公共卫生研究摘要 (2026-06-17)

共收录 54 篇研究文章

1. Machine Diagnostics and Machine Phenotyping of Migraine: A HUNT Study.

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

摘要

In the absence of biomarkers, the true biological footprint of migraine remains incompletely understood. It could perhaps be best characterized using machine learning models of multimodal data. The aim of this study was to (1) develop diagnostic models of migraine using multimodal data and (2) identify data-driven migraine phenotypes. This was a cross-sectional machine learning analysis of demographics, self-reported clinical and headache data, and genome-wide genotype data from the Trøndelag Health Study (data collected 1995-1997 and 2006-2008). All participants who were genotyped and completed the headache questionnaire were included. First, predictive machine learning models were developed using genotype data and general clinical data (excluding headache data) to diagnose individuals with migraine vs headache-free controls. Models were optimized on a training set and evaluated on a held-out test set, scored with the area under the receiver operating characteristic curve (AUC). Second, unsupervised models were trained on the headache data and the most predictive features from the diagnostic models to identify subgroups. The subgroups were compared using genome-wide association analyses, conventional polygenic risk scores (PRSs), and machine learning-based genetic risk scores. A total of 43,197 individuals were included in the diagnostic models, and 12,185 individuals were included in the data-driven phenotyping (mean [SD] age 49.1 [16.7] years; 51.7% women). The top-performing diagnostic model was a light gradient boosting machine, with a test set AUC of 0.80 (95% CI 0.78-0.81). Two main clusters were identified, one with 1,425 individuals, 94% of whom met diagnostic criteria for migraine, and another with 10,760 individuals, whereof 71% had nonmigraine headaches. The former was subclustered into 4 relatively distinct groups: one with only men, one with prominent neck pain, one with more musculoskeletal pain, anxiety and depression, and one with “classic” migraine. The groups were better discriminated by machine learning-based genetic risk scores compared with PRSs. Migraine can accurately be diagnosed from nonheadache data, suggesting that it is biologically describable by combinations of clinical, genetic, and environmental data. Data-driven phenotyping with such data identifies migraine subgroups with distinct phenotypic and genotypic signals, possibly not captured by current diagnostic criteria-but with potential implications for management.

2. Cognitive Aging and Brain Health: A Comparison of Super Movers vs Nonsuper Movers.

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

摘要

Super movers are individuals aged ≥80 years with gait speeds ≥1.5 SDs above age- and sex-adjusted means. Super movers tend to have lower prevalence of chronic medical conditions, healthier lifestyles, and younger biological age. The aim of this study was to examine their risk of incident cognitive impairment, trajectories of cognitive decline, and brain health. This study used a retrospective study design using data from older adults aged ≥80 without Alzheimer disease or dementia enrolled in 5 Health and Retirement Study International Network of Studies (HRS-INS), the LonGenity Study, and the RUSH Memory Aging Project (RUSH MAP). HRS-INS data were used to assess incident cognitive impairment (>1.5 SD below the age-adjusted means on any cognitive test plus impaired Instrumental Activities of Daily Living) in super movers vs nonsuper movers. Age- and sex-adjusted hazard ratios (HRs) from Cox models were pooled in a meta-analysis to obtain risk of incident cognitive impairment. LonGenity data were used to examine (1) decline in cognitive domains using linear mixed-effects models adjusted for age, sex, education, and parental longevity; (2) trajectories of global cognition before and after age 80; and (3) brain structural differences (cortical thickness, hippocampal volume) between super vs nonsuper movers. RUSH MAP data were used to assess dementia-related pathology. HRS-INS study (n = 3,989, baseline age 83.6-84.4 years, 47%-65% females, 358 super movers), after excluding 274 adults with cognitive impairment at baseline, super movers had lower risk of incident cognitive impairment (HR 0.49, 95% CI 0.28-0.71) over follow-ups ranged between 3.4 and 5.4 years. In LonGenity (n = 197, baseline age 84.6 [SD 3.3], 57.8% women), super movers showed slower memory and non-memory-related cognitive decline and preserved hippocampal volume in specific subfields. In RUSH MAP (n = 692, baseline age 85.6 [SD 4.0], 68.9% women), super movers had better antemortem cognition and lower Alzheimer disease and dementia prevalence, but no differences in postmortem dementia-related pathologies. Super movers show slower cognitive aging-indicated as lower risk for cognitive impairment and slower cognitive decline-and preserved hippocampal volumes. Investigating their behavioral and biological traits may reveal novel protective mechanisms against cognitive decline and dementia.

3. The Prodromal Synucleinopathy Rating Scale: An Assessment in Patients With REM Sleep Behavior Disorder.

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

摘要

Clinical trials in REM sleep behavior disorder (RBD) to delay or prevent the development of Parkinson disease (PD), dementia with Lewy bodies (DLBs), and multiple system atrophy (MSA) will soon begin. The Prodromal Synucleinopathy Rating Scale (PSRS) was developed to capture the breadth and severity of clinical burden of prodromal disease. We analyzed the clinicometric properties and reliability of the PSRS in the North American Prodromal Synucleinopathy (NAPS) cohort. PSRS ratings were examined for visits conducted from August 2022-June 2025 on participants who did not have overt PD, DLB, or MSA (n = 348). Clinician raters used clinical judgement to evaluate signs and symptoms within each domain. Scores range from 0 (none) to a maximum of 2-4 points per domain, with a total maximum score of 25. The domains include cognitive (COG), behavioral/psychiatric (PSY), motor-axial (MAX), motor-appendicular (MAP), autonomic (AUT), sleep (SLP), and sensory (SEN). Spearman correlations were generated between ratings for each domain, the total sum score (SUM), and with independent measures of similar constructs. Test-retest reliability for 20 case examples protocols among 20 different raters was quantified using Bayesian generalized linear mixed-effects model. Participants were 79% male with a mean age of 65.4 ± 10.4 years. The following correlations were statistically significant at p < 0.0001: COG with Montreal Cognitive Assessment (r = -0.42) and Clinical Dementia Rating-Sum of Boxes (r = 0.77); PSY with Neuropsychiatric Inventory-Questionnaire (r = 0.38); MAX and MAP with the Movement Disorders Society-Unified Parkinson Disease Rating Scale Motor (r = 0.65 and 0.75, respectively); AUT with Scales for Outcomes in Parkinson’s Disease-Autonomic Dysfunction (r = 0.39); SLP with Epworth Sleepiness Scale (r = 0.23); and SEN with Brief Smell Identification Test (r = -0.66). The PSRS SUM was correlated with the Functional Assessment Scale (r = 0.47), Schwab and England Activities of Daily Living (r = -0.58), and Clinician Global Impression of Severity (r = 0.29, p < 0.0001 for each). The inter-rater and intrarater reliability means ranged from 0.76 to 0.98. In this large multicenter RBD cohort, moderate to strong correlations were observed between PSRS domains and multiple independent measures of clinical burden. Reliability data were good to excellent. These findings demonstrate preliminary validity for the PSRS for measuring synucleinopathy clinical burden in those with RBD. NCT05826457 NAPS Consortium Website: naps-rbd.org/.

4. Delisting From Clinical Improvement in Liver Cirrhosis: A Machine Learning Decision Tree Analysis.

期刊: Transplantation 发表日期: 2026-Jul-01 链接: PubMed

摘要

Following therapeutic advancements, recompensation has gained increasing recognition in patients on waitlist for liver transplantation (LT). Identifying key predictors of waitlist removal because of improvement can enhance prognostication and resource allocation. We hence examined predictors of improvement-related waitlist removal using a machine learning-based approach with data from the United Network for Organ Sharing database. In this retrospective cohort study, adult LT waitlist candidates from 2000 to 2025 in the United Network for Organ Sharing registry were included. A random survival forest model was applied to examine key predictors associated with improvement-related waitlist removal, while accounting for death and LT as competing risks. Variable importance (VIMP) measure and minimal depth were used to guide variable selection. Model performance was evaluated using the concordance index, Brier scores, and time-dependent area under the curve. The cohort included 127 978 individuals listed for LT. Eight thousand four hundred ninety-three (6.6%) were delisted because of clinical improvement. The random survival forest model demonstrated strong performance and discriminatory ability overall at 1, 5, and 15 y (concordance index was 0.777, 0.771, and 0.781; time-dependent area under the curve was 0.78, 0.78, and 0.80). Brier scores were reduced relative to the reference. Strong predictors of recovery highlighted in both VIMP and minimal depth-based assessments of VIMP included diagnosis, age, and serum albumin. Identified variables could inform the development of robust predictive models to guide individualized decision-making for LT. With further validation and integration into clinical workflows, such models could enhance prognostication of patient trajectory on the LT waitlist and facilitate appropriate resource allocation.

5. Producing Mobility, Withholding Authority: Epistemic Drain and Nursing Sovereignty in Nepal.

期刊: Nursing philosophy : an international journal for healthcare professionals 发表日期: 2026-Jul 链接: PubMed

摘要

Global discussions of nursing in low- and middle-income countries (LMICs) are dominated by the language of shortage, staffing, retention, and migration. Although useful, this technocratic vocabulary obscures a deeper philosophical crisis: nurses may be numerically produced yet institutionally denied authority over knowledge, care, and professional futures. Using Nepal as a theory-generating case, this conceptual article employs critical interpretive synthesis and philosophical analysis of nursing, policy, migration, and interdisciplinary scholarship to argue that the central problem is not workforce scarcity alone but a crisis of ‘nursing sovereignty’. The paper introduces three concepts. First, epistemic drain extends the idea of brain drain by naming the erosion of mentorship, pedagogical continuity, professional memory, policy voice, research capacity, and the public credibility of nursing knowledge. Second, professionalised for exit captures a paradox of production in which nursing education expands global mobility more readily than local authority, making migration a morally justified reaction to constrained socioeconomic prospects, rather than a lack of professional dedication. Third, nursing sovereignty names the collective capacity of nurses to shape the ends, authority, knowledge, and institutional conditions of their profession. Drawing together social epistemology, feminist ethics, decolonial lens, political economy, sociology of professions, spatial theory, and digital pedagogy, the article argues that Nepal illuminates a wider LMIC condition in which nurses are essential yet disposable, mobile yet institutionally voiceless, and professionalised yet epistemically diminished. It concludes with a six-domain normative framework for institutional redesign: epistemic authority, educational integrity, governance voice, material justice, spatial and digital parity, and mobility justice. Reframing nursing in this way shifts debate from retention to justice, from labour supply to institutional re-design, and from workforce management to the political philosophy underpinning nursing practice.

6. End-to-Side Ileocolonic Anastomosis after Ileocecectomy for Crohn's Disease is a Safe Option with Low Recurrence.

期刊: Diseases of the colon and rectum 发表日期: 2026-Jun-17 链接: PubMed

摘要

The recent advent of the Kono-S anastomosis has raised the question of the impact of anastomotic configuration on recurrence following ileocecectomy for Crohn’s disease. Determining if there is a superior configuration is an opportunity for improvement in optimization in surgical care for Crohn’s disease patients. At the University of Chicago, we perform a variety of anastomotic configurations, including side-to-side, end-to-end, end-to-side, side-to-end and Kono-S. Determine if there is a difference in recurrence between anastomotic configurations following ileocecectomy for Crohn’s disease at a high volume IBD center. Retrospective chart review. The University of Chicago Medical Center. Two hundred thirty-nine patients who underwent ileocecectomy for Crohn’s disease from January 1, 2018, through December 31, 2022. Endoscopic recurrence rate for each anastomotic configuration. 239 patients with Crohn’s disease who underwent ileocecectomy were included. The anastomotic configurations were similar in terms of patient characteristics. The end-to-side anastomoses were associated with lower blood loss and shorter OR times. On multivariable analysis, elective surgery and end-to-side anastomotic configuration were associated with lower recurrence of Crohn’s disease at an average follow-up of 32 months. Study is retrospective in nature and conducted at a single institution. End-to-side anastomosis configuration is a safe, technically easy to perform reconstruction method that may reduce the rate of disease recurrence. See Video Abstract.

7. Patient reported outcome measures following group and individual therapy in a multidisciplinary functional/dissociative seizure program.

期刊: Epilepsy & behavior : E&B 发表日期: 2026-Jun-16 链接: PubMed

摘要

Functional/dissociative seizures (FDS) are frequently treated with one-to-one therapeutic interventions. However, data describing patient-reported outcome measures (PROMs) following group-based therapy remain limited. This study evaluated changes in PROMs among a large cohort of individuals receiving virtual, group and individual therapy within a multidisciplinary FDS treatment program. We conducted a retrospective cohort study of 823 individuals referred to a specialty FDS program between April 2020 and January 2025. Baseline PROMs were completed by 436 patients and assessed quality of life (QoL), PTSD, anxiety, depression, and dissociative experiences. Follow up PROMs were available for 165 individuals who participated in one of three treatment pathways: 6-Week psychoeducational group therapy only, 6-Week and 12-Week psychodynamic group therapies combined, or individualized therapy. Mixed-effects linear regression examined changes in PROMs between baseline and follow-up, adjusting for relevant characteristics. Across all cohorts, significant improvements were observed in depression (PHQ-9: -1.32, p < 0.01), quality of life (QOLIE-10P: -2.20, p < 0.01), and PTSD symptoms (SPRINT: -2.14, p < 0.01). Within-cohort analyses showed significant reductions in PHQ-9 (-2.16, p < 0.01) and SPRINT (-3.14, p < 0.01) for the 6-Week and 12-Week group therapies combined and improved QOLIE-10P (-3.37, p < 0.01) for the 6-Week group only. No significant changes were observed in anxiety or dissociation, and between-cohort differences were not statistically significant. Analyses identified significant improvements in PROMs across treatment cohorts suggesting that group-based and individual interventions can enhance outcomes for individuals with FDS, though absence of a control group limits causal interpretation. This finding is important given limited treatment availability and opportunity for group therapy to increase FDS access.

8. Implementation of Emotional Connection Training in Pediatric Primary Care: Mixed Methods Study.

期刊: JMIR medical education 发表日期: 2026-Jun-16 链接: PubMed

摘要

In 2021, the American Academy of Pediatrics released a policy statement spotlighting the health-promoting and stress-buffering effects of early relational health (ERH) and calling for universal ERH promotion in pediatric primary care. However, little educational content for the observation and promotion of ERH is available, highlighting the need for scalable ERH training modules. This study aims to investigate the acceptability, feasibility, and impact of the “Lens of Emotional Connection,” a self-paced, asynchronous, ~45-minute ERH training module codeveloped by Reach Out and Read and the Center for Early Relational Health at Columbia University. The module introduces practitioners to emotional connection, an observable component of ERH, through written and video didactic content and experiential rating of emotional connection in videos of parent-child dyads interacting face-to-face. The evaluation was conducted by the Carolinas Collaborative. Pediatric providers across 8 clinical sites were invited to participate and responded to embedded pre-post surveys. Focus groups conducted with participants further examined the educational experience. Of 653 invited clinicians, 207 (31.7%) participated in the module. Individual survey responses were available for 44-75 participants, depending on the question. Of responders, 64 out of 69 (93%) reported the module was a good way to learn about emotional connection, and 63 out of 69 (91%) felt the module provided valuable knowledge. Overall, 60 out of 69 respondents (87%) reported satisfaction with the module length, and 36 out of 44 respondents (82%) reported they would recommend this training to other clinicians. Focus groups echoed these findings. Comparison of pre-post data showed the greatest changes were in familiarity with emotional connection (n=75, pre mean 54.20, SD 18.59; post mean 73.99, SD 14.73; Cohen d=1.14; P<.001) and confidence in observing the quality of the parent- or caregiver-infant relationship during well-child visits (n=75, pre mean 55.36, SD 18.49; post mean 74.20, SD 14.07; Cohen d=1.28; P<.001). Suggested areas for improvement included more thorough explanations of specific components of emotional connection identified in parent-child interaction videos, a desire for synchronous live training, and additional content addressing what to do if low emotional connection is identified. In this evaluation of a training module designed to introduce pediatric practitioners to ERH and emotional connection, acceptability among participants was found to be high, with most responders reporting it as valuable and reporting they would recommend it. Statistically significant impact was noted in both perceptions of the importance of information about emotional connection and perceived knowledge acquisition. Feasibility of widespread implementation with voluntary participation, as here, was relatively low, with only a minority completing the module. Critically, Reach Out and Read’s commitment to iterative creation, validation, and eventual delivery of ERH training creates a scalable avenue for wide-scale implementation, given the organization’s presence in >6500 clinics across the 50 states.

9. Authoritative Textbook-Augmented Large Language Models for High-Altitude Public Health Medical Education in the Xizang Autonomous Region: Cross-Sectional Comparative Evaluation Study.

期刊: Journal of medical Internet research 发表日期: 2026-Jun-16 链接: PubMed

摘要

Public health medical education is increasingly important in the low-resource, high-altitude Xizang Autonomous Region (Tibet). Traditional authoritative textbooks do not meet modern needs for accessibility and interactivity, whereas general large language models (LLMs) may hallucinate in specialized medical domains. Developing specialized LLMs for low-resource regions is also expensive and difficult. This study aimed to explore a novel approach to high-altitude public health medical education in the low-resource Xizang Autonomous Region that integrates modern LLMs and authoritative textbooks, using a comprehensive benchmark evaluation across multiple dimensions and retrieval-augmented generation (RAG) technology. We conducted a 2-stage cross-sectional comparative evaluation study to benchmark publicly available LLMs and evaluate the added value of textbook-augmented retrieval under standardized generation settings and blinded expert assessment. First, 4 publicly available LLMs (GPT-5.2 [OpenAI], Gemini 3.0 Pro [Google], DeepSeek R1 [DeepSeek], and Tencent HY 2.0 [Tencent]) were benchmarked using an 80-question benchmark on high-altitude public health medicine developed by authoritative medical specialists. Each question was asked 3 times, yielding 960 outputs; first responses (n=320) were scored under blinded conditions by 2 independent 8-member physician panels. A clinically weighted evaluation of multidimensional first-response scores (including comprehensiveness, accuracy, clarity, and relevance) and a composite consistency metric (including semantic similarity and algorithmic similarity) was administered. Second, 4 specific and prevalent authoritative textbooks on high-altitude public health medicine-Ward, Milledge and West’s High Altitude Medicine and Physiology, High Altitude Medicine: A Case-Based Approach, High Altitude Medicine, and High Altitude Medical Protection-were deployed as the external knowledge base for the evaluation-optimized model. Statistical analyses included Spearman ρ, Cronbach α, intraclass correlation coefficients, Friedman tests with Dunn multiple comparisons, and paired Wilcoxon signed-rank tests. The significance threshold was set at α=.05. DeepSeek R1 was selected as the optimal base model for achieving the highest weighted score (5.61/10.00), followed by GPT-5.2 (5.51/10.00), Gemini 3.0 Pro (5.39/10.00), and Tencent HY 2.0 (4.71/10.00). The deployed retrieval-augmented model integrating the authoritative textbooks and the optimal LLM DeepSeek R1, HPHME-Xplus-RAG, achieved remarkable improvement in multidimensional scores compared to baseline DeepSeek R1 (median 8.00 [IQR 7.88-8.00] vs median 7.63 [IQR 7.38-7.88]; P<.001, r_rb=0.68, indicating a large effect). Integrating authoritative textbooks with an evaluation-optimized general LLM through an RAG framework showed strong performance for medical education in the low-resource Xizang Autonomous Region. Unlike prior studies that mainly evaluated general LLMs or used clinical guidelines to build RAG systems for diagnosis and treatment, this study used authoritative textbooks for the broader, guideline-scarce field of public health medical education. This work provides a replicable workflow-domain-authoritative knowledge+RAG+model optimization and evaluation-for low-resource settings, with practical implications for medical instructors and students, hospitals, and public health services seeking cost-effective, convenient, and trustworthy educational support.

10. Implementing Digital Respiratory Technologies for People With Respiratory Conditions: Scoping Review.

期刊: Journal of medical Internet research 发表日期: 2026-Jun-16 链接: PubMed

摘要

Digital health offers opportunities for safe, equitable, and accessible care, and its integration into respiratory care is a strategic priority for the European Respiratory Society. However, sustainable implementation remains complex, and guidance for health care systems is limited. This study aimed to undertake a scoping review of the published initiatives that have implemented digital respiratory technologies into real-world routine clinical practice over the past decade, identify the technologies used, implementation strategies used, the challenges and supports they encountered, and the lessons they reported for making care more equitable, strengthening patient-professional relationships, improving the patient journey, and reducing environmental impact. Following Arksey and O’Malley’s methodology, we searched ten databases (December 2013-2023 [updated April 2025 and February 2026]): MEDLINE, Embase, CINAHL, PsycINFO, Cochrane Library, Web of Science, Scopus, IEEE Xplore, CABI Global Health, and WHO Medicus; and used key domains in the commonly used implementation frameworks such as the Consolidated Framework for Implementation Research (CFIR), Nonadaptation, Abandonment, and Challenges to the Scale-up, Spread, and Sustainability of Health and Care Technologies (NASSS), and the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework to categorize results and understand methodologies used. As a scoping review, we mapped the available evidence, rather than synthesizing outcomes, appraising study quality, or estimating effectiveness. To broaden coverage and strengthen interpretation, we crowdsourced additional studies and sought feedback on our preliminary findings from a network of respiratory experts across 17 countries. Overall, 24,672 studies were identified; after deduplication, 14,811 were screened; 84 studies from 31 countries were included in the final review. The digital respiratory technologies comprised apps, platforms, chatbots, and smart devices. Reported technological functionalities encompassed remote consultation, clinician monitoring, video directly observed therapy, remote rehabilitation training, self-management support, education, monitoring medication adherence, and a school-based remote clinic. CFIR, RE-AIM, and the plan-do-study-act (PDSA) cycle were the most widely used frameworks. Successful implementation used simple technologies that fitted existing workflows and avoided additional workload. Co-development and trust-building with end-users influenced motivation and adoption, while leadership, team cohesion, and communication facilitated success. Barriers included insufficient resources, poor interoperability, lack of funding and reimbursement, and limited technical support. This scoping review provides a cross-condition review of digital respiratory technologies implemented in routine clinical practice. Unlike previous disease-specific or experimental-focused reviews, our innovative approach used established implementation Theories, Models, and Frameworks (TMFs) to identify shared barriers and enablers across diverse populations and health care systems. We summarize key implementation domains in state-of-the-art digital respiratory care and identify major gaps related to health equity, patient-clinician trust, continuity of support, and environmental sustainability. These findings emphasize the value of using implementation TMFs for scaling effective, patient-centered digital respiratory care in real-world settings.

11. Impact of Sleep Quality on Gait Variability: Pilot Cohort Study.

期刊: JMIR aging 发表日期: 2026-Jun-16 链接: PubMed

摘要

Higher step width variability while walking is associated with poor physical function and falls. Sleep is an established modifiable risk factor for both gait and physical function impairments, but it remains to be examined whether sleep is also related to step width variability. This study aimed to evaluate the cross-sectional associations between objectively measured sleep quality, using cardiopulmonary coupling spectrograms, and step width variability during a preferred walking condition among middle-aged and older adults. This study included 72 adults (mean age 71, SD 8.3 y; n=37, 51% female; n=65, 90% non-Hispanic White) who had ≥2 nights of objectively measured sleep (cardiopulmonary coupling via SleepImage ring) and completed a 10-m walk at preferred speed while wearing inertial sensors (APDM Mobility Lab). Sleep measures included sleep duration, efficiency, fragmentation, stability, apnea-hypopnea index, percentage of time oxygen saturation level <90%, oxygen desaturation index, and respiratory disturbance index. Additional derived sleep variables were explored using least absolute shrinkage and selection operator models. Step width variability was defined by the asymmetry of lateral step variability and categorized as medial (≤-7.5 cm), minimal (within ±7.5 cm; reference), or lateral displacement (≥7.5 cm). Multinomial logistic regression models adjusted for age, sex, race, education, BMI, and usual gait speed evaluated cross-sectional associations between sleep and step width variability categories. We found that a 1% higher sleep fragmentation was associated with a 6% higher probability of step width variability ≥7.5 cm (95% CI 1.01-1.11), while a 1% higher sleep stability was associated with a 5% lower probability of variability ≥7.5 cm (95% CI 0.91-0.99), compared to minimal variability. From the least absolute shrinkage and selection operator models, we found that a 1% higher sleep quality index, a 1% higher rapid eye movement sleep, a 1-second shorter apnea duration, and a 1-beat per minute slower mean heart rate were also associated with a lower probability of lateral compared to minimal displacement. Poor sleep quality was associated with higher step width variability among middle-aged and older adults. This suggests that sleep may be a modifiable risk factor for maintaining postural stability while walking among middle-aged and older adults. Future studies are needed to examine whether intervening in these sleep measures also lowers the risk of falls.

12. Advance Care Planning Documentation Completeness and End-of-Life Care: Trends and Associations Using HRS 2010-2022 Data.

期刊: The American journal of hospice & palliative care 发表日期: 2026-Jun-16 链接: PubMed

摘要

BackgroundAdvance care planning documentation allows individuals to communicate preferences for medical care and designate surrogate decision-makers. It is unknown if comprehensive documentation confers additional benefits.ObjectivesThis study examined additive associations between comprehensive advance care planning (ACP) documentation and end-of-life care (EOL) outcomes among older adults in the United States.Setting/SubjectsData from the Health and Retirement Study exit interviews (2010-2022) indicated ACP documentation status, based on proxy-reported completion of a living will (LW) and/or durable power of attorney (DPOA) for 5622 decedents representing 23.2 million individuals.MeasurementDocumentation was operationalized as a binary variable (any document, no document) and an ordinal variable (no documentation, one document, two documents). EOL outcomes included binary indicators of intensive care unit use in the last two years of life, use of life-sustaining treatments, hospice utilization prior to death, and location of death (out-of-hospital, hospital).ResultsAbout 42.7% decedents had two documents and 28.9% had none, documentation increased substantially around 2014. Compared with no documentation, having any documentation was associated with lower likelihood of life-sustaining treatment (aRR = 0.85, 95% CI: 0.74-0.98) and higher likelihood of hospice utilization (aRR = 1.43, 95% CI: 1.28-1.60) and out-of-hospital death (aRR = 1.11, 95% CI: 1.06-1.18), but not ICU use. Having two documents showed similar patterns. Associations were stronger among decedents with expected death and attenuated among those with unexpected death.ConclusionsACP is associated with less aggressive EOL care and greater hospice use, although the incremental benefits of having both documents are modest.

13. Prognostic Performance of C-Reactive Protein for Tuberculosis Outcome: Protocol for a Systematic Review and Meta-Analysis.

期刊: JMIR research protocols 发表日期: 2026-Jun-16 链接: PubMed

摘要

Tuberculosis (TB) remains a major global health challenge, with substantial mortality despite the availability of standardized treatment regimens. Accurate prognostication remains difficult, as no host-derived biomarker is routinely used to predict TB outcomes. C-reactive protein (CRP), a widely available acute-phase reactant, has been proposed as a potential prognostic biomarker, but its prognostic value for mortality in TB has not been systematically synthesized. This systematic review and meta-analysis aimed to evaluate the prognostic value of baseline CRP in predicting mortality among adult patients with TB and to examine whether the reported association varies across relevant clinical subgroups and study characteristics. This protocol was developed in accordance with PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) guidelines. Eligible studies included full-text English-language cohort studies, observational studies, case-control studies, and control arms of randomized controlled trials involving adults (aged 18 years and older) with microbiologically confirmed pulmonary or extrapulmonary TB. Included studies were required to assess baseline CRP at or near the time of TB diagnosis and to report mortality using quantitative effect estimates such as hazard ratios, odds ratios, or risk ratios. Studies limited to pediatric or latent TB populations and nonoriginal publication types were excluded. The literature search was conducted in the Cochrane Library, PubMed, Scopus, MEDLINE via Ovid, ProQuest, and medRxiv. Risk of bias was assessed using the QUIPS (Quality in Prognosis Studies) tool, and certainty of evidence was assessed using GRADE (Grading of Recommendations Assessment, Development, and Evaluation). A structured qualitative synthesis was undertaken for all included studies, and a random-effects meta-analysis was performed where studies were sufficiently comparable. The protocol was prospectively registered in PROSPERO (CRD420251101984) in July 2025. The electronic search covered the period from database inception to June 30, 2025, and was conducted from July 10, 2025, to July 14, 2025. Screening, full-text assessment, data extraction, methodological appraisal, and evidence synthesis were completed. A full manuscript reporting the findings of the completed systematic review and meta-analysis was subsequently prepared. This protocol provides a transparent record of the rationale, objectives, and methodological approach used to evaluate CRP as a prognostic biomarker for TB mortality. The completed review is expected to inform the interpretation of CRP in TB care, identify evidence gaps, and guide future prognostic research.

14. Predicting Frailty Trajectories Using Interpretable Machine Learning Among Older Adults Following Hip Surgery: Prospective Longitudinal Study.

期刊: JMIR aging 发表日期: 2026-Jun-16 链接: PubMed

摘要

Postoperative frailty is highly prevalent among older adults undergoing hip surgery and is closely linked to poor clinical outcomes. Despite growing interest in understanding its progression, the temporal patterns of frailty remain underexplored. Moreover, there is a lack of validated models that can predict frailty trajectories and stratify patients by risk in the early postoperative period. This study aimed to identify distinct frailty trajectories within 6 months following hip surgery in older adults and to explore their associated predictors. An interpretable machine-learning model was developed and internally validated for individualized risk prediction and was implemented as a clinically accessible web-based calculator. This prospective longitudinal observational study was conducted among older adults undergoing hip surgery at a tertiary hospital in China. Frailty assessments were performed preoperatively and at 1, 3, and 6 months postoperatively. A total of 209 participants who completed the 6-month follow-up were included in the analysis. Frailty was assessed using the Frailty Index, and group-based trajectory modeling was applied to identify distinct frailty progression patterns. Predictive variables were selected using the least absolute shrinkage and selection operator regression. An interpretable Extreme Gradient Boosting (XGBoost) model was developed using a 60:40 training-test data split. Model performance was evaluated in terms of discrimination, calibration, and clinical utility. Interpretability was assessed using SHAP (Shapley Additive Explanations) at both the global and individual levels. Three distinct frailty trajectories were identified: low-fluctuation frailty (55/209, 26%), high-improvement frailty (81/209, 39%), and high-deterioration frailty (73/209, 35%). Twelve predictors grounded in the Health Ecology Model were selected, spanning individual characteristics, interpersonal networks, and the living environment. The XGBoost model demonstrated excellent discrimination, with a microaverage area under the receiver operating characteristic curve of 0.98 (95% CI 0.96-0.99) in the training set and 0.93 (95% CI 0.90-0.96) in the test set. Calibration was acceptable, with a weighted Brier score of 0.0852. Decision curve analysis showed favorable clinical utility across a range of threshold probabilities. A web-based risk calculator was developed to facilitate personalized frailty trajectory prediction. The XGBoost model demonstrated strong predictive performance and interpretability, enabling the early identification of older patients at risk for adverse frailty trajectories following hip surgery. This tool may support targeted interventions and improve perioperative care in geriatric populations.

15. Gut health, systemic inflammation, and linear growth among Indonesian infants: findings from the Action Against Stunting Hub observation cohort: Erratum.

期刊: Epidemiology (Cambridge, Mass.) 发表日期: 2026-Jun-16 链接: PubMed

摘要

16. Prevalence of and Risk Factors for Metabolic Syndrome, Vascular Damage, and Accelerated Aging (MetVasA) After Pediatric Hematopoietic Stem Cell Transplantation for Hematological Malignancy: Protocol for a Cross-Sectional Cohort Study.

期刊: JMIR research protocols 发表日期: 2026-Jun-16 链接: PubMed

摘要

Survivors of hematopoietic stem cell transplantation (HSCT) in childhood face a high risk of metabolic and cardiovascular disease as well as accelerated aging. Estimates of the prevalence of these severe late effects have varied widely because they have been based on small cohorts or mixed populations of patients that received transplantations for both malignant and nonmalignant diseases, and the co-occurrence of these late effects was not assessed. Therefore, the true burden of these complications in survivors of hematological malignancies remains unclear. Moreover, the role of potentially modifiable risk factors such as health behaviors and inflammation has not yet been determined. This study aims to determine the prevalence of metabolic syndrome (MetS), endothelial dysfunction (ED), and accelerated aging and their risk factors, including treatment-related factors, inflammation, and health behaviors, in a large representative cohort of Dutch survivors of HSCT in childhood. Additionally, the study will examine the co-occurrence of these late effects. This cross-sectional cohort study will combine 2 cohorts of survivors of HSCT in childhood for a hematological malignancy. The first cohort (cohort 1; n=102) consists of survivors who received transplantations before 2002 and were participants of the Dutch Childhood Cancer Survivor Study LATER 2 cohort, a nationwide cohort study focusing on late effects among long-term childhood cancer survivors. The second cohort will include survivors who received transplantations between 2002 and 2021 (cohort 2; projected n=120) and visited the late effects (LATER) outpatient clinic of the Princess Máxima Center between 2024 and 2026. Key outcomes will be the prevalence of MetS (≥3 of 5 clinical criteria), accelerated aging (3 of 5 biological and clinical criteria), and ED (assessed by endothelial peripheral arterial tonometry) and their co-occurrence. A broad range of potential and modifiable risk factors will be investigated, including treatment-related factors; transplant complications (eg, graft-versus-host disease); and health behaviors, including physical activity, dietary intake and status assessed with nutritional biomarkers, substance use, sun exposure, and relaxation. Patient recruitment started in January 2024 and is estimated to last until June 2026. As of September 2025, a total of 77 participants have been included in the study. This study will provide insight into the prevalence of MetS, ED, and accelerated aging, as well as potentially modifiable risk factors, including those that have not been previously examined, among survivors of HSCT for hematological malignancies in childhood. The findings will inform surveillance guidelines and support the development of health behavioral and anti-inflammatory interventions to mitigate the risk of these severe late effects. DERR1-10.2196/77429.

17. Crossroads in Spinal Cord Injury Treatment: A Multidisciplinary Conference at a Pivotal Moment.

期刊: American journal of physical medicine & rehabilitation 发表日期: 2026-Jun-16 链接: PubMed

摘要

The Crossroads in Spinal Cord Injury Treatment: Present and Future conference, held in Houston, Texas in January 2026, brought together a multidisciplinary group of clinicians, researchers, engineers, and individuals living with spinal cord injury (SCI) to examine future directions of SCI care and research. This narrative summarizes themes, emphasizing the need to align scientific innovation with implementation in clinical settings. The conference was structured around priorities from individuals with SCI, including upper limb function, bowel and bladder management, pain, independence, and psychosocial well-being. Across sessions, speakers highlighted gaps in translation into practice. Major topics included challenges in clinical trial design, advocacy efforts to address policy barriers and inequities, and emerging approaches in neuromodulation, surgical reconstruction, and rehabilitation technologies. Additional focus areas included under-researched domains such as neurogenic bowel and bladder, disparities in care for women, and the clinical impact of autonomic dysfunction. Psychosocial health, pain, mental health, and sexuality were emphasized as central to quality of life. Engineering discussions underscored interdisciplinary collaboration and user-centered design. Overall, the conference highlighted that the field of SCI is at a critical crossroads, where progress will depend on effective implementation, equitable access, and integration of lived experience into research and clinical care.

18. High Cost of Cancer Medicines in the United States: Opportunities for Policy Reforms.

期刊: JCO oncology practice 发表日期: 2026-Jun-16 链接: PubMed

摘要

19. Comparing Buprenorphine Treatment Outcomes Among Kentucky Medicaid Patients by Prescriber Specialty and Type.

期刊: Substance use & misuse 发表日期: 2026-Jun-16 链接: PubMed

摘要

Buprenorphine is vital to improving health outcomes for patients with opioid use disorder (OUD). Little is known about variation in buprenorphine retention and related outcomes across different outpatient prescribers and settings. Our 2020-2021 sample includes 10,709 Kentucky Medicaid-enrolled patients with OUD who received most of their buprenorphine prescriptions from primary care physicians, specialty care physicians, or advanced practice providers (APP). Adjusted multivariable linear and logistic regression, respectively, estimated the percentage of days with buprenorphine coverage and the proportion of patients who experienced non-fatal overdose after the first prescription. Compared to specialty physicians and APPs, those with primary care prescribers had a higher percentage of days with buprenorphine (primary: 69.6, 95% confidence interval (CI): [66.7, 72.4]; specialty: 60.1, 95% CI: [54.7, 65.4]; APP: 64.3, 95% CI: [62.1, 66.5]; p < 0.01). A lower proportion of patients with APP prescribers experienced non-fatal overdose (APP: 4.0, 95% CI: [3.4, 4.7]; primary: 5.5, 95% CI: [4.1, 6.9]; specialty: 5.7, 95% CI: [4.2, 7.2]; p < 0.01). Kentucky Medicaid-enrolled patients with primary care physicians had the highest treatment retention, while patients with APPs were less likely to experience a non-fatal overdose. Our findings suggest that although multiple provider types can effectively prescribe buprenorphine, the potentially meaningful differences observed in retention and non-fatal overdose warrant further longitudinal investigation to assess whether these differences by provider type and setting persist over time.

20. Assessing the impact of social determinants of health on rising preterm birth trends in England. A longitudinal ecological study, 2012-17.

期刊: Journal of public health (Oxford, England) 发表日期: 2026-Jun-16 链接: PubMed

摘要

Preterm birth (PTB) is the UK’s leading cause of neonatal morbidity and mortality. There is international evidence of socioeconomic inequalities in PTB. Between 2012 and 2017, the proportion of live births occurring prematurely increased in England. This study explores how changes to major social determinants of health (SDH) may have contributed to recent trends. We analysed PTB trends and their correlation with contemporaneous trends in major SDH predictors (socioeconomic status, income, and unemployment) for English Local Authorities. We used both fixed-effects and mixed-effects modelling to estimate the association between SDH and PTB rates between 2012 and 2017. The gap in PTB inequalities widened over the study period, with the absolute difference in PTB rates between most and least disadvantaged communities rising by 35%. Mixed-effects analysis demonstrated an association between the proportion of children living in low-income households and PTB; for each percentage point increase in child poverty, an estimated additional 0.24 per 1000 births was preterm. We provide evidence of rising PTB rates in England prior to the pandemic, which disproportionately affected the poorest areas of the country. Policies targeting areas with higher child poverty rates are likely to reduce inequalities in PTB in England.

21. A Roadmap for Implementing Virtual Geriatric Mental Health Services for Rural Veterans: Qualitative Longitudinal Evaluation.

期刊: JMIR aging 发表日期: 2026-Jun-16 链接: PubMed

摘要

Access to geriatric mental health (GMH) care is limited in rural areas. To meet this need, the Veterans Health Administration provides specialty tele-GMH care for aging rural veterans via regional telehealth hubs. This study aims to create a roadmap describing key phases and determinants underlying the implementation and sustainment of tele-GMH services as part of a qualitative longitudinal evaluation of tele-GMH teams. Semistructured interviews were conducted with clinicians from all 8 tele-GMH teams (n=25) at 3 time points across a 3-year period (October 2021-September 2024). Interview (n=46) data were summarized into key domains using a templated rapid qualitative approach, guided by the Consolidated Framework for Implementation Research (CFIR) 2.0. Further thematic analysis and team discussion elucidated the findings. We identified key activities and determinants of success in three phases: (1) preimplementation (engaging leaders, securing funding/hiring, and defining services); (2) implementation scale-up and expansion (advertising, addressing challenges, seeking feedback, refining, and growth); and (3) sustainment (maintenance). Activities within each phase were cyclical and iterative (ie, nonlinear). Barriers to implementation included unfamiliarity with local aging resources; facilitators included tailoring strategies and engaging referring clinicians. Similar processes emerged across regions in the development and sustainment of tele-GMH services, allowing for the creation of a unified roadmap. Limitations including sampling bias are discussed. Further work could apply and evaluate the utility of the roadmap to guide creation of tele-GMH services in new regions to enhance access to specialty care for aging rural veterans.

22. Promoting healthy aging in occupational settings: satisfaction with life as a strategic target in the Semmelweis-EUniWell framework.

期刊: GeroScience 发表日期: 2026-Jun-16 链接: PubMed

摘要

The growing burden of aging-related disease and functional decline across Europe underscores the urgent need to optimize aging trajectories rather than simply extend lifespan. Achieving this goal requires identifying modifiable determinants that shape biological, psychological, and functional aging across the life course. Satisfaction with life (SWL) is emerging as one such integrative factor, linking adaptive capacity, resilience, and long-term healthspan outcomes. In this conceptual and translational paper, we integrate evidence from geroscience, psychology, and occupational health to position SWL as both a marker and a potentially modifiable determinant of healthspan. We review biological, psychological, and social mechanisms linking SWL to aging processes, including cardiovascular and inflammatory regulation, neural and affective processing, psychological resilience and reserve, and social integration and generativity. Collectively, these pathways suggest that SWL reflects the functional integrity of adaptive systems that shape vulnerability to age-related functional decline. We further argue that occupational settings represent a uniquely powerful and scalable context for targeting SWL, given their sustained influence on behavior, stress exposure, social roles, and meaning across adulthood. Building on this framework, we discuss the Semmelweis Study, a large prospective workplace-based cohort, together with the Semmelweis-EUniWell Workplace Health Promotion Program, as an integrated model for translating geroscience-informed insights into structured interventions. Such workplace health promotion programs can target core psychological capacities-including savoring, self-regulation, creative and executive efficiency, and resilience-that are closely linked to adaptive capacity and aging-related outcomes. Finally, we discuss implications for geroscience, public health, and policy, highlighting how embedding SWL as a strategic target within workplace systems may contribute to extending healthspan, strengthening workforce sustainability, and reducing the societal burden of population aging. Conceptualizing satisfaction with life not merely as a subjective outcome but as a dimension of biological aging and adaptive resilience opens new avenues for intervention at the interface of geroscience and real-world systems.

23. Response to: comment on "sagittal misalignment patterns and pathomechanical hypothesis of adolescent idiopathic scoliosis: a radiographic analysis".

期刊: Spine deformity 发表日期: 2026-Jun-16 链接: PubMed

摘要

24. Mealtime irregularity is associated with higher serum growth differentiation factor-15 levels in older adults: the explanatory role of dietary quality.

期刊: European geriatric medicine 发表日期: 2026-Jun-16 链接: PubMed

摘要

This study examined the association between mealtime irregularity and Growth Differentiation Factor-15 (GDF-15)-a potential biomarker of biological aging-and evaluated whether this association could be explained by poor dietary quality among community-dwelling older adults. This cross-sectional study analyzed data from 378 disability-free adults aged ≥ 65 years from the Higashiura Study. Eating habits (regular vs. irregular) were assessed during the interviews. Dietary quality was evaluated using nutrient density scores from the Nutrient-Rich Food Index, calculated from 3-day dietary records. The association among mealtime irregularity, dietary quality, and serum GDF-15 levels was examined using mediation analysis after adjusting for age, sex, comorbidities, sleep duration, physical activity, smoking status, employment status, and total energy intake. Participants with irregular mealtimes were significantly younger than those with regular mealtimes (mean ± standard deviation: 73.3 ± 4.6 vs. 75.1 ± 5.6 years, p = 0.014) and had higher serum GDF-15 levels (least-squares means, 95% confidence interval [CI]: 1161.4, 1063.4-1270.2 vs. 1028.0, 988.4-1068.9 pg/mL, p = 0.009). In the mediation analysis, lower nutrient density partially explained the association between mealtime irregularity and higher GDF-15 levels (β, 95% CI: total effect: 0.053, 0.0078-0.0977; direct effect: 0.046, 0.0004-0.0898; indirect effect: 0.008, 0.0001-0.0205; mediation proportion: 14.5%). Although participants with irregular mealtimes were significantly younger than those with regular mealtimes, they showed higher levels of biological aging markers. Dietary quality partially accounted for this association. These findings suggest that dietary quality may be an important consideration for older adults with irregular mealtimes.

25. BMAL1 regulates the initial step of embryo implantation by modulating endometrial cell adhesion and migration.

期刊: Human cell 发表日期: 2026-Jun-16 链接: PubMed

摘要

Embryo implantation is a critical and tightly regulated process essential for successful human reproduction. Although the role of endometrial receptivity is well established, the molecular mechanisms governing this process are not thoroughly understood. Circadian rhythm regulators, particularly brain and muscle aryl hydrocarbon receptor nuclear translocator-like protein 1 (BMAL1), have emerged as key modulators in reproductive biology. In this study, we investigated the role of BMAL1 in regulating endometrial receptivity and embryo implantation. Ishikawa cells were transfected with BMAL1-specific or control siRNA, followed by RT-qPCR, western blotting, and immunofluorescence analyses. Functional assays, including migration assays, co-culture with JEG-3 spheroids, cell viability, and cytotoxicity, were also performed. Our results demonstrated that BMAL1-knockdown in Ishikawa cells downregulated adhesion-related genes, including ITGAV, ITGB3, and ITGB5. Although total ITGB5 protein levels remained stable, its localized expression intensity was significantly reduced; the protein expression of ITGAV and ITGB3 was decreased, and cell migration was impaired. Notably, while BMAL1-knockdown compromised cellular motility, it had no significant effect on cell viability or cytotoxicity. A co-culture model with JEG-3 spheroids further demonstrated significantly decreased embryo adhesion following BMAL1-knockdown. In conclusion, BMAL1 is a critical regulator of integrin-mediated adhesion and endometrial receptivity, underscoring its potential as a therapeutic target for recurrent implantation failure.

26. Hydrogeochemical processes and water quality of the Aïn Taga Karst Spring, Tlemcen, Northwestern Algeria.

期刊: Environmental geochemistry and health 发表日期: 2026-Jun-16 链接: PubMed

摘要

This study presents the first long-term hydrogeochemical monitoring (2014-2024) of the Aïn Taga karst spring, located in the Ghar Boumaâza karst system (northwestern Algeria). The analysis is based on 71 samples, examined for major ions, salinity, hardness and saturation indices, interpreted using Piper and Chadha diagrams, multivariate statistical methods (PCA, CAH) and mineral balance calculations. The results reveal a clear dominance of the Ca-Mg-HCO₃ facies (94.4% of the samples), indicating that carbonate dissolution mainly controls mineralization, with waters supersaturated with calcite and dolomite and a limited influence of evaporitic formations. A cubic polynomial model HCO₃⁻-Q highlights a nonlinear relationship between bicarbonate concentration and flow, characterized by high concentrations at low flow rates (prolonged residence times and strong water-rock interaction) and progressive dilution during high-water episodes, with very good predictive performance (R2 ≈ 0.95, MAE ≈ 15 mg/L, RMSE ≈ 19 mg/L). Principal component analysis clearly distinguishes natural mineralization from low anthropogenic inputs (NO₃⁻, Cl⁻, SO₄2⁻), while the marked negative correlation between flow and bicarbonate (ρ =  - 0.66) highlights the dilution processes during floods. In this strategic, highly vulnerable and historically understudied karst, this integrated approach provides an operational framework to link the hydrodynamic regime and hydrochemical signature, improve the interpretation of carbonate dissolution processes, identify localized contaminations and guide monitoring and protection strategies for water resources.

27. Building a Healthier Workforce: The Value of Employer-Sponsored Vaccinations and Vaccination Programs in the Workplace.

期刊: Journal of occupational and environmental medicine 发表日期: 2026-Jun-16 链接: PubMed

摘要

Vaccination reduces the burden of infection, severe illness, and mortality associated with many vaccine preventable diseases. Workplace vaccination programs are a highly effective strategy for promoting employee health, reducing absenteeism, and improving productivity while yielding significant cost savings to employers. Offering on-site vaccination clinics can further improve vaccine uptake and increase cost efficiency by making immunization more convenient and accessible. Workplace vaccination programs reflect an ethical commitment to public health by fostering a safer environment for employees, their families and their communities. Employers are uniquely positioned to lead these efforts, leveraging their health benefits programs and resources to ensure accessible and effective vaccination coverage.

28. Reverse Transcriptase Activity with CRISPR (REACTR) Assay for Rapid and User-Friendly Therapeutic Drug Monitoring in Cytomegalovirus Care.

期刊: ACS infectious diseases 发表日期: 2026-Jun-16 链接: PubMed

摘要

Cytomegalovirus (CMV) can cause severe disease and death in infants and immunocompromised people. The first-line drug ganciclovir has high pharmacokinetic variability which leads to significant rates of underexposure or toxicity. Intracellular ganciclovir triphosphate (GCV-TP)─ganciclovir’s active anabolite─is associated with concentration-dependent neutropenia, and monitoring could enable dose individualization to improve treatment efficacy. However, GCV-TP is currently measured using liquid chromatography tandem mass spectrometry (LC-MS/MS) which is impractical for routine use, especially in resource-limited settings, due to its high cost, labor-intensiveness, and reliance on specialized equipment. To address this gap, we adapted the REverse transcriptase ACTivity with CRISPR (REACTR) assay to measure GCV-TP. We leveraged previous work using REACTR to measure reverse transcriptase (RT) inhibitors used to treat and prevent human immunodeficiency virus (HIV) because GCV-TP serendipitously inhibits HIV RT. We designed custom DNA templates, primers, and CRISPR complexes to accurately measure GCV-TP spiked into buffer and blood. REACTR reproducibly measured clinically relevant GCV-TP concentrations using a simple workflow and equipment that are readily available in many clinical laboratories. We evaluated the assay’s performance with 40 dried blood spots from infants with congenital CMV and REACTR measurements of clinical samples correlated with LC-MS/MS GCV-TP measurements (Spearman ρ = -0.811; p < 0.0001). REACTR correctly identified samples above and below simulated 50% and 75% adherence thresholds with areas under receiver operating characteristic curves (AUCs) of 0.910 and 0.957, respectively. This study highlights the potential of REACTR as a rapid and accessible alternative to LC-MS/MS for therapeutic drug monitoring of GCV-TP.

29. Response: Assessing Syphilis Partner Services in Georgia (2013-2024): Effectiveness in Partner Notification and Impact on Reinfection.

期刊: Sexually transmitted diseases 发表日期: 2026-Jun-16 链接: PubMed

摘要

30. Gaps in syphilis screening among pregnant women in North Carolina.

期刊: Sexually transmitted diseases 发表日期: 2026-Jun-16 链接: PubMed

摘要

Congenital syphilis rates have risen nationally and in North Carolina (NC). We assessed syphilis screening among pregnant women in NC. A retrospective chart review was conducted among patients with a pregnancy episode-created at first prenatal care encounter or labor/delivery-at a NC health system from 1/1/2019-12/31/2023. We estimated the proportion with syphilis screening at timepoints required by NC law (before 28 weeks of gestation, 28-31 weeks of gestation, and within 1 week of delivery) using syphilis test dates and delivery dates. We estimated prevalence ratios (PR) and 95% confidence intervals (CIs) using log binominal regression with generalized estimating equations to explore associations between clinical and sociodemographic factors and syphilis screening. We identified 64,803 pregnancies among 54,446 patients. Syphilis screening was conducted at least once in 99.5% of pregnancies. Only 27.6% had syphilis screening recorded at 28-31 weeks, and 22.0% had all required syphilis screening. Completion of required syphilis screening was more common among women aged 18-24 compared to ≥35 years (PR 1.15; CI: 1.10-1.21), and those who were uninsured compared to privately insured (PR 1.33; CI: 1.27-1.39), but less common among Black/African American women compared to White women (PR 0.93; CI: 0.89-0.96), those who preferred non-English languages for healthcare communication compared to English (PR 0.85; CI 0.81-0.90), and who initiated care in an emergency department compared to a women’s health clinic (PR 0.13; 95% CI: 0.12-0.15). Completion of all required syphilis screening was low among pregnant women, highlighting a major gap in congenital syphilis prevention.

31. Biotransformation of three hexabromocyclododecane diastereoisomers in HepG2 cells and their cellular metabolomics.

期刊: Ecotoxicology and environmental safety 发表日期: 2026-Jun-16 链接: PubMed

摘要

In this study, human hepatoma cells (HepG2) were exposed to three concentrations (0.05, 1 and 10 mg/L) of individual hexabromocyclododecane (HBCD) diastereoisomers (α-, β- and γ-HBCD) for 24 h to investigate their cytotoxicity, biotransformation, bioisomerization, and induced metabolic disturbances. All isomers showed cytotoxicity, as indicated by dose-dependent decreases cell viability (γ-HBCD > β-HBCD > α-HBCD) and significant GSH depletion (β-HBCD > α-HBCD > γ-HBCD). While their cellular apparent uptake rates were similar, β-HBCD had a higher biotransformation rate than α- and γ-HBCD. High-performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS) identified putative pentabromocyclododecene (PBCDe) as the main metabolite, with varying levels among isomers. Bioisomerization (β/γ-HBCD to α-HBCD; β-HBCD to γ-HBCD) and reductive debromination were the major metabolic pathways. Metabolomic analysis revealed HBCD disrupted multiple metabolic pathways (e.g., choline, glycerophospholipid, fatty acid, purine metabolism), with distinct effects observed across different diastereoisomers.

32. Functional divergence and symbiotic significance of nitrate reductase isoforms in Medicago truncatula.

期刊: Plant physiology 发表日期: 2026-Jun-16 链接: PubMed

摘要

Nitrate reductase (NR) is a key enzyme in nitrate assimilation, yet its function within nodules remains poorly understood. In Medicago truncatula, three NR genes, MtNR1, MtNR2, and MtNR3, exhibit distinct evolutionary origins and regulatory features. Phylogenetic analyses indicate that NR3-type genes, originated from a duplication of NR1 within Inverted Repeat-Lacking Clade (IRLC) legumes, have lost the conserved phosphorylation sites critical for post-translational regulation. To assess the functional significance of these isoforms, we characterized single and double nr mutants obtained through Tnt1 transposon insertion under nitrate nutrition and during symbiosis. MtNR1 is the primary contributor to total NR activity: with nr1 and nr2 mutants retaining around 10% and 30% of wild-type levels, respectively. The nr1/nr2 double mutant shows an almost complete loss of NR activity and fails to survive under nitrate supply, demonstrating the essential and non-redundant roles of both isoforms. Under symbiotic conditions, single mutants displayed normal nodulation, whereas nodule development was nearly abolished in the double mutant despite continued MtNR3 expression. In addition to its role in nitrogen assimilation, single nr mutants showed increased sensitivity to hypoxic stress and impaired recovery of nitrogen fixation, revealing a role for NR in nodule energy metabolism through the phytoglobin-NO respiration pathway. We propose that the combined loss of NR1 and NR2 disrupts NO cycling linked to mitochondrial electron transport, thereby compromising the energy balance required for symbiosis under microoxic conditions. This work provides a framework to investigate NR diversification in legumes and opens perspectives for improving nitrogen fixation under environmental constraints.

33. Exploring Saccharomycopsis vini as a novel parasitoid-friendly attractant for efficient attract-and-kill of Drosophila suzukii (Diptera: Drosophilidae).

期刊: Journal of economic entomology 发表日期: 2026-Jun-16 链接: PubMed

摘要

Effective management of the fruit pest Drosophila suzukii Matsumura (Diptera: Drosophilidae) requires new strategies to reduce insecticide use and minimize their negative impact on beneficial organisms. This study evaluated the effectiveness of Saccharomycopsis vini supernatant, a formulation that retains attractive cues while offering improved storage and handling conditions compared to the non-sterile yeast suspension. In recent years, yeast-based attract-and-kill approaches have shown strong potential, with Hanseniaspora uvarum widely studied as an attractant. However, little attention has been given to alternative yeast species and the use of yeast supernatants rather than live cultures. In this study, we assessed for the first time the attractiveness of S. vini supernatant alongside H. uvarum suspension. In a Y-maze olfactometer bioassay, both formulations were attractive to D. suzukii females. Field trials in a vineyard and cherry orchards confirmed the efficacy of both yeast formulations when combined with spinosad. Importantly, the D. suzukii parasitoid Ganaspis kimorum Buffington (Hymenoptera: Figitidae) did not show increased mortality relative to spinosad alone. In conclusion, S. vini supernatant proved to be as effective as H. uvarum suspension in attracting D. suzukii, while showing no increase in parasitoid mortality compared with spinosad alone under laboratory conditions. These results highlight S. vini as a promising component of yeast-based attract-and-kill strategies and provide a solid basis for developing selective and sustainable management tools for D. suzukii.

34. Using In-Home Air Quality Monitoring to Reduce Cannabis Secondhand Smoke Exposure in Children: Quantitative Pilot Feasibility Study.

期刊: JMIR formative research 发表日期: 2026-Jun-16 链接: PubMed

摘要

An estimated 5 to 8 million US children live with a parent who uses cannabis, and most cannabis users report smoking cannabis inside their homes, placing children at risk for cannabis secondhand smoke (cSHS) exposure. Indoor air quality (IAQ) monitoring provides real-time feedback on airborne pollutants and has shown promise in reducing in-home tobacco secondhand smoke exposure, suggesting its potential as an effective harm reduction strategy for cSHS. This pilot study evaluated the feasibility, acceptability, and preliminary effectiveness of using low-cost, off-the-shelf IAQ monitors to increase caregivers’ awareness of children’s cSHS exposure risk and to change smoking behavior. Secondary aims were to assess participant engagement, perceived usefulness, and household communication regarding in-home cannabis smoking. Between February 2025 and April 2025, 14 adults who smoked cannabis indoors and lived with at least 1 child aged younger than 16 years were recruited primarily via targeted social media advertisements and completed a 3-week trial. Participants received an Awair Element IAQ monitor, printed health education materials, and text messaging prompts for brief surveys. The IAQ monitor continuously measured PM2.5, VOCs, CO₂, temperature, and humidity. Daily surveys captured self-reported PM2.5 readings and recent cannabis use, while baseline and end-of-study assessments evaluated IAQ perceptions, cSHS risk awareness, and in-home smoking behavior. Survey results were summarized via descriptive statistics, and linear mixed-effects models were used to characterize objective IAQ trends. Six additional adult household members provided parallel end-of-study data. Reported engagement was high, with 85% (11/13) of participants indicating that they reviewed the monitor at least daily. The average number of days in the previous week that a caregiver reported a child being home while cannabis was smoked declined from 4.5 (SD 2.2) at the trial start to 2.8 (SD 2.9) at the end (6/13, 46% had a reduction; 1/13, 8% reported an increase). Furthermore, 62% (8/13) of participants reported that they reduced (4/13, 31%) or thought about changing (4/13, 31%) their smoking habits. Around 62% (8/13) of participants agreed or strongly agreed that IAQ monitoring helped drive conversations about changing indoor smoking rules, while 100% (13/13) reported no IAQ-driven disagreements among household residents regarding in-home smoking rules. A linear mixed-effects model did not indicate a consistent trend in PM2.5 levels across participants over time (β=-0.28; SE 1.13; P=.81), but there was heterogeneity in trends, and those with the largest reductions in PM2.5 over the trial had the largest reduction in reported children’s cSHS exposure. In-home IAQ monitoring was feasible and perceived as useful among caregivers who smoked cannabis indoors. Real-time IAQ feedback supported risk awareness, promoted family dialogue, and coincided with reductions in in-home smoking around children. These findings suggest that IAQ feedback may represent a scalable tool for reducing children’s cSHS exposure and merits further testing in larger, controlled trials.

35. Taking the Final Exit: Exploring the Distribution, Risks, and Geospatial Attributes of Truck Driver At-Work Deaths in Harris County, Texas.

期刊: Journal of occupational and environmental medicine 发表日期: 2026-Jun-16 链接: PubMed

摘要

To characterize the distribution, risks, and geospatial attributes of truck driver at-work deaths. At-work medical examiner death data from Harris County, Texas were extracted and analyzed using a case-control design. Truck driver cases (n = 52) were matched on age characteristics to non-truck driver controls (n = 156). These data included place of injury/collapse, manner of death, anthropometrics, and demographics. Medical center and American Community Survey data were extracted for geospatial analyses. Truck driver at-work deaths differed from controls in the distribution of manners of death, and they occurred more commonly in underserved census tracts. Truck driver at-work deaths were predicted by both of these differences. These findings provide preliminary evidence for truck driver vulnerability to natural deaths at work and the characterization of truck driver worksites as medical deserts.

36. Inflammation on the Frontlines: Linking Salivary and Blood Biomarkers to Cardiometabolic Health and Physical Performance Parameters in Firefighters.

期刊: Journal of occupational and environmental medicine 发表日期: 2026-Jun-16 链接: PubMed

摘要

Firefighters experience chronic stress that contributes to elevated cardiometabolic disease (CMD) risk. This study examined associations between blood and salivary biomarkers of inflammation, stress, and oxidative stress with measures of body composition, fitness, and cardiometabolic health among firefighters (n = 140). Principal components analysis was used to reduce multicollinearity among body composition, physical performance, and cardiometabolic variables, followed by multivariate regression models predicting adiponectin, C-reactive protein (CRP), and interleukin-6 (IL-6) concentrations. Body mass and composition, fitness, and atherogenic dyslipidemia were associated with multiple biomarkers. Salivary IL-6 demonstrated robust associations with body composition, physical performance, and salivary CRP. Blood adiponectin and CRP were strongly associated with atherogenic dyslipidemia, insulin resistance and oxidative stress. Salivary inflammatory biomarkers, particularly IL-6, may provide a feasible complement to blood biomarkers for identifying CMD risk among firefighters.

37. Occupational distress factors associated with suicidal ideation among physicians and comparison with other US workers.

期刊: Academic medicine : journal of the Association of American Medical Colleges 发表日期: 2026-Jun-16 链接: PubMed

摘要

This study evaluates associations with suicidal ideation (SI) of impact of work on personal relationships (IWPR), self-valuation (SV), and imposter phenomenon and compares the SI point prevalence in physicians vs other workers. This study used American Medical Association Physician Professional Data to sample US physicians across different specialties between November 2020 and March 2021. Of 7,360 survey respondents, 6,497 (88.3%) completed the SI question. A probability-based sample included 2,508 nonphysician individuals from the US population employed at the time of survey administration, with 2,501 workers (99.7%) completing the SI item. Logistic regression was used to evaluate associations of occupational distress factors, including IWPR, SV, imposter phenomenon, and other factors, with SI before and after adjusting for depression and compare the risk of SI among physicians with other US workers. The study included 6,497 physicians and 2,501 workers in other fields. Adjusting for sex, age, relationship status, parenting status, and depression, each 1-point higher IWPR score (range, 0-10) was associated with 10% increased SI odds (odds ratio [OR], 1.10; 95% CI, 1.05-1.15). Adjusting for the same variables, each 1-point higher SV score (range, 0-10) was associated with 10% lower SI odds (OR, 0.90; 95% CI, 0.85-0.95). The association between imposter phenomenon scores (range, 4-20) and SI was not statistically significant (OR, 1.03; 95% CI, 0.99-1.08). The unadjusted 1-year SI point prevalence was 6.6% (95% CI, 6.0%-7.4%) in physicians vs 5.6% (95% CI, 4.7%-6.6%) among workers in other fields (P =  .09). In a multivariable model, workers in other fields with a bachelor’s or master’s degree had lower SI odds compared with physicians (OR, 0.64; 95% CI, 0.46-0.87). IWPR and low SV are associated with SI among physicians, independent of depression. Development and evaluation of interventions designed to mitigate these factors in physicians may be warranted.

38. Occupational therapists' perspectives on assistive technology for children with disabilities: a scoping review.

期刊: Disability and rehabilitation. Assistive technology 发表日期: 2026-Jun-16 链接: PubMed

摘要

Assistive technology (AT) supports participation and functional independence in children with disabilities; however, its integration within paediatric occupational therapy practice remains inconsistent. This scoping review aimed to map occupational therapists’ perspectives on the recommendation, selection, and implementation of AT for children with disabilities and identify barriers and enablers influencing AT use. This scoping review followed Arksey and O’Malley’s framework and was reported according to PRISMA-ScR guidelines. Searches were conducted in PubMed, Scopus, Web of Science, and CINAHL. Peer-reviewed qualitative, quantitative, and mixed-methods studies exploring occupational therapists’ perspectives on AT use for children (<18 years) published up to 31 March 2025 were included. Data were synthesised using inductive thematic analysis. Eighteen studies met the inclusion criteria across high- and low-resource settings. Three overarching themes emerged: (i) systemic and policy influences on AT utilisation, (ii) professional and contextual determinants of occupational therapy decision-making, and (iii) family and child factors shaping AT adoption. Major barriers included funding limitations, restricted access to devices, inadequate professional training, fragmented services, and sociocultural stigma. Key enablers included therapist expertise, interdisciplinary collaboration, opportunities to trial AT, contextual adaptation, and family-centred practice. Occupational therapists’ use of AT is shaped by interconnected systemic, professional, contextual, and family-related factors. Strengthening training, interdisciplinary collaboration, culturally responsive practice, and equitable access to AT services may support more effective participation-oriented paediatric occupational therapy practice. Occupational therapists are key decision-makers in paediatric assistive technology provision and require structured training, ongoing professional support, and clear role delineation to optimise AT outcomes.Access to funding, opportunities for device trials, and coordinated interdisciplinary services are critical to reduce delayed provision and abandonment of assistive technology.Family-centred, culturally responsive rehabilitation approaches enhance acceptance, sustained use, and functional participation of children using assistive technology across home, school, and community settings.Strengthening policy frameworks and service delivery systems is essential to promote equitable access to assistive technology, particularly in low-resource and underserved rehabilitation contexts.

39. Frequency, Severity and Ergonomic Awareness of Work-Related Musculoskeletal Disorders Among Australian Optometrists: A Cross-Sectional Survey.

期刊: Ophthalmic & physiological optics : the journal of the British College of Ophthalmic Opticians (Optometrists) 发表日期: 2026-Jun-16 链接: PubMed

摘要

Work-related musculoskeletal disorders (WMSDs) are highly prevalent among healthcare professionals, including optometrists. This study aimed to assess the frequency, severity and contributing factors of WMSDs among Australian optometrists, as well as evaluate their awareness and implementation of ergonomic practices. A cross-sectional online survey was distributed to optometrists in Victoria and South Australia. The survey collected data on demographics, work characteristics, ergonomic awareness, frequency and severity of musculoskeletal discomfort and contributing factors. Quantitative data were analysed using descriptive statistics and correlation analysis. Free-text responses were examined using inductive thematic analysis. Of 119 respondents, 84% reported neck discomfort, 71% shoulder discomfort and 73% lower back discomfort. Pain severity was highest in the neck and shoulders (mean ~6.5/10). Strong Pearson correlations were found between neck, shoulder and upper back discomfort. Repetitive tasks, static postures and awkward positioning were identified as primary contributors to discomfort. Slit lamp-based tasks were most frequently associated with exacerbating pain. Only 20% of respondents were aware of workplace health and safety policies and 97% had not received employer-led training on injury reduction. Thematic analysis revealed significant impacts on professional performance and personal wellbeing. WMSDs are highly prevalent among Australian optometrists, particularly affecting the upper body. There is a lack of ergonomics education and workplace support. These findings highlight the need for improved ergonomics training in optometry education, implementation of workplace health and safety protocols and investment in ergonomic equipment. Future interventions should focus on addressing the identified risk factors and promoting a culture of safety in optometric practice.

40. Circadian rhythm sleep disorders and changes in cognitive function and sleepiness among healthcare workers.

期刊: Sleep & breathing = Schlaf & Atmung 发表日期: 2026-Jun-16 链接: PubMed

摘要

Circadian rhythm sleep disorders (CRSDs) are common among healthcare workers (HCWs) and may impair alertness and cognitive performance during night shifts. This study examined CRSDs associations with cognitive function and sleepiness during overnight duty. Seventy-six hospital employees (80.3% female; mean age 31.8 ± 7.5 years) participated in this cross-sectional study. Based on clinical evaluation, participants were classified as normal circadian rhythm, delayed sleep phase syndrome (DSPS), and shift work sleep disorder (SWSD). Sleepiness was measured using Karolinska Sleepiness Scale (KSS) and Epworth Sleepiness Scale (ESS). Cognitive and psychomotor performance were assessed at the start and end of an 8-hour night shift using reaction time, minor lapses, memory span, and digit span tests. Statistical analyses included ANOVA, paired t-tests, Wilcoxon, and Kruskal-Wallis tests. The prevalence of DSPS and SWSD was 13.2% and 15.7%. Total sleep duration did not differ significantly between CRSDs (P > 0.05). Reaction times and minor lapses increased significantly after the night shift (P < 0.05). Memory span, forward and reverse digit recall, and total correct responses all declined post-shift (P < 0.01). KSS scores increased significantly (P = 0.001). Reaction times and minor lapses differed significantly between CRSD subgroups, with SWSD participants demonstrating the greatest decline in performance. HCWs with SWSD, exhibited greater cognitive deterioration and sleepiness during night shifts compared with normal circadian rhythms, whereas individuals with DSPS show relatively preserved performance. These findings highlight the importance of early recognition and occupational strategies to mitigate cognitive fatigue and associated risks in shift-working HCWs.

41. Burnout among healthcare professionals in Bangladesh: a narrative review.

期刊: Discover mental health 发表日期: 2026-Jun-16 链接: PubMed

摘要

Healthcare professionals are particularly vulnerable due to heavy workloads, long duty hours, and emotionally demanding work environments. In Bangladesh, structural constraints within the healthcare system may further increase the risk of burnout. This article synthesizes existing evidence on burnout among healthcare professionals in the country. A structured narrative review was conducted using a comprehensive literature search without time restrictions in PubMed, Scopus, Google Scholar, and BanglaJOL up to 02 February, 2026. Studies were screened using predefined inclusion and exclusion criteria, and eligible studies were thematically synthesized. Eight cross-sectional studies were included with sample sizes ranged from 50 to 2705 and encompassed various healthcare professional groups, including intern doctors, medical officers, postgraduate trainees, consultants, nurses, dentists, Intensive Care Unit (ICU) physicians, and hospital attendants. The Maslach Burnout Inventory was the most frequently used assessment tool. Moderate to high burnout prevalence ranged from approximately 20% to over 55%, with particularly elevated levels reported among female physicians, ICU physicians, and early-career professionals. Domain-specific findings showed extremely high levels of emotional exhaustion (up to 95%) and depersonalization in some cohorts. Consistently identified risk factors were long working hours, excessive workload, frequent night shifts, poor work-life balance, inadequate remuneration, limited organizational support, and pandemic-related stressors. Burnout appears to be common among healthcare professionals in Bangladesh, particularly in high-risk subgroups, and is associated with occupational and organizational factors.

42. Prenatal exposure to PM2.5 specific constituents and child neurodevelopmental delay: The role of maternal metabolites and mediterranean diet.

期刊: Ecotoxicology and environmental safety 发表日期: 2026-Jun-15 链接: PubMed

摘要

Prenatal exposure to fine particulate matter (PM2.5) constituents has been associated with impaired neurodevelopment, yet constituent-specific perturbations in maternal metabolism during pregnancy and their associations with child neurodevelopmental outcomes remain unclear. Among 6661 mother-child pairs in the Maternal and Infant Health Cohort in Hefei (MIH‑Hefei), we estimated associations between prenatal exposure to major PM2.5 constituents and clinically diagnosed neurodevelopmental delay (NDD) using generalized linear regression and multi‑pollutant mixture models. Maternal metabolomic profiles were analyzed to identify pathways associated with each constituent and with NDD, and a meet‑in‑the‑middle (MITM) framework was used to detect overlapping pathways linking exposure and outcome. Effect modification by maternal Mediterranean diet (Med) adherence was tested via interaction terms. The results indicated that higher prenatal exposure to several PM2.5 constituents was associated with increased NDD risk (ORs (95% CIs) for Q4 vs Q1 were: sulfate (SO₄²⁻), nitrate (NO₃⁻), ammonium (NH₄⁺), organic matter (OM), and black carbon (BC): 1.376 [1.026, 1.844], 1.650[1.204, 2.261], 1.431[1.064,1.923], 1.583 [1.166, 2.148], 1.772 [1.314, 2.389]), and mixture models showed consistent positive associations. Metabolomics and MITM have revealed potential links between the constituent-pathway-outcome axis. Among PM2.5 constituents, OM and SO₄²⁻ showed the strongest associations with perturbations in four convergent pathways (including glycine, serine, and threonine metabolism and nutrient/energy metabolism pathways). Greater Med adherence modestly attenuated these adverse associations. Overall, specific PM2.5 constituents may increase NDD risk partly through maternal metabolic dysregulation and Mediterranean‑style dietary patterns during pregnancy may offer limited mitigation.

43. The integrating eco-health risk assessment and driving factors for risks of heavy metals in soils from an open-pit lead-zinc mine area.

期刊: Ecotoxicology and environmental safety 发表日期: 2026-Jun-15 链接: PubMed

摘要

Soil heavy metals (HMs) pollution from mining activities poses a significant threat to environmental health and has attracted widespread attention. This study integrated eco-health risk assessment and identified driving factors for risks of HMs in soils at an open-pit lead-zinc mining area. Results indicated that Pb, As and Cu were the major contaminants, with 46.43%, 32.14% and 25.00% of soil samples exhibited moderate to severe pollution levels. Distinct from the pollution level, Cd total contents and effective available contents showed the highest ecological risk, with an average Er value of 180.06 (heavily polluted) and mean RAC value of 82.01(extreme pollution), respectively. Through the probabilistic health risk assessment, As was identified as the key pollutant posing health risks, contributing 98.6% and 97.8% of the Carcinogenic risks and 68.5% and 76.7% of the Non-carcinogenic risks for adults and children, respectively. Cd and As were identified as the primary pollutants posing potential ecological and human health risks. Redundancy and permutation feature importance analysis further demonstrated that electrical conductivity (EC) was a key predictor strongly associated with the ecological risk and health risk. This study distinguished the target priority pollutant between the ecological and health risks and identified the driving factors for risks, providing valuable insights into the pollution control and targeted soil management in mining areas.

44. Digital nudge emails to increase early registration for an occupational health support program: a stratified randomized controlled trial.

期刊: Journal of occupational and environmental medicine 发表日期: 2026-Jun-15 链接: PubMed

摘要

To evaluate whether nudge emails increased early registration for an occupational health support program among employees advised to act after annual health checkups. In this stratified randomized controlled trial, 871 employees with no documented action after health checkup recommendations were randomized to nudge or standard emails. The primary outcome was registration by July 12, 2022, before a universal desktop reminder; the secondary outcome was registration by July 20, 2022. Adjusted odds ratios were estimated using logistic regression. Among 749 analyzed employees, registration in the unexamined/incomplete-action group was higher with nudge emails than with standard emails (64.7% vs 50.9%; adjusted odds ratio, 1.81; 95% CI, 1.32-2.47). No significant difference was observed among non-responders. Nudge emails accelerated early registration, particularly among employees who had not yet acted.

45. Beyond mental health services Integrating suicide prevention within India's Health System.

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

摘要

46. Spinal afferent endings in the gastrointestinal tract.

期刊: Autonomic neuroscience : basic & clinical 发表日期: 2026-Jun-11 链接: PubMed

摘要

Communication between the gastrointestinal tract and the central nervous system, known as the gut-brain axis, is fundamental to physiology and is implicated in a range of pathological conditions. A critical component of this axis is the sensory information conveyed from the gut to the brain through spinal afferent pathways. Understanding the location and types of spinal afferents present in the GI tract and their mechanisms of activation is essential to advance our knowledge of gut-brain communication in health and disease. Though generally trailing knowledge of gut vagal afferents, major advances have been made in understanding spinal sensory pathways through recent critical adaptations of neuroanatomical tracing, neurogenetics and molecular profiling techniques, revealing an unforeseen diversity in the morphology of their endings in the gut wall and novel classifications based on molecular identity. Moreover, spinal afferents have been implicated in multiple physiological functions besides their well-known role in nociception, including potential roles in nutrient sensing and regulating gut motility. Among spinal afferent endings in the gut mucosal layer, much has been learnt about how enterochromaffin (EC) cells communicate with spinal (and vagal) afferents. Evidence now suggests that EC cells release substances (like serotonin), which activate the terminals of spinal (and vagal) afferent endings via a paracrine, not synaptic, transmission. Here, we review the latest findings regarding spinal afferent endings and point to outstanding questions and future directions for research into this complex and clinically relevant area of neuroscience.

47. Tobacco industry interference with the point-of-sale advertising, promotion, and sponsorship ban near educational facilities in Armenia.

期刊: European journal of public health 发表日期: 2026-Jun-10 链接: PubMed

摘要

Following the introduction of comprehensive bans on tobacco advertising, promotion, and sponsorship (TAPS), little is known about how the tobacco industry (TI) adapts its marketing strategies in low- and middle-income countries at point of sale (POS). This study examined post-ban TI marketing practices in Armenia after the 2022 comprehensive TAPS and display ban, focusing on youth exposure. We conducted a qualitative study using structured observations at 132 POS near educational facilities in Yerevan (capital city) and the Kotayk region, in-depth interviews with store owners/workers (n = 8), and focus group discussions with youth aged 15-20 (n = 28). Thematic analysis was applied with triangulation across data sources. Despite the ban, tobacco products remained widely available and visible near educational facilities. Cigarettes, e-cigarettes, and heated tobacco products were prominently displayed using power walls, illuminated fixtures, and placement near youth-appealing items. Advertising persisted through covert, legally ambiguous tactics such as illuminated displays, integrated signage, colour schemes, flavours, and loyalty-based promotions, coupled with misleading messages, often not recognized as advertising by youth or retailers. Retailer incentive schemes, such as financial rewards, gifts, and staff engagement, were used to secure product prominence and drive sales. Youth access restrictions were weakly enforced, with poor visibility of age-of-sale signage, inconsistent ID checks, and reports of informal access routes. Comprehensive TAPS and POS display bans alone are insufficient to eliminate youth exposure to tobacco marketing. Stronger enforcement, regulation of indirect and retailer-focused marketing, and sustained monitoring of POS environments are essential to protect youth from ongoing TI influence.

48. Screening tools for sleep disorders in patients with psychiatric disorders.

期刊: L’Encephale 发表日期: 2026-Jun 链接: PubMed

摘要

Sleep and mental health are closely interconnected. Alterations in sleep patterns are frequent among patients with psychiatric disorders and can exacerbate symptom severity or interfere with treatment outcomes. Despite this, systematic sleep assessment is not consistently integrated into psychiatric practice. This review presents a comprehensive overview of the main questionnaires available to assess sleep and its disturbances in psychiatric populations. We propose a minimal sleep semiology framework that includes non-specific sleep complaints (satisfaction, non-restorative sleep), sleep symptoms (insomnia, hypersomnolence), sleep-related distress/impairments, specific sleep disorders (sleep-related breathing disorders, sleep-related movement disorders, parasomnias), sleep needs (chronotype, flexibility) and behaviors (duration, timing, regularity, hypnotic use). Generic questionnaires, such as the Pittsburgh Sleep Quality Index (PSQI) and the RU-SATED scale, provide a global view of sleep health, while disorder-specific instruments allow precise evaluation of particular dimensions. This review allows for the selection of the most appropriate tool for specific applications in both clinical and research settings. Integrating these questionnaires with patient history and environmental context enables a holistic approach, improving both diagnosis and management. Ultimately, combining these subjective measures with objective assessments while considering environmental, social, and behavioral factors facilitates the promotion of sleep health, thereby enhancing psychiatric care and potentially benefiting population-level mental health.

49. Extended poly(A) tails are a shared feature of herpesvirus mRNAs.

期刊: PLoS pathogens 发表日期: 2026-Jun 链接: PubMed

摘要

Poly(A) tails are present on most cellular and viral mRNAs, providing a platform for poly(A)-binding proteins that stimulate translation and regulate the deadenylation and stability of transcripts in the cytoplasm. Here we leverage nanopore direct RNA sequencing to analyse the distribution of poly(A) tail lengths on cellular and viral mRNAs across Herpesviridae and other DNA and RNA virus infections. We find that herpesvirus mRNA poly(A) tails are consistently longer than those on cellular and other viral transcripts, presenting a previously unrecognized yet widespread mechanism to potentially advantage herpesviral gene expression. This contrasts with the templated poly(A) tails on coronavirus RNAs and those on cytoplasmically transcribed poxviral mRNAs, which are more similar in length to those on host mRNAs. Herpesviral noncoding RNAs display differential poly(A) tailing patterns while individual herpesviral mRNAs also show variation in the extent to which their poly(A) tail lengths change during the virus lifecycle, suggestive of additional uncharacterised layers of poly(A) tail length regulation. Importantly, while we detect non-adenosine nucleotides within herpesviral poly(A) tails, which are known to oppose deadenylase activity, this “mixed tailing” is not at sufficient frequency to explain the widespread extended tails of herpesvirus mRNAs.

50. Latent profile analysis of personality characteristics among US young adults in relation to cannabis use and intentions over time.

期刊: Addictive behaviors 发表日期: 2026-May-21 链接: PubMed

摘要

Young adults may use cannabis for distinct reasons, for example, related to their personalities or lifestyles. This study examined young adults’ personality profiles and associations with cannabis use-related outcomes. Using 3 waves of survey data (2023-2024) among 4,031 US young adults (Mage = 26.29, 59.8% female, 19.4% Hispanic, 14.0% Black, 14.1% Asian), latent profile analysis was conducted based on 5 personality characteristics (emotional stability, extraversion, openness, agreeableness, conscientiousness). Generalized estimating equations assessed class in relation to past-month use and use intentions and their changes over time. Models controlled for state non-medical cannabis legalization and sociodemographics. Three classes emerged: 1) the All-high-trait class (highest scores on all 5 personality characteristics; 21.1%); 2) the Moderate-extraversion/low-other-trait class (37.1%); and 3) the Low-extraversion/moderate-other-trait class (41.8%). At W1, past-month cannabis use was higher in the All-high-trait (52.2%) and Moderate-extraversion/low-other-trait classes vs. the Low-extraversion/moderate-other-trait class (43.3%). At W1, compared to the All-high-trait class, Low-extraversion/moderate-other-trait reported lower odds of use (aOR = 0.75, 95%CI = 0.63-0.90), and both Moderate-extraversion/low-other-trait and Low-extraversion/moderate-other-trait reported lower intentions (Moderate-extraversion/low-other-trait: B = -0.22, SE = 0.07; Low-extraversion/moderate-other-trait: B = -0.28, SE = 0.07). While odds of use and intentions generally decreased overall, class-by-time interactions indicated that: 1) odds of use decreased less from W1 to W2 in Low-extraversion/moderate-other-trait vs. Moderate-extraversion/low-other-trait (aOR = 1.23, 95%CI = 1.07-1.42); and 2) use intentions increased more from W1 to W2 in Moderate-extraversion/low-other-trait vs. All-high-trait (B = 0.18, SE = 0.09) and decreased less from W2 to W3 in Low-extraversion/moderate-other-trait vs. Moderate-extraversion/low-other-trait (B = 0.15, SE = 0.07). Intervention efforts should consider distinct personality profiles of young adults and potentially distinct mechanisms (e.g., social, emotional) underlying their cannabis use.

51. Exploring parkrun experiences of women aged 35 to 54 in Australia: a qualitative study.

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

摘要

To increase global activity levels, the World Health Organization’s Global Action Plan on Physical Activity includes the implementation of mass-participation, community events that provide an opportunity for individuals to be active in their local spaces. One such initiative is parkrun, with free, weekly 5-km run/walk events worldwide and around 500 events with roughly 50 000 participants every Saturday morning in Australia. While women make up half of parkrun participation in Australia, they face different barriers than men to physical activity and have lower activity levels globally. With the aim of informing how community-based physical activity initiatives like parkrun could increase women’s physical activity levels, 29 semistructured interviews were conducted with women aged between 35 and 54 years old who have participated in parkrun. Using reflexive thematic analysis, four themes were developed based on elements that are important to women in their parkrun experience: (1) parkrun can be whatever you want it to be, (2) the parkrun experience is consistent, (3) parkrun creates connections, and (4) parkrun allows growth and change. Based on these themes, and with the context of health promotion theories, some elements that should be considered when aiming to create initiatives to increase women’s activity levels through community events are to have an element of regularity and repetition; to allow for flexibility in attendance; and to create space for social engagement.

52. From association to causation: a decision-aware framework for reproducible biomarker discovery and precision intervention design in the human gut microbiome.

期刊: Briefings in bioinformatics 发表日期: 2026-May-04 链接: PubMed

摘要

Human gut microbiome research has generated many disease associations, yet few translate into clinical applications. A central obstacle is not a lack of data, but the limited integration of causal reasoning, as most studies report correlations without establishing directionality, confounding control, or mechanistic evidence. We propose a unified causal inference framework that integrates directed acyclic graphs, Mendelian randomization, double machine learning, mediation analysis, and tests of causal reversibility into a single decision-aware workflow. Unlike prior applications of these tools in isolation, our framework explicitly separates assumption mapping, causal identification, effect estimation, and mechanistic interpretation, introducing “assumption guardrails” that constrain interpretation at each stage and prevent overinterpretation of observational findings. Using a colorectal cancer case study with public metagenomic data, we demonstrate how the framework operates under real-world constraints, transforming observational associations into testable, mechanism-based hypotheses. The contribution is architectural in that it organizes existing tools into a disciplined, integrated pipeline that clarifies the strength of evidence at each stage. This operational blueprint provides a reproducible path from correlation to causation in microbiome research and toward precision interventions.

53. From the departing Editors in Chief.

期刊: International journal of epidemiology 发表日期: 2026-Apr-17 链接: PubMed

摘要

54. Participatory Rapid Appraisal and Focus Groups to co-design technology-supported integrated care.

期刊: PloS one 发表日期: 2026 链接: PubMed

摘要

Co-design methods, which create innovation tailored to the end-user needs and setting, are increasingly used to improve research uptake and impact. Peer review and methodologists have emphasised the need for early, meaningful, and continuous involvement of stakeholders, and the transparent and detailed reporting of co-design methods. The implementation of both complex interventions (such as an integrated care pathway), and technology, into healthcare is difficult and has high failure rates. Designing, implementing, and adapting interventions to ensure they work in the local context requires in-depth understanding of multiple end-users’ needs, processes, and contexts. Achieving this requires early, meaningful, and continuous engagement between multiple end-users. This study aimed to contribute to co-design research by reporting the: 1) process used to develop and test Participatory Rapid Appraisal and Focus Groups methods to co-design integrated care. 2) details of how the method was applied in the GERONTE project. 3) core steps involved in this co-design method (to facilitate use and/ or adaptation of the method). The study aimed to develop, test, and evaluate a co-design method that: I. enabled early, continuous, and meaningful engagement of multiple end-users in different locations and across different design iterations. II. enabled timely feedback and checking between the end-users and design team. III. optimised end-users participation by being flexible in the time, duration, and method of data collection and feedback. The Participatory Rapid Appraisal and Focus Group to co-design integrated care method was developed in four stages. The first stage involved defining the project’s co-design needs and reviewing the co-design literature to identify how to meet these. GERONTE aimed to co-design, evaluate, and prepare for EU-wide deployment, an integrated technology-supported care pathway for older adults with cancer and other morbidities. Focus Groups and Participatory Rapid Appraisal, in combination, were chosen as an empirically-based and practical approach. Focus Groups (FG) provided a participatory-based way to collect data in order to identify and agree multiple stakeholders’ needs and collective priorities. Participatory Rapid Appraisal (PRA) provided a timely way; to gain participant feedback on the data collected; and, to ensure accuracy in the data sent to the pathway and technology design teams. The second stage involved applying the method in the GERONTE Project (using meetings between the project team, technologists, and older adults to develop a co-design protocol for the project). The third stage involved the use, refinement, evaluation, and reporting of the co-design method. The fourth stage, evaluation of the method, is ongoing. This study resulted in the development of a structured approach to using Participatory Rapid Appraisal and Focus Groups in combination to co-design technology-supported integrated care. This method is proposed as an evidenced-based, practical, user-friendly way to co-design (or adapt an existing design) an integrated technology-supported care pathway. This co-design method involves three cycles of design. Each cycle involves multidisciplinary FG to collect semi-structured data followed by rapid analysis and feedback of the FG data to the participants to design or refine the intervention.