公共卫生研究摘要 (2026-06-15)

共收录 57 篇研究文章

1. Diet and microbiome shape small-molecule cytokinin pools in mammals.

期刊: Gut microbes 发表日期: 2026-Dec-31 链接: PubMed

摘要

Cytokinins (CKs) are adenine-derived metabolites traditionally characterized as plant hormones, yet their origin, distribution, and functions in mammalian systems remain largely undefined. Using integrated metabolomics, microbiome, and metagenomics approaches, we provide a systematic characterization of CK occurrence and potential sources in mammals. Serum profiling across five animal species revealed consistent detection of multiple CK derivatives, with concentrations markedly lower than in plant tissue. The CK storage form, zeatin-O-glucoside, predominated in mammalian sera, followed by trans-zeatin and kinetin, indicating a CK composition distinct from that in plants. Species-specific differences, such as reduced trans-zeatin in mice and lower kinetin in humans, further suggest divergent regulatory patterns. In mice, CKs were present in vascular tissues of the kidney, heart, and liver, demonstrating systemic distribution. Dietary manipulation showed that starvation significantly reduced CK abundance in serum, colon, feces, and urine, confirming that diet is a major contributor to the mammalian CK pool. Meta-omics analysis of gut microbiomes identified CK-related genes across multiple microbial taxa, with the highest representation in human microbiomes, followed by those of mouse and pig. Germ-free mouse experiments showed substantially lower CK levels than conventionally raised counterparts, establishing a microbiome-dependent contribution. Collectively, our findings identify CKs as diet and microbiome modulated metabolites in mammals, warranting future investigation to elucidate their physiological significance in mammalian biology.

2. Potential implications of increased utilization of oral nirmatrelvir/ritonavir in outpatient care for COVID-19: modeled findings from the Spanish National Health System perspective.

期刊: Journal of medical economics 发表日期: 2026-Dec 链接: PubMed

摘要

This analysis evaluates the clinical and societal impact of increasing utilization of oral nirmatrelvir/ritonavir (NMV/r) for outpatient treatment of mild-to-moderate COVID-19 among high-risk adults in Spain. Despite strong evidence from clinical trials and real-world studies demonstrating NMV/r’s effectiveness in reducing hospitalization and death, uptake in Spain has remained suboptimal. Using a decision tree adapted from a previously published model, we estimated outcomes from the perspective of the Spanish National Health System over a 30-day time horizon. Model inputs included Spanish epidemiological data, healthcare resource utilization rates, and productivity loss parameters. Five NMV/r uptake scenarios were compared: current utilization (30.9%), three hypothetical increased utilization rates (45%, 60%, 75%), and a 0% utilization scenario. Results indicate that increasing NMV/r uptake substantially reduces hospitalizations, ICU admissions, and mortality, while improving productivity outcomes. Compared with the base case, hospitalizations and deaths declined by 15-47% and productivity loss hours by 15-45% across higher utilization scenarios; conversely, the 0% scenario resulted in a 33% increase in hospitalizations and a 32% rise in productivity loss. Sensitivity analyses confirmed the robustness of findings across key parameters. These results underscore the clinical and societal benefits of broader NMV/r adoption and provide timely, policy-relevant evidence to inform strategies that enhance treatment uptake. Greater utilization of NMV/r could alleviate strain on the Spanish health system and prevent avoidable hospitalizations and deaths, reinforcing the importance of interventions that promote timely access for high-risk patients.

3. Socioeconomic Factors and Their Role in Metabolic Dysfunction-Associated Steatotic Liver Disease: A Comprehensive Review.

期刊: Liver international : official journal of the International Association for the Study of the Liver 发表日期: 2026-Jul 链接: PubMed

摘要

Metabolic dysfunction-associated steatotic liver disease (MASLD), a major public health concern, is influenced by an interplay of genetic, environmental, and lifestyle factors, with socioeconomic factors functioning as important upstream determinants whose roles remain not yet fully understood. This review synthesizes current evidence on how different indicators of socioeconomic status as well as related social determinants of health-income, poverty, food insecurity, health insurance, education, migration, and composite indices-relate to MASLD prevalence, severity, and outcomes across different world regions. Several studies associate these socioeconomic factors with an increased risk of MASLD, illustrating the disease’s link with socioeconomic disadvantages. However, socioeconomic factors often lose or attenuate their independent association with MASLD once key downstream determinants-such as diet quality, physical inactivity, and metabolic comorbidities-are considered, supporting a model in which socioeconomic factors mainly shape exposure to metabolic and behavioural risk factors rather than exerting a direct causal effect. Among the factors examined, education and food insecurity demonstrate the most consistent independent associations with MASLD. Notably, the direction of socioeconomic gradients appears to differ by regional income level, with lower SES associated with higher MASLD burden in high-income countries but an inverse pattern in several middle-income settings. Evidence remains largely limited to the United States, Europe, and a small number of Asian cohorts, underscoring the need for more geographically diverse research. This review highlights the association of different socioeconomic factors with MASLD, while also revealing the need for more detailed studies which systematically disentangle individual and area-level social determinants of health, model mediating pathways and incorporate underrepresented regions and paediatric populations. A deeper understanding of how socioeconomic factors and downstream mediators jointly drive MASLD could inform targeted clinical strategies and multi-level policies aimed at mitigating the social gradient in MASLD.

4. Prometheus Revisited: From Liver to Heart.

期刊: Liver international : official journal of the International Association for the Study of the Liver 发表日期: 2026-Jul 链接: PubMed

摘要

5. Mesenchymal Stem Cells Therapy for Intrauterine Adhesions and Endometriosis: Potential, Mechanisms, and Future Directions.

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

摘要

Intrauterine adhesions (IUA) and endometriosis are debilitating gynecological disorders that impair endometrial function and fertility. IUA, typically caused by iatrogenic trauma to the basal endometrium, leads to fibrosis and infertility, whereas endometriosis, characterized by ectopic endometrial growth, induces chronic inflammation, pain, and subfertility. Current treatments, such as surgical adhesiolysis for IUA and hormonal suppression for endometriosis, frequently fail to address underlying pathological mechanisms, including aberrant fibrosis, inflammatory cascades, and impaired tissue regeneration. Recently, mesenchymal stem cells (MSCs) have emerged as a promising therapeutic approach. Their therapeutic benefits are mediated primarily through paracrine actions, which modulate immune responses, promote tissue repair, and attenuate inflammation and fibrosis. Recent studies have further highlighted the potential of MSC-derived exosomes (MSC-Exos) as a cell-free alternative. In this review, we comprehensively summarize current evidence from animal models and clinical studies on the application of MSCs and MSC-Exos in treating IUA and endometriosis, focusing on their therapeutic potential, mechanisms of action, and future directions. We also discuss remaining challenges and promising strategies to overcome them, thereby positioning MSC-based therapies as transformative options for endometrial restoration and disease management.

6. [Association between wearable-derived physical activity patterns and gut microbiota in older adults].

期刊: Beijing da xue xue bao. Yi xue ban = Journal of Peking University. Health sciences 发表日期: 2026-Jun-18 链接: PubMed

摘要

To identify real-world physical activity patterns in older adults using objective measurements from wearable devices, and to analyze the associations between these patterns and gut microbiota composition. Based on data collected from a real-world health management project, a total of 743 participants from Eastern, Central, and Northern China were enrolled between January 2018 and June 2025. A 180-day objective physical activity dataset prior to fecal sampling was collected via smart wearable devices to extract features including mean daily steps, coefficient of variation of steps, and the proportion of active days. Fecal samples underwent 16S ribosomal RNA (rRNA) gene (V3-V4 region) amplicon sequencing to obtain genus-level relative abundance matrices. Covariates, including demographics, lifestyle, and chronic disease history, were collected via questionnaires and physical examinations. The discriminative dimensionality reduction via learning a tree (DDRTree) algorithm combined with K-means clustering was applied to identify physical activity phenotypes. Alpha diversity was evaluated using the Shannon index (Kruskal-Wallis test), and beta diversity was assessed using covariate-adjusted permutational multivariate analysis of variance (PERMANOVA) based on Bray-Curtis distance. Multivariable linear regression with false discovery rate (FDR) correction was used to screen differential taxa. A microbial risk score (MRS) was constructed based on taxa with a raw P < 0.05, defined as the difference between the standardized abundance of beneficial and harmful taxa. Co-occurrence networks were constructed to evaluate micro-ecological topological structures. The cohort comprised 381 (51.3%) individuals aged 60-74 years and 362 (48. 7%) aged ≥75 years. Compared with the 60-74 group, the ≥75 group had higher prevalences of hypertension (45.9% vs. 36.7%, P=0.045) and heart disease (34.0% vs. 25.2%, P=0.032), higher systolic blood pressure (median 130 mmHg vs. 120 mmHg, P < 0.001), and fewer mean daily steps (median 6 200 steps vs. 7 000 steps, P < 0.001). Clustering identified three activity patterns: active group (n=143, 19.2%; high steps, low variation, high adherence), moderate group (n=429, 57.7%), and irregular group (n=171, 23.0%; low steps, high variation, low adherence). The active group exhibited the lowest prevalences of hypertension (35.0%) and heart disease (21.7%), and the lowest systolic blood pressure (mean 124.4 mmHg), whereas the irregular group showed the highest values (51.5%, 40.4%, and 127.6 mmHg, respectively). Alpha diversity showed no significant differences among the groups. After adjusting for covariates, physical activity patterns showed no statistically significant effect on beta diversity (R2=0.003 7, P=0.115). Compared with the irregular group, two genera in the active group showed significant differences (P < 0.05). Specifically, the relative abundance of Roseburia in the active group was significantly lower than that in the irregular group (P < 0.05), and the relative abundance of Butyricimonas was also significantly lower than that in the moderate group (P < 0.01). However, these differences did not remain statistically significant after FDR correction. The MRS exhibited a significant gradient distribution across the groups, with the active group scoring the highest (P < 0.001). Co-occurrence network analysis revealed that the active group had the highest network density and proportion of positive correlations (84.5%), whereas the irregular group had the lowest (60.3%). Physical activity patterns identified from wearable device data are associated with gut microbiota composition and ecological network characteristics in older adults. Active and regular physical activity patterns indicate a higher MRS and more stable microbial co-occurrence networks, suggesting potential associations between activity regularity and gut microbial ecology, though causal inference requires longitudinal confirmation.

7. [Application of biological age for cardiovascular risk prediction in a community-based Chinese cohort].

期刊: Beijing da xue xue bao. Yi xue ban = Journal of Peking University. Health sciences 发表日期: 2026-Jun-18 链接: PubMed

摘要

To independently evaluate the discrimination of the light version of biological age (Light BioAge) model for predicting all-cause mortality, to explore the association of the difference on Light BioAge and chronological age (AgeDiff) with the composite outcomes of cardiovascular disease (CVD), and to assess the performance of CVD risk prediction using the Light BioAge instead of chronological age in a large Chinese population-based cohort. Participants aged 40-79 years without a history of CVD at baseline were drawn from the CHinese Electronic health Records Research in Yinzhou (CHERRY) study. Harrell’ s concordance index (C-index) was employed to assess the discrimination of Light BioAge in predicting all-cause mortality across the overall population and sex-specific subgroups. Cox proportional hazards models were used to assess the association between AgeDiff and the composite outcome of CVD onset and death, adjusting for chronological age, sex, education, region, smoking status, body mass index, systolic blood pressure, total cholesterol, and high-density lipoprotein cholesterol. Hazard ratios (HR) and 95% confidence intervals (CI) were calculated. Restricted cubic spline (RCS) regression was used to further analyze the potential nonlinear association between AgeDiff and CVD outcomes. Light BioAge was introduced to replace chronological age in the World Health Organization (WHO) non-laboratory CVD risk model to evaluate the discrimination and calibration in predicting 10-year CVD risk. A total of 226 406 adults were included, with a mean age of 55.0 years at baseline, 53.2% of whom were women. During a median follow-up of 7.39 years (cumulative 1 562 141 person-years), 11 703 deaths (7.49 per 1 000 person-years) and 9 815 CVD events (6.30 per 1 000 person-years) occurred. The median Light BioAge and AgeDiff were 49.31 and -5.19 years, respectively, suggesting an underestimation of chronological age. Although the Light BioAge model demonstrated good discrimination for predicting all-cause mortality in the overall population (C-index: 0.742, 95% CI: 0.738-0.746), discrimination was lower in men (0.722, 95%CI: 0.714-0.730) than in women (0.755, 95%CI: 0.749-0.761). After adjusting for confounders, the risk of CVD events showed an elevated trend with increasing AgeDiff (Ptrend < 0.001). Compared with the lowest quartile of AgeDiff, the risk of CVD events in the highest quartile increased by 21% in men (HR=1.21, 95%CI: 1.12-1.30) and 27% in women (HR=1.27, 95%CI: 1.17-1.38). RCS regression further indicated that in the overall population, the risk of CVD events increased with AgeDiff. Besides, no significant thre-shold effect was observed in sex-specific subgroups (P for non-linearity >0.05). Replacing chronological age with the Light BioAge in the WHO model did not improve discrimination; however, it significantly enhanced calibration. Calibration improvement was especially evident in women: while chronological age overestimated risk by 20.5% [expected/observed ratio (EOR)=1.205, 95%CI: 1.167-1.246), the Light BioAge reduced this to a marginal 2.1% underestimation (EOR=0.979, 95%CI: 0.948-1.012). The discrimination of the Light BioAge in predicting all-cause mortality seems good, and a wider AgeDiff indicates higher cardiovascular risk in this large population-based Chinese cohort. Replacing chronological age with biological age in the WHO non-laboratory model significantly improved calibration for women.

8. [Prognostic analysis of anticoagulation therapy in elderly patients with cardioembolic stroke].

期刊: Beijing da xue xue bao. Yi xue ban = Journal of Peking University. Health sciences 发表日期: 2026-Jun-18 链接: PubMed

摘要

To systematically evaluate the association between anticoagulant therapy and long-term outcomes (all-cause mortality, stroke recurrence, and hemorrhage events) in elderly patients with cardiogenic stroke, thereby providing evidence for clinical decision-making. A retrospective cohort study design was adopted. A total of 567 elderly patients with cardiogenic stroke from Liang-xiang Hospital in Fangshan District, Beijing, were followed up for 4 years. The primary outcomes included all-cause mortality, stroke recurrence, and hemorrhage events (including intracranial hemorrhage, gastrointestinal bleeding, urinary system bleeding, gingival bleeding, and skin and mucosal hemorrhage). Multivariable Logistic regression was used to analyze the association between anticoagulant therapy and each outcome. All statistical analyses were performed using R software (version 4.2.2). A total of 567 elderly patients were included in this study, with a mean age of (73.92±9.70) years and 49.74% being male. Among them, 142 patients (25.04%) received anticoagulant therapy. During the follow-up period, 266 deaths occurred (crude mortality rate: 46.91%), 107 patients had stroke recurrence (cumulative recurrence incidence: 18.87%), and 28 patients experienced bleeding events (cumulative hemorrhage incidence: 4.94%). Multivariable Logistic regression showed that elderly patients with cardiogenic stroke who received anticoagulant therapy had a significantly lower risk of death (OR=0.22, 95%CI: 0.12, 0.41, P < 0.001). No significant association was found between anticoagulant therapy and the risk of stroke recurrence or hemorrhage (P>0.05). Anticoagulant therapy is beneficial in reducing the risk of all-cause mortality in elderly patients with cardiogenic stroke, and no evidence was found that anticoagulant therapy increases the risk of stroke recurrence or hemorrhage. The study supports considering anticoagulant therapy to improve long-term survival in elderly patients with cardiogenic stroke, and larger prospective studies are still needed to further validate the findings.

9. [Association analysis between genetic nurturing effects of CTNNA gene family and ischemic stroke].

期刊: Beijing da xue xue bao. Yi xue ban = Journal of Peking University. Health sciences 发表日期: 2026-Jun-18 链接: PubMed

摘要

To evaluate the genetic nurture effect of parental genotypes on the risk of ischemic stroke (IS) in offspring and to elucidate the parental origin-specific differences in this effect. This study utilized data from the “Family Cohort of Common Chronic Non-communicable Diseases in Rural Areas of Northern China”. A total of 530 core families and sibling pairs were selected, comprising 1 005 offspring. Single nucleotide polymorphisms (SNPs) within the CTNNA gene family (CTNNA1, CTNNA2 and CTNNA3) were detected. Using offspring as the unit of analysis, parental non-transmitted alleles were inferred based on Mendelian inheritance principles. Rigorous quality control was implemented for genotype imputation, ensuring high reliability of the inferred data. Linear mixed-effects models were constructed to estimate the genetic nurture effect of non-transmitted alleles on offspring IS. These models compared differences between genetic nurture effects and individual genetic effects, distinguished between paternal and maternal effects, and calculated the statistic η to assess the relative magnitude of parental effects. A total of 1 005 offspring from 530 families were included, comprising 308 IS patients (30.6%) with a mean age of 56.3 years. Sixteen independent SNPs associated with IS genetic nurture effects were identified (9 in CTNNA2, 6 in CTNNA3, and 1 in CTNNA1). The effect sizes ranged from -0.282 to 0.480, with rs117741773 (CTNNA2) showing the strongest effect (0.480, 95%CI: 0.278-0.682). Only four of these SNPs exhibited concurrent individual genetic effects, which acted in the opposite direction to the genetic nurture effects. Parent-of-origin specific analysis revealed that 12 SNPs exhibited genetic nurture effects from a single origin: 4 showed exclusively paternal effects (effect size: -0.298 to 0.945; η: 1.21 to 63.83), and 8 showed exclusively maternal effects (effect size: -0.489 to 0.602; η: 0.03 to 0.44). This study provides evidence that multiple IS susceptibility loci within the CTNNA gene family exhibit significant genetic nurture effects. The findings highlight the complex interplay between inherited genetics and the family environment. The heterogeneity of these effects based on parental origin underscores the significant role of parent-specific genetic nurture in the etiology of IS, offering new insights for understanding the missing heritability in stroke genetics.

10. [Analysis of the prevalence and influencing factors of myopia among primary and secondary school students in Inner Mongolia Autonomous Region in 2022].

期刊: Beijing da xue xue bao. Yi xue ban = Journal of Peking University. Health sciences 发表日期: 2026-Jun-18 链接: PubMed

摘要

To investigate the distribution characteristics of myopia among primary and secondary school students in Inner Mongolia Autonomous Region in 2020, and to comprehensively analyze its influencing factors at both school and individual levels, thereby providing scientific evidence for developing targeted myopia prevention and control strategies. A multistage stratified random cluster sampling method was employed to conduct vision examinations and questionnaire surveys among students from fourth grade to senior high school in Inner Mongolia Autonomous Region, collecting information on students’ visual habits, school and family environmental factors. A multilevel regression model was used to analyze the factors influencing myopia detection rates at both school and individual levels. A total of 130 601 students were included, with a myopia prevalence rate of 68.42%. The prevalence was higher among females (72.75%) than males (64.13%), in urban areas (73.63%) than in suburban counties (66.38%), and overall rates increased with educational level (trend test χ2=4 545.53, P < 0.001). Multilevel analysis revealed that at the individual level, female gender (OR=1.553), higher grade level (junior high OR=2.049, senior high OR=3.061), homework duration ≥1 h after school (≥1 h OR=1.050, ≥2 h OR=1.079), poor close-up vision habits (OR=1.059), prolonged close-up vision activities (0.5 h OR=1.070, ≥1 h OR=1.061), infrequent desk/chair height adjustments based on height (OR=1.006), and parental myopia (one parent OR=1.822, both parents OR=2.412) were risk factors for myopia; while ethnic minority status (Mongolian OR=0.956, other ethnicities OR=0.929), daily outdoor activity exceeding 2 hours (OR=0.986), performing eye exercises (1 session OR=0.891, ≥2 sessions OR=0.920), and adequate sleep (OR=0.925) served as protective factors. At the school level, qualified blackboard reflectance ratio (OR=0.874) and qualified blackboard surface illuminance uniformity (OR=0.973) were associated with reduced myopia risk among students. The model indicated that the included variables collectively explained approximately 31.04% of the variance at the school level. The prevalence of myopia among primary and secondary school students in Inner Mongolia Autonomous Region remains high, with influencing factors distributed across multiple levels including individual and school contexts. Comprehensive prevention strategies are recommended, focusing on female students, older grades, and those with genetic predispositions while intensifying interventions on modifiable factors like outdoor activities and visual habits. Improving classroom lighting environments is also crucial to reduce students’ myopia risk.

11. [A population-based survey of myopia on primary school students in an administrative district, 2019 to 2024].

期刊: Beijing da xue xue bao. Yi xue ban = Journal of Peking University. Health sciences 发表日期: 2026-Jun-18 链接: PubMed

摘要

To describe the myopia prevalence and spherical equivalent among primary school students in a district of Anhui Province in 2019, to analyze their changes in 2020 and 2024, to obtain baseline data, and to explore the potential impact of changes in screen time on vision, providing scientific evidence for myopia prevention and control strategies. This cross-sectional study included all the primary school students who underwent vision screening in 2019 (baseline period), 2020 (period of increased screen time), and 2024 (period of slightly resumed screen time). Data on grade, gender, uncorrected distance visual acuity, and refraction were extracted from the screening database. Noncycloplegic refraction was assessed using an FKR-710 autorefractor to measure sphere and cylinder, and uncorrected distance visual acuity was assessed using an K238-AZ LCD visual acuity chart. The spherical equivalent was calculated as sphere + 0.5 × cylinder. Myopia was defined as uncorrected distance visual acuity < 5.0 in either eye with a corresponding spherical equivalent ≤ -0.50 D. Myopia prevalence and spherical equivalent were described using percentage and mean with 95%confidence interval (CI). The Chi-square test and One-way analysis of variance were used to compare myopia prevalence and spherical equivalent across different years, followed by stratified analysis by grade. A total of 183 204 students were screened: 45 294 in 2019, 52 922 in 2020, and 84 988 in 2024. In 2019, the myopia prevalence was 30.8%(95%CI: 30.4%, 31.2%), higher in girls (33.7%) than in boys (28.4%) and increased with grade (P < 0.001), rising from 11.0%in Grade 1 to 35.7%in Grades 2-6. Compared with 2019, the myopia prevalence in 2020 increased by 4.3 (3.7, 4.9) percentage points to 35.1%(P < 0.001). By 2024, it further increased by 6.7 (6.2, 7.2) percentage points from the 2020 level to 41.8%(P < 0.001). In grade-stratified analyses, compared with 2019, Grade 1 students showed the largest increase in 2020; compared with 2020, Grade 1 students showed the smallest subsequent increase in 2024. Quantitative analysis of spherical equivalent showed that the mean spherical equivalent in 2020 was -0.72 D, representing a myopia shift of -0.21 D (-0.23 D, -0.19 D) compared with the 2019 level (P < 0.001); by 2024, the mean spherical equivalent was -0.68 D, indicating a hyperopic shift of 0.04 D (0.02 D, 0.06 D) compared with the 2020 level (P < 0.001). Further grade-stratified analyses indicated that the mean spherical equivalent for Grade 1 students in 2024 (0.08 D) had nearly returned to the 2019 level (0.09 D). The myopia prevalence among primary school students in the study area was 30.8%in 2019, higher than the global level and approximately twice that of the United States and four times that of Germany, indicating that myopia prevention and control among primary school students remains challenging. The myopia prevalence in 2020 and 2024 was higher than in 2019, suggesting that lifestyle changes, such as increased screen time, affect the short-term visual status. Younger students experienced the greatest increase in myopia prevalence in 2020 and the mildest subsequent increased in 2024, and their spherical equivalent in 2024 had almost recovered to the 2019 level, but not for older students. These findings indicate greater ocular plasticity in younger students, i.e. more sensitive to negative exposures and easier to recover after removing such exposures, warranting further investigation on the underlying mechanisms. Additionally, patterns of higher myopia prevalence in girls than in boys and a gradual increase with grade support previous studies, also enhancing the reliability of the relevant results in our study.

12. [Association between periconception maternal cold and heat exposure and the risk of congenital heart disease in offspring in China].

期刊: Beijing da xue xue bao. Yi xue ban = Journal of Peking University. Health sciences 发表日期: 2026-Jun-18 链接: PubMed

摘要

To investigate the associations between maternal exposure to cold and heat exposure during the three months before pregnancy and early pregnancy and the risk of congenital heart disease (CHD) in offspring, and to identify critical exposure windows and modifying factors. This nationwide cohort study included women aged 20-49 years with complete pregnancy outcome follow-up from the National Free Pre-pregnancy Check-ups Project (NFPCP) database between January 1, 2014 and April 21, 2020. Meteorological data from the European Centre for Medium-Range Weather Forecasts Reanalysis v5 (ERA5) dataset were linked to residential addresses. Cold and heat exposure were defined based on relative thresholds stratified by climate zone: heat and cold were defined as temperatures above the 90th percentile or below the 10th percentile, respectively, of the location-specific temperature distribution during each exposure window. Cox proportional hazards models were used to analyze the associations between cold and heat exposure during the three months before pregnancy and early pregnancy and the risk of CHD, and to calculate hazard ratios (HR) and 95% confidence intervals (CI) after adjusting for maternal age, body mass index (BMI), education level, geographical region, conception season, and relative humidity. Stratified analyses were performed to examine the effects of age, BMI, and fetal sex on the associations between cold and heat exposure and the risk of CHD. A total of 6 322 635 women aged 20-49 years with complete pregnancy outcome follow-up were included, and 1 478 cases of CHD were diagnosed among their offspring. The analysis showed that heat exposure during the three months before pregnancy was significantly associated with an increased risk of CHD in offspring (HR=1.49, 95%CI: 1.23-1.80); while no significant association was found for heat exposure during early pregnancy. No significant association was observed for cold exposure during the three months before pregnancy and early pregnancy (three months before pregnancy: HR=0.93, 95%CI: 0.77-1.14; early pregnancy: HR=0.95, 95%CI: 0.79-1.16). Stratified analyses showed that the risk of CHD associated with heat exposure during the three months before pregnancy was increased in women aged ≥30 years (HR=2.18, 95%CI: 1.54-3.10) and in male fetuses (HR=1.73, 95%CI: 1.31-2.29); the risk of CHD associated with heat exposure during early pregnancy was significantly increased in women with BMI ≥24 kg/m2 (HR=1.86, 95%CI: 1.21-2.87). Heat exposure during the three months before pregnancy might increase the risk of congenital heart disease in offspring, and this risk was elevated in both women aged ≥30 years and male fetuses. Furthermore, heat exposure during early pregnancy significantly increased the risk of congenital heart disease in offspring among women with BMI ≥24 kg/m2. No significant association was observed between cold exposure and the risk of congenital heart disease.

13. [Epidemiological characteristics of intussusception in children aged 0-3 years in Jiangsu Province from 2018 to 2023].

期刊: Beijing da xue xue bao. Yi xue ban = Journal of Peking University. Health sciences 发表日期: 2026-Jun-18 链接: PubMed

摘要

To describe the incidence density of intussusception and its distribution characteristics across different ages, genders, and time periods among resident children aged 0-3 years in Jiangsu Province from 2018 to 2023, providing a scientific basis for health administrative departments in the region to formulate prevention and control strategies and measures for intussusception in children aged 0-3 years. A retrospective cohort study was conducted using data from the Jiangsu Regional Health Information Platform (RHIP). Resident children aged 0-3 years born between January 1, 2018, and December 31, 2023, were included. Suspected cases were identified by retrieving the International Statistical Classification of Diseases and Related Health Problems, 10 revision (ICD-10) code “K56.1” and semantically related keywords for “intussusception” from the original text using a regular expression matching algorithm. An incident case was defined as the first occurrence of the disease during the study period. Follow-up person-years were calculated using the exact person-time method. The Poisson distribution was applied to estimate the overall and subgroup incidence densities and their 95% confidence intervals (CI). Poisson regression models were constructed to calculate incidence rate ratio (IRR) and examine the effects of age (in months) and seasonal differences on incidence density. A birth cohort comprising 2 252 691 children aged 0-3 years was established, accumulating a total follow-up of 5 316 389.55 person-years. During the study period, 2 650 incident cases of intussusception were identified, including 1 600 boys (60.4%) and 1 050 girls (39.6%). The overall incidence density was 49.8 (95%CI: 47.9-51.7) per 100 000 person-years. The incidence density was 57.8 (95%CI: 54.9-60.6) per 100 000 person-years for boys and 41.2 (95%CI: 38.7-43.7) per 100 000 person-years for girls, with a statistically significant difference between the sexes. Seasonal variations were observed, with peaks occurring in summer and winter. The incidence density exhibited a unimodal pattern, peaking at 8 months (98.5 per 100 000 person-years). The median age of onset was 19.2 months [interquartile range (IQR): 11.4-26.6 months]. This large retrospective cohort study based on the Jiangsu RHIP clarified the epidemiological characteristics of intussusception among local children aged 0-3 years from 2018 to 2023. Boys and children aged 8 months to 3 years were identified as high-risk populations for intussusception, with peak incidence occurring in summer and winter. These findings provide evidence-based support for health authorities to formulate targeted strategies for early surveillance, prevention, and healthcare resource allocation.

14. [Association between umbilical cord blood proteome and early infant neurodevelopmental risk].

期刊: Beijing da xue xue bao. Yi xue ban = Journal of Peking University. Health sciences 发表日期: 2026-Jun-18 链接: PubMed

摘要

To systematically investigate the associations between umbilical cord blood protein expression profiles and early infant neurodevelopment using a prospective birth cohort, to identify potential early biomarkers through high-throughput proteomics, and to explore underlying biological mechanisms, thereby providing scientific evidence for early identification of neurodevelopmental risks and understanding the molecular basis of neurodevelopmental deviations in general populations. Based on the Peking University Birth Cohort in Tongzhou, this study enrolled 96 children who completed ages and stages questionnaires, third edition (ASQ-3) assessments at 1 and 3 years of age. Participants were classified into an abnormal group (n=42) and a control group (n=54) according to ASQ-3 screening results. Non-targeted quantitative proteomics was performed on cryopreserved umbilical cord blood plasma samples collected at birth. Differential expression analysis, principal component analysis (PCA), orthogonal partial least squares discriminant analysis (OPLS-DA), and weighted gene co-expression network analysis (WGCNA) were conducted to identify differentially expressed proteins, followed by Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) functional enrichment analyses. The fold change (FC) was calculated. Independent samples t-test was used for statistical comparison, with Benjamini-Hochberg method applied to calculate false discovery rate (FDR) for multiple testing correction. Proteomic analysis identified 8 214 common proteins, among which 385 proteins were differentially expressed (P < 0.05, |log2FC| >0.585), including 189 proteins upregulated and 196 proteins downregulated in the abnormal group. PCA and OPLS-DA revealed systematic differences in protein expression patterns between the two groups. WGCN A identified 10 co-expression modules, with the yellow module showing significant negative correlation with ASQ-3 abnormal grouping (r=-0.233, P=0.024) and the pink module positively correlating with communication domain scores (r=0.342, P=0.003). Enrichment analyses demonstrated that differential proteins and key modules were primarily enriched in two functional categories: (1) genetic information processing pathways, including ribosome, spliceosome, and mRNA processing; and (2) cytoskeleton organization and Wnt signaling pathways. These pathways held significant biological relevance in the pathogenesis of neurodevelopmental disorders. Perturbations in proteins associated with genetic information processing and cytoskeleton/Wnt signaling pathways in umbilical cord blood may represent important molecular characteristics of early neurodevelopmental screening abnormalities in infants. This study provides potential peripheral blood biomarker combinations for early identification of neurodevelopmental risks in general populations and offers novel insights into the biological mechanisms underlying neurodevelopmental deviations. Future research should validate these findings in larger-scale cohorts and elucidate specific functional mechanisms of key proteins through experimental studies.

15. [Policy logic and multiple challenges of meal assistance services for older adults under the goal of healthy aging].

期刊: Beijing da xue xue bao. Yi xue ban = Journal of Peking University. Health sciences 发表日期: 2026-Jun-18 链接: PubMed

摘要

To provide empirical evidence for optimizing meal assistance policies and strengthening their role in supporting the health of older adults, this study took Shandong Province as a case to examine the policy logic and practical challenges of meal assistance services for older adults. A combination of policy tool text analysis and qualitative interviews was employed. For the policy tool analysis, 59 policy documents related to meal assistance for older adults at the central and Shandong provincial levels from 2013 to 2024 were selected and categorized using a three-part framework, with policy provisions coded and analyzed as units. Qualitative interviews were conducted in two rounds, from August to October 2023 and again in January 2026, across eight urban and rural sample sites within Shandong’ s three major economic circles, involving 17 providers of meal assistance services for older adults; the interview data were coded and analyzed using thematic analysis. Finally, the two sets of data, including policy tools and implementation themes, were integrated through a comparative approach. The development of meal assistance policies for older adults in Shandong Province can be broadly divided into three stages: The initial stage, the growth stage, and the deepening stage. Overall, policy tools exhibited a balanced emphasis on supply-oriented and environment-oriented instruments, while demand-oriented instruments remained relatively insufficient. Interview findings indicated that urban areas had primarily adopted a “government subsidy + market operation” model, while rural areas mainly relied on happiness homes, village collective resources, and public welfare positions to deliver meal assistance services. However, both urban and rural areas faced common challenges, including a mismatch between financial subsidies and operational costs, a shortage of professional staff, weak motivation for social participation, insufficient expression of demand and sustained spending by older adults, and limited implementation capacity at the grassroots level. Meanwhile, some meal assistance sites showed early signs of health-oriented meal assistance practices, such as adjusting menus according to older adults ‘dietary preferences, chewing ability, and chronic disease conditions, reducing oil and salt in meal preparation, and exploring meal delivery and health education activities. Nevertheless, these efforts remained largely experience-based and fragmented, and had not yet developed into a standardised model. Meal assistance services for older adults are not only a livelihood initiative to ensure access to warm meals for older adults, but also a crucial entry point for promoting balanced diets, maintaining functional capacity, and achieving healthy aging. Future efforts should focus on refining a tiered and categorized subsidy mechanism, optimizing the differentiated supply structure between urban and rural areas, enhancing demand-side mobilization and social collaboration, strengthening grassroots governance and quality supervision, and facilitating the transition of meal assistance services from project-based provision to an institutionalized and sustainable model.

16. [Joint trajectories and evolution patterns of direct and indirect maternal mortality across 204 countries from 2000 to 2021].

期刊: Beijing da xue xue bao. Yi xue ban = Journal of Peking University. Health sciences 发表日期: 2026-Jun-18 链接: PubMed

摘要

To identify joint trajectory patterns of direct and indirect maternal mortality ratios (MMR) at the country level from 2000 to 2021, and to compare phase-specific changes during the millennium development goals (MDG, 2000 to 2015) and the sustainable development goals (SDG, 2015 to 2021) periods, as well as differences in health system and policy environments across trajectory groups. Data on maternal mortality among women aged 15-49 years in 204 countries and territories from 2000 to 2021 were obtained from the Global Burden of Disease (GBD) Study. Direct cause MMR and indirect cause MMR at five time points (2000, 2005, 2010, 2015, and 2021) were jointly analyzed using longitudinal K-means clustering (k=2-6). The optimal number of clusters was determined by the Calinski-Harabasz (CH) index. Based on the clustering results, a piecewise linear mixed effects model with random intercepts was fitted with a knot in 2015 to estimate the baseline intercept in 2000 and period-specific slopes for the MDG and SDG phases. For 2021, health system and policy-related indicators, including antenatal care coverage (≥4 visits, ANC4), proportion of women with a demand for contraception that are using a modern method, cesarean section rate, female human immunodeficiency virus (HIV) prevalence, in facility delivery rate, skilled birth attendance, and an abortion legality index were compared across clusters using the Kruskal-Wallis H test. All tests were two-sided, and P < 0.05 was considered statistically significant. The CH index peaked at k=3 (CH=342.63), classifying the 204 countries and territories into three joint trajectory clusters: high burden (n= 66), medium burden (n=88), and low burden (n=50). In 2021, direct MMR was 334.6 (95%CI: 282.5- 386.7), 65.6 (95%CI: 50.4-80.7), and 5.4 (95%CI: 3.7-7.0) per 100 000 live births in the high, medium, and low burden clusters, respectively; indirect MMR was 33.6 (95%CI: 27.9-39.2), 18.2 (95%CI: 13.5-22.9), and 0.9 (95%CI: 0.6-1.3) per 100 000 live births, respectively. The piecewise mixed effects model showed significant declines in direct MMR during the MDG period in all clusters (slopes: -0.020, -0.016, and -0.036; P < 0.001), whereas declines slowed and became non-significant during the SDG period (-0.011, 0.011, and -0.006; P > 0.05). For indirect MMR, modest increases were observed during the MDG period in the high and medium burden clusters (0.029 and 0.015; P < 0.05), with no significant change in the low burden cluster (P > 0.05). During the SDG period, indirect MMR increased markedly in the medium burden cluster (slope: 0.121; 95%CI: 0.092-0.151; P < 0.001), while remaining broadly stable in the high and low burden clusters (P > 0.05). Health system and policy indicators differed significantly across the clusters (P < 0.001): the high burden cluster showed lower ANC4 coverage, lower in facility delivery and skilled birth attendance, lower demand for contraception satisfied by modern methods, and higher female HIV prevalence; the medium burden cluster achieved near universal in facility delivery and skilled birth attendance but had a higher cesarean section rate; the low-burden cluster generally showed more favorable indicator profiles and a higher abortion legality index. Distinct joint trajectories of direct and indirect maternal mortality were observed globally from 2000 to 2021. While reductions in direct maternal mortality were substantial during the MDG era, progress broadly slowed and plateaued during the SDG era. Meanwhile, the pronounced rise in indirect maternal mortality in medium-burden countries during the SDG period suggests potential structural risk accumulation even when overall MMR appears stable. Incorporating joint direct-indirect trajectories into routine monitoring may facilitate stage and cluster specific prioritization of maternal health interventions.

17. [Spatial accessibility and optimization of pediatric healthcare resources in Beijing].

期刊: Beijing da xue xue bao. Yi xue ban = Journal of Peking University. Health sciences 发表日期: 2026-Jun-18 链接: PubMed

摘要

To assess the spatial accessibility of pediatric healthcare resources in Beijing and to develop an optimization model for resource allocation under a fixed additional resource constraint, with the aim of exploring optimal allocation strategies for 2025 and 2030. Using communities as the unit of analysis, this study integrated data on Beijing ‘ s child population in 2020 and pediatric healthcare resources in 2022. An improved two-step floating catchment area (2SFCA) method was applied to measure spatial accessibility. Based on projected child population data for 2025 and 2030, an optimization model was constructed to minimize regional disparities in accessibility. Under the constraint of a fixed total number of additional resources, optimal spatial allocation schemes were derived and compared with a conventional population-based allocation approach. In 2022, Beijing had 4 704 pediatric beds and 4 011 pediatric physicians. The mean spatial accessibility for pediatric beds and pediatric physicians was 1.17 and 0.97, respectively, with a standard deviation of 2.78 for bed accessibility, exhibiting a clear spatial pattern of higher accessibility in central districts and lower accessibility in suburban districts. In the same year, the number of pediatric physicians per 1 000 children in Beijing reached 1.52, already exceeding the targets for 2025 and 2030; therefore, no additional increase in total physician numbers was required. Under the 2025 optimization scenario, the mean accessibility of pediatric beds increased to 1.68, with the standard deviation declining to 2.45, indicating a reduction in regional disparities. Under the 2030 scenario, the mean accessibility further increased to 2. 31, with a standard deviation of 2.56, reflecting continued improvement in accessibility. The optimization model identified Daxing District, Tongzhou District, and Mentougou District as priority districts for additional bed allocation, whereas the conventional population-based approach allocated more resources to Daxing District, Haidian District, and Tongzhou District. While the two approaches showed general consistency in overall spatial allocation, the optimization model more effectively addressed inter-district disparities in accessibility. Significant spatial disparities were identified in the distribution of pediatric healthcare resources in Beijing. The accessibility-oriented optimization approach, under a fixed resource constraint, improved the alignment between supply and demand and reduced regional inequities. It served as a useful complement to conventional population-based allocation methods and provided quantitative evidence to support refined planning and dynamic adjustment of pediatric healthcare resources. Given that the total number of pediatric physicians has already met national targets, leveraging integrated medical consortium and multi-site practice policies to promote the mobility of qualified pediatric physicians toward underserved areas represents a promising pathway toward structural optimization of spatial resource distribution.

18. [Differences in the formation mechanism of performance-based compensation in public hospitals with different administrative affiliations].

期刊: Beijing da xue xue bao. Yi xue ban = Journal of Peking University. Health sciences 发表日期: 2026-Jun-18 链接: PubMed

摘要

One of the explicit goals of public hospital salary reform is to gradually and steadily narrow the salary gap among public hospitals. This study, taking public hospitals at different administrative levels as its starting point, seeks to investigate the differences in the formation mechanisms of performance-based pay. From June to November 2024, a purposeful sampling strategy was adopted. A total of 43 in-depth interviews were conducted across 14 public hospitals located in a certain municipality directly under the central government. These hospitals covered three administrative tiers: the national level, the provincial and ministerial level, and the prefectural and municipal level. All interview data were analyzed using grounded theory methodology. Through three-level coding, a total of seven core categories were extracted: external constraints, strategic positioning, market capabilities, business structure, incentive systems, management capabilities, and personnel characteristics. These seven factors jointly influenced performance-based salary distribution in public hospitals, but their specific manifestations and interactions showed marked differences across hospitals at different administrative levels. Specifically, public hospitals at higher administrative levels might be fully exempt from wage total amount constraints, or, even when operating within the total framework, still retained a considerably large distributable space. Relying on their high-level strategic positioning, these hospitals developed strong market capabilities and a business structure dominated by high-pricing medical services. They adopted a metric-based, incremental incentive model that allocated rewards directly to individual physicians, with the incentive scope covering the entire chain of medical care, education, and research. In contrast, public hospitals at lower administrative levels faced triple constraints: insufficient bargaining power in the healthcare market, limited and unstable patient sources, and a single compensation pathway heavily reliant on service volume. Their business structure was mainly composed of low-pricing projects with limited profitability. Consequently, they were forced to adopt a position-based performance model, where the incentive scope narrowed to basic medical quality, leaving these hospitals struggling with fragile incentives and persistent talent loss. Public hospitals at different administrative levels present structural differences in their mechanisms for determining performance-based salaries. During the top-down transmission of reform policies, the hierarchical institutional environment, together with stratified market capabilities and management capacities, acts as a multi-layer filter. This filtering process leads to heterogeneous policy performances across different hospital tiers.

19. [Associations of subjective perceptions and income change with transitions in usual source of care among Chinese residents: A study based on China Family Panel Studies].

期刊: Beijing da xue xue bao. Yi xue ban = Journal of Peking University. Health sciences 发表日期: 2026-Jun-18 链接: PubMed

摘要

Using the China Family Panel Studies (CFPS, 2012-2022), this study aimed to characterize changes in the distribution of usual sources of care and in subjective perceptions among Chinese adults, and to examine the associations of subjective perceptions and income change with next-wave transitions in usual source of care. This was a retrospective longitudinal observational study based on adult CFPS data from 2012, 2014, 2016, 2018, 2020, and 2022. We first described temporal trends in three types of usual source of care (primary care, hospitals, and clinics), as well as trends in residents’ subjective perceptions of healthcare providers, and in relative income change. We then constructed person-period samples from adjacent survey waves and analyzed two transition processes separately: outflow from primary care among baseline primary care users and inflow to primary care among baseline non-primary care users. Key predictors were prior-wave satisfaction, perceived medical competence, and relative income change; the income-change variable was defined based on changes in relative income group within the same wave and same province sample. Descriptive analyses applied cross-sectional weights; the main regressions were unweighted binary Logistic models with individual-level cluster-robust standard errors, reporting odds ratios (OR), 95% confidence intervals (95% CI), and P va-lues. The pooled sample comprised 135 986 observations from 34 010 individuals. From 2012 to 2022, the proportion using primary care as the usual source of care declined from 43.49% to 30.34%, whereas the hospital share rose from 34.06% to 46.81%. The decline in primary care was steeper during 2012-2018 (43.49% to 33.72%) and persisted at a slower pace thereafter (33.72% to 30.34%). Across adjacent survey waves, primary care outflow increased from 35.47% to 45.22%, while primary care inflow decreased from 30.09% to 19.60%, indicating simultaneous increases in exits and decreases in entries. Subjective perceptions improved for all three provider types over time; however, the relative gap between primary care and hospitals widened on perceived medical competence, and primary care shifted from a slight advantage over clinics to a clear disadvantage in composite subjective perceptions. The proportion of residents with unchanged relative income group rose from 50.64% to 60.33%. In multivariable models, each one-unit increase in satisfaction with primary care was associated with 7.5% lower odds of leaving primary care (OR=0.925, P < 0.001). In contrast, each one-unit increase in perceived medical competence of non-primary care providers was associated with 5.3% lower odds of moving into primary care (OR=0.947, P < 0.001). Compared with stable relative income group, upward relative income-group mobility, particularly low-to-high movement, was associated with higher odds of outflow from primary care and lower odds of inflow to primary care (outflow OR=1.166; inflow OR=0.840), whereas downward relative income-group mobility, especially high-to-low movement, showed the opposite pattern (outflow OR=0.785; inflow OR=1.371). Primary care utilization in China continued to decline, with increased outflow from primary care and reduced inflow to primary care occurring simultaneously. Residents ‘ subjective perceptions were associated with different considerations in retention in versus movement into primary care: the former was more closely related to satisfaction, whereas the latter was more closely related to perceived medical competence. People with upward relative income-group mobility showed a lower inclination to use primary care. Hierarchical care policy should address both entry into and retention in primary care by strengthening continuity of care, reinforcing service capability and institutional design, and aligning payment incentives.

20. [Evaluation of bilateral vaccine cooperation priority countries on Chinese human papillomavirus vaccine using hierarchical K-means hybrid clustering].

期刊: Beijing da xue xue bao. Yi xue ban = Journal of Peking University. Health sciences 发表日期: 2026-Jun-18 链接: PubMed

摘要

To evaluate priority target countries and formulate context-specific cooperation modalities for China ‘ s bilateral international collaboration on human papillomavirus (HPV) vaccines, thereby furnishing an evidence-based reference for optimizing China ‘ s bilateral vaccine cooperation stra-tegies and contributing to global health equity. Using a previously established index system designed for selecting preferred countries in China ‘ s international vaccine cooperation, we comprehensively applied a weighted-scoring approach to quantitatively rank 29 Phases 3 and 4 Global Alliance for Vaccines and Immunization (Gavi) eligible countries in HPV vaccine cooperation. Based on 5 first-level index (legal and regulatory factors, economic factors, political factors, social factors, and technological factors) scores, a hierarchical K-means hybrid method was used for clustering the countries. Hierarchical clustering was initially utilized to explore the underlying data structure and determine the optimal number of clusters, followed by K-means clustering to precisely categorize the evaluated nations based on their multidimensional characteristics. The top10 countries were mostly Asian countries. African countries were mostly in the lower ranks. The countries were clustered into three types: (1) Technology transfer priority (n=3: Indonesia, Viet Nam, Uzbekistan), characterized by above-average economic, techno-scientific and political scores, robust vaccine-import volumes, non-negligible domestic manufacturing capacity and high political stability-recommended for priority collaboration; (2) Basic assistance (n=25), approximating mean indicator values, typically low-population or low-income economies suitable for aid-based or concessional-procurement models; (3) High barrier (n=1: India), exhibiting high socio-demographic and scientific base yet minimal legal-regulatory scores, indicating large demand, established vaccine industry, but formidable registration barriers. Policy recommendations included: concessional product export plus clinical-trial cooperation with Indonesia, with prospective licensing and technology transfer; clinical-trial collaboration with Viet Nam; and licensing/technology-transfer schemes with Uzbekistan. Indonesia, Viet Nam, and Uzbekistan are identified as the priority target countries for China ‘ s bilateral international cooperation on HPV vaccines. For these technology-transfer priority nations, cooperation should be strategically conducted through diverse modalities encompassing vaccine product export, clinical trial collaboration, authorized licensing, and technology transfer.

21. [Dynamic stretching promotes osteogenic differentiation of human bone marrow mesenchymal stem cells in three-dimensional culture].

期刊: Beijing da xue xue bao. Yi xue ban = Journal of Peking University. Health sciences 发表日期: 2026-Jun-18 链接: PubMed

摘要

To explore the promotion of dynamic distraction on osteogenic differentiation of human bone marrow mesenchymal stem cells (hBMMSCs) in three-dimensional culture. Dynamic stretching in a three-dimensional culture for hBMMSCs was achieved with proportions set at 5%, 10%, and 20%, a frequency of 0.5 Hz, and a dynamic stretching duration of 2 hours per day. Static culture was used as the control group. Deformation of hBMMSCs induced by dynamic stretching was observed through cytoplasmic fluorescence staining. After 7 days of dynamic stretching culture, the impact of dynamic stretching on the viability of hBMMSCs was observed through cell live/dead staining. The effect of dynamic stretching on the osteogenic differentiation of hBMMSCs was observed through alkaline phosphatase (ALP) staining and the expression of osteogenic related genes and proteins after 7 days of dynamic stretching culture. Dynamic stretching in a three-dimensional culture for hBMMSCs was successfully constructed, which could achieve different durations, frequencies, and ratios of dynamic stretching. Dynamic stretching led to deformation of hBMMSCs, and the greater the stretching ratio, the more pronounced the cell deformation, transitioning from a circular to a flat oval shape. After 7 days of dynamic stretching culture, hBMMSCs in the static control group and dynamic stretching groups were mostly green stained live cells, with only a few red stained dead cells. The difference in the proportion of live cells between the groups was not statistically significant (P>0.05). The ALP staining in the dynamic stretching group was deeper than that in the static control group, and the number of ALP staining positive cells observed under the microscope was higher. The expression of osteogenic related genes and proteins increased after 7 days of dynamic stretching culture, and the difference was statistically significant (P < 0.05). Among them, the dynamic stretching group with 10% had the deepest ALP staining, the highest number of positive cells, and the most significant increase in the expression of osteogenic related genes and proteins compared with the static control group. Dynamic stretching caused deformation of hBMMSCs without a significant impact on cell viability, and it could effectively promote the osteogenic differentiation of hBMMSCs.

22. [Association between ambient personal temperature exposure and oxygen saturation during sleep in patients with chronic obstructive pulmonary disease].

期刊: Beijing da xue xue bao. Yi xue ban = Journal of Peking University. Health sciences 发表日期: 2026-Jun-18 链接: PubMed

摘要

To assess the association between personal temperature exposure and oxygen saturation (SpO2) during sleep in chronic obstructive pulmonary disease (COPD) patients, to analyze potential susceptibility factors and to provide a scientific basis for the adoption of effective measures to safeguard the health of susceptible populations. In this prospective panel study, 96 stable COPD patients were recruited. From March 2021 to September 2023 in Beijing, all participants completed 202 nights (from 20:00 to 08:00) of dynamic real-time SpO2 monitoring during sleep, simultaneously monitoring personal exposure level to temperature, alongside environmental humidity and other key air pollutant data. Based on previous clinical studies, SpO2 < 90% was defined as desaturation to assess the risk of hypoxic events occurring during sleep. Linear mixed-effects models and generalized linear mixed-effects models were used to analyze the association between personal temperature exposure and SpO2 during sleep, as well as the risk of oxygen desaturation. Interaction models were constructed to evaluate susceptibility factors. During the study, the average personal temperature exposure was (27.5± 2.6) ℃, with a temperature range from 16.5 ℃ to 40.0 ℃. Short-term exposure to personal temperature was associated with a decline in SpO2 and an increased risk of oxygen desaturation during sleep in the COPD patients. The effect of temperature exposure was strongest at lag 0-30 min, with a 0.24% (95%CI: -0.28%, -0.20%) decrease in SpO2, and with an odds ratio (OR) of oxygen desaturation was 1.26 (95% CI: 1.12, 1.42) for each interquartile range (IQR, 6.0 ℃) increase in temperature. Besides, the patients exposed to medium and high humidity levels were more likely to be affected by temperature exposure compared with the patients exposed to low humidity levels. Personal temperature exposure had a stronger effect on SpO2 during sleep in the patients with global initiative for chronic obstructive lung disease (GOLD) Ⅲ-Ⅳ compared with the patients with GOLD Ⅰ-Ⅱ (Pinteraction < 0.05). From 16.5 ℃ to 40.0 ℃, personal temperature exposure is associated with SpO2 decline during sleep in COPD patients. There was a significant synergistic amplification between temperature and humidity, patients were more susceptible to damage under high temperature and high humidity conditions. Moreover, patients with poorer lung function are more significantly affected by temperature.

23. Patient perspectives on general practitioners in forensic psychiatric wards.

期刊: Nordic journal of psychiatry 发表日期: 2026-Jun-13 链接: PubMed

摘要

Forensic psychiatric patients experience high rates of preventable physical illness. Integrating primary care within forensic settings may help address this gap, yet little is known about how patients experience such services. To explore how forensic psychiatric patients experienced an on-ward general practitioner (GP) service and how these experiences shaped engagement with integrated care. We conducted a qualitative interview study with 14 patients from two Danish medium-secure forensic psychiatric wards. Semi-structured interviews were analyzed using reflexive thematic analysis to identify key patterns of meaning. Patients generally perceived the GP service as relevant and valued its distinct somatic focus, which countered perceptions that physical symptoms were overlooked by psychiatric staff. The GP’s proximity and accessibility encouraged consultations, and the outsider role provided a less custodial relationship. However, engagement was conditional and barriers were experienced, such as limited continuity, perceptions of redundancy due to existing services, and discomfort during intimate examinations, especially when staff were present or of the opposite sex. While broadly welcomed, GP engagement remained reactive and dependent on trust and privacy. These findings suggest that future integrated care models may benefit from considering relational continuity, sensitive examination practices, and structures supporting preventive somatic care.

24. Nurses' and Physicians' Experiences With Digital Remote Patient Monitoring-Transforming the Boundaries of Breast Cancer Care.

期刊: Journal of clinical nursing 发表日期: 2026-Jun-13 链接: PubMed

摘要

To explore expectations and experiences of nurses and physicians with remote care monitoring for breast cancer patients within the Norwegian specialist health service. Qualitative exploratory study. Individual semi-structured interviews were conducted with nine nurses and physicians before and after the implementation of remote patient monitoring. The data were analysed using reflexive thematic analysis. Three key themes were developed: (1) ‘Navigating patient empowerment: Reassurance, misinterpretation and guidance in remote patient monitoring communication’; (2) ‘Digital care impacts the workflow: Efficiency gains and hidden burdens’; and (3) ‘Clinical judgement in a digital context: Balancing standardisation and clinical discretion’. While remote patient monitoring increased flexibility and targeted follow-up, it also reshaped roles and workloads and introduced new interpretive demands that often lack formal delegation, highlighting the need for clearer task allocation and organisational support. Remote patient monitoring expands nurses’ roles in symptom assessment and digital follow-up. As such, clear role boundaries and support for clinical judgement are essential for its successful implementation. The results are relevant for management in healthcare services, nurses and other healthcare professionals implementing remote patient monitoring. The study followed CORQ guidelines. Four user representatives with lived experience of breast cancer contributed to the design of the study and gave input regarding the interview guide.

25. Global trends and emerging themes in digital human resource management in healthcare: A bibliometric analysis.

期刊: Health services management research 发表日期: 2026-Jun-13 链接: PubMed

摘要

This study aims to systematically examine global research on digital human resource management (HRM) in healthcare using bibliometric analysis of 61 documents published between 1988 and 2024. This number reflects the emerging and highly specialized nature of digital HRM in healthcare research. VOSviewer software was utilized to map co-authorship networks and keyword co-occurrences and to generate overlay and density visualizations. A threshold-based approach was applied to identify key themes and research patterns across the literature. There has been significant publication growth, especially after 2018, with the United States, United Kingdom, and India emerging as the leading contributors. Results reveal four thematic clusters representing technological, organizational, demographic, and governance perspectives. These insights illuminate underexplored areas, such as leadership integration and equity, which are essential for guiding digital transformation in healthcare workforce management. Healthcare managers and policymakers should prioritize the strategic integration of digital HRM tools into system-level planning. Emphasis should be placed on aligning digital solutions with organizational leadership, workforce development, and public health goals, particularly in resource-constrained settings.

26. Beyond Surveillance: Reframing Nursing Observation as Therapeutic Engagement in Psychiatric Care.

期刊: Journal of psychiatric and mental health nursing 发表日期: 2026-Jun-13 链接: PubMed

摘要

27. E-cigarette aerosols induce the hydrolysis of lysosomal glycerophospholipids through PLA2G4A activation initiated by nicotine binding to CHRNA3/α3 nAchr in airway epithelial cells.

期刊: Autophagy 发表日期: 2026-Jun-13 链接: PubMed

摘要

Accumulating evidence has demonstrated a significant association between e-cigarette exposure and airway epithelial damage. Nevertheless, the molecular drivers orchestrating this pathology remain unclear. Here, we demonstrated that nicotine is the key component of e-cigarette aerosols that induced pathogenic changes, including apoptosis, oxidative stress, and mucus overproduction, in mouse airway epithelium and in human bronchial epithelial (HBE) cells. We further established that the nicotine of e-cigarette aerosols induced autophagosome formation via MTOR inhibition, while concurrently suppressing autolysosomal degradation through lysosomal membrane permeabilization (LMP). Restoration of lysosomal membrane integrity reversed e-cigarette aerosol-induced LMP and the subsequent macroautophagy/autophagy inhibition, thereby alleviating airway epithelial damage. Mechanistically, nicotine of e-cigarette aerosols permeabilized lysosomal membranes via calcium-dependent activation of PLA2G4A, which hydrolyzed the sn-2 ester bond of lysosomal glycerophospholipids, generating lysophospholipids. This process was initiated by nicotine binding to CHRNA3/α3 nAChR, a ligand-gated ion channel whose activation triggered intracellular Ca2+ overload. Genetic or pharmaceutical inhibition of CHRNA3 reduced intracellular Ca2+ content, abolishing PLA2G4A activation. This inhibited lysosomal glycerophospholipid hydrolysis, thereby attenuating LMP and subsequently resolving autophagic flux blockade and cytotoxicity in HBE cells. Moreover, the role of CHRNA3-mediated PLA2G4A activation in e-cigarette aerosol-induced autophagy-lysosome dysfunction and cellular toxicity was validated in human lung organoids. Overall, our study underscores the importance of CHRNA3 activation, as a molecular initiating event (MIE), in the regulation of PLA2G4A-mediated hydrolysis of glycerophospholipids and autophagic flux impairment, and CHRNA3 inhibition could serve as a potential therapy for airway disorders induced by e-cigarette aerosols.

28. Determinants of obstructed labor among pregnant women in Mogadishu, Somalia: A case-control study.

期刊: International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 发表日期: 2026-Jun-13 链接: PubMed

摘要

Obstructed labor is a preventable cause of maternal and perinatal mortality, with a disproportionately high burden in low-resource settings. In Somalia, decades of conflict have fragmented the health system, contributing to one of the world’s highest maternal mortality ratios. The aim of the present study was to identify the determinants of obstructed labor among women delivering at Banadir Hospital, Mogadishu, Somalia. A hospital-based unmatched case-control study was conducted from June to August 2025. A total of 450 participants were enrolled. Data were collected using a structured questionnaire through participant interviews. Multivariable logistic regression analysis was performed to identify independent risk factors associated with obstructed labor. Results are presented as adjusted odds ratios (aOR) with 95% confidence intervals (CIs). Cephalopelvic disproportion was the primary cause of obstructed labor (63.3%). Significant independent risk factors included diabetes in pregnancy (aOR = 9.09, 95% CI: 2.73-30.29), being referred from another health facility (aOR = 7.00, 95% CI: 2.98-16.46), labor duration ≥12 h (aOR = 5.11, 95% CI: 2.71-9.63), and attending fewer than four antenatal care (ANC) visits (aOR = 3.71, 95% CI: 1.21-11.40). Other determinants included residing outside Mogadishu (aOR = 2.84, 95% CI: 1.16-6.93), maternal overweight body mass index (BMI) (aOR = 2.56, 95% CI: 1.36-4.82), neonatal birth weight ≥3.5 kg (aOR = 2.41, 95% CI: 1.37-4.24), and a previous history of obstructed labor (aOR = 2.06, 95% CI: 1.20-3.53). Primiparity was also a major risk factor, as multiparity demonstrated a 90% reduction in risk (aOR = 0.10, 95% CI: 0.05-0.23). Obstructed labor in Mogadishu is driven by a convergence of physiological vulnerabilities and systemic health system failures, characterized by the three delays in accessing and receiving care. To reduce the burden of this condition, interventions must focus on strengthening the continuum of care. Key priorities include improving early risk identification and diabetes screening during ANC, streamlining referral pathways from peripheral clinics, and ensuring the consistent use of partographs for intrapartum monitoring to prevent dangerously prolonged labor.

29. Synthesis of 15N-Labeled Bevirimat Derivatives as Isotopic Chemical Probes of HIV-1 Maturation Inhibition.

期刊: Magnetic resonance in chemistry : MRC 发表日期: 2026-Jun-13 链接: PubMed

摘要

Characterizing protein-drug interactions at the atomic level is challenging partly because small molecules can be difficult to detect within large biomolecular complexes. We have developed a strategy to introduce NMR-active isotopic 15N labels into derivatives of bevirimat (BVM), a triterpenoid inhibitor of HIV-1 maturation. Isotopically labeled compounds were synthesized through concise and efficient routes using commercially available, isotopically enriched building blocks. Three 15N-labeled BVM derivatives were prepared to be used as molecular probes to investigate HIV-1 protein interactions. These labeled compounds enable site-specific 15N detection of the inhibitor in both solution and solid-state NMR experiments, which will be useful to obtain molecular-level insight into the interactions between BVM derivatives and its target HIV-1 Gag protein. Synthetic incorporation of NMR-active isotopes produces chemical probes for atomic-level analysis of next-generation HIV-1 therapeutics derived from BVM and can be applied to other derivatives of betulinic acid with various medical applications.

30. Feasibility and acceptability of a multi-level school-based intervention for adolescent mental health in Nepal: a mixed-methods study.

期刊: Child and adolescent psychiatry and mental health 发表日期: 2026-Jun-13 链接: PubMed

摘要

Adolescence is a crucial developmental stage characterized by rapid biological, psychological, and social changes, that increase vulnerability to mental health issues. Nearly half of all mental health conditions have their onset during this period and are influenced by individual, family, and environmental factors. Schools play a key role in promoting mental well-being among adolescents due to their accessibility and reach. While school-based mental health prevention interventions have shown positive outcomes in high-income countries, evidence from low- and middle-income countries (LMICs) is limited. This study aimed to assess the feasibility and acceptability of Health Action in Schools for a Thriving Adolescent Generation (HASHTAG), a comprehensive school-based intervention for adolescents aged 13-16 years in Nepal. A feasibility cluster-randomized controlled trial was conducted in four secondary schools in Morang district, Nepal. Adolescents completed surveys at baseline and at a 3-month follow-up to evaluate mental well-being, emotional and behavioral outcomes, social support, school climate, and functioning. The intervention comprised two components: Thriving Environment in Schools (TES), implemented over three months and Thriving Together (TT), delivered through six weekly sessions. Quantitative data were collected electronically and analyzed descriptively. Qualitative data were gathered through focus group discussions and in-depth interviews with adolescents, teachers, and facilitators to explore implementation experiences and were analyzed thematically. Both the TES and TT components were well received, with TT sessions achieving an average attendance rate exceeding 70%, and being delivered as planned by trained facilitators, indicating good acceptability and feasibility. Explanatory analysis suggested a positive trend in anxiety outcomes in the intervention group while, social support showed a modest increase. Other outcomes showed small, non-significant changes. Qualitative findings highlighted perceived benefits such as improvements in school cleanliness, staff-student relationships, bullying and discrimination reduction, and positive social and behavioral changes. Participants found breathing exercises, games, the workbook, and the ‘feeling box’ particularly helpful. Implementation challenges included limited space, logistical constraints, COVID-19 related disruptions, and session length. HASHTAG demonstrated feasibility and accessibility as a school-based intervention for adolescents in Nepal, with preliminary indications of potential benefits. Addressing identified implementation challenges will be important for optimizing delivery in future studies. A fully powered randomized controlled trial is warranted to evaluate effectiveness.

31. Psychosocial predictors of mental well-being in higher education students: a comprehensive approach.

期刊: BMC public health 发表日期: 2026-Jun-13 链接: PubMed

摘要

Time spent in tertiary education can be crucial in establishing practices and attitudes that last a lifetime. Although higher education institutions can be one of the main promoters of health, students seem to be a particularly vulnerable group, exposed to constant pressure for academic results and to various stimuli with consequences for their health. It is common to find psychological distress situations, with high levels of depression, anxiety, stress, and even suicidal ideation. Strategies for preventing and promoting health in higher education need to be based on research on predictors of student well-being. Due to the large number of factors that can have a significant impact on student well-being, it is essential to analyze all of these influences together and identify potential priorities for intervention. In this study, this is done by taking a holistic approach to the various factors at multiple levels of analysis. The aim was to test the differential role of multiple predictors of mental well-being on a representative sample of Portuguese university students, using seven factors: (i) sociodemographic; (ii) health status; (iii) lifestyle choices; (iv) life satisfaction and self-esteem; (v) academic-related aspects; (vi) relationships; and (vii) leisure and cultural activities. The research is based on a probabilistic stratified cluster sample representative of the student population of 30 Portuguese public higher education institutions for the 2021/2022 academic year (n = 9,611). Mental well-being was measured using the WHO-5 Well-being Index. A hierarchical multiple regression analysis with seven blocks of predictors was performed to test the differential role of sociodemographic, health status, lifestyle, life satisfaction and self-esteem, academic-related, relationship, and leisure and cultural activity factors. Multiple imputation (15 datasets) was used to handle missing data. Findings indicate that health, lifestyle, self-esteem, and life satisfaction are most predictive of mental well-being among students, followed by sociodemographic, leisure and cultural activities, academics, and relations. Conversely, lower levels of mental well-being were associated with being female, being younger, and experiencing persistent pain. By taking these multiple factors into account, we can better promote mental health interventions for students in higher education settings. These findings highlight the need for comprehensive mental health promotion strategies in higher education settings. Interventions should prioritize improving self-esteem, sleep quality, and leisure time, while also addressing the specific needs of more vulnerable groups, such as female and younger students. By adopting a psychosocial approach that considers multiple levels of influence, higher education institutions can play a pivotal role in promoting student mental well-being.

32. Alleviation of noise annoyance generated by exhaust ventilation at a school campus surrounded by residential buildings.

期刊: Journal of environmental science and health. Part A, Toxic/hazardous substances & environmental engineering 发表日期: 2026-Jun-13 链接: PubMed

摘要

Noise is a widespread harmful environmental stressor that burdens large urban populations globally. Exposure to environmental noise at elevated levels increases annoyance and disturbance, posing substantial risks to both mental and physical health. While the dangers of noise exposure have been widely recognized, the quantitative relationship between noise exposure and psychological response is not well translated to the environmental noise community. This study attempts to estimate people’s annoyance generated by exhaust ventilation noise in a residential community through field measurements and theoretical exposure modeling. The sound pressure levels (SPLs) were sampled at multiple points first, and then a double-layer sound insulation strategy was implemented to reduce the noise levels. Acoustic computations show that the percentage of highly annoyed population in building A before and after duct-borne noise treatment were 11.6% vs. 9.8%, demonstrating reasonable alleviation of noise annoyance and voluntary compliance with the WHO health-based guidelines. Moreover, issues in current environmental noise regulations and their implementation were pointed out, offering suggestions for potential improvements in local legislation. Finally, the methodology and recommendations presented in this study can assist environmental health professionals and policymakers in their efforts to alleviate noise annoyance and develop informative noise control guidelines in the future.

33. Moral injury severity profiles and their pathways to negative emotions in medical staff: the differential mediating role of emotion regulation.

期刊: BMC psychology 发表日期: 2026-Jun-13 链接: PubMed

摘要

Moral injury (MI) and negative emotions (NE) are core psychological issues that severely impair the mental health and professional competence of medical staff, while emotion regulation serves as a crucial psychological resource for coping with occupational psychological distress. However, the latent severity profiles of MI among medical staff, as well as the differential mediating effects of emotion regulation strategies, i.e., cognitive reappraisal (CR) and expressive suppression (ES), between MI and negative emotion (NE) remain unexplored. This study aimed to identify the latent subtypes of MI among medical staff via latent profile analysis and to explore the mediating role of CR and ES between MI and NE, so as to provide empirical evidence for formulating targeted psychological intervention strategies for medical staff. This was a cross-sectional survey. 1001 medical staff were enrolled via a convenience sampling method. Questionnaires were used to assess MI, anxiety, depression and emotion regulation among medical staff, with latent profile analysis applied for subgroup identification. The relationships among variables were analyzed using Pearson correlation analysis and mediation analysis. Three profiles of MI were identified and designated as the low injury profile (62.84%), emotion injury profile (25.27%), and value injury profile (11.89%). MI correlated positively with NE (r = 0.38-0.41) and negatively with CR (r = -0.19). Overall, CR had mediated MI-NE associations, while ES did not. Critically, profile‑specific mediation showed that ES had mediated effects in value injury profile, whereas CR partially mediated effects in emotion injury profile. To mitigate negative emotions in medical staff, administrators should account for individual differences in MI profiles. For the emotion injury profile, prioritize CR to restructure self-blame. For value injury profile, focus on reducing ES and fostering healthy emotional expression. Tailoring emotion regulation strategies to specific MI profiles is essential to safeguard staff mental health and care quality.

34. Co-creating an action to promote health literacy among parents with immigrant backgrounds.

期刊: BMC health services research 发表日期: 2026-Jun-12 链接: PubMed

摘要

Health literacy is a resource that enables individuals to make health related choices to promote and protect their health and that of those around them. For parents, health literacy is essential to access and use information and services in ways that support their child’s health. Immigrant parents may face health literacy challenges due to language barriers, differing approaches to managing child health and parenting, unfamiliar services, and divergent expectations of services and staff. Since parental health literacy is linked to child health outcomes, addressing the needs of immigrant parents may help prevent avoidable inequities in child health. Few studies have developed and tested interventions to promote health literacy among parents with immigrant backgrounds. Based on results from a needs assessment conducted in a culturally and linguistically diverse population in Oslo, Norway, we aimed to co-create an action to promote parental health literacy. We undertook a two-phase co-creation process drawing on methods from the Optimising Health Literacy and Access (Ophelia) Process and the James Lind Alliance Priority Setting Partnership. In phase one, we collected action ideas from a broad range of stakeholders; analysed and synthesised the ideas; facilitated prioritisation workshops with user representatives; and selected one idea for co-design. In phase two, we co-designed the action with user representatives; and conducted quality-improvement cycles in the clinical setting. In phase one, 14 immigrant parents and 59 staff from different disciplines generated 302 action ideas. Analysis reduced these to a short-list of 22 ideas which were prioritised by user representatives (parents and staff) resulting in two Top-10 lists. Five priorities overlapped and one of these was selected for development: improving communication on services provided by the family health clinic. In phase two, we operationalised this idea by co-designing short, multilingual, animated videos about follow-up at the clinic. The videos were refined through five iterative quality improvement cycles with input from 43 end users (parents and staff). We successfully engaged user representatives, stakeholders and end users across multiple stages of co-creation and co-designed a health literacy action. The videos developed were completed to the stage of feasibility testing in the clinical setting.

35. Heterogeneous Oral Health Outcomes by Combustible Cigarette Smoking, E-Cigarette Use and Dual Use: A Cross-Sectional Population-Based Analysis.

期刊: Oral diseases 发表日期: 2026-Jun-12 链接: PubMed

摘要

Combustible cigarette smoking is a well-established risk factor for poor oral health, but the implications of e-cigarette use and dual use remain uncertain. Distinguishing the effects of vaping from the lingering consequences of prior smoking is a persistent challenge in the literature. To assess how distinct nicotine use profiles relate to oral health-related quality of life, self-reported oral health indicators and self-rated dental health among adults in England, while differentiating e-cigarette users by smoking history. We conducted a cross-sectional analysis of 6027 adults (aged ≥ 16 years) from the nationally representative 2021 Adult Oral Health Survey for England. Participants were classified into five current smoking/vaping categories (never users, former smokers, exclusive cigarette smokers, exclusive e-cigarette users, dual users) and, separately, by combined vaping-smoking history. Outcomes included any oral health difficulty and the number of impacts derived from the 14-item Oral Health Impact Profile (OHIP-14), as well as loose teeth, gum disease history, dry mouth and self-rated dental health. Binary outcomes (any oral health difficulty, loose teeth, gum disease history) were analysed using logistic regression, and ordinal outcomes (number of OHIP-14 impacts, dry mouth, self-rated dental health) using ordered logistic regression, with adjustment for sociodemographic, behavioural and oral hygiene covariates. Compared with never users, exclusive cigarette smokers had the highest adjusted odds of reporting any oral health difficulty (OR = 1.85, 95% CI: 1.51-2.27), loose teeth (OR = 3.18, 95% CI: 2.47-4.09), gum disease history (OR = 1.94, 95% CI: 1.52-2.49) and poorer self-rated dental health (OR = 2.88, 95% CI: 2.36-3.52). Dual users showed similarly elevated odds for loose teeth (OR = 3.11, 95% CI: 1.95-4.97), the highest odds for gum disease history (OR = 3.21, 95% CI: 2.06-4.99) and elevated odds for any oral health difficulty (OR = 1.55, 95% CI: 1.04-2.30) and poorer self-rated dental health (OR = 2.45, 95% CI: 1.68-3.58). Exclusive e-cigarette users also showed elevated odds across outcomes, though generally of smaller magnitude. Estimates for the very small subgroup of never-smoking current e-cigarette users did not show significant excess odds across outcomes, but were imprecise and should be regarded as exploratory. In this cross-sectional population-based analysis, combustible cigarette smoking and dual use were associated with poorer self-reported oral health outcomes. Findings related to e-cigarette use require cautious interpretation because of prior smoking history, the sparse never-smoker vaping subgroup and the absence of detailed exposure data (e.g., smoking intensity, pack-years, time since cessation, vaping duration, device type and nicotine concentration). Smoking cessation should remain central to preventive dentistry.

36. A Systematic Review and Meta-Analysis of Risk Factors for Secondary Oral Squamous Cell Carcinoma After Allogeneic Hematopoietic Stem Cell Transplantation.

期刊: Head & neck 发表日期: 2026-Jun-12 链接: PubMed

摘要

Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is widely used to treat patients with malignant and nonmalignant hematologic disorders. The development of secondary malignancies is recognized, especially secondary oral squamous cell carcinoma (OSCC). This study aimed to evaluate and summarize the risk factors for secondary OSCC after allo-HSCT. The search was conducted in 3 electronic databases for studies published up to May 2025. The quality of the identified studies was evaluated using the Newcastle-Ottawa Quality Assessment Scale for nonrandomized studies. The results were presented as risk ratios (RRs) with corresponding 95% confidence intervals (95% CI). Overall, 15 924 patients from 16 studies were included in the systematic review. The results show that, among many factors involved in HSCT, chronic graft-versus-host disease (cGVHD; RR = 4.01, 95% CI = 1.91-8.39, p = 0.0002), malignant primary diagnosis (RR = 0.40, 95% CI = 0.19-0.84, p = 0.02), and intensity of conditioning myeloablative therapy (RR = 0.41, CI = 0.17-0.98, p = 0.04) were found to be risk factors for secondary OSCC after allo-HSCT. Patients with cGVHD, with a primary diagnosis of malignant disease, or myeloablative intensity of conditioning are more likely to develop secondary OSCC. Our analysis of the literature shows patients after allo-HSCT that required close follow-up, especially examining oral mucosa regularly.

37. Global, Regional, and National Burden of Ovarian Cancer Attributable to High Body-Mass Index Among Women Aged 55 Years and Older: A GBD 2021 Analysis.

期刊: Cancer investigation 发表日期: 2026-Jun-12 链接: PubMed

摘要

High body-mass index (BMI) defined in the Global Burden of Disease Study as BMI above the theoretical minimum risk exposure level, is an established modifiable risk factor for ovarian cancer, particularly among older women. However, a comprehensive assessment of the global disease burden attributable to high BMI, including its spatiotemporal evolution and underlying drivers, remains lacking, particularly for older women. Using data from the Global Burden of Disease Study 2021, we analyzed disability-adjusted life years (DALYs) and deaths from ovarian cancer attributable to high BMI among women aged ≥55 years from 1990 to 2021. We examined temporal trends, geographic disparities by Socio-Demographic Index (SDI), region, and nation, and performed decomposition analyses to identify contributions from population growth, aging, and epidemiological changes. Globally, the attributable burden increased from 1990 to 2021, with population growth as the main driver. of rising absolute DALYs (86.72) and deaths (85.17). Marked socioeconomic disparities were observed. While high-SDI regions had the highest age-standardized rates in 2021, they showed declining trends., whereas low-middle and low-SDI regions experienced the most rapid increases. Regionally, the fastest increases occurred in South Asia, Southeast Asia, and East Asia, while nationally the largest rises were observed in Timor-Leste, Viet Nam, and Bangladesh. In these settings, epidemiological changes were the dominant contributor to increasing burden. The global burden of ovarian cancer due to high BMI is rising and unequally distributed across SDI regions. While population growth drives the overall increase, escalating obesity prevalence is the key driver in rapidly developing regions. Targeted obesity prevention, improved early detection, and strengthened health-care systems should be prioritized, particularly in high-growth regions. Future studies should improve data quality in low-resource settings and explore cost-effective interventions.

38. Social Avoidance Trajectories, Core Characteristics and Maintenance Factors in Postoperative Breast Cancer Patients: A Longitudinal Mixed-Methods Study.

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

摘要

To examine the trajectories, core characteristics, and maintenance factors of social avoidance in patients with breast cancer during the first postoperative year. Longitudinal, explanatory sequential mixed-method design. This longitudinal study enrolled 176 postoperative breast cancer patients, conducting six follow-up assessments over 1 year. Latent class growth analysis was employed to identify heterogeneous trajectories of social avoidance behaviour, with multivariate logistic regression subsequently analyzing predictive factors. Building on these quantitative findings, semi-structured in-depth interviews were administered to target individuals identified through the analysis. Phenomenological methods were then utilized to elucidate core manifestations and maintenance factors of social avoidance. Among the 176 enrolled breast cancer patients, 138 completed all six follow-up assessments. Latent class growth analysis identified two distinct subgroups with significant differences in social avoidance trajectories: ‘persistent high social avoidance’ and ‘persistent low social avoidance group’. Logistic regression revealed melancholic temperament as an independent risk factor for ‘persistent high social avoidance group’, while choleric temperament demonstrated protective effects. Phenomenological analysis of qualitative data systematically identified four core themes: (1) affective manifestations, (2) behavioural patterns, (3) psychological drivers, and (4) environmental determinants of social avoidance. This study revealed heterogeneous dynamic trajectories of social avoidance behaviour in breast cancer patients, with core manifestations encompassing both affective and behavioural dimensions, sustained by multiple factors of personality, psychology, and environment. This mixed-methods study systematically examined the developmental trajectories, core manifestations, and sustaining factors of social avoidance behaviour in breast cancer patients. The results provide robust evidence to inform precision screening for social avoidance risk, early prevention initiatives, and tailored intervention strategies in clinical nursing practice. Journal article reporting standards for mixed-methods research. No patient or public contribution.

39. QEEG Guided Neurofeedback to Enhance Intellectual Functioning in Children with Intellectual Disability.

期刊: Clinical EEG and neuroscience 发表日期: 2026-Jun-12 链接: PubMed

摘要

ObjectiveThis study evaluated whether quantitative electroencephalography (QEEG) guided neurofeedback (NF) improves intellectual functioning and attention in children with mild to severe intellectual disability (ID).MethodsSixty-five children (38 males, 27 females; mean age ≈11 years) with DSM-5 diagnoses of mild-to-severe ID (IQ 28-68) and histories of unsuccessful standard treatments were enrolled. Baseline assessments included 19-channel QEEG referenced to FDA-approved Nx-Link™, BrainDx™, and NeuroGuide™ databases, Wechsler Intelligence Scale for Children (WISC-R or WISC-IV),and the Test of Variables of Attention (TOVA). Participants underwent 80-120 QEEG-guided NF sessions. Training protocols targeted deviant z-scores, with hypercoherence addressed prior to amplitude abnormalities. IQ and attention were reassessed 6-12 months post-treatment. Outcomes were analyzed using paired t-tests, correlation analyses, and generalized linear models.ResultsMean full-scale IQ increased by approximately 10 points (≈53 to ≈63; +18.6%, p < 0.001). Significant gains were observed in both WISC-IV (+≈11 points) and WISC-R (+≈10 points), with improvements across verbal, perceptual, working memory, processing speed, and performance domains (all p < 0.001). Two thirds of participants’ IQ increased by ≥6 points. TOVA scores improved but were not correlated with IQ changes. QEEG analyses showed normalization of resting-state networks, including increased alpha power in default mode network hubs and reduced coherence and phase lag; reductions in slow-wave coherence predicted IQ improvement.ConclusionQEEG-guided NF was associated with clinically meaningful improvements in intellectual functioning and attention in children with ID, exceeding gains expected from environmental enrichment. Findings support NF as a promising nonpharmacologic intervention warranting randomized controlled trials.

40. Social and environmental determinants of dementia risk: An umbrella review.

期刊: Journal of Alzheimer’s disease : JAD 发表日期: 2026-Jun-12 链接: PubMed

摘要

BackgroundGrowing evidence suggests that dementia risk is influenced not only by genetic factors but also by social and environmental determinants. Understanding these modifiable factors is critical for informing prevention strategies.ObjectiveTo synthesize existing evidence from systematic reviews on the associations between social and environmental determinants and the risk of dementia, including Alzheimer’s disease, vascular dementia, and frontotemporal dementia.MethodsAn umbrella review was conducted by systematically searching five major databases for systematic reviews published between 2004 and 2024. Eligible reviews examined the relationship between at least one social or environmental determinant and dementia outcomes.ResultsThe review found strong associations between environmental exposures and increased dementia risk. Exposure to fine particulate matter (PM2.5) was consistently linked to elevated dementia risk, with estimates ranging from 3% to 226% per 10 μg/m3 increase. Occupational exposures to toxic metals, pesticides, and electromagnetic fields were also associated with higher neurodegeneration risk. Conversely, protective environmental factors included residential greenness and walkable neighborhoods. Among social determinants, higher education, socioeconomic status, and social engagement were found to promote cognitive resilience. In contrast, social disadvantage and limited access to healthcare contributed to increased dementia risk, likely through cumulative psychosocial stress.ConclusionsThis umbrella review underscores the significant role of social and environmental determinants in dementia risk. Targeted public health policies aimed at reducing environmental hazards and addressing social inequalities are essential for mitigating dementia risk and promoting cognitive health at the population level.

41. Sustaining values-driven innovation in primary healthcare: a protocol for identifying implementation strategies for long-term impact (longitudinal participatory study).

期刊: Implementation science communications 发表日期: 2026-Jun-12 链接: PubMed

摘要

Responding to system pressures, fragmentation, and growing project fatigue in primary care, this study examines how values-driven innovations (VDIs) can be successfully embedded and sustained by (1) defining what constitutes a values-driven innovation, (2) identifying strategies and mechanisms that support long-term implementation, and (3) co-developing evidence-based sustainability indicators with stakeholders. By integrating four complementary theoretical frameworks and examining the full lifecycle from conceptualization to long-term sustainment, it generates actionable insights to strengthen enduring, values-based transformation in primary care. This study uses a longitudinal, theory-informed, multi-stakeholder design. Over three years, we follow selected VDIs from conceptualization through long-term sustainment, using multiple data sources and repeated timepoints to capture dynamic implementation processes. An integrated conceptual framework: combining realist evaluation, the Dynamic Sustainability Framework, Consolidated Framework for Implementation Research, and Normalization Process Theory, guides all phases. The three-phase design includes: (1) defining VDI and mapping the innovation landscape; (2) conducting longitudinal case studies using document analysis, serial interviews, and questionnaires; and (3) co-creating an actionable sustainability model and monitoring indicators with stakeholders. Continuous reflexive practice, triangulation, and participatory engagement ensure rigor and relevance. Despite the analytical complexity of using multiple frameworks, this integration provides a comprehensive understanding of sustainability and contextual adaptation in primary care. The study protocol was approved by the Ethics Committee of the University of Antwerp (reference number 2025-7124).

42. Emotional and sleep problems and their associated factors among specialized operation personnel on surface vessels.

期刊: BMC psychology 发表日期: 2026-Jun-12 链接: PubMed

摘要

To investigate the prevalence of anxiety, depression, and sleep problems among specialized operation personnel on surface vessels, and to analyze their influencing factors. A total of 600 participants were randomly selected. Basic demographic and occupational information was collected using a general information questionnaire. The Self-Rating Anxiety Scale (SAS), Self-Rating Depression Scale (SDS), and Pittsburgh Sleep Quality Index (PSQI) were administered to assess anxiety, depression, and sleep quality. Spearman correlation analysis indicated that anxiety symptoms was associated with years of service (r = 0.130, P = 0.001), family residence (r = -0.153, P < 0.001), and sleep quality (r = 0.199, P < 0.001). Depression symptoms was associated with parental relationship (r = -0.134, P = 0.001), family residence (r = -0.144, P < 0.001), and sleep quality (r = 0.122, P < 0.05). Binary logistic regression further showed that PSQI was associated with anxiety (OR = 2.187, P = 0.001). All PSQI subscales were correlated with SAS and SDS total scores (P < 0.05). Sleep and emotional problems are prevalent among specialized operation personnel on surface vessels. Greater attention should be given to the psychological health of subgroups at higher risk, such as older individuals, those with rural backgrounds, and those with longer years of service. Routine psychological screening is recommended for this population.

43. Health inequities in the comorbid association between pneumoconiosis and chronic obstructive pulmonary disease: a nationwide study of age-related heterogeneity.

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

摘要

Pneumoconiosis patients have a higher prevalence of chronic obstructive pulmonary disease (COPD). While age is a known associated factor, its impact across different populations is unclear. We included 9,964 pneumoconiosis patients from 27 Chinese provinces. Factors were identified using multivariable logistic regression, and the non-linear age-COPD association was examined with restricted cubic spline (RCS) modelling. Stratified analysis and interaction tests assessed sociodemographic heterogeneity. Sensitivity analyses comprised RCS models with varying knots and propensity score matching. The prevalence of COPD among patients with pneumoconiosis was 24.1%. Each additional year of age was associated with a significant increase in the odds of COPD (adjusted odds ratio [aOR] = 1.03, 95% confidence interval [CI]: 1.03-1.04). RCS analysis revealed a significant nonlinear relationship, with the odds increasing more steeply at older ages (P for overall < 0.001; P for nonlinear = 0.002). Subgroup analyses showed substantial heterogeneity in these associations. Among urban residents and individuals covered by work-related injury insurance (WRII), the odds of COPD increased sharply and then gradually plateaued in later life. In contrast, among rural residents and those without WRII, the odds increased steadily with advancing age. Sensitivity analyses confirmed the robustness of these findings. The nonlinear relationship between age and COPD in pneumoconiosis in patients with pneumoconiosis is significantly modified by sociodemographic factors.

44. Impact of professional type on job satisfaction and job burnout among physicians in oncology-specialty hospital: the mediating and moderating roles of perceived organizational support and career adaptability.

期刊: BMC health services research 发表日期: 2026-Jun-12 链接: PubMed

摘要

As cancer incidence continues to rise globally, oncology-specialty hospitals have assumed an increasingly central role in modern healthcare systems. Within these institutions, differentiation in professional roles may be associated with variations in physicians’ occupational experiences. This study examines the association between professional type (oncological vs. non-oncological physicians) and job satisfaction and job burnout, and explores the mediating and moderating roles of perceived organizational support and career adaptability. A cross-sectional survey was conducted among 383 physicians from five provincial-level oncology-specialty hospitals in China. Physicians were classified according to departmental function as oncological physicians directly involved in cancer diagnosis and treatment, and hospital-based non-oncological specialist physicians providing diagnostic, perioperative, imaging, pathological, or other supportive services within oncology-specialty hospitals. The latter group did not include general physicians practicing outside oncology-specialty hospitals. Standardized instruments were used to assess job satisfaction, job burnout, perceived organizational support, and career adaptability. Available demographic and work-related covariates, including sex, age, education level, years of clinical experience, and weekly working hours, were considered in the adjusted analyses. Group comparisons, bootstrapped mediation analyses, and joint moderation models were performed using SPSS and Stata. Oncological physicians reported significantly higher job satisfaction than non-oncological physicians. However, they also reported higher overall levels of job burnout, a pattern primarily characterized by elevated emotional exhaustion and depersonalization. Perceived organizational support and career adaptability were both associated with job satisfaction and job burnout and served as mediating variables linking professional type with these outcomes. In addition, both resources functioned as moderators, conditioning the magnitude of professional-type differences. Career adaptability was particularly relevant for non-oncological physicians, showing a buffering pattern in relation to job burnout. Differences in professional roles within oncology-specialty hospitals are closely associated with physicians’ job satisfaction and job burnout. Perceived organizational support and career adaptability play complementary process and boundary roles in shaping these associations.

45. Beta-lactam de-labelling as a core antimicrobial stewardship strategy in the era of the antimicrobial resistance pandemic: a narrative review.

期刊: Current opinion in allergy and clinical immunology 发表日期: 2026-Jun-11 链接: PubMed

摘要

Antimicrobial resistance (AMR) is increasingly recognised as a global public health emergency that threatens the foundations of modern medicine. While much attention has focused on antimicrobial overuse, under-emphasised drivers such as inaccurate drug allergy labels continue to undermine antibiotic stewardship efforts. Beta-lactam allergy (BLA) labels, particularly penicillin allergy labels, are among the most prevalent and most consequential of these inaccuracies. Mounting evidence demonstrates that the vast majority of individuals labelled as beta-lactam allergic are not truly allergic, yet these labels persist across healthcare systems and generations, driving the use of broader-spectrum, less effective, more toxic and resistance-promoting antibiotics. In this timely review, we argue that beta-lactam de-labelling should no longer be viewed as a niche allergy intervention but as a core antimicrobial stewardship strategy and an ethical obligation in the era of the AMR pandemic. Drawing on emerging inpatient and outpatient evidence, including recent paediatric inpatient de-labelling studies, we examine clinical, behavioural, system-level and ethical barriers to de-labelling and propose a reframing of beta-lactam de-labelling as a public health intervention essential for preserving antibiotic effectiveness. We conclude by outlining policy-relevant recommendations for embedding de-labelling into routine care pathways, particularly in low and middle-income countries (LMICs), where the consequences of AMR are likely to be most severe.

46. Probiotics in allergic disease: from adjunct supplement to immune-modifying strategy (2026 update).

期刊: Current opinion in allergy and clinical immunology 发表日期: 2026-Jun-11 链接: PubMed

摘要

Allergic diseases continue to increase globally, and accumulating evidence implicates early-life microbial exposures as central determinants of immune tolerance. This review synthesizes advances from 2024 to 2026 regarding probiotic-mediated immune modulation and their translational implications in allergy prevention and therapy. Recent studies confirm strain-specific expansion of Foxp3+ regulatory T cells, suppression of Th2 polarization, reinforcement of epithelial barrier integrity, and durable epigenetic stabilization mediated by short-chain fatty acids such as butyrate. Clinical trials demonstrate benefit in perinatal prevention of atopic dermatitis, modulation of allergic rhinitis symptoms, early-life asthma risk reduction, and probiotic-adjuvanted oral immunotherapy. Probiotics are evolving from adjunctive supplements to biologically active immune modulators with disease-modifying potential. Integration with allergen immunotherapy and precision microbiome profiling may redefine preventive and therapeutic strategies in allergic disease.

47. Limits of viability: are we heading in right direction?

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

摘要

Background The limits of viability, commonly defined by gestational age and/or birth weight thresholds associated with a survival probability exceeding 50 %, have evolved with advances in neonatal care. However, these thresholds vary substantially across countries, reflecting differences in health system capacity rather than fixed biological boundaries. ContentThis review critically examines the definition of the limits of viability as a context-dependent construct shaped by access to perinatal and neonatal care. It analyzes global disparities in survival at the margins of prematurity, with marked differences between high-income (HIC) and low- and middle-income countries (LMIC). These inequities are discussed within the framework of the Sustainable Development Goals (SDG), particularly SDG 3 and SDG 10, and in relation to the child’s right to the highest attainable standard of health. The role of global health governance, including the World Health Organization (WHO), and emerging challenges affecting international collaboration are also considered. Current trends in both HIC and LMIC are evaluated to assess alignment between technological progress and global health equity.SummaryThe limits of viability are not fixed biological thresholds but reflect health system capacity. Persistent disparities in periviable survival remain substantial and result in outcomes determined largely by place of birth rather than biological potential.OutlookReducing inequities requires prioritizing equitable implementation of evidence-based interventions, strengthening health systems, and sustaining global collaboration. Aligning advances in neonatal care with global equity is essential to improving outcomes for the most vulnerable newborns.

48. Implementation of smoking cessation interventions in real-world lung cancer screening: a RE-AIM-guided scoping review.

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

摘要

Although evidence-based smoking cessation interventions are widely recommended in lung cancer screening programs, real-world implementation remains poorly understood. This scoping review aimed to identify and characterize smoking cessation interventions implemented in lung cancer screening programs, guided by the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework. Eligible sources described real-world (nontrial) lung cancer screening programs from 2013 onward. We searched 6 databases in February 2025 and multiple grey literature sources and categorized implementation data by RE-AIM domains in narrative form. Of 55 unique studies, most were from the United States (84%), described a wide range of behavioral support (96%) and/or pharmacological (58%) interventions, and focused primarily on individual-level outcomes across RE-AIM domains. Reflecting strong Reach, most cessation interventions offered were generally acceptable to lung cancer screening participants and providers. Opt-out referral to embedded programs showed consistently high uptake. More intensive (eg, group/multicomponent) interventions had evidence of relatively high cessation (ie, Effectiveness) outcomes. Implementation most often involved delivery of low-intensity behavioral interventions. Program-level implementation factors under the Adoption (eg, provider readiness to adopt: 7%), Implementation (time and cost: 5%), and Maintenance (sustained intervention delivery: 4%) domains were rarely reported. Future real-world studies should generate and comprehensively report implementation data across key domains, particularly program-level conditions that support sustainable, long-term integration of cessation into lung cancer screening. This is critical given that many lung cancer screening programs globally still have not implemented formal cessation supports. Strengthening the evidence base will inform scalable, context-specific approaches and maximize reach across the diverse populations and settings of jurisdictions implementing lung cancer screening.

49. Understanding Medicaid Estate Recovery: The Experience of North Carolina and Policy Implications for Future Reforms.

期刊: Health services research 发表日期: 2026-Jun 链接: PubMed

摘要

To estimate the prevalence of Medicaid estate recovery in North Carolina. We descriptively analyzed the number of estates, amount recovered, and hardship waiver applications using North Carolina public records data. The data contained information on the number of estates and amount recovered through Medicaid estate recovery between 2017 and 2021 (n = 2975). Additionally, we analyzed hardship waiver application data for residents who applied and had their application processed between 2018 and 2021 (n = 301). We found approximately $83 billion was recovered from beneficiaries between 2017 and 2021, or 0.6% of the total cost of North Carolina’s annual Medicaid program and just 0.9% of the fee-for-service annual long-term services and supports Medicaid budget. We found that Black homeowners were more likely to have lower value estates recovered, and overall, more money was recovered from white estates. While states hope Medicaid estate recovery may balance Medicaid spending through increased revenue, our findings demonstrate that these efforts may be insufficient. Policymakers should opt for strategies outside of the Medicaid program that can more precisely target high-net-worth individuals instead of policies like estate recovery that disproportionately impact low-income families.

50. Impact of Respiratory Viral Codetections on RSV Disease Burden in Young Children in Primary Care.

期刊: Influenza and other respiratory viruses 发表日期: 2026-Jun 链接: PubMed

摘要

Young children with respiratory syncytial virus (RSV) often have viral coinfections. This study assessed the impact of respiratory viral codetections on RSV disease burden in children < 5 years and whether this varies by specific codetected viruses. Retrospective analyses were performed using data from the RSV ComNet study prior to implementation of passive immunisation. Children < 5 years with acute respiratory infection (ARI) were eligible for testing for RSV and other viruses (multiplex real-time Polymerase Chain Reaction). Primary care physicians completed a short report on day 1, and parents completed follow-up questionnaires (digital or by phone) on days 14 and 30. Disease burden was measured by healthcare resource utilisation, clinical course, and parental work absence. Of the 2637 children tested, 822 (31%) were RSV-positive, of which 585 (52%) had completed day 1 data. There were 378 (65%) children with RSV monoinfection and 207 (35%) with RSV codetection. Rhinovirus/enterovirus was most frequently codetected (60%). Healthcare resource utilisation, clinical course, and parental work absence did not significantly differ between children with RSV codetection and RSV monoinfection. Hospitalisation rate was 7% (CI: 5%-10%) versus 8% (CI: 5%-13%) and mean duration of illness 11 (CI: 10.6-11.9) versus 12 days (CI: 11.4-13.4), respectively. RSV-infections with viral codetections were generally not associated with increased healthcare resource utilisation, symptomatology, or parental work absence in children in primary care, suggesting that viral codetection alongside RSV disease does not impose a greater burden on patients or society. Further research is needed to determine whether specific RSV codetected viruses differentially impact disease burden.

51. Factors Influencing Nurses' Person-Centred Care Practices in Dementia Care: A Scoping Review Based on the Donabedian Model.

期刊: Scandinavian journal of caring sciences 发表日期: 2026-Jun 链接: PubMed

摘要

This study aimed to identify the structural, process and outcome factors influencing nurses’ implementation of person-centred care (PCC) for people with dementia, guided by Donabedian’s structure-process-outcome (SPO) model. A scoping review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Review (PRISMA-ScR) guidelines. A scoping review was conducted. The final search was conducted on January 28, 2025, were from the following major international and Korean databases: MEDLINE, EMBASE, Cochrane Library, PubMed, CINAHL, PsycINFO, Web of Science, KCI and NDSL. Studies addressing factors related to nurses’ PCC practices in dementia care were systematically analysed and categorized using the SPO model. Fourteen studies were included in this scoping review. The structural factors included nurses’ personal characteristics (e.g., demographics and knowledge), organizational conditions and educational factors; some factors were positively associated with PCC practices (e.g., salary satisfaction), whereas others demonstrated inconsistent findings across studies (e.g., age and clinical experience). Process factors encompassed attitudes, emotional responses, behavioural management and practice strategies, which were identified as facilitators or barriers to PCC practices. The outcome factors indicated that PCC practices were associated with improvements in nurses’ knowledge, attitudes, satisfaction, care efficacy and care provision capacity, while being associated with reduced care burden. This review provided a systematic analysis of the factors influencing nurses’ PCC practices in dementia care. Effective promotion of person-centred care requires multifaceted strategies at both the individual nurses and organizational levels.

52. Predicting Outpatient Follow-Up Retention After Inpatient Treatment in Patients With Alcohol Use Disorder: A Data-Driven Random Forest Approach.

期刊: Addiction biology 发表日期: 2026-Jun 链接: PubMed

摘要

Longer treatment engagement is associated with improved recovery outcomes in alcohol use disorder (AUD), making patient retention a critical determinant of reduced return to drinking. This study aimed to identify factors predicting outpatient treatment engagement, operationalized as the number of follow-up visits, among individuals with AUD following inpatient care. We applied a five-step analytic framework integrating random forest modelling (RFM) and Least Absolute Shrinkage and Selection Operator (LASSO) regression to identify predictors of outpatient visit frequency. Clinical, psychological and physiological variables (n = 177 per participant) collected during inpatient treatment prior to discharge were included. RFM ranked variables associated with follow-up visits, with LASSO used for validation and complementary selection. Over a 5-year period, 119 treatment-seeking patients with AUD (mean age = 45.8) returned for outpatient care, averaging 5.14 visits, following a medical treatment inpatient stay. Positive urgency (VIP = 44.31) and positive life events (VIP = 41.19) emerged as the strongest predictors; both inversely associated with visit frequency. LASSO confirmed positive urgency as a significant predictor (coefficient: -0.03296). Greater alcohol use severity and higher haemoglobin levels were also associated with fewer outpatient visits, whereas higher depressive symptom severity predicted increased follow-up engagement. Using complementary machine learning and regression approaches, this study identified affective traits, alcohol use severity and physiological factors as key determinants of outpatient engagement following inpatient AUD treatment. Interestingly, positive urgency and positive life events, often considered markers of recovery or resilience, were linked to reduced outpatient attendance, suggesting that certain personality or motivational factors may diminish perceived need for continued care. These findings highlight the importance of integrating psychological and motivational variables into postdischarge planning to enhance retention and improve early recovery outcomes.

53. The Prognostic Value of Serum Inflammatory Markers in Nasopharyngeal Carcinoma Patients Treated With Immune Checkpoint Inhibitors: A Multicenter Study.

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

摘要

Although immune checkpoint inhibitors (ICIs) have revolutionized the treatment of nasopharyngeal carcinoma (NPC), reliable predictive biomarkers need to be further explored. This study aimed to investigate the predictive ability of inflammatory markers for poor prognosis in NPC patients treated with ICIs. In this multicenter retrospective study, a total of NPC patients treated with at least two cycles of ICIs from May 2019 to December 2022 at three independent medical centers in China were included. In this study, we collected the multiple hematological parameters from patients prior to treatment to calculate serum inflammatory markers, and we performed the multivariate COX analysis to identify independent prognostic factors for constructing columnar plots. Then the ROC survival curves, calibration curves, and clinical curve analysis were used to assess the predictive performance of the model. A total of 170 patients were included in the training group with a median follow-up of 26 months. Univariate and multivariate Cox regression analyses showed that Hb, Prognostic Nutritional Index (PNI), and the number of metastases were independent prognostic factors for overall survival (OS). A nomogram was constructed based on these three factors to predict the prognosis of NPC patients after ICI treatment. The nomogram achieved a C-index of 0.733 in the training cohort and 0.743 in the validation cohort, indicating good discriminative ability. Time-dependent ROC curves demonstrated favorable predictive accuracy, with area under the curve (AUC) values for 1-, 2-, and 3-year OS of 0.701, 0.756, and 0.760 in the training set, and 0.773, 0.784, and 0.777 in the validation set. The model was further validated using calibration plots and decision curve analysis (DCA), and patients were categorized into high- and low-risk groups, with the validation cohort also showing consistent survival differentiation. The combination of serum inflammatory markers and clinicopathological factors may serve as a practical prognostic tool to predict NPC patients who may benefit from ICIs.

54. Childhood Speech Impairment and Dementia Risks Among U.S. Older Adults.

期刊: International journal of language & communication disorders 发表日期: 2026 链接: PubMed

摘要

Speech problems in childhood have profound implications for learning, communication, as well as the development of social and cognitive skills in adulthood. However, research has yet examined how early life speech problems may be associated with subsequent dementia risks in later life. Using nationally representative data from the longitudinal Health and Retirement Study, this study aimed to investigate how the experience of speech problems before age 16 was associated with the risk of dementia among older adults aged 50 and older. The analysis pooled the full life history information about childhood speech problems for N = 17,863 participants who had one to eleven observations for cognitive and sociodemographic information from 2000 to 2020. We constructed person-interval data and estimated discrete-time event history models to examine risks for developing dementia, which was measured using a validated Langa-Weir classification of cognitive function. Results showed that older adults with childhood speech problems had a higher risk of developing dementia in later life, compared to those who never had speech problems in childhood. The effect of childhood speech problems on cognitive function was partially explained by economic status and health conditions in midlife. Findings highlight the long-arm implications of early life health adversity and suggest needs for screening and early intervention programs for childhood speech impairment. What is already known on this subject Literature had documented various developmental and health outcomes of childhood speech impairment. This research addresses the gap in the literature by examining the long-term implications of childhood speech impairment on dementia risk in later life. What this paper adds to existing knowledge Using longitudinal data from the Health and Retirement Study, this study investigated how the experience of childhood speech impairment was associated with the risk of dementia among U.S. older adults. We found about 3% of U.S. older adults had speech impairments in childhood, and they had a higher risk of developing dementia in later life compared to those who did not have speech impairments in childhood. What are the potential or actual clinical implications of this work? Findings suggest needs for screening and early intervention programs for childhood speech impairment.

55. Nurses' Roles in Supporting Mental Health Among Preoperative Cardiac Patients in Kazakhstan: A Qualitative Study.

期刊: Journal of nursing management 发表日期: 2026 链接: PubMed

摘要

Patients with cardiovascular disease undergoing surgery commonly experience psychological distress, including anxiety, depression, and fear of mortality, which may negatively influence surgical outcomes and recovery. However, mental health support for patients with cardiovascular disease remains unprioritized in many healthcare systems, particularly in middle-income countries such as Kazakhstan, where mental health services are still fragmented and underdeveloped. This study aims to explore and describe the mental health promotion strategies employed by nurses when caring for preoperative patients with cardiovascular disease. This study employed an exploratory-descriptive qualitative design. Data were collected through semistructured interviews with 13 nurses working in cardiac surgery units in Kazakhstan from February 3 to April 10, 2025. The interview data were analyzed using thematic analysis. The study was conducted in accordance with the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines. Initially, 96 codes were generated from the data. These codes were subsequently organized into 19 subthemes and further synthesized into four major themes: “Patient Emotional Support Needs,” “Mental Health Implementation Strategies,” “Challenges to Mental Health Promotion,” and “Influencing Factors in Mental Health Promotion.” Nurses play a pivotal role in promoting the mental health and psychological well-being of patients with cardiovascular disease, with therapeutic communication and professional presence serving as fundamental components of holistic care. In Kazakhstan, this responsibility also requires adapting nursing management strategies to culturally grounded perspectives on mental health, thereby ensuring the delivery of compassionate, culturally sensitive, and comprehensive care that extends beyond physical recovery.

56. Salivary Inflammatory Biomarkers in Males With Nephrolithiasis Correlate With Periodontal Status: A Case-Control Study.

期刊: BioMed research international 发表日期: 2026 链接: PubMed

摘要

Systemic inflammation links periodontal disease (PD) and nephrolithiasis. Proinflammatory cytokines like IL-6, IL-8, TNF-α, IL-1β, and MMP-8 are implicated in both conditions. This study investigates salivary levels of these biomarkers in young adult males with kidney stones and their association with periodontal status (CPITN) and body mass index (BMI). This case-control study enrolled 109 males (25-35 years): 52 with kidney stones and 57 healthy controls. Unstimulated whole saliva was analyzed for IL-6, IL-8, TNF-α, IL-1β, and MMP-8 via ELISA. Periodontal health was assessed using the community periodontal index of treatment needs (CPITN). Serum C-reactive protein (CRP) and BMI were also measured. The kidney stone group had significantly higher salivary IL-6 (3.95 [2.0-5.2] pg/mL vs. 2.7 [1.5-4.0] pg/mL; adj. p = 0.042) and TNF-α (11.99 [8.5-13.8] pg/mL vs. 9.5 [7.0-11.6] pg/mL; adj. p = 0.021) than controls. Differences in IL-1β (adj. p = 0.051) and MMP-8 (adj. p = 0.058) showed a consistent trend toward elevation but did not retain statistical significance after FDR correction. No significant difference was observed in salivary IL-8 levels (adj. p = 0.120). Patients also showed elevated CRP (p = 0.010) and worse CPITN scores (p = 0.002). In the kidney stone group, salivary IL-6, TNF-α, and MMP-8 positively correlated with CPITN scores (p < 0.01), whereas TNF-α also correlated with BMI (p = 0.048). Elevated salivary inflammatory biomarkers (IL-6 and TNF-α) are significantly associated with kidney stones and periodontal status (CPITN) in young males, whereas IL-1β and MMP-8 showed a trend toward elevation. Salivary analysis may be a noninvasive tool for assessing systemic inflammation and identifying at-risk individuals.

57. First Report of Human Infection Caused by Aspergillus steynii and Analysis of Its Whole-Genome Characteristics.

期刊: Transboundary and emerging diseases 发表日期: 2026 链接: PubMed

摘要

The incidence of infections caused by rare pathogens has increased in recent years. This necessitates the development of effective diagnostic and therapeutic approaches. In this study, we report the first documented case of Aspergillus steynii-induced pulmonary infection in humans. We evaluated the morphological and molecular characteristics of this fungus to elucidate its role in human infections. A 47-year-old woman with immunosuppression after bone marrow transplantation developed symptoms of pulmonary infection. The pathogen was identified as A. steynii through culture techniques, microscopy, mass spectrometry, multigene molecular identification, and whole-genome sequencing. Antifungal susceptibility testing was performed, and comparative genomic analysis was conducted to assess the phylogenetic relationship and genomic characteristics of A. steynii and other pathogenic Aspergillus species. Genomic analysis revealed a high degree of similarity with other pathogenic Aspergillus species. Furthermore, we identified 470 unique gene families primarily associated with ABC transporter pathways linked to multidrug resistance. The strain was sensitive to triazoles and echinocandins but exhibited elevated minimum inhibitory concentrations (MICs) for amphotericin B, flucytosine, and fluconazole. In addition, multiple potential drug resistance genes were identified, indicating the potential for multidrug resistance. The emergence of A. steynii in humans poses new clinical challenges and risks, including cross-species transmission and multidrug resistance. The potential for A. steynii infections, particularly in immunosuppressed patients, highlights the importance of early diagnosis and timely intervention to reduce the risk of misdiagnosis or delayed treatment. Thus, our findings have the potential to improve the clinical and differential diagnosis of this infection and facilitate the development of effective therapeutic approaches.