公共卫生研究摘要 (2026-06-16)

共收录 53 篇研究文章

1. The feasibility of promoting recreational physical activity to manage type 2 diabetes in urban Bangladesh: A qualitative study.

期刊: Global public health 发表日期: 2026-Dec-31 链接: PubMed

摘要

Urbanisation has contributed to increased sedentary behaviour, which is a major risk factor for non-communicable diseases. In South Asia, the type 2 diabetes burden is rapidly increasing, and there is a need to understand the effect of different social categories, such as gender, socio-economic status, and diabetes status, in shaping opportunities to participate in physical activity. We used a rapid participatory qualitative research methodology and intersectional analysis in urban Faridpur, Bangladesh, to analyse the feasibility of promoting recreational physical activity to manage and prevent type 2 diabetes. Diabetes was defined as an individual as opposed to a community health issue in Faridpur. Narratives about the causes of diabetes blamed the individual, which prevented the development of a positive diabetes identity and resulted in intersectional stigma. Women, and poorer women in particular, felt disempowered by their diabetes and therefore hid this from others. There was a collective lack of awareness about community barriers to physical activity for women, and a need to create a safe and empowering space for women, while working at the community level to address these barriers. Cross-sectoral complex, community-engaged interventions that consider intersectional experiences are needed to increase physical activity in urban areas of South Asia.

2. Human enterotoxigenic Escherichia coli (ETEC) infections elicit antibodies that broadly neutralize mucinases of pathogenic Escherichia coli and Shigella.

期刊: Proceedings of the National Academy of Sciences of the United States of America 发表日期: 2026-Jun-23 链接: PubMed

摘要

Enterotoxigenic Escherichia coli (ETEC) and Shigella are the most common bacterial diarrheal pathogens among young children of low-middle income regions. Enteric pathogens must overcome formidable host defenses, including the protective barrier formed by intestinal mucus. ETEC produce a virulence protein called EatA, a member of the Serine Protease Autotransporter of the Enterobacteriae (SPATE) family, where the secreted passenger domain (EatAp) specifically degrades MUC2, the major mucus secreted by goblet cells of the human intestine. Notably, some Shigella spp., as well as other diarrheagenic E. coli pathovars, secrete homologues of EatA known as SepA, and Pic. Here, we demonstrate that EatA, SepA, and Pic are functionally redundant MUC2 mucinases and that recombinant monoclonal antibodies (mAbs) derived from plasmablasts of ETEC-infected humans can inhibit MUC2 degradation by all three proteases. We present cryo-EM structures of EatA and the related SPATE proteins, SepA, and Pic, complexed to fragment antigen-binding portions of these mAbs to demonstrate that those targeting a core β-helix epitope shared by all three SPATE molecules broadly neutralize the capacity to degrade MUC2. These mAbs effectively prevent MUC2 degradation by each SPATE as well as mucus penetration by ETEC, Shigella flexneri, and Pic-producing enteroaggregative E. coli (EAEC). We anticipate that these studies could facilitate rational design of vaccines that broadly protect against major enteric pathogens by targeting a shared virulence feature.

3. Uncovering thousands of endosymbiont DNA transfer events within single cockroach genomes.

期刊: Proceedings of the National Academy of Sciences of the United States of America 发表日期: 2026-Jun-23 链接: PubMed

摘要

Horizontal gene transfer (HGT) between organisms can be a valuable source of genetic variation and innovation. Research on HGT in eukaryotes has hitherto focused on transfers of coding sequences; insertions of noncoding DNA remain poorly understood. Here, we investigated HGT in cockroaches, which have a long-standing evolutionary relationship with the transovarially transmitted endosymbiont Blattabacterium cuenoti, making them a valuable system for assessing the potential scale of HGT. We aligned 150-bp genomic fragments of B. cuenoti to 23 cockroach and termite genomes, including 8 genomes newly sequenced, and revealed pervasive endosymbiont DNA transfer events. Australian panesthiine and geoscapheine cockroaches were consistently found to harbor >3000 HGT inserts, more than an order of magnitude higher than the previous maximum estimate in other eukaryotes, excluding rotifers. Some inserts appear to have persisted for ≥28.7 million years in this group, which may reflect functional roles. We identified numerous chimeric inserts comprising up to nine short segments from different locations in the B. cuenoti genome. Our findings indicate pervasive HGT in eukaryote genomes, with potentially far-reaching implications for adaptation and speciation.

4. Scent and adhesion drive insect dispersal of environmental yeast.

期刊: Proceedings of the National Academy of Sciences of the United States of America 发表日期: 2026-Jun-23 链接: PubMed

摘要

Insects and terrestrial fungi have lived on planet earth together for over 400 My. Different insect species are commonly associated with distinct mycobiomes. These insect-fungal associations are thought to provide a major dispersal mechanism for fungi in the environment. The Rhodotorula genus of pigmented basidiomycetous yeasts is commonly found in association with insects. Here, we demonstrate that yeasts of Rhodotorula spp. are highly attractive to the vinegar fly Drosophila melanogaster and the African malaria mosquito Anopheles gambiae. We characterized strains of the environmental yeast Rhodotorula taiwanensis that emit simple scent signatures predominated by the common microbial volatile 3-methyl-1-butanol (isoamyl alcohol) alongside other characteristic volatiles including acetone and acetaldehyde. Insect odorant receptors are required for attraction to R. taiwanensis and promote yeast dispersal to new growth niches. In addition to scent, dispersal is also likely mediated by the adhesive qualities of these yeasts to insect cuticles via hydrophobic interactions, as well as consumption. Strikingly, Rhodotorula dispersal was also facilitated by An. gambiae, although mosquitoes often died after becoming stuck to slimy lawns of these yeasts. Our work reveals that scent and adhesion drive insect dispersal of these environmental yeasts.

5. Multimodal Prehabilitation for Older Adults Undergoing Spinal Fusion : A Randomized Clinical Trial.

期刊: Annals of internal medicine 发表日期: 2026-Jun-16 链接: PubMed

摘要

Older adults often have impaired physiologic reserve and are at higher risk for postoperative complications after spinal fusion surgery. To evaluate the efficacy of multimodal prehabilitation plus Enhanced Recovery After Surgery (PREERAS) versus ERAS alone on 90-day postoperative complications in older adults undergoing elective spinal fusion. Multicenter, open-label, assessor-blinded, 1:1 parallel-group randomized controlled trial. (ClinicalTrials.gov: NCT06140797). 3 tertiary hospitals in China. Adults aged 75 years or older undergoing elective spinal fusion surgery between May 2024 and May 2025. Participants were randomly assigned to receive either preoperative Vivifrail-based, multimodal PREERAS (PREERAS group) or ERAS alone (ERAS group). The 4-week prehabilitation program integrated supervised group sessions, Vivifrail multicomponent exercise, nutritional optimization, and psychological interventions. The primary outcome was the occurrence of any postoperative complication within 90 days of surgery, recorded and graded per the Clavien-Dindo classification system. A total of 312 patients were assessed for eligibility, with 164 randomly assigned. Of the 159 patients included in the final analysis (mean age, 78.7 years; 59% women), 59 patients (74.7%) in the PREERAS group and 73 patients (91.2%) in the ERAS group experienced at least 1 complication (risk ratio, 0.80 [95% CI, 0.67 to 0.95]; risk difference, -18.0% [CI, -27.0% to -9.0%]). Unblinded participants and clinicians. Generalizability may be limited with longer hospital stays in the Chinese health care system. The implementation of multimodal prehabilitation in 3 tertiary hospitals in China reduced 90-day postoperative complications in older adults undergoing enhanced recovery after spinal fusion surgery. However, individual sites will need to consider applicability of findings and resource requirements of prehabilitation before implementation. Capital’s Funds for Health Improvement and Research.

6. Dementia Risk After Recombinant Herpes Zoster Vaccination in Older Adults With a Recent Skilled-Nursing Facility Stay : A Target Trial Emulation.

期刊: Annals of internal medicine 发表日期: 2026-Jun-16 链接: PubMed

摘要

Observational studies report a protective association between herpes zoster (HZ) vaccination and dementia, but they have methodological limitations or examined a live attenuated vaccine no longer available in the United States. Among older adults recently admitted to a skilled-nursing facility for postacute or long-term care, to estimate the association between dementia and receipt of the recombinant HZ vaccine (RZV) within 12 months of entering the facility or after discharge. The researchers conducted a cohort study using target trial emulation and the clone-censor-weight approach. Participants were followed for up to 4 years until the outcome of dementia, Medicare disenrollment, or death. Inverse probability of clone-censoring weights were applied to pooled logistic regression models to estimate effects. Medicare claims linked to nursing home electronic health record (EHR) data. Medicare fee-for-service beneficiaries aged 66 years or older who were admitted to a skilled-nursing facility between 1 January 2017 and 31 December 2022, had linked EHR data, had no diagnosed dementia, and were eligible for RZV. Receipt of at least 1 RZV in the facility or, if discharged, by 12 months after admission versus no receipt of RZV. Validated dementia diagnosis and 57 baseline and time-varying covariates. The study cohort included 509 926 participants (mean age, 79 years); 8843 (1.73%) received at least 1 RZV dose within 12 months after admission, and of these, 87.0% received RZV after discharge. Receipt of RZV was associated with risk for dementia being 5.8 percentage points lower (95% CI, 3.9 to 7.5 percentage points lower; risk ratio, 0.76 [CI, 0.69 to 0.84]; 4-year risk, 18.8% with ≥1 RZV vs. 24.6% with no RZV). Associations were attenuated in men and those with prior live HZ vaccination. Negative control analyses suggest some residual confounding. Receipt of RZV during admission to a skilled-nursing facility or within 12 months was associated with lower dementia risk. GlaxoSmithKline.

7. Isolation precautions: special considerations for immunocompromised hosts.

期刊: Current opinion in infectious diseases 发表日期: 2026-Jun-16 链接: PubMed

摘要

To summarize current approaches to isolation precautions and infection prevention and control (IPC) practices in immunocompromised hosts, including patients with hematologic malignancies, those receiving cellular therapies, and transplant recipients, with attention to variability in evidence and practice. Standard and transmission-based precautions remain foundational but often require adaptation for immunocompromised populations due to increased infection severity, prolonged pathogen shedding, and heightened transmissibility. Protective environments, including HEPA (high-efficiency particulate air) filtration and positive pressure rooms, may be of benefit for the highest risk populations but are resource-intensive and inconsistently applied. Emerging data support strategies such as universal masking to reduce respiratory viral infections (RVIs) and tailored transmission-based precautions. The role of multidrug-resistant organism (MDRO) screening and isolation continues to evolve, with mixed evidence and reconsideration of prior practices. Enhanced environmental cleaning and no-touch disinfection technologies hold potential but lack consistent outcome data. Several long-standing practices, including the neutropenic diet, are increasingly being re-evaluated. IPC in immunocompromised patients is complex and multifaceted, with limited high-quality evidence guiding practice resulting in significant practice variability. A shift toward individualized, risk-adapted strategies - balancing risk mitigation, resource utilization, and patient-centered care - will ultimately optimize outcomes.

8. Increasing threat to the healthcare setting: Candida auris.

期刊: Current opinion in infectious diseases 发表日期: 2026-Jun-16 链接: PubMed

摘要

This review summarizes the current knowledge related to infection prevention for Candida auris in the healthcare setting. Colonization, pathogenesis, and control strategies are discussed. There are numerous well documented C. auris outbreaks in healthcare settings, however, evidence is lacking on how to manage these colonized and postinfection patients long term in the acute care setting. C. auris is an emerging fungal pathogen with unique characteristics that make it challenging to eradicate in healthcare settings once introduced. Mitigation and control strategies have been investigated, but more research is needed about tangible effects of skin colonization, environmental disinfection, duration of transmission-based precautions, and topical decolonization.

9. Cash to carrots: Testing food environment mediation of cash transfer effects on children's diet in the Baby's First Years Study.

期刊: Health & place 发表日期: 2026-Jun-15 链接: PubMed

摘要

In the US, low-income children have poorer dietary behaviors than high-income children and suffer disproportionately from nutrition-related chronic diseases. A growing literature examines whether food environments contribute to nutritional inequality, given evidence that low-income families differentially concentrate in neighborhoods characterized by limited access to healthy foods. Here we use a rigorous, randomized controlled trial (RCT) of poverty reduction among 901 low-income families to test whether improvements in the food environment mediate a demonstrated effect of cash transfers on children’s diet. We first replicate prior work on the RCT showing a protective effect of treatment-i.e., assignment to a “high-cash” gift group (in which mothers received $333/month), relative to a “low-cash” gift group ($20/month)-on age-2 fruit and vegetable consumption. We then apply inverse odds ratio weighting (IORW) mediation methods to decompose the total effect of cash transfers into direct and indirect effects operating through changes in four food environment measures: 1) food deserts (census tract); 2) number of SNAP outlets (1-mile buffer); 3) Modified Retail Food Environment Index (mRFEI; census tract); and 4) supermarket proximity (straight-line distance). The proportion of the total effect explained by each food environment mediator ranged from 11% (mRFEI: β = 0.019, CI: -0.066, 0.104) to 14% (supermarket proximity: β = 0.025, CI: -0.057, 0.107) with all confidence intervals including zero, providing no evidence of mediation. Results suggest that changes in neighborhood food environments do not explain the effect of a poverty reduction trial on dietary improvements in early childhood.

10. A taxonomy of states' approaches to plans of safe care.

期刊: Child abuse & neglect 发表日期: 2026-Jun-15 链接: PubMed

摘要

The 2016 Comprehensive Addiction and Recovery Act amended the Child Abuse Prevention and Treatment Act (CAPTA), expanding requirements for the development of state-specific Plans of Safe Care (POSC) for prenatal substance exposure. POSCs were intended to amplify existing efforts to include maternal referral to treatment and services in addition to infant safety planning. States were left to re-operationalize their own POSC procedures, including the extent to which the POSC process involved the child welfare system. We reviewed state statutes, regulations, and reports to create a taxonomy of state POSC approaches based on their relationship with child protective services (CPS) and healthcare systems. We evaluated state POSC-related statutes, regulations, and federally mandated child welfare state reports (Annual Progress & Services Reports, Child & Family Services Plans, & CAPTA plans) for all 50 states and Washington, D.C. from 2012 to 2024. Using artificial intelligence-assisted text extraction and subject matter expert textual interpretation, we reviewed 634 documents and more than 123,000 pages of text. Through iterative categorization, we developed a five-domain POSC taxonomy, organizing POSC policies by their proximity to and engagement with CPS and healthcare systems. We then identified the number of states with POSC policies in each domain and the timing of implementation. Nearly all states had implemented their POSC by 2024. Our final taxonomy consisted of the following domains: (a) All CPS Referrals (26%), (b) Open Case Only (28%), (c) Alternative Response (26%), (d) Hospital-initiated (16%), and (e) Dual Pathways, that uses type of substance exposure to determine receipt of a Hospital-initiated POSC or traditional CPS response (14%). Eighty percent (80%) of states restrict POSC access to families already subject to CPS reporting or investigation. Despite federal intent to broaden public health supports, state POSC policies largely reinforce existing CPS practices rather than offering proactive, non-punitive interventions. The proposed taxonomy offers a framework for future comparative research, policy evaluation, and reform efforts.

11. "Others Decide for Us": Recommendations became restrictions in services for people with intellectual disability in Sweden.

期刊: Research in developmental disabilities 发表日期: 2026-Jun-15 链接: PubMed

摘要

Research on COVID-19 and people with intellectual disability has largely relied on proxy reports and early pandemic data, with limited focus on everyday policy implementation. In Sweden, where pandemic-related responses were based on recommendations rather than lockdowns, this raises questions about how participation was affected in practice. This study examined how people with intellectual disability receiving social services in Sweden experienced participation and involvement in everyday life during the COVID-19 pandemic, focusing on how national recommendations were implemented in practice. Five focus groups with 24 adults with mild to moderate intellectual disability were conducted in late 2022. Data were analysed using reflexive thematic analysis. Participants described difficulties accessing understandable information and increased reliance on staff for interpreting recommendations. At the same time, they demonstrated knowledge of the virus and described actively following protective measures. Despite this, national recommendations were frequently translated by staff and managers into binding rules within housing and daily activities, limiting opportunities to influence decisions in everyday life. This resulted in experienced participation restrictions, including constraints on work, social contact, and use of shared spaces. Several participants also described ongoing consequences of these practices beyond the pandemic period. The findings show that, even without lockdowns, local implementation of recommendations can create de facto restrictions in everyday life, despite participants’ ability to understand and follow public health measures. The study underscores how translating policy into practice within social services can affect participation in ways not visible at the policy level.

12. A Pilot mHealth Text Messaging Program Targeting Parents During the First 2000 Days: Nonrandomized Repeat Cross-Sectional Analysis to Evaluate Feasibility, Engagement, Acceptability, and Potential Effectiveness.

期刊: JMIR mHealth and uHealth 发表日期: 2026-Jun-15 链接: PubMed

摘要

The first 2000 days can profoundly influence long-term health. Healthy Beginnings for Hunter New England Kids (HB4HNEKids) is an SMS text messaging program delivered alongside routine Child and Family Health Nursing (CFHN) care, which provides families with evidence-based, age- and stage-related preventive health information across the first 2000 days. This pilot study aimed to explore the feasibility, engagement, and acceptability of the HB4HNEKids program. It also aimed to explore the potential effectiveness of the program at 6 and/or 12 months post partum on outcomes including breastfeeding, child diet, child movement, and parental mental well-being. During the pilot phase (October 2021 to July 2024), project records were used to assess the number of families enrolled, number of SMS text messages sent (feasibility), and the number of opt outs (engagement). Repeat cross-sectional surveys were conducted at 5-7 months post partum and again at 12-14 months post partum using validated survey instruments. Using convenience sampling methods, survey participants consisted of birthing parents who had received HB4HNEKids and a concurrent nonrandomized comparison group that did not receive the program. Surveys assessed parental self-reported engagement with the messages, program acceptability, breastfeeding status, child diet, child movement, and parental mental well-being. Mixed linear regression analyses were conducted to calculate mean differences and odds ratios. During the pilot phase, HB4HNEKids was delivered to 6243 families (73.4% of families contacted by CFHN). A total of 383 birthing parents completed the survey at 6 months (99/383, 26% receiving HB4HNEKids), and 283 completed the survey at 12 months (104/283, 37% receiving HB4HNEKids). Of the survey participants who received HB4HNEKids (n=200), between 76% and 83% reported that they always or very often read the SMS text messages, spending on average 5-7 minutes engaged with the content. At both survey time points, more than 90% of participants receiving HB4HNEKids agreed that the program was acceptable. Child daily intake of vegetables was significantly higher in the HB4HNEKids group (adjusted mean difference 0.23, 95% CI 0.07-0.40; P=.006) than in the comparison group at 12 months. Parents receiving HB4HNEKids also reported significantly better mental well-being scores (P=.005). While HB4HNEKids participants reported breastfeeding rates 5 percentage points greater than comparison participants at 6 and 12 months, this result was not statistically significant. There were no statistically significant differences between HB4HNEKids, and comparison participant responses related to child movement behaviors. The HB4HNEKids SMS text messaging program is feasible to deliver at scale alongside routine CFHN care and is highly acceptable and engaging to parents. This pragmatic evaluation of the pilot, embedded into usual care, indicates potential effectiveness of the program for improving child vegetable intakes and parental mental well-being. Further evaluation of this program using robust methodology is needed to determine the effectiveness of this innovative mHealth program across the first 2000 days.

13. Characterizing Social Determinants of Health in Patients With Type 2 Diabetes and Liver Disease: Cross-Sectional Survey Study.

期刊: JMIR formative research 发表日期: 2026-Jun-15 链接: PubMed

摘要

The mortality rate from liver disease among people with type 2 diabetes mellitus (T2DM) increased by 20% between 2001 and 2018. There are marked racial and ethnic differences among people with T2DM at risk of metabolic dysfunction-associated steatotic liver disease (MASLD) and related complications. We aimed to investigate the distribution of individual-level social determinants of health (SDOH) in people living with both T2DM and MASLD. In this small cross-sectional study, patients (N=50) were recruited from a tertiary care general hepatology clinic to complete a survey that assessed potential determinants of health. We sought to oversample Black and Hispanic patients to better understand the prevalence of SDOH. Electronic health records were reviewed to determine stage of liver disease, and these data were linked to survey results to identify the distribution of individual-level determinants of health in patients with cirrhosis. Black and Hispanic respondents were more likely to report more experiences of racial discrimination, worries about being discriminated against, and group-based medical mistrust, especially regarding unsupportive health care providers. Cirrhosis groups tended to have lower incomes and less coverage from private health insurance. However, no substantial trends were observed in the distribution of health literacy, discrimination, and diabetes stigma among patients with and without cirrhosis. These findings will inform a future study aimed at assessing and developing interventions to address the combined impact of individual- and neighborhood-level SDOH on health-related outcomes in patients with T2DM and MASLD.

14. A Multilingual Digital Microlearning Intervention for Oral Health in Refugee Shelters: Randomized Controlled Trial.

期刊: Journal of medical Internet research 发表日期: 2026-Jun-15 链接: PubMed

摘要

Refugees frequently face language and access barriers to preventive oral health information. Brief multilingual digital interventions may help reduce such barriers in shelter settings. This randomized controlled trial evaluated whether a multilingual digital microlearning video improved plaque control and selected self-reported oral health-related behaviors among adults living in refugee shelters. A 2-arm, parallel-group randomized controlled trial was conducted among 86 adults living in 2 municipal refugee shelters in Germany. Participants were randomized (1:1) to receive either a multilingual 4-minute oral hygiene microlearning video or delayed access (control group). Plaque index and gingival index were assessed clinically at baseline and at 2-month follow-up. Secondary outcomes included questionnaire-based measures of oral health literacy-related cognitions and self-reported oral health behaviors. Between-group differences in change scores were analyzed using 2-sided tests; exploratory multivariable regression analyses were conducted to assess potential effect modifiers. Follow-up was completed by 83 (97%) of 86 participants. Plaque index decreased more in the intervention group than in the control group (mean change -0.21, SD 0.27 vs mean change -0.04, SD 0.17; P=.002). Gingival index decreased in both groups, but the between-group difference was not significant. Among questionnaire-based outcomes, toothbrushing frequency increased substantially, whereas the remaining oral health literacy-related items showed small numerical changes that did not reach statistical significance or remained stable. Approximately three-quarters of participants in the intervention group (32/42, 76%) reported reviewing the video at least once. Brief multilingual digital microlearning improved plaque control and self-reported toothbrushing frequency in refugee shelters. Effects on broader oral health literacy-related outcomes were limited and should be interpreted cautiously. Larger, prospectively powered trials with longer follow-up periods and blinded outcome assessment are warranted.

15. Developing a Virtual Reality Application for Social and Emotional Wellbeing and Cultural Determinants of Health Support With an Aboriginal Community of Sydney, New South Wales, Australia: Protocol for an Acceptability and Feasibility Study.

期刊: JMIR research protocols 发表日期: 2026-Jun-15 链接: PubMed

摘要

As the first peoples of Australia, Aboriginal and Torres Strait Islander peoples have continuing cultures that are essential to wellbeing. Complex sociocultural, health, and wellbeing inequities stemming from colonization, settler-colonialism, and mental health system challenges have led to high rates of negative mental health and wellbeing for Aboriginal and Torres Strait Islander peoples. Improving Aboriginal and Torres Strait Islander mental health and wellbeing outcomes is a national public health priority. Social and emotional wellbeing (SEWB) and the cultural determinants of health (CDH) provide evidence-based approaches for providing culturally centered wellbeing support. There is a need to increase the availability, accessibility, and effectiveness of culturally relevant, holistic, and strengths-based wellbeing supports. It is essential that Aboriginal communities have self-determined opportunities to develop and implement culturally centered wellbeing supports informed by SEWB and the CDH. Aboriginal digital health and wellbeing support research is an emerging field offering potential to help improve wellbeing outcomes. This study aims to explore how virtual reality (VR) could be used to provide SEWB and CDH support for Aboriginal and Torres Strait Islander peoples. This study protocol outlines a 3-phase mixed-methods approach that will inform the co-design and codevelopment of a VR application that aims to provide SEWB and CDH support. In partnership with Tribal Warrior, an Aboriginal Community Controlled Organization, Studio Gilay, an Aboriginal-led animation and storytelling studio, and Phoria, an Australian immersive storytelling technology company, this study will assess cultural relevance, acceptability, and feasibility of the VR application. Using Indigenist and Participatory Action Research methodologies, purposive sampling will be used to recruit 35 Tribal Warrior staff and Aboriginal community members to participate in each phase of research. Qualitative data collection will occur in each phase through yarning circles. Reflexive thematic analysis will guide qualitative analysis. Phase 3 will involve a quantitative survey, generating cultural relevance, acceptability, and feasibility evidence. Descriptive statistics analysis will be used to report results. As of April 2026, data collection and analysis for phases 1 and 2 are complete. This study will culminate in the development and assessment of a co-designed and codeveloped VR application that aims to provide SEWB and CDH support for Aboriginal peoples. Findings from each phase will be published in academic papers and nonacademic outputs. The VR application will be implemented by Tribal Warrior into existing community programs and supports. Findings from this study have potential implications for improving availability and accessibility to culturally centered wellbeing supports for Aboriginal and Torres Strait Islander peoples. Assessing the cultural relevance, acceptability, and feasibility of using VR technology to provide culturally centered wellbeing support will contribute novel evidence to the fields of public health, digital health, and design-based research.

16. Contemporary survival outcomes of patients with isolated nodal recurrences of breast cancer: A population-based study.

期刊: Cancer radiotherapie : journal de la Societe francaise de radiotherapie oncologique 发表日期: 2026-Jun-15 链接: PubMed

摘要

Modern adjuvant therapies, including systemic treatments and radiotherapy, have significantly improved outcomes for patients with breast cancer. However, isolated nodal recurrences remain rare, comprising less than 1 % of cases, and pose a therapeutic challenge, with historical 5-year overall survival rates below 50 %. This study evaluated the clinical outcomes of patients with isolated nodal recurrences in the modern era using the Surveillance, Epidemiology, and End Results (SEER) database and examined factors associated with survival. We analysed data from 1479 female patients with cT0N+M0 breast cancer diagnosed between 2000 and 2021 in the SEER database. Patients were categorized as having isolated nodal recurrences if they had prior ipsilateral breast cancer or occult primary breast cancer if presenting with a first cancer diagnosis. Demographics, tumour characteristics, and treatments were recorded. Survival outcomes were assessed using Kaplan-Meier and Cox regression models. Of 1479 patients, 42 (2.8 %) had isolated nodal recurrences, and 1437 (97.2 %) had occult primary breast cancer. Median time to isolated nodal recurrences was 105 months. Most initial tumours were early-stage (T1-T2, 75 %) and node-negative (78.6 %). Five-year overall- and cancer-specific survival rates of patients with isolated nodal recurrences were 72.4 % (95 % confidence interval [CI]: 57.6-91.0 %) and 81.5 % (95 % CI: 67.8-97.9 %), respectively, compared to 80.4 and 86.6 % for patients with occult primary breast cancer. Trends toward improved survival with adjuvant chemotherapy (5-year overall survival rates: 78.0 versus 68.0 %) and radiotherapy (5-year overall survival rates: 83.6 versus 63.2 %) were observed but not statistically significant. No survival benefit was found for total mastectomy in cases of isolated nodal recurrences following breast-conserving surgery. This study showed encouraging survival outcomes for patients with isolated nodal recurrences in the modern era, with 5-year overall survival exceeding historical benchmarks. Comparable survival between patients with isolated nodal recurrences and occult primary breast cancer highlights the potential for curative approaches. Further research is required to refine treatment strategies and identify patient subgroups that may benefit from tailored therapies.

17. An Evaluation of Pretrained Generative Models for Augmenting Small Health Data: Comparative Modeling Study.

期刊: Journal of medical Internet research 发表日期: 2026-Jun-15 链接: PubMed

摘要

Synthetic data generation (SDG) has emerged as a promising solution to address data scarcity in health care, where privacy concerns, regulatory barriers, and the high cost of data acquisition limit access to real patient datasets. Machine learning models in this domain often operate in low-data regimes, with training set sizes as low as 20 and a median dataset size of around 600 records-conditions that hinder model generalization and increase the risks of overfitting and bias. SDG addresses these challenges by producing artificial samples that mimic real-world patient data, enabling robust and privacy-preserving model development. This study was a comprehensive assessment of SDG-augmented training across a wide array of models-both pretrained and non-pretrained-for outcome prediction in 13 health care datasets. For small datasets of sizes 50 and 350 records, we answer 3 key questions: (1) Do pretrained SDG models generate more effective augmentations than their non-pretrained counterparts for small datasets? (2) Is augmentation beneficial for both pretrained and non-pretrained classifiers for small datasets? (3) Among 3 state-of-the-art classification models, which offers the best predictive performance on small datasets? The workload that this study aimed to improve was binary classification. The 3 classifiers considered were light gradient boosting trees, large language models (LLMs) adapted to tabular data, and Tabular Prior-Data Fitted Network (TabPFN), a transformer-based method that has become the new state of the art in terms of tabular data classification. Each classifier was augmented through different SDG methods: current state-of-the-art techniques (Bayesian networks, conditional tabular generative adversarial networks, tabular variational autoencoders, and sequential trees) and the use of LLMs for tabular data generation. Augmented TabPFN demonstrated superior performance, yielding significantly higher area under the curve and integrated calibration index scores compared to other classifiers. Post hoc analysis revealed that, for the dataset sizes examined, SDG and LLM models exhibited overfitting tendencies. Notably, simple dataset augmentation through sampling with replacement achieved performance comparable to that of SDG-based and LLM-based augmentation methods for TabPFN, suggesting that gains were primarily driven by increased sample size rather than SDG. Given its strong performance and minimal computational overhead, we recommend augmenting TabPFN through sampling with replacement as the optimal approach for small-data binary classification tasks. This method achieves performance comparable to that of more complex SDG techniques while offering substantial computational advantages.

18. Approaches to Collect Comprehensive Electronic Patient Data Across Multiple Providers and Payers for Research: Landscape Analysis.

期刊: Journal of medical Internet research 发表日期: 2026-Jun-15 链接: PubMed

摘要

The digitization of medical data and advances in interoperability have opened opportunities for research studies to use more comprehensive, longitudinal patient data from multiple sources. As patients often interact with many providers and payers over time, collecting data across organizations may have critical implications for accuracy and bias in study results. US policy has promoted exchanging health information among providers, payers, and patients, but less attention has focused on facilitating data collection for research, which presents unique challenges. This study aimed to identify and evaluate existing and emerging approaches for collecting comprehensive provider and payer data for research in the United States, with the goals of informing researchers of possible methods and generating evidence to inform policy initiatives. Our focus was on electronic approaches to data aggregation for studies requiring patient consent. We conducted a landscape analysis through interviews with subject matter experts (SMEs). SMEs were selected based on expertise. We created a list of evaluation criteria, identified existing and emerging approaches, and described the benefits and limitations of each approach by applying the evaluation criteria. We interviewed SMEs until saturation was achieved. Data collection was limited to the United States. A total of 20 SMEs helped identify 8 distinct approaches: (1) general-purpose smartphone app, (2) commercial app, (3) research community app, (4) structured data export, (5) Trust Exchange Framework and Common Agreement Individual Access Service, (6) regional study query, (7) national study query, and (8) aggregated data source. Participant-mediated exchange approaches (1-5) leveraged patients’ right of access. Three approaches leveraged existing data exchange services (5-7). To evaluate these approaches, we identified 12 criteria, including perspectives of participants, research teams, and broader stakeholders. Each approach had benefits and limitations; no single approach emerged as superior for all use cases. While currently available approaches for participant-mediated exchange bypass the need for complex governance arrangements, they are limited by participant burden, effort needed by research teams, and data gaps, especially from payers. Some regional health information exchanges and aggregated data sources address governance challenges and can provide services such as preparing analytic datasets but are restricted to specific locations and/or data-source coverage. National networks currently do not allow queries for research and confront challenges in establishing trust and enforcing compliance with data-sharing requirements among network sites. Collecting comprehensive health data from multiple providers and payers in the United States is a complex and evolving process. The suitability of an approach may vary based on the needs of a study. Given the numerous barriers and the lack of a clear dominant method, further exploration and benchmark comparisons of all identified approaches are necessary. Ongoing public policy efforts will likely play an important role in progress.

19. How Online Scheduling Platforms Affect Insurance-Based Disparities in Access to Specialist Outpatient Care in Berlin, Germany: Cross-Sectional Audit Study.

期刊: Journal of medical Internet research 发表日期: 2026-Jun-15 链接: PubMed

摘要

Online scheduling platforms are increasingly chosen by patients for scheduling outpatient appointments. Due to payment for listing or platform decisions on listing visibility, they can amplify access inequalities. Especially in Germany’s dual insurance system, the beneficiary difference in waiting times for private health insurance (PHI) patients compared to statutory health insurance (SHI) patients for specialist appointments might increase. The objective of this study was to quantify differences in waiting times for the first available specialist outpatient appointments for SHI versus PHI profiles on a large commercial online scheduling platform (Doctolib) in Berlin and to assess whether practices offering equal appointment options for both insurance types are deprioritized by the platform. We performed a cross-sectional, internet-based audit between January 6, 2025, and February 26, 2025. Two standardized simulated patient profiles (SHI and PHI) were used to query 1867 platform listings; practices with at least 1 bookable slot for both profiles were documented (n=492). The primary outcome was the waiting time in days for the earliest available appointment. Paired 1-tailed t tests and Wilcoxon signed-rank tests were used to compare within-provider waiting times, while exploratory subgroup analyses examined specialty-specific differences. Sensitivity analyses excluded the top 5% of the longest waits. Effect sizes (Hedges g) were computed. Across 492 practices, mean waiting times were 50.4 (SD 52.2) days for SHI and 22.6 (SD 36.8) days for PHI, yielding a mean difference of 27.8 days (95% CI 23.6-31.9 d; t491=13.05; P<.001; Hedges g=0.59). After excluding the top 5% of waiting times (n=44), the difference remained significant (Δ=23.1 d; 95% CI 20.0-26.2 d; t447=14.77; P<.001). Providers that offered earlier PHI appointments showed substantially longer SHI waiting times (61.8 vs 37.5 d; P<.001) and substantially shorter PHI waits (12.0 vs 38.2 d; P<.001). Platform ranking was correlated with earlier PHI availability (Spearman rank correlation r=0.574; P<.001). On this commercial online scheduling platform in Berlin, SHI patients experienced substantially longer waits for the first available specialist appointments than PHI patients across multiple specialties. Potential mechanisms that could amplify pre-existing insurance-based access inequities are discussed. Transparency about the platform’s ranking criteria should be considered to promote equitable access.

20. AI-Assisted Systematic Literature Review of the Economic Burden of Pneumococcal Disease: Development and Validation Study.

期刊: JMIR AI 发表日期: 2026-Jun-15 链接: PubMed

摘要

Automated systematic literature review (SLR) may reduce the workload and errors associated with manual review, enabling faster, up-to-date reviews even with increasing publication volumes. Large language models (LLMs) have demonstrated strong capabilities in understanding unstructured languages. However, few studies have explored the potential of a comprehensive LLM platform to streamline the entire SLR process from article screening to data extraction. This study aimed to investigate the feasibility of applying an LLM-based system to assist with SLR development. We developed the Intelligent Systematic Literature Review (ISLaR 2.0) platform, powered by an LLM, and applied it to a use case of the economic burden of pneumococcal disease (PD) literature. First, we established the inclusion and exclusion criteria for the SLR. Second, we defined data elements related to economic burden and domain knowledge, along with guidelines for applying these definitions. Finally, we used the criteria and data element specifications to develop LLM prompts for screening and data extraction. For data extraction, we identified relevant study characteristics and economic burden outcomes. We evaluated ISLaR 2.0’s performance against a gold standard of 50 expert-curated PD articles, using standard metrics (accuracy, precision, recall, and F1-score). We also conducted a qualitative analysis to describe errors made by the system. ISLaR 2.0 performed well in abstract and full-text screening (F1-scores of 86.27 for abstract screening and 87.18 for full-text screening) and data extraction from text (F1-scores of 92.83 for study details and 79.76 for economic burden outcomes). The F1-score for data extraction of tabular economic burden outcome data was 94.83. The qualitative analysis revealed 2 main challenges in extracting economic burden details: misclassification of cost categories and failure to extract relevant information. ISLaR 2.0 enabled efficient execution of an SLR regarding the economic burden of PD. The platform allowed users to flexibly define and modify criteria and data elements, supporting its use across a broad range of health research topics.

21. Temporal trends and future projections of amphetamine use disorder in China and the United States: findings from the Global Burden of Disease Study 2023.

期刊: The American journal of drug and alcohol abuse 发表日期: 2026-Jun-15 链接: PubMed

摘要

Background: Amphetamine use disorder (AUD) is a growing public health concern, yet comparative evidence on long-term trends and future burden in China and the United States remains limited due to differing drug policy and sociocultural contexts.Objectives: To compare sex-specific long-term trends and future burden of AUD in China and the United States.Methods: Data on incidence, mortality, and disability-adjusted life years (DALYs) from 1990 to 2023 were obtained from the Global Burden of Disease 2023 study for males and females. Given known sex differences in substance use burden, analyses were stratified by sex. Joinpoint regression, age - period - cohort (APC) analysis, and autoregressive integrated moving average (ARIMA) models were applied to assess trends and project rates through 2038.Results: Males had consistently higher age-standardized incidence rate (ASIR) and age-standardized disability-adjusted life year rate (ASDR) than females in both countries. In 2023, ASDR among males and females were 51.92 and 30.73 per 100,000 in China, compared with 175.38 and 82.82 per 100,000 in the United States, respectively. China showed significant declining trends in ASIR and ASDR (average annual percent change [AAPC] -1.38% and -1.67%, both p < .05), whereas the United States showed increasing trends (AAPC 1.03% and 4.26%, both p < .05). APC analysis showed declining cohort effects in China but increasing risks among recent U.S. cohorts. Projections suggested continued increases among U.S. males.Conclusions: AUD burden declined in China but increased in the United States. Strengthening prevention and treatment strategies may help reduce future burden.

22. A retrospective medical record review of patients' decisions to utilise or refrain from brief admission.

期刊: Discover mental health 发表日期: 2026-Jun-15 链接: PubMed

摘要

Brief Admission (BA) allows patients to independently access short-term psychiatric care during periods of acute stress or perceived threat, offering a safe and structured respite. BA has been associated with reduced self-harm and hospital readmissions. Understanding the factors behind individual differences in BA use and experience is therefore essential. To examine patients’ decisions to utilise or refrain from brief admission. A retrospective review of 66 medical records (representing 47% of all cases with BA agreements) was conducted using a convergent mixed-methods design. Conventional qualitative content analysis was performed, and the resulting categories were summarized using frequencies and percentages based on the number of records assigned to each category. According to the medical records, 49% of the patients had never utilised BA, while 23% reported using it less than once per year. The patients perceived BA as beneficial in managing their mental health. By maintaining meaningful activities and self-care routines, the patients were able to preserve behaviours that contributed to their well-being during BA. Identified challenges that could hinder the utilisation of BA included difficulties in assessing appropriate timing, staff attitudes, fear of detention, concerns about contact with other individuals with mental health problems, and the need for social support to facilitate engagement with BA. Despite BA’s aim of offering a safe environment, it may also trigger past traumatic or negative experiences in patients and relatives, potentially limiting its use. Access to BA may enhance patient well-being. Given the overlapping challenges patients often face, individually tailored strategies, supported by existing networks and outpatient staff, can help determine when BA or other interventions are appropriate.

23. Inequity in quality of life among culturally and linguistically diverse children in Australia.

期刊: Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation 发表日期: 2026-Jun-15 链接: PubMed

摘要

The aims of this study were to investigate whether children from different culturally and linguistically diverse (CALD) backgrounds in Australia have similar Health Related Quality of Life (HRQoL), in early childhood, middle childhood, and adolescence. We used data from 9099 children from the Longitudinal Study of Australian Children (LSAC), aged between 2 and 17 years, including HRQoL measured with the parent proxy Pediatric Quality of Life Inventory (PedsQL). The study pertained to cohort data from 2004 to 2018. CALD groups were defined according to child, mother’s and father’s country of birth and main language spoken at home. The association of child HRQoL with CALD group, was analysed using generalised estimating equations, adjusted for age, sex, socioeconomic position (SEP) and weight status. Children of Middle Eastern or North African, South-East Asian, South and Central Asian and Oceania backgrounds had significantly lower HRQoL (p < 0.05) than children from English speaking backgrounds. These disparities were greatest during middle childhood and adolescence and only partly explained by lower SEP and weight status. Disparities in physical HRQoL were greater than psychosocial HRQOL. Considerable inequity in HRQoL is present in Australian children from different CALD backgrounds. This study highlights the need for culturally tailored programs for school-aged children to improve their physical HRQoL. Health-related quality of life is an important measure of child overall health and includes physical and psychosocial health. There is evidence for lower quality of life in some culturally diverse populations, but no studies have examined this in children and adolescents. We used data from a very large Australian study that measured quality of life of children from age 2 to age 17 years and found lower quality of life among some cultural groups that developed primarily in middle childhood. Disparities in physical HRQoL were greater than psychosocial HRQOL. This highlights the need for culturally tailored programs for school-aged children to improve their physical HRQoL.

24. Neuromuscular electrical stimulation affects the change in stretch tolerance by static stretching.

期刊: Experimental brain research 发表日期: 2026-Jun-15 链接: PubMed

摘要

Neuromuscular electrical stimulation (NMES) generates contractions by repetitive depolarization of axons under stimulating electrodes, and neural pathways activating motor units are affected by the stimulation parameters and delivery location. The present study examined the differences in acute effects of NMES applied over the nerve trunk and over the muscle belly on changes in range of motion and passive torque by static stretching. Effects of NMES or prolonged resting and 5-min stretching on the maximal dorsiflexion angle and passive torque were investigated. NMES consisted of 60 stimulation trains (10 s ON, 10 s OFF) at 10 Hz to the tibial nerve or triceps surae. Passive ankle dorsiflexion was performed before and after NMES and stretching interventions. Stretch tolerance and stiffness of the muscle-tendon unit were evaluated by the peak and slope of passive torques, respectively. Increases in the maximal dorsiflexion angle by stretching did not differ significantly among NMES over the nerve trunk (3 ± 2°), the over the muscle belly (2 ± 3°), and prolonged resting (2 ± 2°). Decreases in stiffness of the muscle-tendon unit by stretching were not significantly different among NMES over the nerve trunk (- 13.2 ± 7.1%), over the muscle belly (- 8.8 ± 11.3%), and prolonged resting (- 11.5 ± 11.5%). Significant increases in stretch tolerance by stretching were observed with NMES over the nerve trunk (9.0 ± 10.2%) and over the muscle belly (6.9 ± 14.6%), but not with prolonged resting (1.5 ± 8.7%). NMES tended to facilitate greater stretch tolerance by static stretching regardless of electrode location.

25. Pathways from non-communicable diseases to depression among older adults in India.

期刊: Social psychiatry and psychiatric epidemiology 发表日期: 2026-Jun-15 链接: PubMed

摘要

Depression co-occurring with non-communicable diseases is a major public health concern among ageing population, particularly in low and middle-income countries like India. But, the complex hidden patterns, predictors and interrelationships among functional health, lifestyle behaviours and NCDs burden in shaping depressive symptoms remain insufficiently explored. The present study utilized data from the Longitudinal Ageing Study in India Wave-1 (2017-2018), comprising 59,298 individuals aged 45 years and above. Exploratory and confirmatory factor analyses were conducted to derive latent constructs of functional limitations, lifestyle behaviours and NCDs burden. Structural equation modeling was used to examine direct and indirect associations with depressive symptoms and ordinal regression modeling was applied to assess important predictors of depression severity. Approximately 40% of participants reported some level of depressive symptoms. Three latent domains were identified, representing functional limitations, lifestyle behaviours and NCDs burden. The SEM showed acceptable fit (CFI = 0.923, RMSEA = 0.062). Functional limitations exhibited the strongest positive association with depressive symptoms (β = 2.052, p < 0.001), followed by NCDs burden and lifestyle behaviours. Ordinal regression modeling results were consistent with functional impairment and poor self-rated health emerging as key predictors of higher depression severity. The findings suggest that functional health plays a central role in the relationship between chronic disease burden, lifestyle factors and depressive symptoms. Interventions aimed at maintaining functional ability, alongside integrated management of NCDs and promotion of healthy behaviours, may help improve mental health outcomes among ageing population.

26. The Development of the Paraphilic Disorders Short Screen (PDSS) and Its Examination in Diverse Populations: A Large, Multi-Nation Study.

期刊: Sexual abuse : a journal of research and treatment 发表日期: 2026-Jun-15 链接: PubMed

摘要

To date, there is no reliable and valid screening tool for paraphilic disorders (PDs) based on the diagnostic criteria of the International Classification of Diseases (ICD-11). The present study aimed to develop and cross-culturally examine the cross-cultural applicability of a new screening tool for PDs following the ICD-11 guidelines. Top-down item development was conducted with expert practitioners in the field. Data were collected in 26 languages across 42 countries (N = 82,243; 39.5% men; 57.0% women; 3.4% gender-diverse; Mage = 32.39 years, SD = 12.52). Cut-off scores were established per ICD-11 guidelines, and at-risk groups were compared with low-risk groups along theoretically relevant correlates (e.g., depression, anxiety). The Paraphilic Disorders Short Screen (PDSS) assesses seven paraphilias via 21 items. Voyeurism was most common paraphilic interest (PI) (19.42% of the total sample; n = 15,970), which also had the highest number of participants meeting the ICD-11 diagnostic cut-off (3.24%; n = 2,662). PI and PD groups consistently demonstrated more severe depression and anxiety symptoms than others. The PDSS is a reliable and valid screening tool that follows the latest ICD-11 guidelines; therefore, it has the capacity to enhance clinical practice and research by identifying individuals at risk.

27. Depressive Symptom Patterns and Digital Screen Exposure Among Adults in Qatar: A Cross-Sectional Study With Implications for Psychiatric and Mental Health Nursing Practice.

期刊: Journal of psychiatric and mental health nursing 发表日期: 2026-Jun-15 链接: PubMed

摘要

Depression is a major global health concern, yet population-based evidence on depressive symptom patterns and associated lifestyle factors in Qatar remains limited. Understanding symptom distribution is important for informing nurse-led prevention and early identification strategies. A cross-sectional secondary analysis was conducted using data from 1098 adults enrolled in the Qatar Biobank. Depressive symptoms were assessed using the nine-item Patient Health Questionnaire. Descriptive statistics summarized total scores, severity categories and individual symptoms. Bivariate analyses and hierarchical multivariable regression were conducted to examine associations between depressive symptoms and selected sociodemographic and behavioural variables including screen-based digital device exposure (television, mobile phone, tablet and computer). The mean nine-item Patient Health Questionnaire (PHQ-9) score was 5.28, indicating overall low symptom severity. More than half of participants (52.7%) reported no depressive symptoms, while 30.9% reported mild symptoms. Moderate to severe symptoms were observed in a minority of participants. Low energy and sleep-related symptoms were most frequently reported, whereas suicidal ideation was least endorsed. Higher screen-based digital device use showed small but statistically significant associations with multiple depressive symptoms (r≈0.06-0.10), indicating small effect sizes with limited clinical significance, although these associations were not retained after adjustment in multivariable analysis. Depressive symptoms in this population were generally mild. The findings highlight the relevance of symptom-focused assessment and consideration of digital behaviours in psychiatric and mental health nursing practice, supporting nurse-led preventive and health promotion initiatives in Qatar. Psychiatric and mental health nurses are central to early identification and prevention of depressive symptoms in primary care and community settings in Qatar. This study provides population-based evidence on depressive symptom patterns and their associations with screen-based digital device exposure among adults. Findings support symptom-focused screening beyond total depression scores and highlight the need to routinely assess digital behaviours, sleep-related complaints and fatigue as part of nurse-led mental health assessment. The results inform culturally responsive health promotion, brief interventions and referral pathways that nurses can implement to prevent progression from mild symptoms to clinically significant depression.

28. Beyond the Mosquito: Social Determinants of Health and Global Strategies for Aedes-Borne Disease Control.

期刊: Tropical medicine & international health : TM & IH 发表日期: 2026-Jun-15 链接: PubMed

摘要

Aedes-borne diseases, including dengue, chikungunya and Zika, have emerged as a growing global health concern, particularly in tropical and subtropical regions. Their spread is not only driven by biological and environmental factors but also shaped by a wide range of social determinants of health (SDH). This systematic review synthesizes available evidence on SDH that shape the transmission, prevention and control of these diseases, as well as the strategies implemented internationally to address them. We conducted five systematic reviews following PRISMA guidelines, each corresponding to one of the major Aedes-borne diseases (dengue, chikungunya, Zika and other Aedes-related illnesses). Searches were performed in PubMed and Scopus for the period 2000-2024, using both MeSH terms and free-text keywords. Quality appraisal was conducted using appropriate checklists, that is, CASP, STROBE and results were synthesized narratively. Thematic coding was applied to identify patterns across social, economic and environmental determinants, while intervention data were summarized descriptively. The systematic search figured out a large number of potentially relevant records across the five reviews. One hundred sixty-nine studies were included for full analysis including 27 studies on Aedes in general, 54 on dengue, 3 on chikungunya, 14 on Zika and 71 on preventive interventions. The main themes that emerged from the study analysis included: Poverty and Related Indicators, Education and Health Literacy, Community Engagement, Urban Infrastructure and Social Support, Access to Health Services, Demographic Factors, Culture and Beliefs and Migration and Human Mobility. Interventions that engaged communities and combined educational, infrastructural and environmental actions demonstrated the greatest impact and sustainability. Findings of the study suggest that effective and sustainable Aedes-borne disease control depends on tackling structural inequities-particularly poverty and poor urban infrastructure-while promoting health literacy and community engagement. Future research should further investigate underexplored determinants, including cultural and migratory factors, to inform context-specific, multisectoral responses.

29. Robot-Assisted Oral Examination: Challenges and Innovations.

期刊: International dental journal 发表日期: 2026-Jun-15 链接: PubMed

摘要

To summarize and evaluate the core components, functional modules, and developmental challenges of intelligent oral examination robots, and to clarify their potential clinical relevance as well as the mechanisms by which robotics and artificial intelligence can enhance diagnostic efficiency and standardization in dentistry. This study employed a systematic literature review methodology, retrieving relevant publications from the PubMed and ScienceDirect databases up to September 2025. The search strategy utilized Boolean operators to combine keywords such as ‘robot,’ ‘AI,’ ‘oral diagnosis,’ and ‘intraoral scanner,’ aiming to comprehensively cover the fields of robotic technology, oral diagnostics, artificial intelligence, and related sensing technologies. The initial search yielded approximately 1,027 articles, of which 134 were ultimately included after screening. Inclusion criteria comprised studies related to oral robotic technologies, applications of artificial intelligence in diagnosis, and robotic navigation, while exclusion criteria included non-peer-reviewed publications and studies with insufficient methodological descriptions. A combined approach of narrative review and critical analysis was adopted, with a focus on key technical domains, including hardware architecture, software integration, multimodal perception systems, and force feedback mechanisms. The analysis identified several key technological components of intelligent oral examination robots, including high-resolution intraoral imaging systems, multimodal data fusion frameworks, force-sensing and adaptive control technologies, automated navigation systems, and AI-driven data-processing algorithms. These systems contribute to improved image acquisition accuracy, standardized diagnostic procedures, enhanced data management, and optimized clinical workflow. However, challenges remain in system integration, safety assurance, real-time responsiveness, and clinical validation. Current technological advances suggest that intelligent oral examination robots have significant potential to reduce clinician workload, improve diagnostic accuracy, and enhance consistency in oral examinations. Continued refinement in hardware-software integration, safety mechanisms, and clinical adaptability will be essential for broader implementation. Intelligent oral examination robots may significantly improve diagnostic quality through automation, standardized data acquisition, and enhanced imaging capabilities. Their application could facilitate early disease detection, improve patient management, and streamline clinical workflows in modern dental practice.

30. Peer-assisted learning in medical radiation sciences education and training: A scoping review.

期刊: Radiography (London, England : 1995) 发表日期: 2026-Jun-15 链接: PubMed

摘要

Peer-assisted learning (PAL) is a student-centred teaching approach widely used in the health sciences to enhance student engagement, academic performance, clinical competence, and professional development. Although PAL is receiving increasing attention in academia, its use as a supplementary teaching strategy in medical radiation sciences education remains limited and underexplored. In this scoping review study, students include those in diagnostic radiography, ultrasound, therapeutic radiography, and nuclear medicine. Therefore, this review aims to synthesise a perspective on the impact of PAL on the academic performance, clinical competence, and professional development of medical radiation sciences students. This review followed PRISMA-ScR guidelines and was managed using Covidence. The five-step approach of Arksey and O’Malley guided the methodological process. Articles from 2010 to 2025 were identified through electronic library databases using predefined inclusion and exclusion criteria. A total of 650 articles were identified, with 10 studies meeting the inclusion criteria. Data were extracted using a structured template and were synthesised thematically. Four main themes were developed: (1) learning environment and student engagement, (2) development of professional and mentorship skills, (3) academic performance and learning outcomes, and (4) challenges and limitations of PAL. The results show that PAL fostered collaboration and student engagement, enabling peer mentors to develop leadership, teaching, and communication skills. PAL enhanced knowledge retention, exam preparation, and clinical readiness, though limited mentor training and variable teaching quality remained key challenges. This review suggests that PAL may provide meaningful academic and professional benefits for medical radiation sciences students. However, its effectiveness seems to depend on mentor training, well-designed learning content, and faculty oversight to ensure quality of teaching and learning. PAL complements lecturer-led teaching by promoting engagement, collaboration, and professional competence, while offering a practical way to enhance student participation and expand teaching capacity in resource-limited settings.

31. Genotoxic evaluation and gene expression in Mus musculus exposed to landfill soil simulated leachates.

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

摘要

Exposure to hazardous substances from landfill frequently occurs through complex chemical mixtures called leachates with a significant source of environmental and health concern. This study generated simulated leachates from soils collected at three landfill sites, Obajana (OBSL), Ajaokuta (AJSL), and Anyigba (AYSL) simulated leachate and evaluated their genotoxic and molecular effects using Mus musculus as a model organism. The leachates were characterized for physicochemical properties and leachate pollution indices. Mice orally exposed to 4 different (15 - 75 %) concentrations of each test leachates were examined for clinical signs of toxicity, body weight gain during exposure, genotoxicity and gene expression. Chemical analyses revealed elevated concentrations of biochemical oxygen demand (BOD), chemical oxygen demand (COD), total dissolved solid (TDS), and heavy metals. The clinical toxicity signs observed include skin brownish discoloration, hair loss, ungroomed hair, reduced food consumption and decreased activities, neck abscesses and measurable tumour development. All leachates produced significant concentration dependent increases in DNA damage relative to the negative control, as demonstrated by alterations in polychromatic erythrocytes (PCE) and normochromatic erythrocytes (NCE) ratios (PCE/NCE), increased frequencies of Micronucleated Polychromatic Erythrocyte (MNPCE) and Micronucleated Normochromatic Erythrocyte (MNNCE), and elevated olive tail moment, tail DNA (%), and tail length. Genotoxicity or DNA damage induction follow the order AJSL > OBSL > AYSL. The observed effects may reflect individual, synergistic, or antagonistic interactions among the chemical constituents of the leachates. RT-qPCR gene expression analysis revealed significant down regulation of HSP70 and TNF-α in liver tissue, indicating suppression of stress response and inflammatory pathways consistent with potential immunosuppression and impaired cellular defense. These findings demonstrate that leachates from landfill sites possess substantial genotoxic and immunomodulatory potential, underscoring the risk to exposed populations and the need for strengthened waste management and environmental monitoring.

32. Reagent-Free Prediction of Free-Ammonia Toxicity in Algal Systems Using Chlorophyll Fluorescence Transients and Interpretable Sparse Regression.

期刊: Environmental science & technology 发表日期: 2026-Jun-15 链接: PubMed

摘要

Accurate assessment of free ammonia (NH3) is critical for managing nutrient-rich effluents and algal-based treatment systems, but conventional assays are reagent-intensive and poorly suited to real-time monitoring. Chlorophyll a fluorescence offers a rapid, reagent-free proxy for photosynthetic health, yet widely used indices such as Fv/Fm respond nonspecifically to diverse stresses and rarely yield quantitative NH3 concentrations. Here, we develop a reagent-free framework that predicts NH3 toxicity in microalgae from fast chlorophyll fluorescence transients (O-J-I-P; OJIP) analyzed with interpretable sparse regression. Three species (Chlorella vulgaris, Acutodesmus obliquus, and Arthrospira platensis) were exposed to environmentally relevant NH3 levels, and OJIP responses were monitored for 35 h. Among several multivariate approaches, Lasso regression optimized by nested cross-validation provided the best compromise between accuracy (R2 = 0.93-0.98 within species) and transferability across taxa (R2 = 0.81-0.87 for green algae). The selected OJIP parameters captured conserved fluorescence signatures of NH3-induced stress and retained predictive power under light-induced photoinhibition that markedly depressed Fv/Fm. Incorporating model evaluation diagnostics enabled transparent uncertainty quantification and discrimination of extrapolative predictions. This workflow converts routine OJIP measurements into real-time, reagent-free, and quantitative information on ammonia toxicity in algal cultures and high-ammonia effluents, providing a transparent biosensing platform for environmental risk assessment.

33. Smartphone-Assisted Real-Time Monitoring of Erythromycin in Real Samples and Pressure-Sensitive Behavior Enabled by a Dual-Function Tetraphenylethylene-Based Eu-MOF.

期刊: Inorganic chemistry 发表日期: 2026-Jun-15 链接: PubMed

摘要

Erythromycin (ERY) residues have emerged as a critical global concern to food safety and environmental security in recent years. Detecting ERY in food and environment is important for safeguarding public health. In this study, a metal-organic framework [Me2NH2][Eu(TCBPEF)(HCOO)(DMF)]·2.5DMF Eu-TCBPEF, H4TCBPEF = 4’,4‴,4‴″,4‴″″-(ethene-1,1,2,2-tetrayl)tetrakis(3-fluoro-[1,1’-biphenyl]-4-carboxylic acid) was synthesized and utilized as a fluorescence “turn-on” sensor for real-time visual monitoring of ERY, which demonstrated the first TPE-based MOF for ERY detection. Eu-TCBPEF could selectively detect ERY in water with a limit of detection (LOD) of 0.327 μM and exhibited excellent detection performance for ERY in seawater and chicken samples with good recovery percentage ranging from 96.9% to 105.4%. Furthermore, a portable Eu-TCBPEF@PVA was fabricated, enabling real-time and on-site monitoring of ERY in combination with a smartphone-assisted platform. In addition, Eu-TCBPEF exhibited a remarkable mechanofluorochromism: the fluorescent color can be reversibly switched between cyan and yellow upon grinding and exposure to acetonitrile. This study presents a dual-function MOF that provides new insights into the function of TPE-based MOFs and meanwhile offers an effective solution for on-site monitoring of antibiotic residues in food and environment, with promising applications in advanced anticounterfeiting security materials.

34. Nasal Instillation of Complex Metal Oxide Particles Induces Brain Metal Accumulation and Neurobehavioral Toxicity in Mice.

期刊: Environmental science & technology 发表日期: 2026-Jun-15 链接: PubMed

摘要

The rapid expansion of complex metal oxide particles (CMOPs) in energy technologies raises emerging health concerns, yet their neuropsychiatric impacts remain unclear. Using intranasal exposure to lithium iron phosphate (LFP) and nickel-cobalt-manganese oxide (NCM) at dose levels selected with reference to reported ambient and occupational monitoring scenarios (0.8 and 8 mg/kg/day, n = 8 per group), we show that short-term CMOP exposure induces distinct neurobehavioral alterations in mice, characterized by changes in cognitive performance, risk assessment, and stress-related coping behavior. These changes co-occurred with dose-dependent brain accumulation of Li, Ni, Mn, and Co. Unexpectedly, low-dose exposure yielded 5-17-fold higher brain bioaccumulation factors than high-dose exposure, indicating disproportionate brain retention at lower exposure levels. Neurotransmitter profiling showed alterations consistent with perturbation of catecholamine metabolism, the tryptophan-kynurenine pathway, and the glutamate-glutamine cycle. At the molecular level, brain metal burden was associated with changes in barrier-related, neuroimmune, and synaptic signaling markers prioritized in relation to behavioral outcomes. Collectively, the findings indicate that short-term CMOP exposure can co-occur with brain metal bioaccumulation and neurobehavioral dysfunction, supporting the need for future inhalation-based and chronic studies to better define toxicokinetics, exposure relevance, and long-term health implications.

35. How Health Care Workers Can Manage Digital Fatigue.

期刊: Journal of medical Internet research 发表日期: 2026-Jun-15 链接: PubMed

摘要

One of the key aims of the digitization of health care is reducing burden on health care workers and health care systems. In this News and Perspectives article, JMIR Correspondent Sara Novak reports on one of its paradoxical consequences: digital fatigue.

36. Health Care Providers' Perspectives on a Hybrid Outpatient Stroke Telerehabilitation Program: Qualitative Implementation Study.

期刊: JMIR rehabilitation and assistive technologies 发表日期: 2026-Jun-15 链接: PubMed

摘要

Although patient outcomes are improved by stroke rehabilitation, the suggested amount of therapy is rarely maintained. The COVID-19 pandemic aggravated this situation further due to disruptions in health care. One solution was the rapid and extensive transition to virtual care. A hybrid outpatient stroke telerehabilitation program (HOSTP) was introduced by St John’s Rehab-a tertiary rehabilitation hospital in Toronto, Ontario. The HOSTP integrated in-person and virtual care in an effort to alleviate long-standing obstacles that challenge stroke rehabilitation. This study explored health care providers’ (HCPs) experiences with the HOSTP and their perspectives on its implementation, quality, and impact to determine the modifications needed to optimize its delivery and sustainability. A qualitative implementation study was conducted, with semistructured interviews conducted among HCPs involved in the HOSTP. The interview guide was informed by the CFIR (Consolidated Framework for Implementation Research). In total, 14 HCPs were recruited and interviewed from St John’s Rehab outpatient program. Interview transcripts were analyzed using a 2-stage analytic approach involving inductive thematic analysis, followed by deductive categorization using CFIR. Four main themes were identified across CFIR domains: (1) adaptability and flexibility of the hybrid care model (intervention characteristics), (2) alignment with patient needs and resources (outer setting), (3) the impact of organizational resources and infrastructure (inner setting), and (4) variability in provider confidence and perceptions of virtual care (characteristics of individuals). Key determinants were identified as adaptability, patient-related factors, resource availability, and provider beliefs about virtual care. Our findings suggest that, from HCPs’ viewpoints, optimizing virtual care processes and resources may support access and care quality within hybrid outpatient stroke rehabilitation. HCPs viewed maintaining virtual care as important for supporting ongoing access and patient-centered care. Lastly, optimizing the benefits and mitigating the drawbacks of hybrid care can ensure future integration of virtual care into standard outpatient stroke rehabilitation.

37. Artificial Intelligence in Occupational Health: Aligning Technological Innovation with Occupational Safety and Health Policies in Malaysia.

期刊: Journal of occupational health 发表日期: 2026-Jun-15 链接: PubMed

摘要

38. Low Back Pain: A Review.

期刊: JAMA 发表日期: 2026-Jun-15 链接: PubMed

摘要

Low back pain is defined as pain localized below the costal margin and above the inferior gluteal fold, with or without leg pain. Low back pain affects approximately 619 million people worldwide and is the leading cause of years lived with disability worldwide. Approximately 90% of patients presenting for care with low back pain have nonspecific low back pain, which is defined as low back pain that is not associated with specific spinal disorders (such as lumbar radiculopathy, lumbar spinal stenosis, vertebral fracture, axial spondyloarthritis, infection, or malignancy). Low back pain is classified as acute if the duration is shorter than 6 weeks, subacute if the duration is 6 to 12 weeks, and chronic when the duration is longer than 12 weeks. The age-standardized prevalence of low back pain is higher in females (9330 per 100 000) than in males (5520 per 100 000). The prevalence of low back pain increases with age, peaking at approximately 85 years. Risk factors for low back pain include obesity, depressive symptoms, occupational exposures (eg, heavy lifting), tobacco use, chronic disease (eg, diabetes), and previous low back pain. Acute nonspecific low back pain is usually self-limited, and approximately 72% of individuals recover by 12 months. Prognosis is less favorable for chronic nonspecific low back pain, but 42% of patients recover within 12 months. Initial management of patients with low back pain of any duration includes reassurance that serious underlying disease is unlikely, discussion about the expected time course of recovery, and the recommendation to remain physically active. Patients should be encouraged to continue their usual activities (including work), avoid prolonged rest, and be advised to self-manage their condition, which consists of symptom-relief strategies (such as heat application) and activity pacing (maintaining or gradually increasing usual activities and work). For patients with acute nonspecific low back pain, first-line therapies include heat application, spinal manipulation, massage, and acupuncture (typically provided by physical therapists, chiropractors, acupuncturists, and massage therapists) as well as nonsteroidal anti-inflammatory drugs (NSAIDs; such as ibuprofen) and skeletal muscle relaxants (such as cyclobenzaprine). For chronic nonspecific low back pain, first-line therapies include exercise of any type, psychological therapies (eg, cognitive behavioral therapy), or combined multidisciplinary approaches (such as pain management programs and integrated exercise and psychological care) along with spinal manipulation, massage, and acupuncture. NSAIDs should be considered as second-line therapy for chronic nonspecific low back pain. Low back pain is a leading cause of disability worldwide. Acute nonspecific low back pain is often self-limited, whereas chronic nonspecific low back pain has a less favorable prognosis. For patients with acute nonspecific low back pain, first-line treatments include selected nonpharmacological therapies and medications (such as NSAIDs and skeletal muscle relaxants). For patients with chronic nonspecific low back pain, first-line treatment consists of exercise, psychological therapies (such as cognitive behavioral therapy), and combined multidisciplinary care.

39. To the Editor Re: Miller et al., Occupational Protection in Interventional Radiology. A Joint Guideline of the Cardiovascular and Interventional Radiological Society of Europe and the Society of Interventional Radiology: a comment on occupational protection guidelines and the potential role of antioxidants.

期刊: CVIR endovascular 发表日期: 2026-Jun-15 链接: PubMed

摘要

40. The impact of urinary catheterization on urinary tract infection and renal function in elderly patients undergoing hip fracture surgery: A prospective randomized controlled trial.

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

摘要

Urinary tract infection(UTI) is a common complication following hip fracture surgery in elderly patients. Urinary catheterization is frequently used to improve patient comfort during prolonged preoperative immobilization; however, its impact on UTI risk and renal function remains controversial. This prospective randomized study aimed to evaluate the effect of urinary catheter use on postoperative UTI incidence and renal outcomes in geriatric patients undergoing hip fracture surgery. This prospective randomized controlled trial included 150 patients aged > 65 years who underwent surgical treatment for proximal femur fractures between December 2022 and May 2025. Patients with UTI at admission, prior indwelling catheter use, high-energy trauma, multiple fractures, or a history of pelvic radiation were excluded. Patients were randomized into two groups: catheterized(n = 75) and non-catheterized(n = 75). Urinary tract infection was defined according to European Association of Urology (EAU) guideline criteria. Renal function was assessed using serum urea and creatinine levels measured preoperatively and on postoperative day 1. Demographic data, comorbidities, fluid intake, and perioperative variables were recorded and compared between groups. The mean patient age was 79.8±7.2 years, and 61.3% were female. Postoperative UTI occurred in 20 patients (15.2%) overall. UTI was detected in 12 patients (18.5%) in the catheterized group and in 8 patients (11.9%) in the non-catheterized group, with no statistically significant difference between the groups (p = 0.296). Female sex and advanced age were identified as significant risk factors for UTI development. Postoperative creatinine levels were significantly higher in the non-catheterized group (p < 0.01), which was also associated with lower preoperative oral fluid intake. No significant association was found between UTI development and diabetes mellitus, hypertension, or coronary artery disease. Indwelling urinary catheterization did not significantly increase postoperative UTI risk in elderly patients undergoing hip fracture surgery. Moreover, catheter use may help prevent dehydration-related renal dysfunction by facilitating adequate oral fluid intake. Careful, short-term catheterization may therefore represent a reasonable strategy in selected geriatric hip fracture patients.

41. Dengue and chikungunya vaccines past, present and future: implications for travelers.

期刊: Current opinion in infectious diseases 发表日期: 2026-Jun-11 链接: PubMed

摘要

Novel vaccines for dengue and chikungunya viruses offer new prevention options against two globally important arboviral diseases. This review summarizes recent developments in vaccine licensure, implementation, real-world experience and research priorities, with emphasis on implications for both endemic populations and travelers. Of the three live-attenuated dengue vaccines licensed to date, TAK-003 is authorized in >40 countries and Butantan-DV in Brazil, while manufacturing of CYD-TDV is discontinued. Long-term and postmarketing data continue to refine understanding of serotype-specific protection, waning immunity, and rare adverse events.For chikungunya, two single-dose vaccines are licensed-a live-attenuated vaccine (VLA1553) and virus-like particle vaccine (PXVX0317). Uptake is guided by emerging safety and effectiveness data, with each platform offering potential advantages in different settings.Further data on long-term protection, safety, effectiveness, use in vulnerable populations and integration into outbreak management and immunization systems is anticipated. Dengue and chikungunya vaccines are increasingly being used in immunization programs and pretravel consultations. Further real-world data are needed-particularly for seronegative dengue vaccine recipients and older, immunocompromised or medically at-risk adults. Research priorities include developing single-dose, nonlive dengue vaccines suitable for high-risk groups, understanding long-term chikungunya vaccine performance, and exploring broader flaviviral or pan-arboviral platforms.

42. Prevention is all you need: generative artificial intelligence for infection prevention and healthcare epidemiology.

期刊: Current opinion in infectious diseases 发表日期: 2026-Jun-11 链接: PubMed

摘要

Generative artificial intelligence, particularly large language models, has emerged as a promising tool for processing the vast amounts of unstructured clinical data generated in healthcare. Infection prevention and control relies heavily on manual review of clinical text for surveillance, reporting, and risk assessment, making it a natural application area. We examine the current evidence for these technologies in infection prevention workflows. Large language models have been evaluated for healthcare-associated infection surveillance, including central line-associated bloodstream infections, surgical site infections, and catheter-associated urinary tract infections, with pooled sensitivities exceeding 90% across studies. These tools have also been applied to diagnostic stewardship, risk assessment for multidrug-resistant organism exposure, public health surveillance for avian influenza, and central line necessity auditing. Across applications, models performed best when used to augment rather than replace expert review. Common limitations included reduced specificity, sensitivity to prompt framing, and dependence on the completeness of clinical data provided to the model. Generative artificial intelligence applications show the greatest promise when aligned with their core capability: natural language processing of unstructured clinical text. While current evidence supports their use as screening and decision-support tools with human oversight, further validation across diverse settings and integration within electronic health records are needed before widespread adoption.

43. Transportation mode impact on care service utilization and community integration after burn injury - A Burn Model System National Database Study.

期刊: Burns : journal of the International Society for Burn Injuries 发表日期: 2026-Jun-06 链接: PubMed

摘要

Community health is affected by transportation access, an underexplored factor in burn outcomes. Therefore, this study aimed to examine the associations of transportation mode with health service utilization and social community integration after burn injury. A multicenter burn longitudinal dataset was analyzed from 2018 to 2024. Self-reported transportation modality was examined primarily six months post-injury. The population was categorized into two groups: driving their own vehicle (DOV) and other modes of transportation (OMT). Outcomes included community integration and four health services (physical/occupational therapy, peer support, psychological services, and burn-related surgeries). Regression analyses examined the association between transportation mode and health services, and community integration, controlling for demographic and clinical factors. Of the 563 participants, 373 (66.3%) reported DOV, 151 (26.8%) riding with someone else, and 31 (5.5%) using public transit. The regression model demonstrated that the DOV group had higher community integration than the OMT group (b = 1.23; 95% CI = 0.74, 1.71; p < 0.001). Logistic regression analyses revealed no significant associations between DOV and service utilization, controlling for demographic and clinical variables. DOV was associated with better social integration. Addressing transportation barriers may contribute to improved social integration outcomes after burn injury.

44. Sexual health following hyperbaric oxygen treatment in pelvic cancer survivors with radiation injuries: a longitudinal observational study.

期刊: The journal of sexual medicine 发表日期: 2026-Jun-05 链接: PubMed

摘要

Hyperbaric oxygen therapy (HBOT) is an established treatment for pelvic late radiation tissue injuries (LRTIs) in cancer survivors, yet its impact on sexual health outcomes has previously not been examined. To investigate longitudinal changes in sexual health following HBOT in pelvic cancer survivors with LRTIs and to examine whether baseline severity and changes in pelvic LRTI symptoms predict sexual health outcomes, including gender differences. This one-group longitudinal observational study included eight assessment points. A total of 137 cancer survivors with pelvic LRTIs underwent 27-30 HBOT in monoplace chambers, breathing 100% oxygen for 90 min at 2.4 atmospheres absolute. Data were analyzed using latent growth curve modeling. Sexual health was assessed using the EORTC Quality of Life Sexual Health Questionnaire, while pelvic LRTIs (urinary and bowel) were measured using the Expanded Prostate Cancer Index Composite. Sexual health scores did not change significantly over 58 weeks (total change = -0.49, P = .742), despite significant improvements in urinary (total change = 8.98 points; P < .001) and bowel symptoms (total change = 8.25 points; P < .001). Greater early improvement in urinary symptoms predicted higher sexual satisfaction (95% CI = 0.02-0.19; P = .015), with stronger associations observed among men (bmale*change = 3.30, P = .032, CI = 0.38, 6.32). Although HBOT improves pelvic LRTIs, persistent sexual health challenges highlight the need for comprehensive, multidisciplinary survivorship care. Strengths include a relatively large, gender-balanced sample, longitudinal design, validated measures, and a standardized treatment protocol. The absence of a control group limits causal inference. Despite improvement of urinary and bowel symptoms, HBOT does not seem to restore sexual health. Further research is needed to confirm these findings and address other sexual health interventions. ClincalTrials.gov registration number NCT03570229.

45. The epidemiology of violence against children in England, 1971-2024: A longitudinal ecological analysis of 1.7 million care entries.

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

摘要

Violence against children (VAC) is a major public health concern, yet persistent measurement challenges limit understanding of its epidemiology. Routinely collected administrative data, such as children entering care, represent an underused resource for measuring a subset of VAC serious enough to trigger state intervention. However, national analyses using these data have not been comprehensively updated since 2016, leaving evidence gaps. We integrated historical data from the iCoverT database (1971-2016) with recent Department for Education releases (2011-2024) to construct and analyse a 50-year national time series of children entering care in England. From 2011 to 2024, generalised estimating equations compared trends by reason for care entry, legal pathway, sex, and age. Geographic variation was examined across nine regions and 146 local authorities, and associations between child poverty and care entry for child protection reasons were assessed. Abuse and neglect were consistently the dominant reason (56-64%) for care entry. Between 1971 and 2005, care entry rates declined by 1.34% annually (95%CI:-1.53, -1.14), before reversing in 2005. From 2005 to 2024, rates increased by 1.20% per year (95% CI:0.68, 1.73), reaching 33100 new care entries in 2024 (250.0 per 100000 children). Recent increases were driven by entries for child protection reasons and emergency legal pathways, with disproportionate increases among males and adolescents. Marked geographic inequalities were observed, with higher rates concentrated in deprived local authorities; however, short-term changes in child poverty did not explain year-to-year variation in care entry for child protection reasons. This study identifies a sustained reversal in long-term declines in children entering care in England since the mid-2000s. Considerable inequalities were observed across age, sex, and place. These findings underscore the need for long-term preventive policies addressing structural disadvantage alongside national responsive measures protecting children during periods of economic and societal disruption.

46. Impact of hypothermia on the care outcome of burns patients transferred to a tertiary burn unit in NSW, Australia.

期刊: Burns : journal of the International Society for Burn Injuries 发表日期: 2026-Jun-01 链接: PubMed

摘要

Hypothermia is common after major burn injury and may influence both systemic and wound-related outcomes. Although hypothermia has been associated with coagulopathy and higher rates of mortality in the trauma patient cohort, limited literature has examined its effects on the outcomes for patients with burns. The aim of this study was to identify the rate of hypothermia in patients transferred to a specialised burn unit, and to assess the impact on morbidity and mortality. This retrospective, single-centre study examined all burns presentations between 2009-2013. Hypothermia was defined as a core body temperature ≤ 35 °C on arrival. Statistical analysis used logistic regression for binary outcomes and negative binomial models for continuous outcomes. Multivariable logistic regression assessed hypothermia using continuous age, total body surface area burned (TBSA), and their interactions. Of 268 patients with recorded temperature, 41 (15%) were hypothermic. Hypothermia increased with burn size (11.6% in <20% TBSA vs 35.7% in >50% TBSA; p < 0.01). Hypothermic patients had higher mean age (46.6 vs 41.0 years; p < 0.05) and larger burns (22.8% vs 14.7% TBSA; p < 0.01). Adequate first aid and use of the modified Parkland Formula were less frequently documented in hypothermic patients (75.7% vs 92.3% and 60.7% vs 79.5%, respectively; both p < 0.01). There was no significant difference in burn size across age groups (p = 0.918). On multivariable analysis, increasing TBSA was independently associated with hypothermia, whereas age was not, and no significant age-TBSA interaction was identified (p = 0.647). Hypothermia was associated with higher in-hospital mortality (14.6% vs 3.5%), longer ICU LOS (4.39 vs 2.33 days), and higher sepsis rates (9.8% vs 2.6%); but lower rates of skin grafting (36.6% vs 51.1%) and shorter hospital LOS (17.3 vs 19.7 days). On multivariable analysis, hypothermia independently predicted mortality, LOS, grafting, wound infection and sepsis. Hypothermia remains common in burn patients transferred to a tertiary centre in NSW and is associated with larger burns, a higher average age, reduced adherence to early management protocols and poorer systemic outcomes despite reduced grafting rates and shorter hospital admissions.

47. Dollars Needed to Pay per Early-Detected Colorectal Cancer Case in Stool-Based Screening.

期刊: Annals of internal medicine 发表日期: 2026-Jun 链接: PubMed

摘要

48. Viral hepatitis co-infections with tuberculosis in India: A systematic review and meta-analysis.

期刊: The Indian journal of medical research 发表日期: 2026-Jun 链接: PubMed

摘要

Background and objectives Tuberculosis (TB) and viral hepatitis (hepatitis B and C) co-infection is a significant threat in low-and middle-income countries like India. To optimise treatment protocols and prevent liver-related complications, it is essential to estimate the burden of these co-infections. This systematic review and meta-analysis were conducted to determine the prevalence of hepatitis B and C co-infection with tuberculosis in India. Methods In line with PRISMA guidelines, a systematic search of PubMed, Scopus, Embase, CINAHL, and Web of Science was conducted for English-language observational studies published up to January 6, 2026, that reported hepatitis B or C co-infection among TB patients in India. Pooled prevalence estimates were calculated using a random-effects model, heterogeneity was assessed using the I2 statistic, and risk of bias was evaluated using the Joanna Briggs Institute (JBI) critical appraisal tool. Results A total of 11 studies with 4502 participants reporting hepatitis B or C co-infections in among TB patients in India were included. The pooled prevalence of hepatitis B was 10% [95% Confidence Interval (CI):5%-16%], while the pooled prevalence of hepatitis C was 6% (95% CI:5%-7%). Among TB patients co-infected with HIV, the pooled prevalence of hepatitis B was 17% and pooled prevalence of hepatitis B among drug-resistant TB patients was 11%. Higher rates were reported in Southern and Western India. Interpretation and conclusions High prevalence of hepatitis B and C co-infections among TB patients in India suggests the need for integrated screening and management of these co-infections within the national programme strategies.

49. Stronger Association of the Japanese Cognitive Function Test Than the Mini-Mental State Examination With Mortality in Community-Dwelling Older Adults.

期刊: American journal of preventive medicine 发表日期: 2026-May-28 链接: PubMed

摘要

Cognitive function is associated with mortality in older adults, but the relative strength across cognitive assessment tools remains unclear, complicating population-level risk screening. The Mini-Mental State Examination is widely used but is limited by ceiling effects and educational bias. This study compared the associations of Mini-Mental State Examination and the Japanese Cognitive Function Test, a digital assessment, with all-cause mortality in a community-based cohort. A cohort study was conducted among older adults in the National Center for Geriatrics and Gerontology-Study of Geriatric Syndromes in Japan. Participants aged ≥65 years completed the Mini-Mental State Examination and Japanese Cognitive Function Test at baseline during 2015-2018; data were analyzed in 2025. Cox proportional hazards models estimated hazard ratios for mortality, with exposures analyzed as both continuous and categorical variables. The duplication method tested the differences between the 2 tests. Among 9,514 participants (mean age of 72.9; 55% female), 588 (6.2%) died. Higher scores on both tests were inversely associated with mortality, but the associations were stronger for Japanese Cognitive Function Test. In continuous analyses, adjusted hazard ratios were 0.64 (0.54-0.77) for Mini-Mental State Examination and 0.44 (0.36-0.55) for Japanese Cognitive Function Test (p<0.001). In quintile analyses, hazard ratios for the highest versus the lowest quintile were 0.70 (0.52-0.93) and 0.37 (0.26-0.54). Stronger associations for Japanese Cognitive Function Test were more pronounced among participants with preserved baseline cognition (Mini-Mental State Examination≥24). Mini-Mental State Examination and Japanese Cognitive Function Test were inversely associated with 5-year mortality, but the association was stronger for Japanese Cognitive Function Test. Japanese Cognitive Function Test captured mortality risk even among those with preserved cognition, supporting its potential as a community-level tool for public health in older adults.

50. Expanded burn registry: Epidemiological profile, clinical variables, and multivariate analysis of outcomes in the Dominican Republic (2020-2024).

期刊: Burns : journal of the International Society for Burn Injuries 发表日期: 2026-May-21 链接: PubMed

摘要

Burns represent a significant global public health problem, imposing a disproportionate burden in low- and middle-income countries. In the Dominican Republic, a previous study in the pediatric population revealed a concerning profile of high mortality and frequent electrical burns, raising critical questions for adults. To describe the epidemiological profile, identify independent predictors of mortality, and benchmark outcomes against international severity metrics in adult burn patients in the Dominican Republic. This retrospective cohort study included 1005 adult patients (≥15 years) admitted to the country’s main burn reference center (2020-2024). Demographic, clinical, and event-related variables were analyzed. Multivariable logistic regression, probit analysis for LA50, and Kaplan-Meier survival curves were used. Overall mortality was 32.2%. The cohort was predominantly male (73.4%), with a median age of 37 years. Men sustained mainly electrical burns (37.7%) in occupational settings (48.5%); women, flame burns (64.0%) in the domestic sphere (74.9%). Independent mortality predictors were TBSA ≥ 60% (aOR 29.85, 95% CI 11.37-78.34), complications (aOR 250.00, 95% CI 55.56-1000.00), full-thickness depth (aOR 4.33, 95% CI 2.48-7.58), and inhalation injury (aOR 2.09, 95% CI 0.98-4.46). The LA50 was 48.0% (95% CI 45.0-50.9%). Median survival was 42.0 days, decreasing to 4.0 days for TBSA ≥ 60% and 20.0 days for septic patients (log-rank p < 0.001 and p = 0.012). The leading causes of death were septic shock (40.1%) and respiratory failure (36.1%). This registry reveals one of the highest global burn mortality rates, driven by extensive injuries and complications. The LA50 of 48.0% and the predominance of sepsis-related deaths underscore the extreme vulnerability of this population and the urgent need for targeted prevention, strengthened clinical protocols, and a prospective national registry to guide interventions and reduce mortality.

51. Projecting the incidence of burn injuries and its associated economic burden for 195 countries.

期刊: Burns : journal of the International Society for Burn Injuries 发表日期: 2026-May-15 链接: PubMed

摘要

Burn injuries remain a persistent global health burden affecting low- and middle-income countries. Projections of future incidence and disability-adjusted life years (DALYs) are needed to guide prevention and resource allocation. Age-, sex-, and country-specific burn incidence and DALY rates were pulled from the Global Burden of Disease and combined with World Bank population projections for 2030, 2040, and 2050 to generate estimates by country and region. Economic burden was modeled by multiplying DALYs by gross domestic product (GDP) per capita. Globally, projected burn cases increase from 10,319,496 in 2030 to 10,865,524 in 2050 (+5%), while disability-adjusted life years rise from 11,517,819 to 14,144,178 (+18.6%). The burden is concentrated in South Asia, reaching 1,627,305 cases in 2050, and in Sub-Saharan Africa, which rises to 3,850,835 cases. Individuals aged 15-19 years account for the largest share of global cases in both 2030 and 2050. Among young adults and children under 19 years, India is projected to have the highest burden, with 334,168 cases in 2030. The global burden remains balanced between males and females, with women representing 52% of cases through 2050. Case-to-population ratios highlight disproportionate burdens in smaller nations, with Chad, Argentina, and Azerbaijan among the countries with the highest per-capita rates. In economic terms, the United States produces the largest cost estimate at $20.6 billion, while countries such as India ($13.2 B) and China ($14.5 B) carry substantial burdens driven by extremely high DALY counts despite moderate GDP per capita. Burn-related morbidity remains a significant global challenge, particularly in South Asia and Sub-Saharan Africa, with children disproportionately affected. Investment in prevention and burn care is essential to reduce inequities.

52. Towards optimal environmental policies: policy learning under arbitrary bipartite network interference.

期刊: Biostatistics (Oxford, England) 发表日期: 2026-Jan-20 链接: PubMed

摘要

The substantial effect of air pollution on cardiovascular disease and mortality burdens is well-established. Emissions-reducing interventions on coal-fired power plants-a major source of hazardous air pollution-have proven to be an effective, but costly, strategy for reducing pollution-related health burdens. Targeting the power plants that achieve maximum health benefits while satisfying realistic cost constraints is challenging. The primary difficulty lies in quantifying the health benefits of intervening at particular plants. This is further complicated because interventions are applied on power plants, while health impacts occur in potentially distant communities, a setting known as bipartite network interference (BNI). In this paper, we introduce novel policy learning methods based on Q- and A-Learning to determine the optimal policy under arbitrary BNI. We derive asymptotic properties and demonstrate finite sample efficacy in simulations. We apply our novel methods to a comprehensive dataset of Medicare claims, power plant data, and pollution transport networks. Our goal is to determine the optimal strategy for installing power plant scrubbers to minimize ischemic heart disease (IHD) hospitalizations under various cost constraints. We find that annual IHD hospitalization rates could be reduced in a range from 23.37 to 55.30 per 10,000 person-years through optimal policies under different cost constraints.

53. Perceptions of physical and occupational therapists on the utility of surface electromyography data in spinal cord injury rehabilitation.

期刊: PloS one 发表日期: 2026 链接: PubMed

摘要

Spinal cord injury (SCI) impacts physical, emotional, and social well-being, contributing to decreased quality of life and increased healthcare burden. Surface electromyography (sEMG), a non-invasive tool for measuring muscle activity, has demonstrated potential as a biomarker for recovery in SCI research, yet remains underutilized in clinical practice. Understanding how physical therapists (PTs) and occupational therapists (OTs) perceive the use of sEMG is necessary for integrating sEMG into post-SCI treatment and advancing personalized rehabilitation. A cross-sectional, qualitative descriptive design was employed. Ten participants (9 PTs and 1 OT) were recruited through convenience sampling. Semi-structured interviews were conducted and analyzed inductively using a thematic analysis approach. Two major themes were identified: 1) Perceived value of the use of electrophysiology and sEMG data in clinical practice. Participants valued sEMG as an adjunct assessment tool for providing objective feedback after incomplete SCI and setting goals during treatment. 2) Barriers and facilitators to implementing sEMG. Key barriers highlighted include the lack of training and standardized protocols. Continued training, resources, and educational support were key facilitators. PTs and OTs perceive sEMG as a valuable tool in SCI rehabilitation, but desire education and standardized protocols to support its clinical integration.