphatase-positive multinucleated cells and decreased tartrate-resistant acid phosphatase activity, without significantly affecting cell viability. In ovariectomized mice, the extract increased trabecular region length and cortical bone thickness. In a separate experiment, it enhanced femoral mechanical strength in a three-point bending test. High-performance liquid chromatography analysis identified rosmarinic acid and salviaflaside in the extract. These findings suggest that defatted Perilla frutescens seed residue may be a functional resource for improving bone health.

34. Beyond Public Health and Medicine: The Potential Impact of GLP-1s and Other Incretin Mimetic Medications on Greenhouse Gas Emissions.

期刊: Journal of public health management and practice : JPHMP 发表日期: 2026-Jun-12 链接: PubMed

摘要

Manufacturing and use of pharmaceuticals is responsible for nearly 20% of US health care’s greenhouse gas footprint. As highly effective weight-loss medications such as incretin mimetics become widely prescribed, it is important to understand environmental implications. More than 33.5 million Americans have tried incretin mimetic medications (IMMs), and nearly 30 million are projected to be consistent users by 2030. This article examines the broader potential implications of glucagon-like peptide-1 and other IMMs on climate change. We conducted a preliminary and speculative carbon footprint of IMMs using a life cycle assessment approach. Our findings suggest widespread IMM use could reduce greenhouse gas emissions by decreasing caloric consumption, food production, and health care activities, leading to a maximum estimated reduction of 760 kg CO2e/person/year. This reduction would be greater than the environmental benefits of switching to electric vehicles or adopting a vegetarian diet. This study highlights the need for more research into potential environmental benefits of IMMs.

35. Membrane Fusion-Mediated Cytosolic Delivery of Threose Nucleic Acids via Homotypic Nanoparticles Overcomes Drug Resistance in Triple-Negative Breast Cancer.

期刊: Advanced science (Weinheim, Baden-Wurttemberg, Germany) 发表日期: 2026-Jun-12 链接: PubMed

摘要

Triple-negative breast cancer (TNBC) remains lethal due to its aggressive molecular heterogeneity and drug resistance. We report a biomimetic nanoplatform (PLL/TNAAKT2@CM NPs) integrating biostable threose nucleic acid (TNA) with a donor-derived cell membranes (CMs) “cloak” for subtype-specific therapy. By complexing TNAAKT2 antisense oligonucleotides with poly-L-lysine (PLL) and coating them with TNBS-subtype membranes (MDA-MB-468 or MDA-MB-231), we achieve potent homotypic affinity. PLL/TNAAKT2@468CM NPs exhibited significant enhanced uptake in donor-matched basal-like 1 cells compared to heterotypic TNBC, non-TNBC and normal epithelial cells. Mechanistically, these nanoparticles internalize via a rapid membrane-fusion, bypassing endosomal entrapment for direct cytosolic delivery. This facilitates robust silencing of the AKT2 oncogene, achieving a ∼70% protein knockdown and outperforming conventional transfection reagents. In a drug-resistant MDA-MB-468 xenografts, systemic administration led to superior tumor accumulation, effective AKT2 knockdown, and significant tumor regression via the p21/Caspase-3 apoptotic axis, without systemic toxicity. This versatile “plug-and-play” strategy addresses tumor heterogeneity and endosomal sequestration, providing a transformative paradigm for targeted nucleic acid delivery in refractory cancers.

36. One-Step Preparation of Lanthanide-Doped Polyurea Multicolor Microspheres for Versatile Fluorescent Applications.

期刊: Advanced science (Weinheim, Baden-Wurttemberg, Germany) 发表日期: 2026-Jun-12 链接: PubMed

摘要

Lanthanide-doped polyurea microspheres (LTP@PUMs) are prepared through a facile one-step precipitation polymerization, without stabilizer under quiescent condition. The process features simple operation, mild condition and low LTP doping. The size of the microspheres and their fluorescence color are precisely adjustable by tuning experiment conditions. LTP@PUMs are of great interests in several aspects, including multicolor fluorescence, high quantum yield (75.3%), remarkable stability, redispersibility and biocompatibility, owing to good compatibility of LTP with PU, strong hydrogen-bonding and coordination interactions. These excellent properties allow LTP@PUMs to achieve versatile applications. Taking LTP@PUMs as fluorescent sensor, selective detection for 4-nitrophenol is shown with high sensitivity (detection limit: 0.076 µM) and good reusability. In latent fingerprint imaging, high-quality and durable fluorescence images on various substrates are easily obtained. Strong fluorescence is also retained after heating to 260°C, making LTP@PUMs a high-thermal-resistant multicolor filler for 3D printing, an interesting property rarely reported. In vivo, LTP@PUMs are demonstrated to accumulate selectively in spleen (71.0%, 2.87 µm) and lungs (90.1%, 10.12 µm), enabling high-contrast imaging without obvious abnormal behaviors observed after eight months. This work offers, therefore a new strategy for the fabrication of multifunctional fluorescent microspheres, with promising prospects in environmental monitoring, public security, advanced manufacturing, and biomedicine.

37. Probabilistic Concentration-Response Modeling and Risk Prioritization of Defined Mixtures of PFAS Using Human In Vitro Assays.

期刊: Environmental science & technology 发表日期: 2026-Jun-12 链接: PubMed

摘要

Per- and polyfluoroalkyl substances (PFAS) are persistent environmental contaminants. Some individual PFAS are linked to adverse health effects, but little data is available to evaluate PFAS mixtures. We tested the biological effects of 20 defined PFAS mixtures (containing 4-56 PFAS) across eight human cell types, including iPSC-derived cardiomyocytes, neurons, and hepatocytes; primary hepatocytes; and HepG2s, endothelial, and renal proximal tubule epithelial cell lines. Mixtures were designed to reflect realistic exposures based on drinking/surface water data, regulatory limits, biomonitoring results, and prior in vitro studies. Cells were exposed to five 10-fold dilutions spanning environmentally relevant concentrations, and cell-specific viability and functional endpoints were measured. Concentration-response was modeled to derive mixture-specific points of departure (PODs). Mixtures based on prior in vitro bioactivity and highly contaminated water samples were the most potent. HepG2s, hepatocytes, and iPSC-derived neurons were the most sensitive cells. Experimental mixture PODs were compared with predictions from concentration addition (CA) models based on individual PFAS data. CA showed low accuracy in distinguishing active from inactive mixtures and underestimated potency (∼300-fold). Overall, our findings demonstrate that direct testing of PFAS mixtures provides more health-protective estimates than component-based models and supports a tiered testing strategy prioritizing sensitive human liver cell models.

38. Dairy Worker Infection Prevention Knowledge, Beliefs, and Behaviors.

期刊: Journal of agromedicine 发表日期: 2026-Jun-12 链接: PubMed

摘要

Recent outbreaks of infectious diseases on dairy farms, with workers becoming ill, have focused attention on the potential for zoonotic disease transmission of pathogens between animals and humans in dairy production. While many dairy farms have a biosecurity plan and protocols in place to reduce the possibility of cow-cow transmission of pathogens such as foot-and-mouth disease, previous surveys have indicated that few farms have organized ongoing infection‑prevention programs to prevent the spread of infection to workers. The purpose of the current study is to describe knowledge, attitudes, and practices surrounding infection control and prevention by job tasks among dairy workers and to assess the influence of the COVID-19 pandemic on infection prevention behaviors. Study findings can inform research aimed at implementing sustainable infection control and prevention strategies on dairy farms. We conducted a cross-sectional analysis of baseline survey data from an observational study of dairy workers that began in 2017, with enrollment continuing through 2022. We restricted the analysis to dairy workers who had worked on a dairy farm for at least 6 months and who spoke Spanish or English. Bilingual study staff administered the questionnaires in Spanish or English based on the participants’ preferred language. The survey questions included self-reported job tasks as well as reported use of preventive measures such as hand hygiene and personal protective equipment (PPE) on dairy farms. We calculated proportions of reported behaviors for different job tasks such as milking or herd health. We found that a low level of concern about getting disease from animals or giving disease to animals was associated with lower odds of handwashing after glove use. Frequency of self-reported PPE use varied by task. Proportions of self-reported measures of handwashing were 20% or higher among participants whose data collection occurred during the COVID-19 pandemic compared to participants whose data collection occurred before COVID-19. Conclusion: Efforts to increase infection prevention and control on dairy farms need to address workers’ perceptions about the risk of pathogen transmission between workers and cows, since this appears to affect both PPE use and handwashing frequency.

39. The Role of Estrogen Receptors and House Dust Mite-Induced DNA Methylation in a Mouse Model.

期刊: American journal of physiology. Lung cellular and molecular physiology 发表日期: 2026-Jun-12 链接: PubMed

摘要

Asthma is a chronic respiratory disease affecting over 230 million people worldwide, with higher prevalence in women. Environmental allergens such as house dust mite (HDM) trigger airway inflammation and hyperresponsiveness (AHR), yet the epigenetic mechanisms underlying these responses remain poorly understood. Furthermore, the role of estrogen receptors in the context of asthma is understudied. We aimed to investigate whether estrogen receptor-specific DNA methylation contributes to HDM-induced airway remodeling and hyperresponsiveness. Male and female C57BL/6J wild-type mice and estrogen receptor α and β knockout mice (Esr1-/- and Esr2-/-) were exposed to HDM or phosphate-buffered saline for five weeks. DNA methylation and RNA sequencing data were obtained from snap-frozen whole lung tissues. HDM exposure resulted in widespread differential methylation of genes associated with inflammation and AHR, including Itgal, Tmem267, Rap1b, Bmf, Mid1, Fgd1, Ddx4, Comtd1, Filip1l, Grb10, and Chst7. Notably, the absence of estrogen receptor β (in Esr2-/- mice) produced the most pronounced methylation patterns, particularly in females. Pathway enrichment analysis revealed asthma-relevant processes such as extracellular matrix remodeling, leukocyte adhesion and migration, airway smooth muscle contraction, and inflammatory signaling. Integration of methylation and gene expression data confirmed significant correlations (p<0.05) for Itgal, Rap1b, and Tmem267, and a marginal correlation for Chst7 (p<0.1), implicating these genes in allergic asthma pathogenesis. Our findings demonstrate that HDM exposure induces sex-specific epigenetic changes mediated by estrogen receptor status, highlighting a potential mechanism for increased asthma susceptibility in women. These results can inform estrogen receptor-targeted treatment strategies for allergic airway diseases.

40. Vision-based work posture assessment: monocular pose estimation and fuzzy REBA methods.

期刊: Ergonomics 发表日期: 2026-Jun-12 链接: PubMed

摘要

With the implementation of China’s National Occupational Disease Prevention Plan (2021-2025), workers’ health has gained growing attention. To reduce incidence of work-related musculoskeletal disorders (MSDs), this study developed a contactless, vision-based system for posture risk assessment. An MMPose-based monocular pose estimation model was designed to extract skeletal landmarks for joint-angle computation, and it demonstrated the accuracy superior to that of Kinect V2 in challenging industrial environments. Experimental validation demonstrated that the proposed model achieved an average joint-angle root mean square error (RMSE) of 5.7° (lower than the 10.7° of Kinect V2), with 91% of joints exhibiting errors below 8°. Furthermore, the enhanced fuzzy-logic REBAPRO reduced false risk transitions by 38% and increased expert agreement from 67% to 92%, with the system achieved an inference latency of 6.9 ms/frame to support real-time industrial monitoring. Deployment in an automotive manufacturing plant confirmed its potential for real-time ergonomic monitoring and proactive risk mitigation. To address limitations in traditional observation, we developed a contactless ergonomic assessment system integrating monocular pose estimation with fuzzy logic. This approach eliminates risk-score discontinuities, enabling accurate, real-time and continuous risk monitoring for injury prevention in industrial settings.

41. Social inequalities in return-to-work among colorectal cancer survivors in Germany.

期刊: Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer 发表日期: 2026-Jun-12 链接: PubMed

摘要

For working-age patients with colorectal cancer, returning to work is a key rehabilitation goal. This study examines the association between socio-economic position (SEP) and return-to-work (RTW), including competing outcomes (pension entry and death), following medical rehabilitation. German Pension Insurance data (2013-2022) were analysed, including 32,174 formerly employed patients (ICD-10 C18-C20) of working age undergoing oncological rehabilitation. Patients were categorised by SEP (education, occupational position, income). Logistic regression and restricted mean survival time (RMST) analyses investigated socio-economic differences in RTW, unemployment, sick leave, pension, and death. Following rehabilitation, 31% of patients returned to work in the first month, and by 2 years, 65% had experienced a long-term RTW lasting ≥ 6 months. SEP was significantly associated with both initial and long-term RTW. The strongest associations were observed for income (long-term RTW highest vs. lowest income tertile: adjusted odds ratio [aOR] 3.06; 95% CI 2.84-3.31) and university education (long-term RTW ISCED‑2011 levels 5-8 vs. 1-3: aOR 2.20; 95% CI 1.94-2.50). RMST showed that patients with higher SEP spent more time in employment and less time unemployed or receiving disability pension than those with lower SEP. The employment time lost between the highest and lowest SEP levels was 8 months for education, 8 months for occupational position, and 10 months for income. Fifty-eight percent of patients with colorectal cancer were stably employed 2 years after medical rehabilitation. However, despite universal access to rehabilitation in Germany, strong social inequalities in RTW were observed. Monthly employment and pension data allowed reliable estimates, preventing selective non-response and recall bias. However, the results might not generalise to those who do not undergo rehabilitation.

42. Assessment of Operating Room Staff Compliance with Radiation Safety Measures in Morocco: A Cross-sectional Study.

期刊: Health physics 发表日期: 2026-Jun-12 链接: PubMed

摘要

The aim of this study was to assess the level of compliance of operating room personnel with radiation protection and safety measures against ionizing radiation. A cross-sectional study was conducted among operating room staff in three Moroccan hospitals equipped with a fluoroscopy system. Data were collected using a self-administered questionnaire addressing practices, knowledge, and attitudes related to radiation protection. Among participants, 78% considered wearing a personal dosimeter during image-guided procedures as necessary, yet only 16% reported actually using one. None of the respondents indicated receiving monthly or annual dosimetric reports. Regarding protective measures, 45% used only a lead apron, 25% relied on distance as a means of protection, and only 6% used both a lead apron and a thyroid shield. Concerning knowledge, 75% were unaware that distance is the most effective means of reducing exposure to ionizing radiation; 33% considered the lead apron as the main protective tool, while 42% had no idea. Finally, only 22% of respondents were familiar with the three fundamental principles of radiation protection (justification, optimization, limitation), and 17% mentioned two of them, mainly justification and optimization. This study highlights a low level of adherence to radiation protection measures among operating room staff, reflecting a lack of awareness and training. Strengthening education programs and standardizing protective practices are essential to enhance occupational safety.

43. Discovery of shikonin as a safe and potent oral candidate for the sustainable management of ichthyophthiriasis.

期刊: Veterinary parasitology 发表日期: 2026-Jun-11 链接: PubMed

摘要

Ichthyophthirius multifiliis remains a devastating ciliate parasite in global aquaculture, yet sustainable therapies are critically scarce. While many plant-derived compounds display potent in vitro efficacy, their practical application is frequently hindered by the failure of immersion treatment to reach tissue-embedded parasites. To overcome this challenge, following a screening of 20 natural compounds, we identified shikonin (SK) as a highly promising orally bioavailable candidate with a novel mechanism. In vitro, SK demonstrated potent efficacy with EC50 values of 0.24, 0.37, and 4.05 mg/L against theronts, protomonts, and tomonts, respectively. Mechanistically, it acts primarily by inducing mitochondrial dysfunction and ATP depletion rather than non-specific membrane disruption. Crucially, driven by favorable in silico oral bioavailability predictions, we evaluated its in vivo potential via in-feed administration in goldfish (Carassius auratus). The results revealed that a 4-day oral regimen (80 mg/kg body weight) drastically reduced trophont burdens by 73.9%, profoundly suppressed tomont reproduction, and blocked secondary infection cycles. Furthermore, this dietary treatment effectively eliminated infection-induced tissue damage and restored host survival to 100%, compared to 57.1% in untreated controls. Coupled with a high safety margin (LD50 = 562.6 mg/kg, approximately 7-fold above the therapeutic dose), these findings highlight SK as a promising and safe oral phytomedicine for the sustainable management of ichthyophthiriasis.

44. Does integrating pharmaceutical coverage into publicly financed health insurance reduce out-of-pocket spending? Difference-in-differences evidence from Kerala, India.

期刊: Social science & medicine (1982) 发表日期: 2026-Jun-08 链接: PubMed

摘要

Publicly financed health insurance expansions in India have often increased inpatient utilisation without commensurate reductions in out-of-pocket (OOP) spending. Whether integrating benefits to cover chronic-disease medicines improves financial protection has received little empirical attention. This study examines whether the Karunya Arogya Suraksha Padhathi (KASP), Kerala’s implementation of Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB PM-JAY), which consolidated multiple state and national schemes under a unified purchaser and expanded package-based cashless coverage for secondary, tertiary, and eligible day-care services from April 2019, reduced household OOP health expenditure. We use household panel data from the Consumer Pyramids Household Survey (CPHS) covering April 2017 to February 2020, comprising 58,171 household interview observations across Kerala, Tamil Nadu, and Karnataka, and apply a difference-in-differences (DiD) design. Outcomes include net OOP health spending and its components. KASP reduced net OOP health spending by approximately 31.7% in specifications allowing Kerala-specific trends. The decline was concentrated in medicine spending, while hospitalisation rates were statistically unchanged. Total health spending declined in baseline two-way fixed-effects (TWFE) models but was statistically indistinguishable from zero in trend-adjusted specifications; the net OOP reduction remained robust. Effects were larger among poorer households and those with chronic conditions, and smaller in rural areas, consistent with limited access to empanelled hospitals. Results are robust to event-study diagnostics, alternative comparator pools, and a timing placebo based on Tamil Nadu’s December 2018 inpatient-cap expansion. Benefit expansion covering medicine costs can improve financial protection by reducing point-of-care payments, even without reducing total costs in the short run. The findings suggest that aligning public insurance benefit packages with households’ pharmaceutical spending patterns, particularly among those managing chronic conditions, may offer a more direct route to financial protection than hospitalisation-focused expansion alone.

45. Modulating the neuroendocrine-immune network in depression: Therapeutic targets and pharmacological mechanism of natural products.

期刊: Phytomedicine : international journal of phytotherapy and phytopharmacology 发表日期: 2026-Jun-06 链接: PubMed

摘要

Major depressive disorder (MDD) represents a significant global public health challenge, yet the complexity of its pathophysiology has long hindered meaningful advancements in clinical precision medicine. With the advent of systems biology, the dysregulation of the neuroendocrine-immune (NEI) network has been identified as the core pathological foundation mediating the onset and progression of depression. This discovery provides a critical entry point to overcome the limitations of single-target therapies. Plant-derived natural products, with their unique advantages of multicomponent synergy, multitarget action, and multipathway regulation, show significant therapeutic potential by indirectly remodeling NEI network homeostasis through modulation of key physiological intermediates. However, a comprehensive review detailing the specific role of the NEI network in the pathogenesis of depression, and the mechanisms by which natural products systematically regulate this network, is currently lacking in the literature. This review aims to systematically elucidate the pivotal role of the NEI network in the pathology of depression, explore the molecular mechanisms and key targets of natural product interventions within this network, and critically assess current challenges related to toxicological evaluation, mechanistic understanding, and clinical translation. Ultimately, the review seeks to provide a solid theoretical foundation and strategic guidance for the development of novel antidepressant drugs based on natural products. To investigate the primary pharmacological mechanisms by which natural products regulate the NEI network to treat depression, we conducted a comprehensive search across multiple databases, including PubMed, Web of Science, and ScienceDirect. We then categorized and synthesized the relationship between the NEI network and depression, as well as the regulatory mechanisms of natural products. Numerous studies indicate that abnormalities in the NEI network play a central role in the pathology of depression and that modulation of this network is intrinsically linked to the efficacy of antidepressants. Natural products, including flavonoids, terpenoids, saccharides, and saponins, regulate the NEI system through various multidimensional pathways to exert antidepressant effects. We have consolidated the role of natural products in regulating the NEI network within the context of antidepressant therapy, offering a unique perspective on their application. Nevertheless, it is crucial to invest substantial efforts in both clinical and preclinical research to further elucidate the mechanisms by which antidepressant agents influence the NEI network. This step is essential for the development of effective therapeutic interventions.

46. Examining associations between school suspension and expulsion in early life and later-life cognitive health: A mediation analysis of lifecourse educational pathways.

期刊: Social science & medicine (1982) 发表日期: 2026-Jun-04 链接: PubMed

摘要

Exclusionary school discipline (e.g., suspension, expulsion) - a documented facilitator of structural marginalization - is associated with lower midlife cognitive health, a predictor of later-life dementia risk. No studies have examined through which mechanisms this might unfold. Using National Longitudinal Survey of Youth (1979) data, a study of US adults followed prospectively since adolescence (N = 8138), we evaluated if lifecourse educational trajectories mediate this relationship. First, we estimated associations between exposure to early-life exclusionary discipline (no vs. any suspension/expulsion prior to 1980) and participants’ age 14-48 educational trajectories. We then evaluated whether these lifecourse educational trajectories mediate the association between exclusionary school discipline and later-life cognitive health (global cognition z-score; mean age at cognitive assessment: 55.2 years) using inverse odds weighting to estimate total, natural direct (NDE), and natural indirect (NIE) effects. Participants who were men, Black, had lower childhood socioeconomic status, or were born in the southern US were overrepresented in early-life exclusionary discipline. Suspension/expulsion was associated with educational trajectories characterized by lower attainment (e.g., less-than high school, HS), completed later in life (e.g., General Educational Development HS equivalency exam, GED, after long delay/late 30s), and following early exit from HS without a diploma (e.g., some college after GED). Suspension/expulsion was also associated with lower later-life global cognition (z-score mean difference: -0.226; 95%CI: -0.230, -0.223) and this relationship was mediated by the education trajectories (mediation proportion: 47.2%; NIE: -0.107, 95%CI: -0.110, -0.104; NDE: -0.120, 95%CI: -0.124, -0.115). Findings suggest exclusionary school discipline - an exposure modifiable at multiple policy levels - is associated with later-life cognitive health by interrupting educational progress or pushing students out of the education system altogether.

47. Constitutional BRCA1 Promoter Methylation in Patients With Ovarian Cancer: Results of the Observational AGO-TR1 Study.

期刊: JCO precision oncology 发表日期: 2026-Jun 链接: PubMed

摘要

Constitutional epimutations arise early in development and are present across normal tissues, including peripheral blood. Constitutional BRCA1 promoter methylation has emerged as a risk factor for BRCA1-associated cancers, such as ovarian cancer (OC), and may serve as a biomarker for OC risk. This study retrospectively evaluated the clinical relevance of constitutional BRCA1 promoter methylation in 473 patients with OC enrolled in the observational AGO-TR1 study (ClinicalTrials.gov identifier: NCT02222883). BRCA1 promoter methylation was quantified by the methylation-specific real-time polymerase chain reaction using whole blood-derived DNA from 476 female controls and 473 patients with OC along with 473 corresponding tumor-derived DNA samples. Methylation levels ≥1.0% were considered methylation-positive. BRCA1 promoter methylation in blood-derived DNA was detected in 42 of 473 patients with OC and in 26 of 476 controls (8.9% v 5.5%; odds ratio [OR], 1.69 [95% CI, 1.02 to 2.80], P = .0432), with the strongest association observed with methylation levels ≥10% (OR, 6.17 [95% CI, 1.37 to 27.72], P = .018). Patients with BRCA1 promoter methylation in blood-derived DNA were diagnosed at a younger median age than those without (54.0 v 60.0 years, P = .018). Constitutional BRCA1 promoter methylation was less frequent in patients carrying pathogenic germline variants in OC predisposition genes than in noncarriers (4.1% v 10.5%; OR, 0.37 [95% CI, 0.14 to 0.96], P = .04) and showed no association with a family history of cancer or platinum-based chemotherapy before blood draw. BRCA1 promoter methylation in blood-derived DNA was correlated with tumor BRCA1 promoter methylation (P < .001). Tumor BRCA1 promoter methylation was observed in 64 of 473 samples (13.5%), half (32 of 64) of which were attributable to constitutional BRCA1 promoter methylation also detectable in the blood. Constitutional BRCA1 promoter methylation accounts for a substantial proportion of OCs and represents a robust biomarker for individual OC risk.

48. Liquid Biopsy Monitoring in BRAF V600E-Mutated Patients With Non-Small Cell Lung Cancer Treated With Dabrafenib Plus Trametinib: The Prospective, Multicenter LiBRA Study (GOIRC-03-2020).

期刊: JCO precision oncology 发表日期: 2026-Jun 链接: PubMed

摘要

Dabrafenib plus trametinib is a standard first-line treatment for BRAF V600E-mutated non-small cell lung cancer (NSCLC). The LiBRA study aimed to explore the role of liquid biopsy in detecting and monitoring BRAF V600E mutation, assessing its potential to predict treatment response and emerging resistance. This prospective multicenter study enrolled patients with BRAF V600E-mutated NSCLC treated with first-line dabrafenib plus trametinib. Plasma samples were collected at baseline (t0), after 4 weeks (t1), and longitudinally until disease progression (PD). BRAF V600E was monitored by digital droplet PCR (ddPCR). Next-generation sequencing (NGS) was performed at t0 and PD to identify resistance mechanisms. Forty patients were enrolled. Dabrafenib plus trametinib achieved an overall response rate of 42.5%, with a median progression-free survival (PFS) and overall survival (OS) of 8.3 and 21.1 months, respectively. At t0, BRAF V600E was detectable by ddPCR in 24 (62%) of 39 patients. Among 21 shedders evaluated at t1, 17 (81%) cleared the mutation. Higher baseline BRAF V600E allele frequency was associated with shorter PFS (hazard ratio [HR], 1.09, P = .013) and OS (HR, 1.10, P = .010), whereas clearance at t1 correlated with longer PFS (8.3 v 1.4 months, P < .001) and OS (10.5 v 2.2 months, P < .001). Biological PD anticipated radiologic/clinical PD by a median of 4.9 weeks (IQR, 1.4-9.8). Baseline EGFR and MET CNVs were associated with shorter PFS and OS. Resistance mechanisms at PD included NRAS, KRAS, TP53 mutations and MET, EGFR, ERBB2 CNVs. The LiBRA study supports liquid biopsy as a prognostic and monitoring tool in BRAF V600E-mutated NSCLC undergoing targeted therapy.

49. Development of a Machine Learning‑Based Prognostic Model for Intermediate Trophoblastic Tumors: A Single-Center Study With Web-Based Tool Implementation.

期刊: JCO precision oncology 发表日期: 2026-Jun 链接: PubMed

摘要

Current prognostic systems are inadequate for intermediate trophoblastic tumors (ITTs). The aim of this study was to develop a machine learning (ML)-based model to predict progression-free survival (PFS) in patients with ITT and implement a web-based tool for individualized risk stratification. We analyzed a retrospective cohort of 236 patients with ITT treated at a national tertiary center between 2000 and 2024. A multimodal feature selection strategy-integrating Cox regression, LASSO, Gradient Boosting Machine (GBM), and Random Survival Forest (RSF)-was used to identify robust predictors from clinicopathologic and inflammatory variables. The final prognostic model was constructed using the RSF approach. Model performance was evaluated through a rigorous nested 5-fold cross-validation framework to prevent data leakage. Five key predictors were identified: International Federation of Gynecology and Obstetrics stage, interval from antecedent pregnancy, Ki-67 index, neutrophil-to-lymphocyte ratio, and systemic immune-inflammation index. The RSF model demonstrated robust discrimination with a cross-validated concordance index of 0.816 (95% CI, 0.721 to 0.895) and excellent calibration (Integrated Brier Score, 0.113). Decision-curve analysis confirmed clinical utility within the relevant 20%-60% threshold range. An interactive web tool (Shinyapps) was deployed to generate real-time individualized PFS predictions with 95% confidence intervals. To our knowledge, this study presents the first ML-based prognostic model specifically for ITT. By integrating immune-inflammatory markers with traditional clinicopathologic features, the RSF model offers superior risk stratification compared with anatomic staging or alternative models. The developed online tool serves as a proof-of-concept prototype to facilitate future external validation and research on personalized clinical decision making for this rare malignancy.

50. From policy to practice: An anthropological analysis of implementing community-based healthcare reform in Catalonia.

期刊: Social science & medicine (1982) 发表日期: 2026-May-27 链接: PubMed

摘要

Many European health systems have promoted community-based and integrated care reforms, although reform trajectories and implementation priorities remain uneven across contexts. Translating these policy ambitions into routine practice therefore remains a significant challenge. This study examines how organisational, cultural, and structural dynamics shape the implementation of community-based healthcare reform in Catalonia, Spain. Drawing on multi-sited ethnographic research conducted in Catalonia between 2022 and 2024, the study combines 41 semi-structured interviews, two focus groups, ethnographic observation, and document analysis across primary care, municipal, and regional health settings. Data were analysed through iterative thematic and interpretive analysis informed by implementation anthropology and critical implementation science. The findings identify four interrelated domains shaping implementation: hierarchical governance and constrained local agency; uneven professional recognition and evaluation frameworks; fragmented systemic vision and leadership gaps; and structural constraints generating competing priorities. These domains operate through interacting mechanisms across micro, meso, and macro levels, producing path-dependent patterns that contribute to the partial and uneven embedding of community-based care. Building on these findings, the study proposes an Anthropological Implementation Barriers Framework that conceptualises implementation challenges as relational and systemic processes rather than isolated obstacles. The framework highlights how governance arrangements, professional hierarchies, valuation regimes, and material conditions interact to shape reform trajectories. The study contributes to ongoing dialogue between implementation science, Health Policy and Systems Research (HPSR), and anthropology by demonstrating how ethnographic approaches can illuminate the dynamics of health system change. In doing so, it highlights the value of anthropological analysis for developing more context-sensitive approaches to reform implementation relevant to policymakers, practitioners, and researchers.

51. Recruitment and Retainment Trends in Diverse Family Medicine Academic Leadership: A CERA Secondary Analysis.

期刊: Family medicine 发表日期: 2026-Apr 链接: PubMed

摘要

Increasing the representation of female and Black, Indigenous, and People of Color (BIPOC) identities among family medicine faculty leaders is important for improving community health outcomes. While prior studies show rising percentages, they don’t clarify whether these gains stem from recruitment or retention. We examined the proportion of leaders who are female and BIPOC to determine how long they’ve held their roles. We conducted a secondary analysis of Council of Academic Family Medicine Educational Research Alliance (CERA) survey data from 2011 to 2023. Leadership duration was classified as <1 year (recruitment) and ≥5 years (retention). Descriptive statistics and Pearson’s correlation test evaluated trends in duration across leadership roles over time. Increases in BIPOC representation were observed only among leaders with ≥5 years of duration. Increases in the proportion of BIPOC male and female clerkship directors with ≥5 years rose from 4.8% each in 2012 to 19.3% and 14.0% in 2023 (P=0.005, P=0.009). BIPOC female program directors with ≥5 years of duration increased from 4.4% in 2018 to 17.3% in 2023 (P=0.001). No significant trends were identified among department chairs or among leaders with <1 year of duration. In family medicine academic leadership, observed increases in BIPOC men and women clerkship directors and BIPOC women program directors are driven by retention rather than recruitment into leadership roles. Departments should therefore sustain and scale retention practices while implementing formal mentorship and sponsorship programs, transparent promotion pathways, and targeted outreach to ensure equitable growth in leadership diversity.

52. The Good Life with Dementia approach: A realist-informed qualitative study of a peer-tutored course, co-produced with and for people living with dementia.

期刊: PloS one 发表日期: 2026 链接: PubMed

摘要

People with dementia often report a lack of post-diagnostic support, and much of the current dementia training available is for staff or carers, not for the person diagnosed. The Good Life with Dementia course was designed with and for people with a diagnosis of dementia and is co-delivered by peer-tutors living with dementia, supported by a trained facilitator. This study used realist-informed methods, underpinned by a co-productive ethos which values all sources of expertise equally, to better understand the core constructs underpinning the Good Life approach and how these operate to produce outcomes. The resultant, evidence-based programme theory suggests that - in a context characterised by shared experience, equality and positive expectations - three key mechanisms can trigger: sharing of experiences and resources; peer-led learning and responding; and the taking on of meaningful roles. Qualitative evidence indicates that these mechanisms are likely to lead to four interconnected outcomes: enjoyment; feeling valued (personhood); (re)building social confidence and connections; and positive reframing of life with dementia, meaning participants felt more prepared to face the challenges ahead. Not everyone diagnosed with dementia will want to take part in a peer-led course, but interventions like a Good Life with Dementia could be part of a suite of post-diagnostic options available to help people with dementia to live as well as possible. The next step will be to establish whether the approach can be manualised, delivered with different communities and evaluated in trial conditions. This will be assessed via an inclusive feasibility study already underway and due to conclude in August 2027.

53. A next generation of the schema therapy model of personality pathology: A cross-cultural and international study protocol.

期刊: PloS one 发表日期: 2026 链接: PubMed

摘要

Personality disorders are highly prevalent worldwide imposing substantial personal and social challenges. Schema Therapy is an effective psychotherapeutic approach for personality pathology and other complex characterological problems. New scientific insights prompted a re-evaluation of its theoretical underpinnings leading to a reformulated Schema Therapy theory. Furthermore, the assumed cross-cultural universality of the Schema Therapy model has not been tested. This project has two primary aims: (1) To develop revised instruments based on the reformulated theory that are psychometrically sound and valid across diverse cultures and languages. (2) To validate the Schema Therapy-related constructs and their inter-relationships across cultures. New draft versions of the Young Schema Questionnaire, Schema Coping Inventory, and Schema Mode Inventory were developed. Before dissemination, these instruments will undergo rigorous psychometric evaluation to refine item sets and ensure linguistic and conceptual consistency. A minimum of 100 adult mental health patients and 100 non-patients from each participating country will complete the revised instruments. Sociodemographic and mental health-related variables will also be assessed. Statistical analyses will evaluate (a) internal consistency, (b) unidimensionality, (c) cross-cultural invariance, (d) factorial validity (if possible), and (e) known-group validity. Malfunctioning items will be deleted, and subscales will be shortened, if possible, targeting internal consistency of ≥.80. This study is expected to yield optimized versions of the three instruments aligned with the reformulated theory. These findings will inform subsequent international studies to further assess the structural and cross-cultural validity of the revised scales. The resulting empirically validated scales will be openly accessible, facilitating worldwide utilization. This protocol outlines the first international study based on the reformulated theory, aiming to extend the psychopathological coverage and enhance the cross-cultural application of evidence-based treatments for personality pathology. Results will be disseminated through peer-reviewed publications and conference presentations. Potential limitations are discussed.

54. Who becomes a dermatologist? A repeated cross-sectional study on diversity in the Dutch dermatology workforce.

期刊: PloS one 发表日期: 2026 链接: PubMed

摘要

Workforce diversity in dermatology is crucial for equitable, high-quality care, given the impact of skin tone, culture, and socio-economic status on skin conditions. Although this has been studied in other countries, data on the demographic makeup of Dutch dermatologists is lacking. This study aims to assess workforce diversity in Dutch dermatology over time. We conducted a nationwide repeated cross-sectional study using pseudonymized microdata from Statistics Netherlands, including sex, migration background, and parental socio-economic indicators. Descriptive statistics were used to track demographic trends between 2005 and 2023, and multivariable logistic regression analyses were performed to evaluate which variables influenced the odds that registered physicians in the 2023 national healthcare professional register (BIG register) had to be a dermatologist. Female representation rose from 35.4% in 2005 to 61.7% in 2023. In 2023, 84.4% of dermatologists had no migration background or a European migration background. Dermatologists with Turkish, Moroccan, Surinamese, or Caribbean Dutch origins were underrepresented. Despite a net increase of 289 dermatologists, only 56 of this net increase consisted of dermatologists with a non-European background. Multivariable regression analysis showed that being female (OR 1.609 [1.143-2.266]), having parents in the top 20% assets bracket (OR 2.251 [1.272-3.984]), or having physician parents (OR 1.326 [1.011-1.740]) were associated with higher odds of being a registered dermatologist among the younger generation of physicians. The findings highlight a persistent lack of ethnic and socio-economic diversity in the Dutch dermatology workforce, despite broader demographic shifts in the general population and medical student cohorts. The underrepresentation of dermatologists with a migration background may have implications for equitable patient care, particularly in the context of cultural and linguistic barriers, as well as differences in disease presentation across skin tones. Further research is warranted to explore the potential impact of workforce diversity on patient outcomes.

55. Perspectives of community-dwelling older adults with chronic diseases on Baduanjin practice: A qualitative study.

期刊: PloS one 发表日期: 2026 链接: PubMed

摘要

With the accelerating aging of China’s population, Baduanjin has been promoted as a community-based exercise to enhance public health, particularly among older adults with chronic diseases. As a traditional Chinese exercise with a long history and profound cultural connotations, Baduanjin has attracted a large number of practitioners. However, the factors underlying the sustained practice of Baduanjin remain insufficiently explored. This study aims to explore the factors underlying the persistence of older adults with chronic diseases in practicing Baduanjin. A qualitative research approach was adopted in this study. 25 practitioners participated in semi‑structured face‑to‑face interviews. Thematic analysis was employed to analyze the data and generate core themes. The factors driving community-dwelling older adults with chronic diseases to persist in practicing Baduanjin were analyzed across five dimensions: perceived safety and learning-practice ease, improvements in physical health, promotion of mental well-being, enhancement of social functioning, and appreciation of traditional culture. Community-dwelling older adults with chronic diseases maintain long-term Baduanjin practice not only due to its perceived safety and ease of learning and practice, but also because it embodies the essence of traditional Chinese culture. Moreover, regular practice contributes to improved physical health, promoted mental well-being, and enhanced social functioning in this population. Accordingly, Baduanjin shows considerable potential as a community-based exercise intervention to support health promotion among community-dwelling older adults with chronic diseases.

56. Correction: Programme for the Effective Promotion of Maternal Psychosocial Wellbeing (PREPWELL) in Ghana: Development and field-testing of a mHealth Intervention in a rural setting.

期刊: PLOS mental health 发表日期: 2026 链接: PubMed

摘要

[This corrects the article DOI: 10.1371/journal.pmen.0000571.].

57. Evaluating respiratory syncytial virus immunization strategies for infants in Canada: A cost-utility analysis.

期刊: PloS one 发表日期: 2026 链接: PubMed

摘要

Respiratory syncytial virus (RSV) is a leading cause of lower respiratory tract infections and hospitalizations among infants in Canada. New long-acting monoclonal antibodies (mAbs) and vaccines administered during pregnancy have expanded prevention options, yet the most cost-effective immunization program remains uncertain. We updated a Canadian cost-utility model to evaluate seven seasonal RSV prevention strategies over one year (with a lifetime horizon for mortality impacts), from health system and societal perspectives. Strategies included RSVpreF vaccination in late pregnancy; targeted or universal infant mAb programs using nirsevimab or clesrovimab; and combination programs in which infants could receive protection from either RSVpreF or mAbs. Sequential incremental cost-effectiveness ratios (ICERs) were estimated in 2024 Canadian dollars per quality-adjusted life year (QALY), using a $50,000/QALY threshold. The primary analysis used immunization product list prices. The most cost-effective strategy was a seasonal combination program: RSVpreF vaccination for pregnancies due during the RSV season, with mAb for infants at high risk (<32 weeks’ gestation), including catch-up for infants at high risk born before the season. This strategy had an ICER of $35,408/QALY compared to seasonal mAb for infants at moderate risk (320/7 to 366/7 weeks’ gestation) or high-risk with catch-up. Expanding mAb to unimmunized non-high-risk infants born in-season increased the ICER to $132,131/QALY. Universal infant protection, with mAb alone or combined with RSVpreF in pregnancy, was not cost-effective across analyses. RSVpreF alone was dominated. Results were most sensitive to product prices, target populations, age at administration, and RSV burden. A seasonal combination program with RSVpreF for in-season deliveries and mAb for infants at high risk of RSV offers the best value for money for protecting Canadian infants from RSV disease. Broader infant immunization programs may be cost-effective with substantial price reductions or in regions with higher disease burden and healthcare costs.

58. Dynamic analysis of critical maternal complications in tertiary hospitals in Wuxi: A study based on four years of monitoring data.

期刊: PloS one 发表日期: 2026 链接: PubMed

摘要

Severe maternal morbidity (SMM) is a significant public health concern. This study analyzed the incidence, trends, causes, and pregnancy outcomes of SMM in Wuxi to inform future clinical and public health strategies. A retrospective analysis was conducted on 315 critical maternal cases identified from 156,435 deliveries in Wuxi between October 1, 2020, and September 30, 2024. Data were extracted from a citywide near-miss maternal surveillance system. Statistical analyses were performed using SPSS 25.0, employing chi-square tests and Cochran-Armitage trend tests to evaluate trends, and chi-square tests for comparisons between groups. The overall incidence of SMM was 0.20%. Initially, this rate remained stable at 0.19% across the first three cycles (P > 0.05); however, it significantly increased to 0.24% during the cycle from October 2023 to September 2024 (χ² = 5.24, P = 0.02). This increase was closely associated with a rise in the proportion of women of advanced maternal age (≥35 years), which reached 26.03% (χ² = 11.76, P = 0.001). Over time, the distribution of risk levels shifted. Initially, the high-risk group was dominant (63.29%), but in recent cycles, the moderate-risk group became more prominent (64.44%). The moderate-risk group was associated with a higher rate of adverse outcomes (25.00-25.71%) compared to the high-risk group (17.11-20.69%; χ² = 10.83, P = 0.01). Direct obstetric factors were the primary causes, accounting for 79.05% of cases, with obstetric hemorrhage being the most prevalent (53.97%). In contrast, the proportion of cases attributable to indirect obstetric factors increased from 17.81% to 26.67%, primarily due to heart disease and infectious diseases. Improving maternal safety involves dynamic risk assessments, tiered referrals for moderate-risk pregnancies, better multidisciplinary management of complications, optimized emergency responses in primary care, and refined regional referral systems to reduce preventable SMM and mortality.

59. First major Clade IIb mpox outbreak in Africa: Narrative review of Sierra Leone's 2025 epidemic.

期刊: Igiene e sanita pubblica 发表日期: 2026 链接: PubMed

摘要

The mpox outbreaks observed in 2025 highlighted significant shifts in transmission dynamics, viral clades, and public health responses, particularly in Africa. In contrast, Sierra Leone experienced its largest mpox outbreak that year-Africa’s first major Clade IIb epidemic-which ran from 10 January to 17 December 2025. It involved 5,442 confirmed cases among 7,110 suspected cases, a case fatality rate of 1.1%, and 22,536 contacts identified. A public health emergency was declared on 13 January 2025. Transmission peaked in epidemiological week 20 (May 2025) with 654 confirmed cases. The burden was highest in Western Area Urban (55.4%, 3,014 cases), Western Area Rural (19.9%), and Bombali (6.1%). Cases predominantly affected young adults aged 20-39 years (median age 26) and males (52.5%). Key affected groups included sex workers, children under 15 years (6.5%), and pregnant women (1.6%). High population density in Freetown, limited resources, weak coordination, misinformation, and surveillance gaps facilitated spread. Genomic evidence revealed undetected Clade IIb (hMPXV-1 lineage, including G.1) circulating for ~3 months from Nigeria. Environmental contamination affected 13.5% of healthcare surfaces. Symptoms included rash, fever, headache, lymphadenopathy, sore throat, and pain; 28.9% of cases were hospitalized, often delayed by stigma and fear. Among those screened for HIV co-infection (23.6%), 82% of deaths occurred in co-infected individuals. The National Public Health Agency (NPHA) implemented seven response pillars: case management and isolation, infection prevention and control (IPC), risk communication, targeted vaccination (186,470 doses administered from 267,000 received), coordination, surveillance, and research. The outbreak ended after 42 consecutive case-free days, underscoring the importance of early surveillance and genomic monitoring to prevent sustained urban transmission.

60. Is asymmetric upper trapezius muscle activation during work associated with neck pain? A cross-sectional and longitudinal analysis.

期刊: PloS one 发表日期: 2026 链接: PubMed

摘要

Previous studies have linked activity in the upper trapezius muscle with neck pain. However, no studies have examined whether asymmetric activation of these muscles during the working day is associated with neck pain. This study aimed to investigate this relationship. Seven research institutes provided data on bilateral upper trapezius muscle activity on one working day, along with corresponding questionnaire data on cross-sectional (n = 530) and longitudinal (n = 256) neck pain intensity. The asymmetry, defined as the activity difference between the two upper trapezius muscles, was calculated as an average across the entire workday and within various intensity levels in relation to maximum voluntary isometric contraction (MVIC). Unadjusted and adjusted linear regression analyses were executed to examine the association between asymmetric muscle activation and neck pain intensity. In cross-sectional analyses, asymmetry in the levels 0-0.05 and 0.05-2%MVIC was significantly positively associated with neck pain intensity in both unadjusted and adjusted analyses. Asymmetry in the levels of 4-6, 6-8 and 8-10%MVIC was significantly negatively associated with neck pain in unadjusted analyses. In longitudinal analyses, significant positive associations were found for asymmetry in level 0-0.05%MVIC and negative associations for asymmetry in levels > 20%MVIC. While asymmetry in the very low levels of muscle activity may be associated with higher neck pain intensity, asymmetry in the higher levels of muscle activity was negatively associated with neck pain intensity. However, the explained variance of the models was small, and the results should therefore be interpreted with caution. The findings suggest that work conditions facilitating simultaneous relaxation during breaks and balanced activation of both muscles during static activities may be relevant for neck pain prevention, though further research is needed to establish causality.