公共卫生研究摘要 (2026-06-18)

共收录 59 篇研究文章

1. Neurologic Diagnoses Before and After Traumatic Brain Injury: A Retrospective Cohort Study of Older Veterans.

期刊: Neurology 发表日期: 2026-Jul-28 链接: PubMed

摘要

Traumatic brain injury (TBI) during mid-to-late life is associated with increased risk of stroke, Parkinson disease (PD), epilepsy, and dementia. These conditions may also predispose to TBI. Thus, we investigated the incidence of dementia, stroke, epilepsy, and PD in older Veterans before and after acute TBI to determine whether there is a bidirectional association. In this retrospective cohort study, we identified Veterans aged ≥55 years who received care at US Veterans Health Affairs (VHA) facilities between October 1, 1999, and September 30, 2021, and who had acute TBI (concurrent International Classification of Diseases (ICD) code + emergency department visit + brain imaging) using VHA databases. We matched participants 3:1 to a non-TBI cohort based on age, sex, race/ethnicity, and visit date. Incident stroke, PD, epilepsy, and dementia were determined from ICD codes one year before and after TBI in the TBI cohort and over a two-year period in the non-TBI cohort. We excluded those with prevalent conditions at least 1 year before the study period. Incidence rate ratios (IRRs) and 95% CIs were calculated by comparing the pre-TBI period with the post-TBI period and with the non-TBI cohort. We included 13,801 Veterans with acute TBI and a balanced cohort of 41,403 Veterans without TBI (average age 77.8 years, 96.5% male). Veterans with TBI had higher incidence rates of the 4 conditions before TBI compared with the non-TBI cohort: incidence of stroke (IRR = 3.2 [95% CI 2.9-3.5]), dementia (IRR = 3.1, [95% CI 2.9-3.4]), and PD (IRR = 3.0 [95% CI 2.4-3.7]) was 3 times higher, and that of epilepsy was over 4 times higher (IRR = 4.4 [95% CI 3.6-5.4]). Results were slightly attenuated but remained significant after adjusting for comorbidities and health care utilization. Veterans with TBI also had higher incidence rates 1 year after TBI compared with the pre-TBI period. Incident stroke (IRR = 1.83 [95% CI 1.65-2.04]) and epilepsy (IRR = 2.29 [95% CI 1.88-2.78]) rates were twofold higher; dementia incidence was also higher (IRR = 1.24 [95% CI 1.12-1.38]), but PD rates did not differ (IRR = 1.06 [95% CI 0.82-1.36]). We found a bidirectional association between TBI and several neurologic conditions, with higher incidence rates preceding TBI and higher rates after TBI. Generalizability to non-Veteran populations is uncertain. Future studies may determine whether TBI prevention measures for adults with stroke, dementia, PD, and epilepsy are warranted.

2. Comprehensive management of a chronic patient in community pharmacy: impact of Comprehensive Medication Management on health outcomes and quality of life.

期刊: Farmaceuticos comunitarios 发表日期: 2026-Jul-15 链接: PubMed

摘要

A 56-year-old male with asthma, ischemic heart disease, and hyperuricemia attended the San Francisco Javier Pharmacy with knee and ankle swelling problem. Through the implementation of Comprehensive Medication Management (CMM), a patient-centered intervention was developed that included in-depth interviews, pharmacotherapy review, and collaboration with primary care. Eight drug-related problems (DRPs) were identified, six of which were resolved, highlighting the disappearance of joint symptoms that were highly limiting to daily life. Clinical and functional improvements were observed, along with a significant enhancement in health-related quality of life indicators assessed using the EQ-5D-5L questionnaire. The patient reported an increase in EQ-VAS from 10 to 90 and a gain in quality-adjusted life years (QALYs). This case highlights the effectiveness of CMM in optimizing therapeutic outcomes and improving quality of life in complex patients with polypharmacy. It also reinforces the value of community pharmacies as accessible health agents capable of delivering integrated, biopsychosocial care. Varón de 56 años, asmático, con cardiopatía isquémica e hiperuricemia, acude a la Farmacia San Francisco Javier por un problema de inflamación de rodillas y tobillos. A través de la prestación de la Gestión Integral de la Medicación (GIM) se desarrolló una intervención centrada en el paciente que incluyó entrevistas en profundidad, revisión farmacoterapéutica y coordinación con atención primaria. Se detectaron ocho problemas farmacoterapéuticos (PFTs), de los cuales seis fueron resueltos, destacando la desaparición de síntomas articulares altamente limitantes para la vida diaria. Los resultados mostraron una mejora clínica y funcional significativa, así como un incremento en los indicadores de calidad de vida evaluados mediante el cuestionario EQ-5D-5L, incluyendo un aumento de 80 puntos en la escala EQ-VAS y ganancia de años ajustados por calidad de vida (AVAC). Este caso pone de manifiesto el valor clínico, social y humano de la GIM en pacientes polimedicados, con enfermedades crónicas, así como el rol activo de la farmacia comunitaria en el abordaje integral del paciente.

3. Time-Dependent Association Between Breast Cancer and Risk of Ischemic Stroke: A Nationwide Cohort Study.

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

摘要

The association between breast cancer diagnosis and treatment and the risk of incident ischemic stroke remains unclear. We investigated ischemic stroke risk among breast cancer survivors and evaluated associations by age, follow-up duration, and type of cancer treatment. We conducted a nationwide, retrospective, matched cohort study using the Korean National Health Insurance Service database. Women aged 18 years and older with newly diagnosed breast cancer who underwent breast cancer surgery between January 2010 and December 2016 and had no prior stroke were identified. Each was matched 1:3 by birth year to cancer-free women. The primary outcome was first ischemic stroke, defined as hospitalization with International Classification of Disease, Tenth Revision codes I63/I64 plus inpatient brain CT or MRI. Subdistribution hazard ratios (sHRs) and 95% CIs were estimated using Fine-Gray models that accounted for death as a competing risk and adjusted for sociodemographic factors and cardiovascular and non-CV comorbidities. We analyzed 107,606 breast cancer surgery survivors (mean age, 50.0 years) and 322,818 matched cancer-free women. Over a mean 7.2-year follow-up, ischemic stroke occurred in 1,155 survivors (1.07%). Stroke risk was elevated shortly after breast cancer diagnosis (1-year sHR 1.59; 95% CI 1.34-1.89; 3-year sHR 1.17; 95% CI 1.05-1.30) compared with cancer-free women, with stronger associations at 3 and 6 months after diagnosis across all age groups. Over the long term, survivors had a slightly lower risk of stroke (sHR 0.94; 95% CI 0.88-1.00), and in a 1-year landmark analysis including only event-free individuals, the risk was lower (sHR 0.87, 95% CI 0.81-0.93). Among survivors, anthracycline use (sHR 1.25) and combined tamoxifen-aromatase inhibitor therapy (sHR 1.49) were associated with increased risk of stroke, whereas radiation therapy was associated with decreased risk (sHR 0.84). These associations attenuated and became nonsignificant beyond 1 year. Stroke risk was also higher among survivors with low income, hypertension, diabetes, or current smoking. The association between breast cancer and ischemic stroke risk is time dependent, with a short-term increase after diagnosis and treatment followed by a gradual decline over time. These findings highlight the need for proactive stroke risk management, including early CV assessment and ongoing monitoring for thromboembolic events during survivorship.

4. Semaglutide and Risk of Adult-Onset Seizure: A Target Trial Emulation.

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

摘要

Adult-onset seizure reflects the burden of acquired brain insults, but established disease-modifying preventive strategies are limited. We evaluated whether semaglutide initiation is associated with a lower incidence of adult-onset seizure compared with sodium-glucose cotransporter 2 inhibitors (SGLT2i) and other glucose-lowering drugs (GLDs) in adults with type 2 diabetes. Using the All of Us Research Program, we emulated a population-based target trial in new-user, active-comparator cohorts from January 2018 to October 2023. We compared semaglutide vs other GLDs and semaglutide vs SGLT2i. Incident epilepsy or seizure was identified from diagnostic codes. Effects were estimated using inverse probability of treatment weighting with weighted Cox models and targeted maximum likelihood estimation (TMLE). Subgroup and sensitivity analyses with multiple outcome definitions and analytic approaches were conducted to assess the robustness of findings. We evaluated mediation through hemoglobin A1c (HbA1c) and body mass index (BMI) using the longitudinal Vansteelandt framework. We analyzed 10,213 patients in the semaglutide (n = 2,586, mean age, 60.1 years; 56.8% female) vs other GLDs cohort (n = 7,627, mean age, 63.7 years; 54.2% female) and 8,605 patients in the semaglutide (n = 2,814, mean age, 60.5 years; 66.2% female) vs SGLT2i cohort (n = 5,791, mean age, 64.4 years; 47.3% female). Semaglutide was associated with a lower risk of adult-onset seizure compared with other GLDs (weighted HR 0.44 [95% CI 0.25-0.79]; 4-year risk difference -1.78% [95% CI -2.58 to -0.98]) and SGLT2i (weighted HR 0.48 [95% CI 0.27-0.85]; 4-year risk difference -1.46% [95% CI -2.41 to -0.51]). TMLE estimated risk differences per 1,000 persons of -14.20 (95% CI -18.33 to -10.07) vs other GLDs and -7.62 (95% CI -11.65 to -3.60) vs SGLT2i, corresponding to numbers needed to treat of 70 and 131, respectively. Mediation was minimal for HbA1c (2.4% vs other GLDs; 6.5% vs SGLT2i) and BMI (0% vs other GLDs; 0.7% vs SGLT2i). Semaglutide initiation was associated with a lower risk of adult-onset seizure compared with SGLT2i and other GLDs in patients with type 2 diabetes, independent of glycemic and weight effects. Residual confounding, low event counts, and shorter follow-up limit causal interpretation. This study provides Class II evidence that semaglutide use was associated with a lower risk of adult-onset seizures compared with other GLDs and SGLT2i.

5. PROSTACYCLIN ANALOGS AND DIABETIC RETINOPATHY OUTCOMES IN PATIENTS WITH PULMONARY HYPERTENSION : A Cohort Analysis.

期刊: Retina (Philadelphia, Pa.) 发表日期: 2026-Jul-01 链接: PubMed

摘要

The aim of this study was to evaluate the association between prostacyclin analog (PCA) therapy and the long-term incidence of diabetic retinopathy (DR) in patients with diabetes and pulmonary arterial hypertension. In this retrospective, real-world cohort study, the authors used 1:1 propensity score matching within the TriNetX Global Collaborative Network to compare patients receiving dual therapy including PCAs versus matched controls treated with endothelin receptor antagonists, phosphodiesterase-5 inhibitors, or soluble guanylate cyclase stimulators without PCAs. Patients with a prior DR diagnosis were excluded. The incidence of nonproliferative DR, proliferative DR, and diabetes with ophthalmic complications was assessed over a 5-year period using Cox proportional hazards models and Kaplan-Meier survival analyses. Among 2,584 matched patients in both cohorts, PCA therapy was associated with a significantly lower incidence of nonproliferative DR (24 vs. 42 events; hazard ratio [HR] = 0.59; 95% confidence interval [CI], 0.35-0.97; P = 0.0345) and diabetes with ophthalmic complications (65 vs. 99 events; HR = 0.67; 95% CI, 0.49-0.91; P = 0.0105). No statistically significant difference was observed in proliferative DR incidence (10 vs. 15 events; HR = 0.63; 95% CI, 0.27-1.43; P = 0.2617). PCA therapy may be associated with a reduced risk of developing DR, suggesting potential systemic microvascular protective effects. Further prospective studies are warranted to explore the therapeutic role of PCAs in diabetes-related retinal disease.

6. Digital Marketing Tactics, Non-Compliance With the International Code of Marketing of Breastmilk Substitutes and Legal Breaches of Code-Based Legislation by the Commercial Milk Formula Industry in Central America and the Caribbean.

期刊: Maternal & child nutrition 发表日期: 2026-Jul 链接: PubMed

摘要

Digital marketing has become the dominant channel for the promotion of commercial milk formula (CMF), accounting for most consumer exposure in many settings. This study characterized the digital CMF marketing landscape in Guatemala, Panama, and the Dominican Republic, identified prevalent promotional tactics, and assessed non-compliance with the International Code of Marketing of Breastmilk Substitutes (the Code) and breaches of national Code-based legislation. We applied the World Health Organization’s CLICK monitoring framework, including mapping the digital ecosystem and analyzing active marketing campaigns. From November 2023 to May 2024, we manually monitored CMF brand websites and official social media accounts to document promotional practices and assess Code non-compliance and legal breaches. A total of 355 digital advertisements were identified, with growing-up milks accounting for 98.3% of promoted products. On average, each advertisement employed 13 marketing tactics and contained 7.5 instances of Code non-compliance. Overall, 2 797 instances of Code non-compliance were documented, of which 1 480 constituted legal breaches in Guatemala, 2 189 in Panama, and 2 160 in the Dominican Republic. The most frequent breaches involved labeling requirements. Major regulatory gaps were identified, particularly regarding growing-up milks, cross-promotion strategies, and health and nutritional claims. These findings reveal a highly sophisticated and insufficiently regulated digital marketing environment for CMF in Central America and the Caribbean, underscoring the need to strengthen and update Code-based legislation to explicitly address digital environments.

7. Perceived Challenges and Solutions to Adopting Healthy Diets Among Women and Children: A Photovoice Study in Urban Ethiopia.

期刊: Maternal & child nutrition 发表日期: 2026-Jul 链接: PubMed

摘要

Ethiopia has one of the highest rates of undernutrition among children under five (U5) and women of reproductive age (WRA) globally, alongside rising overweight/obesity, particularly in urban areas. Poor diet is a shared driver of multiple forms of malnutrition. We used a participatory photography (Photovoice) approach to explore the lived experiences of WRA and their children U5 in adopting healthy diets across lower- and higher- socio-economic status (SES) groups in Addis Ababa. Women took photographs illustrating challenges to healthy diets, and five focus groups (n = 31 women) were conducted to discuss challenges and solutions, with separate sessions held for different SES groups. A hybrid thematic analysis, combining deductive and inductive approaches, identified themes/subthemes, with comparisons across SES groups. Financial and physical barriers to accessing healthy foods, time constraints and perceived poor food safety were major contributors to poor diets. In lower SES groups, women also reported limited knowledge about healthy diets, inadequate family support and poor home food environments. In higher SES groups, unhealthy food preferences coupled with easy access to and aggressive promotion of unhealthy foods were key challenges. Proposed government-level solutions included job creation, nutrition education, affordable healthy food, investment in household infrastructure, expanded childcare and restrictions on unhealthy food availability and promotion. Societal-level solutions included gender equality, strengthened community-based loan schemes and support for urban agriculture. These findings highlight that women recognise their needs and who should support them, and emphasise the importance of including women’s voices in decision-making processes. Findings also underscore the need for integrated interventions targeting individual, food environment and socio-economic drivers to improve diets among women and children in urban Ethiopia.

8. Myopic Paravascular Retinoschisis With Retinal Telangiectasia: Multimodal Imaging Insights.

期刊: Retina (Philadelphia, Pa.) 发表日期: 2026-Jul-01 链接: PubMed

摘要

9. Protecting US Children From Lead Exposures: Applications of a Data-Mapping Blueprint for Focusing High-Impact Interventions.

期刊: American journal of public health 发表日期: 2026-Jul 链接: PubMed

摘要

Objectives. To describe a data-mapping blueprint for identifying US locations at high risk for childhood lead exposure and to apply this approach to inform targeted public health interventions. Methods. We developed a stepwise, flexible blueprint integrating environmental and housing data, blood lead level data, and geospatial mapping to identify potential lead exposure hotspots, characterize contributing sources, and guide intervention prioritization. We applied the blueprint in multiple federal and state case studies through interagency collaboration. Results. Application of the blueprint identified high-risk locations for childhood lead exposure and informed targeted actions across diverse contexts. In data-rich settings, integration of blood lead level and environmental data enabled identification of exposure hotspots and prioritization of outreach, enforcement, and remediation. In data-limited settings, lead exposure indices and environmental indicators supported targeted surveillance and resource allocation. Across applications, the blueprint facilitated coordination among agencies, improved lead-based paint and infrastructure intervention targeting, and supported expansion of screening and prevention efforts. Conclusions. A coordinated, data-driven mapping approach can improve identification of lead exposure hotspots and support prioritization of impactful interventions. Public Health Implications. Broader implementation of the blueprint, along with enhanced data integration and interagency collaboration, may strengthen efforts to reduce childhood lead exposures and improve public health outcomes. (Am J Public Health. 2026;116(7):1030-1037. https://doi.org/10.2105/AJPH.2026.308440).

10. Minimal and Substantial Improvement Thresholds for Oxford Scores Following Primary Hip and Knee Replacement Based on Patient Satisfaction.

期刊: The Journal of bone and joint surgery. American volume 发表日期: 2026-Jun-22 链接: PubMed

摘要

The mandatory collection of patient-reported outcome measures and the implementation of thresholds for hip and knee replacement surgery represent a growing international trend in value-based health-care policy. Our aim was to investigate whether the Oxford Hip Score (OHS) and Oxford Knee Score (OKS) can be used to accurately predict patient satisfaction, and to estimate thresholds to guide value-based health-care policy. All primary total hip replacements (THRs) and total knee replacements (TKRs) for osteoarthritis undertaken at a tertiary academic institution over a 6-year period were identified. Logistic regression models were used to evaluate preoperative and postoperative values for the OHS and OKS, and the change between them, as predictors of patient satisfaction. Optimal thresholds for both the minimal clinically important difference (MCID) and the substantial clinical benefit (SCB) were identified. A total of 1,429 THRs (mean patient age, 66.1 years, standard deviation [SD], 11.1 years; 819 [57.3%] female) and 1,079 TKRs (mean patient age, 68.3 years, SD, 8.4 years; 635 [58.9%] female) were included. For the postoperative OHS, thresholds of 35.5 (95% confidence interval [CI], 29.1 to 41.9) for the MCID and 36.5 (95% CI, 33.0 to 40.0) for the SCB were identified. For the postoperative OKS, thresholds of 30.5 (95% CI, 24.2 to 36.8) for the MCID and 38.5 (95% CI, 36.7 to 40.3) for the SCB were identified. For the change in OHS, thresholds of 19.5 (95% CI, 13.4 to 25.6) for the MCID and 20.5 (95% CI, 16.0 to 25.0) for the SCB were identified. For the change in OKS, thresholds of 13.5 (95% CI, 8.3 to 18.7) for the MCID and 14.5 (95% CI, 11.7 to 17.3) for the SCB were identified. Patients with worse preoperative function had higher thresholds. Preoperative Oxford scores were poor predictors of patient satisfaction. The thresholds for the postoperative Oxford scores and change scores may guide value-based health-care decision-making using the OHS and OKS. Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

11. Spatial transcriptome mapping identifies Ppara-Anxa2 cross-talk in microplastic-induced hepatotoxicity.

期刊: Science advances 发表日期: 2026-Jun-19 链接: PubMed

摘要

Microplastics (MPs) are increasingly recognized as an urgent global health concern, with mounting evidence linking their bioaccumulation to chronic disease risks. The liver, as a central organ for metabolic homeostasis and detoxification, is particularly sensitive to sustained MP exposure. However, the mechanisms underlying hepatic responses to polyethylene (PE), the most prevalent yet relatively understudied plastic type, remain poorly defined. By performing combined bulk and spatial transcriptomic analyses, we observed that PE resulted in hepatic dysfunction in mice fed on standard or metabolic dysfunction-associated steatohepatitis (MASH)-inducing diets, driving both globally and spatially distinct transcriptional alterations, including a nuclear receptor (NR), Ppara. Spatial transcriptomics uncovered the cell type heterogeneity and gene expression patterns masked in bulk analyses. Spatial clustering uncovered inflammatory hotspots characterized by reduced cellular diversity and distinct PE-responsive gene signatures. Among these, NR signaling emerged as a key regulatory axis, with Ppara identified as a modulator. We further demonstrated that Ppara regulates Anxa2, a gene involved in damage response and tissue recovery, through enhancer and promoter binding. These findings offer insights into how PE disrupts hepatic homeostasis and underscores the value of spatial transcriptomics in elucidating environmental impacts on tissue organization and gene expression regulation. This study provides a molecular framework for understanding MP-associated disruption of liver pathophysiology and highlights potential targets for therapeutic intervention.

12. Cefazolin for Methicillin-Susceptible Staphylococcus aureus Bacteremia.

期刊: The New England journal of medicine 发表日期: 2026-Jun-18 链接: PubMed

摘要

Staphylococcus aureus bacteremia is associated with high mortality. Whether cefazolin or an antistaphylococcal penicillin should be preferred for the treatment of methicillin-susceptible S. aureus bacteremia is unclear. In an ongoing international Bayesian adaptive platform trial, we conducted an open-label, randomized comparison of cefazolin with an antistaphylococcal penicillin (flucloxacillin or cloxacillin) in adult patients with penicillin-resistant, methicillin-susceptible S. aureus bacteremia. The primary outcome, which was evaluated with a hierarchical Bayesian logistic-regression model, was death from any cause within 90 days after enrollment in the platform. We assessed the posterior probability of the noninferiority of cefazolin to flucloxacillin or cloxacillin (with the criterion for noninferiority prespecified as an adjusted odds ratio of <1.2, which approximates an absolute difference in mortality of <2.5 percentage points if mortality in the antistaphylococcal-penicillin group is 15%), as well as the posterior probability of superiority (with the criterion of an adjusted odds ratio of <1.0). Secondary safety outcomes included the development of acute kidney injury within 14 days. This domain of the ongoing trial was conducted between February 17, 2022, and August 7, 2024, by which time the criterion for noninferiority had been met. Mortality at 90 days among adults who could be evaluated was 15.0% (97 deaths among 645 patients) in the cefazolin group and 17.0% (109 deaths among 642 patients) in the antistaphylococcal-penicillin group (adjusted odds ratio, 0.81; 95% credible interval, 0.59 to 1.12; probability of noninferiority, 99.2%; probability of superiority, 89.8%). Acute kidney injury occurred in 92 of 660 patients (13.9%) in the cefazolin group, as compared with 127 of 648 (19.6%) in the antistaphylococcal-penicillin group (adjusted odds ratio, 0.67; 95% credible interval, 0.50 to 0.89; probability of superiority, 99.7%). In patients with methicillin-susceptible S. aureus bacteremia, cefazolin was noninferior to flucloxacillin or cloxacillin with respect to 90-day mortality and was associated with a lower incidence of acute kidney injury. (Funded by the National Health and Medical Research Council and others; SNAP ClinicalTrials.gov number, NCT05137119.).

13. Virtual Surgical Grand Rounds Allow Greater Multidisciplinary and Interprofessional Education and Collaboration.

期刊: Journal of surgical education 发表日期: 2026-Jun-17 链接: PubMed

摘要

Over the past few years, Surgical Grand Rounds across the country have been overwhelmingly transitioned from in-person to a virtual or hybrid format. This has been shown to have improved attendance, allowed for greater geographical diversity of speakers and learners, and led to less disruption of clinical duties. At our institution we have used the opportunity to embrace more multidisciplinary and interprofessional involvement by opening sessions to include all members of our surgical specialties, anesthesiology, and palliative care teams. This survey aimed to assess the utility of the virtual format to facilitating this collaboration. A survey was developed using interviews with surgical attending, nurses, and physician assistants (PAs) and validated using a pilot group of 5 surgical attending, nurses, and PAs to ensure clarity, relevance, and comprehensiveness. In total, it was distributed to 264 attendees, including surgical attending, residents/fellows, PAs, medical students, nurses, and administrative assistants. We received 123 responses (46.6%) which included multiple choice, a 5-point Likert scale as well as open ended responses. Overall, attendees rated virtual grand rounds as superior to in-person in terms of audience diversity (94.31%), convenience of attending (99.18%), diversity of speakers (93.5%), and opportunities for inter-professional education (78.86%). They rated in-person as superior in only audience engagement (74.80%) and networking and collegiality (88.64%). They rated either “agree” or “strongly agree” to the statements that presenters were from different health professions and specialties (97.56%), geographic locations (97.57%), different institutions (97.57%), and different genders and racial backgrounds (97.56%). They overwhelmingly agreed that the interprofessional format of the grand rounds facilitates connections that improve interprofessional collaboration in daily practice (94.3%). Virtual and hybrid formats for grand rounds can allow for increased diversity of speakers in terms of discipline, geographic location, institution, gender, and race. It can also allow for increased multidisciplinary and interprofessional inclusion, which can expand to greater collaboration outside of grand rounds. Further interventions are necessary to improve networking and collegiality in this virtual format.

14. Praxis-BGM: Clustering of Omics Data Using Semi-Supervised Transfer Learning for Gaussian Mixture Models via Natural-Gradient Variational Inference.

期刊: Bioinformatics (Oxford, England) 发表日期: 2026-Jun-17 链接: PubMed

摘要

High-dimensional omics data are typically measured on limited sample sizes, which challenges model-based clustering methods such as Gaussian mixture models (GMMs), often leading to instability and poor generalization under complex mixture structures. To address these limitations, we developed Praxis-BGM, a natural-gradient variational inference framework for GMMs. Praxis-BGM enables semi-supervised transfer learning by incorporating an informative prior GMM estimated from large-scale reference data with robust cluster structures. The prior model can encode cluster-specific means, covariance structures, and structural connectivity patterns, and is updated using the target data with variational inference to improve clustering in small-sample settings. Using the Variational Online Newton (VON) algorithm, we derived natural-gradient updates for the standard parameters of GMMs. Implemented in the Python library JAX for accelerator-oriented computation, Praxis-BGM is computationally efficient and scalable. Across extensive simulations and two real-world applications-breast cancer bulk transcriptomics for subtype recovery and single-cell transcriptomics for cross-platform cell-type label transfer-Praxis-BGM improves posterior clustering performance, stability, and biological interpretability, even when priors are partially mismatched. Praxis-BGM is freely available at https://github.com/ContiLab-usc/Praxis-BGM, and an archival version is available on Zenodo at https://doi.org/10.5281/zenodo.19657680. Supplementary data are available at Bioinformatics online.

15. The association between lifetime marital histories and later-life cognitive function: Evidence from the United States and China.

期刊: The journals of gerontology. Series B, Psychological sciences and social sciences 发表日期: 2026-Jun-17 链接: PubMed

摘要

We adopted a life course perspective to characterize lifetime marital history typologies and examined their associations with later-life cognitive function in two nationally representative cohorts of adults aged 65+ in the United States and China. We also explored whether the associations vary by gender. We used data from the Harmonized Cognitive Assessment Protocol from the Health and Retirement Study (HRS-HCAP) (n=3,318) and the China Health and Retirement Longitudinal Study (CHARLS-HCAP) (n=5,766). Cognition was measured by general cognitive function, executive function, memory, language, and orientation. Country-specific marital histories from age 18 to 65 were constructed using sequence and cluster analysis. Population-weighted linear regression models examined the associations of marital histories with general and domain-specific cognitive outcomes. Marital histories in the United States are more heterogeneous than in China. Relative to lifelong marriage with a normative age at onset (mid- to late-20s and 30s in both the United States and China), lifelong marriage with an onset in early 20s and premature widowhood by age 50 were associated with worse cognitive function in both countries. American older adults divorced and remarried, or divorced by age 40 without remarrying, did not perform worse across all cognitive outcomes, compared to the normatively married. Lifelong singlehood was associated with worse general cognitive function in China, but not in the United States. Our findings demonstrate that marital histories, including timing, sequence, and transition, have enduring implications for later-life cognitive health, with patterns shaped by cultural norms and the timing of marital transition.

16. Bifidobacterium lactis XLTG11 Reduces Eczema and Infections in Infants: A Randomized Trial.

期刊: QJM : monthly journal of the Association of Physicians 发表日期: 2026-Jun-17 链接: PubMed

摘要

Early-life gut microbiota profoundly influences immune system maturation and disease susceptibility. Perturbations in microbial development have been linked to rising rates of allergic and infectious diseases in children. Probiotic interventions offer a promising strategy to restore microbial-immune homeostasis; however, evidence from rigorously designed, strain-specific randomized trials integrating clinical and microbiome outcomes remains limited. To evaluate the efficacy of Bifidobacterium animalis subsp. lactis XLTG11 in reducing the incidence of eczema and respiratory infections during early childhood, and to explore its associations with gut microbial ecology and immune function. In this randomized, double-blind, placebo-controlled trial, 352 healthy infants and young children (aged <3 years) were randomly allocated to receive XLTG11 (1 × 1010 CFU/day) or placebo for 180 days. Primary outcome was eczema incidence; secondary outcomes included respiratory and gastrointestinal symptoms, growth parameters, gut microbiota composition (16S rRNA gene sequencing), and gut immune biomarkers. Children receiving XLTG11 showed significantly lower incidence of eczema (p = 0.017) and erythema (p = 0.028), and a lower incidence of physician-confirmed pneumonia (RR = 0.40, 95% CI 0.17-0.94; p = 0.030) compared with placebo. Probiotic supplementation improved stool consistency (p = 0.018) without affecting growth. 16S rRNA gene sequencing revealed enrichment of Faecalibacterium, Akkermansia, and other short-chain fatty acid-producing taxa, alongside suppression of Helicobacter and Citrobacter. Predictive functional profiling suggested enrichment of pathways related to energy metabolism, vitamin biosynthesis, and antimicrobial peptide (DEFB2, LL-37) production, alongside preservation of secretory IgA. Daily B. lactis XLTG11 supplementation safely reduces eczema and respiratory infection risk in early childhood by remodeling the gut microbiome and reinforcing mucosal immunity. These findings support its use as a preventive strategy for allergy and infection via gut-immune modulation. ClinicalTrials.gov (NCT07490587). Shanghai Sixth People’s Hospital Human Ethics Committee (No. 2023-142).

17. Distinct Humoral Response Development to Measles Virus across Vaccine Platforms.

期刊: The Journal of infectious diseases 发表日期: 2026-Jun-17 链接: PubMed

摘要

Different measles vaccine platforms protect against clinical disease, but characteristics of the resulting humoral responses remain incompletely defined. In this study, a phage-display immunoprecipitation sequencing technology, VirScan, was employed to evaluate measles viral epitope coverage by antibodies following wild-type (WT) measles virus (MeV) infection of rhesus macaques, or vaccination with a live-attenuated MeV vaccine (LAMV), the triple measles mumps rubella vaccine (MMR) or a novel recombinant MeV hemagglutinin protein-based vaccine (rMeVH). Vaccinated animals were also challenged with WT MeV to measure antibody epitope reactivity during a recall. The results demonstrate that WT MeV infection elicited a broader epitope reactivity profile than LAMV-containing vaccines. Also, rMeVH vaccination not only resulted in a narrow H-protein specific antibody profile, but epitopes recognized were distinct from LAMV-vaccinated or WT-challenged animals. All vaccine groups expanded the breadth of MeV-specific antibody repertoires following WT MeV challenge. In addition, MeV-specific VarScore, a measure of overall antigen-binding, was positively correlated with IgG titer assessed by ELISA, as well as antibody avidity, and neutralizing titers. The results demonstrate the distinct effects of vaccination platforms on the breadth and fine specificity of anti-measles induced humoral responses, and the utility of VirScan for comprehensively assessing antibody epitope targets.

18. Frailty in rheumatoid arthritis and the general population: A cross-sectional analysis of the Groningen Frailty Indicator and Fried criteria.

期刊: Rheumatology (Oxford, England) 发表日期: 2026-Jun-17 链接: PubMed

摘要

To compare frailty prevalence and factors driving frailty between older adults with rheumatoid arthritis (RA) and controls, using two conceptually distinct frailty instruments. Cross-sectional data from the STudying Ageing in Rheumatoid arthritis (STAR) study were used, including 207 patients with RA and 214 population controls aged 55-85 years. Frailty was assessed using the Groningen Frailty Indicator (GFI; 15 yes/no items; physical, cognitive, social, psychological domains; frail≥4/15) in all participants and the Fried criteria (5 yes/no items; physical domain; prefrail=1-2, frail≥3, and combined frail/prefrail≥1 deficit) in a clinically assessed subgroup (RA: n = 88, controls: n = 96). Prevalence and overlap between instruments were described by group. Uni- and multivariable logistic (GFI: frailty vs. robust) and Poisson (Fried: frail/prefrail vs. robust) regressions assessed effects of age, group, the agegroup interaction, and additional covariates. Frailty prevalence was higher in RA than controls for GFI-frailty (34% vs 18%) and Fried-frailty/prefrailty (72% vs 50%). Among GFI-frail persons, 88% of patients with RA compared to 69% of controls were also frail or prefrail by Fried. Age was not associated with frailty in uni- or multivariable analyses for either instrument, in RA or controls (p  interaction agegroup>0.10). The association with RA became insignificant after multivariable adjustment. Living alone, comorbidity score ≥1, higher fatigue, and anxiety were associated with GFI-frailty, and higher BMI and poorer physical function with Fried- frailty/prefrailty. Older adults with RA show higher (pre)frailty prevalence than controls, which is associated with disease-related consequences and vulnerability rather than age, questioning the added value of frailty assessment beyond routine clinical evaluation.

19. Cost-Effectiveness Analysis of Chatbot-Supported Remote Patient Monitoring for Anticoagulation Management: Health Economic Evaluation Within a Pilot Crossover Trial.

期刊: Journal of medical Internet research 发表日期: 2026-Jun-17 链接: PubMed

摘要

Digital health technologies (DHTs) are increasingly integrated into clinical practice, yet economic evaluations remain scarce, particularly in the early development stages. Within the NICE (National Institute for Health and Care Excellence) Evidence Standards Framework, Tier C DHTs comprise technologies with direct clinical implications and measurable health outcomes, for which robust economic evidence is essential. Early-stage assessments are particularly important to inform subsequent development, refinement, and adoption decisions across the digital health lifecycle. This study aims to explore the feasibility of integrating a full trial-based economic evaluation within an early-stage pilot comparing a chatbot-supported remote patient monitoring (RPM) solution for anticoagulation management with the standard of care (SOC). A cost-effectiveness analysis was performed alongside a pilot crossover trial among adult cardiac surgery patients receiving vitamin K antagonists. Participants were allocated to two 6-month sequences (SOC→RPM or RPM→SOC). The intervention consisted of a rule-based chatbot integrated with home-based international normalized ratio self-testing using portable coagulometers to support communication and therapy management. Effectiveness was measured as time in therapeutic range (TTR), and costs were estimated from the Portuguese National Health Service and a limited societal perspective over a 1-year horizon. The analysis 1 applied a within-patient cost-effectiveness approach to estimate incremental costs, incremental TTR, and incremental cost-effectiveness ratios. Uncertainty was explored through nonparametric bootstrapping (5000 replications) and deterministic sensitivity analyses. Complementary comparisons examined differences between sequences (analysis 2), between periods (analysis 3), and within each sequence (analysis 4). A total of 19 patients were included in the analyses. In analysis 1, RPM improved anticoagulation control, with a mean within-patient increase of 10.43 percentage points in time in TTR. The mean incremental costs were €198.61 (€1=US $1.08) from the Serviço Nacional de Saúde perspective and €270.05 from the limited societal perspective. The corresponding incremental cost-effectiveness ratios were €19.03 and €25.88 per additional percentage point of TTR gained. Sensitivity analyses produced consistent estimates across parameter variations. Complementary analyses (2-4) suggested that RPM tended to be more cost-effective when implemented after the initial 6-month postoperative period. This proof-of-concept study demonstrates that a full trial-based economic evaluation can feasibly be embedded within an early-stage Tier C DHT. The intervention showed improved anticoagulation control alongside higher costs, providing initial insights into its cost-effectiveness profile. Positioned within the digital health evidence continuum, such assessments can function as a learning stage within the lifecycle. To address the persistent adoption-evidence gap, tier- and stage-aligned frameworks are needed to guide the economic evaluation of DHTs. This study contributes to that goal by providing a set of recommendations specifically for Tier C DHTs.

20. From Concept to Protocol: Iterative Approach of a Target Trial Emulation on GnRH Analogue Safety in Transgender and Gender Diverse Youth.

期刊: European journal of endocrinology 发表日期: 2026-Jun-17 链接: PubMed

摘要

The scarcity of robust long-term safety data has contributed to increasing restrictions on the use of gonadotropin-releasing hormone analog (GnRHa) treatment in transgender and gender diverse adolescents (TGDAs) in several countries. Methodological limitations of earlier studies have led to controversy and debate, underscoring the urgent need for high-quality evidence in this field. To present a study design using target trial emulation (TTE) to evaluate long-term safety of GnRHa treatment in TGDAs using observational data from national healthcare registries, and highlight methodological challenges. We applied a stepwise TTE approach, to emulate a randomized trial using real-world data. The main methodological challenges were identified as the selection of the control group and the definition of time zero. To address these, we engaged independent experts in causal inference to review the concept design and provide feedback on potential solutions. Expert feedback was systematically summarized and discussed. The resulting study design will select late-presenting TGDA individuals as the control group and defines time zero as the initiation of GnRHa treatment for the intervention group, with the equivalent age assigned as time zero in controls. Sensitivity analyses using alternative control groups and time zero definitions will be included to assess robustness. This approach allows for adjustment of confounders and aims to emulate the conditions of a randomized trial as closely as possible within the constraints of observational data. This discussion paper serves as a methodological example of target trial emulation with observational data to study long-term safety of GnRHa in TGDA. By transparently addressing methodological challenges and incorporating expert input, this approach offers a feasible and ethically sound alternative to RCTs, and contributes to the evidence base needed for informed clinical and policy decisions in transgender healthcare.

21. Radiological-pathological correlation of tumour size and depth of invasion of oral squamous cell carcinoma using Dual-Energy CT in comparison to MRI and the impact on T-stage.

期刊: Dento maxillo facial radiology 发表日期: 2026-Jun-17 链接: PubMed

摘要

This study aimed to evaluate Dual-energy CT (DECT) reconstructions for tumour size determination including depth of invasion of primary oral squamous cell carcinoma (OSCC) compared to MRI. Retrospectively forty-six consecutive patients with primary OSCC who underwent contrast-enhanced DECT and MRI were included. Tumour size, including maximum diameter (MD), tumour thickness (TT), and depth of invasion (DOI), was assessed using DECT weighted average (WA) images, virtual monoenergetic imaging at 40 keV (VMI), iodine overlay maps (IOM), and MRI, and compared to pathology as the reference standard. DECT DOI showed stronger correlations with pathological DOI (pDOI) than TT or MD (.85 to .88 for DOI compared to .69 to .78 for TT and MD, p<.001 for all). ICC between DECT DOI and pDOI was highest for DECT VMI (.79). MRI measurements resulted in the highest overestimation of TT, MD and DOI. Bland-Altman plots showed acceptable mean differences. T-stage based on rDOI instead of tumour size increased agreement for all imaging. A DECT and MRI cut-off score of 5 mm could accurately discriminate pDOI >5mm achieving a sensitivity of 100%. While DECT DOI showed stronger correlations and agreement with pDOI than MRI, both DECT and MRI showed high discriminative ability for pDOI > 5 mm. This study provides new insights into the capability of DECT for radiologically assessing the depth of invasion in OSCC offering a reliable alternative to MRI and potentially improving preoperative tumour diagnosis.

22. Early vs Late Initiation of Extracorporeal Membrane Oxygenation: Protocol for a Prospective, Randomized, Multicenter Study.

期刊: JMIR research protocols 发表日期: 2026-Jun-17 链接: PubMed

摘要

Acute respiratory distress syndrome (ARDS) is characterized by severe inflammatory lung injury leading to life-threatening hypoxemia. Standard treatment includes lung-protective mechanical ventilation and adjunctive measures, while veno-venous extracorporeal membrane oxygenation (vvECMO) is used as a rescue therapy in refractory cases. However, the optimal timing for initiation of vvECMO remains uncertain, with official recommendations identifying it as a rescue therapy, while emerging evidence suggests that earlier implementation of vvECMO during the disease course might provide benefits. The ELIEO (Early vs Late Initiation of vvECMO) trial aims to determine whether early initiation of vvECMO improves survival and clinical outcomes compared with a conventional strategy in patients with severe ARDS. ELIEO is a prospective, randomized, multicenter clinical trial enrolling 508 adult patients with severe ARDS. Participants will be randomized to one of two groups: (1) early vvECMO initiation within 24 hours after admission to the intensive care unit of an extracorporeal membrane oxygenation center or (2) conventional management according to ARDS Network guidelines, with vvECMO used only as rescue therapy. All-cause mortality at day 90 will serve as the primary outcome and will be analyzed using a 2-sided log-rank test within an O’Brien-Fleming group-sequential design. Secondary end points include Sequential Organ Failure Assessment scores, functional status at days 28 and 90, bleeding events, and intensive care unit-related complications, which will be analyzed using appropriate regression and nonparametric methods, with adjusted Cox models for sensitivity analyses. Patient recruitment started on March 1, 2025, and is ongoing; study completion is expected in August 2028. An interim analysis is planned after the 94th patient has been enrolled. The trial is designed to evaluate whether early initiation of vvECMO reduces 90-day mortality and improves organ function and functional recovery compared with a conventional rescue strategy. Results will be reported after completion of enrollment and follow-up. As of May 2026, a total of 9 patients have been recruited. The ELIEO trial will provide robust evidence regarding the optimal timing of vvECMO initiation in patients with severe ARDS. The findings may influence clinical decision-making, resource allocation, and organizational strategies for the management of ARDS in specialized intensive care settings. ClinicalTrials.gov NCT04208126; https://clinicaltrials.gov/study/NCT04208126. DERR1-10.2196/86652.

23. Measuring the Quality of Datasets: Development of the IDEFIM Indicator Set for Empirical Health Research.

期刊: Journal of medical Internet research 发表日期: 2026-Jun-17 链接: PubMed

摘要

To be beneficial for empirical health research, a dataset must be fit for use. The quality of a dataset can only be influenced during data collection, yet it is evaluated multiple times during analysis or secondary use by applying quality indicators. This study aimed to establish an up-to-date set of indicators measuring the quality of datasets in empirical health research. A total of 3 pillars were combined. First, the 51 indicators of a German guideline from 2014 about the management of data quality were revised. Second, a literature review was performed looking for evidence sources since 2013 that describe, propose, or apply dataset quality indicators. Third, indicators were supplemented by a manual search and other sources. The quality indicators were then integrated into the IDEFIM framework. The IDEFIM framework distinguishes between the categories’ data, metadata, context, and openness quality. In this work, only the categories data and metadata quality, with their 14 dimensions were considered. In total, 69 indicators qualified for the IDEFIM indicator set, 53 related to the category data quality, and 16 to the category metadata quality. A total of 30 indicators originated from the German guideline, 31 from the literature review. Three indicators were added to cover aspects of diversity, equity, and inclusion, and an additional 5 related to specifics of data and metadata quality not addressed so far. Most indicators were found in the dimensions accuracy (data) with 12 measures, completeness (data) with 12 measures, and consistency (data) with 19 measures. According to the number of supporting evidence sources, missing values in data elements (48 evidence sources), contradictions (31), and currentness (26) were the most popular quality indicators. Metadata quality was significantly less frequently addressed. The presented IDEFIM indicator set can be used for the management of data collections as well as for the verification of a dataset’s quality for an intended use. The indicator set should also be considered in the design of a study in empirical health research and the development of software tools supporting the visualization of issues related to the quality of a dataset.

24. Examining the Association Between Internet Addiction and Nonsuicidal Self-Injury Among Chinese Middle School Students: Prospective Cohort Study.

期刊: Journal of medical Internet research 发表日期: 2026-Jun-17 链接: PubMed

摘要

While cross-sectional studies have consistently reported an association between nonsuicidal self-injury (NSSI) and internet addiction (IA), longitudinal evidence regarding the directionality and dose-response relationship remains limited. Furthermore, the roles of sex and varying degrees of problematic internet use in predicting new-onset NSSI are not fully understood. This prospective cohort study aimed to investigate whether baseline IA and its intermediate states predict the subsequent new onset of NSSI among Chinese adolescents over a 6-month period and to explore potential sex differences in this longitudinal association. A prospective cohort design was used. A total of 1315 junior high school students without a history of NSSI were recruited at baseline, and 704 (53.5%) students completed the 6-month follow-up. IA and NSSI were assessed using the Chinese Internet Addiction Scale-Revised and a self-report questionnaire from the Adolescent Health-Related Risky Behavior Inventory, respectively. Logistic regression analysis was conducted to examine the predictive value of IA exposure for incident NSSI, adjusting for key covariates, including sex, age, ethnicity, only child status, anxiety, and depression. Restricted cubic spline regression was used to model the dose-response relationship between distinct states of IA and NSSI risk. The baseline prevalence of IA was 9.09% (64/704). At the 6-month follow-up, the incidence rate of NSSI was 9.8% (69/704). Restricted cubic spline regression revealed a linear dose-response relationship, where the risk of incident NSSI escalated with increasing IA severity. In the fully adjusted model for the total sample, baseline IA was a significant predictor of subsequent NSSI (odds ratio [OR] 2.185, 95% CI 1.031-4.627; P=.04). Crucially, stratified analyses revealed significant sex disparities: the longitudinal association between IA and subsequent NSSI was statistically significant among female adolescents (OR 3.271, 95% CI 1.101-9.717; P=.03) and the intermediate internet-dependent state (OR 2.593, 95% CI 1.002-6.710; P=.049) but not among male adolescents (IA: P=.44; internet-dependent state: P=.87). NSSI incidence is notably prevalent among Chinese junior high school students. While IA serves as a robust, independent risk factor for predicting the new onset of NSSI in the overall adolescent population, sex-stratified analyses revealed that this longitudinal association was statistically significant (P=.03) only among female students. These findings underscore the critical need to integrate IA assessments into school-based mental health screenings and highlight the necessity of developing sex-specific, emotion-focused prevention strategies to mitigate NSSI risk.

25. Prevalence of Work-Related Pain or Discomfort Among Urologists in the State of Florida: Results From the Florida Urologic Society Task Force on Ergonomic Challenges Experienced by Its Members.

期刊: JMIR human factors 发表日期: 2026-Jun-17 链接: PubMed

摘要

Pain and work-related musculoskeletal disorders are commonly seen in surgeons, significantly impacting quality of life and burnout. A questionnaire-based study was conducted to further investigate the nature and etiology of work-related pain among urologists in the state of Florida. This study aimed to quantify the number of urologists who reported work-related musculoskeletal disorders >25% of the time. The Florida Urologic Society Task Force developed a survey based on the Nordic Musculoskeletal Questionnaire, with additional input from Cornell’s ergonomic studies. The Mayo Clinic Survey Research Center conducted the survey and distributed it to 504 members of the Florida Urologic Society in 2023. The total response rate was 18.6% (94/504). The primary outcome (number of urologists who reported pain >25% of the time) was 45.3% (34/75). In total, 32.4% (22/68) of the respondents reported pain associated with endoscopic surgery >25% of the time, 40.0% (14/35) reported pain for major open cases, 20.6% (13/63) reported pain for minor open cases, and 22.7% (5/22) reported pain for robotic cases. In total, 68.8% (53/77) of the respondents attributed their work-related pain to uncomfortable operating positions, and 29.9% (23/77) chose to ignore their pain. In this contemporaneous population of Florida urologic surgeons, almost half of the respondents describe having work-related pain >25% of the time. The data show that major open surgery had the highest rate of pain, followed closely by endoscopic surgery. Over 70% of the urologists in Florida are interested in official ergonomics training, which, if developed, may lead to increased productivity and better emotional, personal, and interpersonal well-being.

26. The Feasibility of an App-Based Worksite Health Promotion Program to Improve Mental Well-Being and Work-Related Vitality in University Hospital Workers: Process and Preliminary Effect Evaluation Study.

期刊: JMIR formative research 发表日期: 2026-Jun-17 链接: PubMed

摘要

University hospital employees face role-specific stressors that can impair mental well-being and work-related vitality. While worksite health promotion programs show potential for improving mental well-being by targeting lifestyle behaviors, most target single professions or hospital subunits, and evidence for mental well-being and work-related vitality remains mixed. Mobile apps offer unique advantages for delivering such worksite health promotion programs hospital-wide. However, accessible interventions tailored to a diverse workforce are lacking. This study aimed to investigate the feasibility of an app-based worksite health promotion program (the Recharge360 program [The Recharge Company]) targeting multiple lifestyle behaviors, including a team-based competition element, for improving mental well-being and work-related vitality of hospital employees over a 5-month follow-up period by evaluating two objectives: (1) the implementation process of the program, and (2) the preliminary effects of the program on mental well-being and work-related vitality. We included 532 employees (mean age 43, SD 12 y; n=482, 91% women; n=480, 90% highly educated) from a university hospital in Amsterdam, the Netherlands. The study had a single-arm, longitudinal pretest-posttest design lasting 5 months, during which employees participated in the 5-day Recharge360 program (Recharge week) 3 times-in weeks 1, 9, and 17. At baseline (T0) and after each Recharge week (T1-T3), we assessed mental well-being, work ability, need for recovery, and task performance. The process was evaluated by assessing recruitment, attrition, and survey completion rates, and the degree of participation. Preliminary effects were evaluated by linear mixed model regression analyses to assess changes in mental well-being and work-related vitality between baseline and follow-up. Recruitment appeared feasible, but attrition rates were high (up to 70% in the final Recharge week), and the degree of participation decreased over time. We showed statistically significant, albeit small, increases in well-being at T3 (unstandardized β coefficient=2.08, 95% CI 0.33-3.84), with progressively larger improvements in the analyses among those who started at least 1, 2, and all 3 Recharge weeks (unstandardized β coefficient=3.27, 95% CI 1.09-5.45). Results for work-related vitality were mixed. The need for recovery remained unchanged, task performance increased slightly at T3 (unstandardized β coefficient=0.16, 95% CI 0.07-0.24). Work ability showed a small, but statistically significant, decline across follow-up (unstandardized β coefficient=-0.46, 95% CI -0.64 to -0.29). This app-based worksite health promotion program might be feasible to implement in a university hospital setting and shows potential to slightly improve mental well-being, but primarily for a selective group of highly educated, health-conscious women. While these findings support further investigation in a randomized controlled trial in similar university hospital settings, they also highlight the need for more participatory study designs to improve the tailoring of program components and engagement of underrepresented groups, as well as for a supportive culture and population-based approaches at the organizational level.

27. Robust prioritization of genomic features with stability selection.

期刊: Bioinformatics (Oxford, England) 发表日期: 2026-Jun-17 链接: PubMed

摘要

The heterogeneity of complex diseases including cancer leads to heavy-tailed distributions in the disease traits. In such settings, non-robust variable selection methods are inherently susceptible to data contamination and can yield unstable or misleading results. This vulnerability becomes more severe for recently proposed approaches that introduce pseudo-features as negative controls, as these methods further amplify the curse of dimensionality by expanding the genotype matrix in the presence of outliers and high-dimensional genomic features. We develop a robust variable selection framework with stability selection to prioritize genomic features in the presence of contamination. In contrast to existing approaches that rely on pseudo-features for error control, the proposed method achieves double robustness. First, it adopts least absolute deviation (LAD) LASSO to ensure robustness against outliers and heavy-tailed errors in disease traits. Second, it avoids augmenting the genotype matrix with pseudo-features, thereby mitigating the curse of dimensionality that is particularly problematic in high-dimensional genomic data. The proposed method has been extensively evaluated in simulation studies to demonstrate its effectiveness over multiple competing methods for variable selection. In addition, we have applied the proposed method and competing approaches to two real-data case studies: the The Cancer Genome Atlas (TCGA) Skin Cutaneous Melanoma (SKCM) dataset and an eQTL dataset. The results demonstrate that the proposed method achieves superior performance by identifying genomic features with higher reproducibility. The source code for implementing the proposed methods is publicly available at https://github.com/cenwu/RSS with an archival DOI https://doi.org/10.6084/m9.figshare.32306883.

28. The Warmth of Medicine: The Irreplaceability of Doctors in the Era of Artificial Intelligence.

期刊: Journal of medical Internet research 发表日期: 2026-Jun-17 链接: PubMed

摘要

This article argues that despite the remarkable advances of artificial intelligence (AI) in medicine -including demonstrated capabilities in image recognition, diagnosis, treatment planning, and even empathic communication in controlled settings-the core of medical practice remains irreducibly human. We identify three domains in which AI cannot replace doctors: the holistic, sensory art of clinical observation and intuition; the longitudinal, trust-based doctor-patient relationship built on genuine emotional connection; and the capacity to embrace clinical uncertainty, exercise moral responsibility, and make courageous decisions in the absence of algorithmic guidance. The intended audience includes clinical doctors, medical students, medical educators, and health policy makers navigating the integration of AI into practice. We conclude that preserving “AI-free clinical time” in medical training and safeguarding the humanistic dimensions of care are essential, and technology is to complement rather than diminish the healing arts.

29. The System Under Pressure: Burnout in the Public Health Workforce.

期刊: American journal of public health 发表日期: 2026-Jun-17 链接: PubMed

摘要

Objectives. To characterize burnout among state and local governmental public health workers and identify implications for public health workforce capacity and sustainability. Methods. We analyzed 2024 Public Health Workforce Interests and Needs Survey (PH WINS) data to assess self-reported burnout and generational differences among US state and local employees. Results. At least 1 symptom of burnout was reported by 71% of respondents. However, burnout was most prominent among Generation Z and Millennials, with 17% and 19% reporting persistent symptoms and 4% and 5% reporting complete burnout, respectively; 10% of Baby Boomers reported persistent symptoms and 1% reported complete burnout. A Rao-Scott adjusted χ2 test showed that the association between burnout and generation was significant, F (7.6, 6674.4) = 89.7, P < .001. Conclusions. High rates of burnout across the PH WINS respondents indicate a systemwide issue. However, higher burnout rates among younger workers highlight the need for targeted interventions and institutionalized changes to support the workforce going forward. Public Health Implications. Systemwide, sustained worker well-being improvements are essential to maintaining a thriving public health workforce, especially as younger generations continue to move into the workforce. (Am J Public Health. Published online ahead of print June 18, 2026:e1-e4. https://doi.org/10.2105/AJPH.2026.308562).

30. Patient Perspectives on and Willingness to Pay for Navigation Services Billed Under Centers for Medicare & Medicaid Services Principal Illness Navigation Codes.

期刊: JCO oncology practice 发表日期: 2026-Jun-17 链接: PubMed

摘要

In 2024, the Centers for Medicare & Medicaid Services (CMS) introduced Principal Illness Navigation (PIN) codes to provide provider reimbursement for patient navigation. However, a potential unintended consequence of these PIN codes is patient cost sharing. This study sought to understand patient perspectives on and willingness to pay for navigation services among patients with cancer. This convergent, mixed-methods analysis used cross-sectional survey data from patients with cancer previously served by Patient Advocate Foundation (PAF; collected January 2025) and interview data from navigated patients with cancer at University of Alabama at Birmingham (collected January-July 2025). Surveys elicited respondent experiences with and willingness to pay for navigation services. Interviews explored patient experiences with navigation, including perceptions of funding and expenses. Surveys were analyzed descriptively, interviews were analyzed using a framework method, and quantitative and qualitative results were analyzed convergently. Of 565 survey respondents, 88% were aged ≥56 years, 33% were non-White, and 58% had annual household incomes of <$35,000 in US dollars (USD). Half of respondents (53%, n = 299) were interested in receiving navigation services, including 70% with prior navigation and 48% with no prior navigation. Respondents were most interested in receiving financial navigation (50% ranked as most interested), followed by nurse navigation (29%). Only 5% (n = 31) were willing to pay for navigation services, with a median out-of-pocket cost of $28 USD per month (IQR, $20-$45 USD). Factors influencing willingness to pay included affordability (cited by 30% of respondents), insurance coverage (12%), and perceived benefit/value of navigation (12%). Of 20 interviewed patients (mean age 60 years [IQR, 48-69], 40% non-White, 60% employed), navigation was emphasized as important for addressing health system complexities, decreasing distress or anxiety, and as part of the whole “package” of receiving cancer care, saying, “the mental health aspect of it is as important as the physical.” However, interviewees did not believe patients should be required to pay out of pocket for navigation services, stating, “you don’t want to limit people [if] they can’t pay.” Of the few patients who were willing to pay for navigation, cited amounts for a preferred “one-time fee/copay” were between $5 and $20 USD. Though new PIN codes may allow for sustainable provider reimbursement for navigation, patient cost sharing may affect usage and equity. Inclusion of patient perspectives during development and implementation of value-based payment reform efforts, as well as policy-level changes such as zero-dollar cost sharing, should be considered for successful uptake, equity, and sustainability.

31. Tailoring the message: Communication strategies to promote safer driving behaviors among cannabis users.

期刊: Traffic injury prevention 发表日期: 2026-Jun-17 链接: PubMed

摘要

Cannabis-impaired driving is an increasing public health concern. Effective communication strategies are essential for shaping risk perceptions, influencing normative beliefs, and encouraging safer behaviors. UC San Diego Transportation Research and Education for Driving Safety Center evaluated how cannabis consumers perceive and respond to cannabis-impaired driving messages, message sources, and strategies to promote safer driving behaviors. Eligible participants were adults who reported cannabis use within the past three months, perceived it as safe to drive on the same day of use, and resided in one of eight U.S. states selected for diversity in cannabis policy contexts. The study aimed to recruit 800 participants. Using a cross-sectional, mixed-methods design, participants reported cannabis use patterns and driving behaviors before reviewing a series of cannabis-impaired driving messages. Messages were developed through an iterative process informed by literature, expert review, and formative testing, and represented communication styles commonly used in safety campaigns. Participants rated each message on attention, appeal, relevance, believability, influence on behavioral intentions, and source credibility. 846 cannabis users participated. Messages emphasizing concrete effects and impairment (e.g., Feel Different, Drive Different) consistently received the highest ratings across attention, appeal, relevance, and believability. In contrast, more informational or evaluative messages (e.g., Studies Show) performed significantly less favorably. Factual messages yielded the highest proportion of participants reporting they were very likely to increase wait time before driving (59%), while self-reflective messages were most effective in encouraging alternative transportation (55%). All message types produced similar effects on intentions to remain in the same location (56-58%), and substantially fewer participants reported intentions to reduce cannabis use overall (23-29%). Message responsiveness varied by driving risk profile. Ultra-high-risk drivers reported lower likelihood of engaging in safer behaviors compared with medium- and high-risk drivers, although differences were not uniformly statistically significant. Qualitative findings indicated that exaggerated, fear-based, or stigmatizing messages were viewed negatively across groups, whereas messaging that was clear, evidence-based, and nonjudgmental was perceived as credible and effective. Source trust also varied, with healthcare providers and science-based organizations rated most credible and celebrities and social media influencers rated least trustworthy. This study offers new evidence on how cannabis users respond to messaging about cannabis-impaired driving. Messages emphasizing concrete effects and impairment, particularly those that are factual, direct, and evidence-based, were most consistently associated with higher ratings on outcome measures. However, differences in behavioral intentions across message types were modest, with limited impact on intentions to reduce cannabis use. Findings also indicate that individuals reporting higher-risk cannabis use and driving behaviors, particularly ultra-high-risk drivers, may be less responsive to messaging overall and may require more tailored approaches and complementary strategies to mitigate impaired driving. Across groups, messages perceived as exaggerated, stigmatizing, or fear-based were viewed as less credible and potentially counterproductive. These results can inform the development of user-centered, harm-reduction safety campaigns as cannabis legalization expands, while underscoring the need for continued evaluation and refinement of messaging strategies.

32. Mental and Social Health Recovery after Major Burn Injuries: A Burn Model System Study.

期刊: Journal of burn care & research : official publication of the American Burn Association 发表日期: 2026-Jun-17 链接: PubMed

摘要

Although survival after major burn injury is increasingly common, persistent psychosocial morbidity often remains prevalent, and the relationship between burn severity and long-term psychosocial recovery is less understood. We aimed to evaluate longitudinal trajectories of mental health and social recovery across large burn-size strata to examine whether injury severity differentially influences internal psychological outcomes versus external social participation. We conducted a retrospective, multicenter longitudinal analysis of adults with ≥20% total body surface area burns enrolled in the Burn Model System National Longitudinal Database, using outcome measures available across their respective collection periods. Participants were stratified by total body surface area groups of large (20-49.9%), very large (50-69.9%), or massive (≥70%). Outcomes included Patient-Reported Outcomes Measurement Information System domains of Depression, Anxiety, and Ability to Participate in Social Roles; Community Integration Questionnaire-Social Integration; and employment status assessed at 6-, 12-, and 24-months post-injury. Mixed-effects linear regression models adjusted for demographic and clinical covariables. Among 815 participants, depression and anxiety remained elevated relative to population norms, while social participation improved across all burn sizes longitudinally. Survivors with massive burns demonstrated the greatest improvement in mental health over 24-months, with changes reaching clinically meaningful magnitude, and their community integration at 24-months was comparatively preserved, coming closest to pre-injury burn levels despite lower perceived social role ability and employment. These findings demonstrate that psychosocial recovery over the first 24-months does not worsen in proportion to injury severity, indicating that injury severity alone should not define prognosis. Rather, survival and rehabilitation after massive burn injury can translate into meaningful psychological adaptation and social integration that benefits from sustained, multidisciplinary follow-up across all burn severities.

33. Marital sexual autonomy and pleasure among Palestinian women: Negotiating religion, culture, and emotional wellbeing.

期刊: Community health equity research & policy 发表日期: 2026-Jun-17 链接: PubMed

摘要

This study investigates married Palestinian women’s experiences of sexual rights, autonomy, and pleasure, emphasizing the interplay of religion, culture, and marital communication. Using a qualitative phenomenological design, 20 women from urban, rural, and refugee camp settings were interviewed. Findings reveal that women perceive sexual rights and pleasure in Islam as mutually reciprocal, yet cultural norms and social expectations often constrain the enactment of sexual autonomy and enjoyment. Religious guidance serves as both empowerment and a site of negotiation, helping women interpret their rights and navigate tension with local customs. Emotional wellbeing, trust, privacy, and knowledge of sexual rights emerged as critical enablers of sexual decision-making and pleasurable experiences. The study underscores the importance of culturally and religiously sensitive education, counseling, and marital support to foster sexual autonomy and pleasure, contributing to relational equity and wellbeing in Palestinian marital contexts.

34. The mobile resistome in the water-soil-air nexus: horizontal gene transfer and environmental dissemination of antimicrobial resistance genes.

期刊: FEMS microbiology ecology 发表日期: 2026-Jun-17 链接: PubMed

摘要

The rapid emergence and global dissemination of antimicrobial resistance pose a serious threat to public health, environmental sustainability, and economic development. Central to this crisis is the resistome, defined as the collection of all antimicrobial resistance genes present in pathogenic and non-pathogenic microorganisms across clinical, agricultural, and natural ecosystems. The environmental resistome plays a crucial role in the evolution and transmission of resistance, serving as both a reservoir and a conduit for ARG exchange through horizontal gene transfer. This review provides a comprehensive overview of the structure, diversity, and dynamics of the resistome, with emphasis on the interconnected water-soil-air continuum. Key mechanisms driving resistome dissemination, including mobile genetic elements such as plasmids, integrons, transposons, and bacteriophages, are discussed alongside the major routes of gene transfer, conjugation, transformation, and transduction. The review highlights anthropogenic drivers that intensify resistome expansion, including antibiotic misuse, wastewater discharge, agricultural runoff, and exposure to heavy metals, pesticides, and disinfectants, which promote co-selection. Advances in resistome profiling approaches, such as quantitative PCR, metagenomics, long-read sequencing, and functional metagenomics, are critically evaluated for their capacity to resolve ARG diversity, mobility, and host associations.

35. Postoperative activity participation and functional recovery after robotic-assisted unicompartmental knee arthroplasty: a systematic review and single-arm meta-analysis.

期刊: Journal of robotic surgery 发表日期: 2026-Jun-17 链接: PubMed

摘要

This study aimed to systematically evaluate postoperative activity participation and functional recovery after robotic-assisted unicompartmental knee arthroplasty (RA-UKA). A systematic review and single-arm meta-analysis was conducted according to PRISMA guidelines. PubMed, Embase, Web of Science, and the Cochrane Library were searched from inception to May 2026. Eligible studies included adults undergoing RA-UKA and reporting postoperative activity participation, return to sport, range of motion, or validated functional outcomes. Methodological quality was assessed using MINORS, RoB 2, and ROBINS-I according to study design. Pooled estimates with 95% confidence intervals (CIs) were calculated using Stata version 18.0. Twelve studies involving 486 RA-UKA cases were included. The pooled Forgotten Joint Score was 64.58 (95% CI 49.38, 79.77), and the pooled range of motion was 110.92° (95% CI 91.83, 130.02). The pooled estimate for return to sport after RA-UKA was 0.93 (95% CI, 0.87, 1.00). The pooled postoperative pain-related score at the last follow-up was 6.06 (95% CI 3.56, 8.57). The pooled proportion of patients reporting being “very satisfied” with return to recreational activities was 0.57 (95% CI 0.29, 0.86). Sensitivity analyses indicated that the main findings were generally stable. Single-arm evidence suggests that RA-UKA may be associated with encouraging postoperative recovery profiles, including acceptable joint awareness, functional knee motion, return-to-sport signals, and patient-reported outcomes. However, these findings are descriptive and hypothesis-generating rather than evidence of clinical superiority. Further prospective comparative studies with standardized activity outcomes are needed.

36. Pilot Evaluation of a Mobile Health Intervention for Smoking Cessation in Rural and Urban Georgia.

期刊: American journal of health promotion : AJHP 发表日期: 2026-Jun-17 链接: PubMed

摘要

PurposeImproving access to low-burden, evidence-based smoking cessation interventions for rural communities is essential. This study evaluated the feasibility and acceptability of a text messaging program for smoking cessation (iQuit Mindfully) in rural and urban Georgia.DesignPilot study with randomization to iQuit Mindfully or usual care at each site.SettingUrban Atlanta and Rural Georgia.Sample60 adults who smoked cigarettes (61.7% female, 41.7% African American, 53.3% with annual household income <$30,000).InterventionAll participants received nicotine replacement therapy, self-help materials, and Tobacco Quitline referrals. iQuit Mindfully participants also received daily personalized, interactive text message support for quitting smoking.MeasuresProgram evaluations and remote exhaled carbon monoxide at 8 and 12 weeks.AnalysisDescriptive statistics quantified primary feasibility outcomes (engagement, retention, participant ratings) and smoking cessation by condition and rural vs urban site.ResultsMost iQuit Mindfully participants (88.9% overall; 100% rural, 78.6% urban) read most or all text messages. On average, iQuit Mindfully participants found the program helpful (median = 8 on 1-10 scale) and recommended it for others (median = 8). Biochemically verified 7-day abstinence rates were 34.8% among iQuit Mindfully vs 25.0% among usual care at week 8, and 13.6% among iQuit Mindfully vs 8.3% among usual care at week 12.ConclusionMindfulness-based text messaging appears feasible and acceptable for providing accessible smoking cessation support in rural and urban Georgia.

37. Urate-Lowering Therapy in Cardiovascular Pharmacotherapy: From Mendelian Randomization Data to Cardio-Renal-Metabolic Risk Modulation.

期刊: European heart journal. Cardiovascular pharmacotherapy 发表日期: 2026-Jun-17 链接: PubMed

摘要

Serum uric acid (SUA) and hyperuricemia have re-emerged as determinants of cardiovascular (CV) risk beyond gout. This review integrates epidemiological, Mendelian randomization (MR), and pharmacological evidence to define the role of SUA and urate-lowering therapy (ULT) in contemporary cardiovascular pharmacotherapy. We synthesized population-based studies, MR and drug-target MR analyses, and randomized trials of xanthine oxidase inhibitors (XOIs), uricosurics/URAT1 inhibitors, biologic uricases, and CV drugs with urate-modifying effects. Hyperuricemia is prevalent and rising, often closely accompanying obesity, hypertension, diabetes, and chronic kidney disease. Higher SUA correlates with coronary artery disease, heart failure, stroke, cardio-renal-metabolic syndromes, and mortality, with non-linear risk relationships and sex- and age-specific thresholds. MR suggests a modest causal contribution of genetically elevated SUA to blood pressure, coronary disease, and advanced CKD, partly mediated via haemodynamic, renal, and inflammatory pathways. Pharmacologically, XOIs, URAT1 inhibitors, and uricases differ in kinetics and safety profiles. However, large trials and real-world cohorts show no consistent reduction in CV events when ULT is added to guideline-directed therapy in asymptomatic hyperuricemia, stable ischaemic heart disease, chronic heart failure, or chronic kidney disease. Observational data suggest that long-term, adequately dosed XOIs and high cumulative uricosuric exposure may reduce coronary risk. SUA is a cardio-renal-metabolic biomarker and a plausible therapeutic target in selected cardio-renal-metabolic phenotypes. However, evidence does not support routine ULT for CV prevention in asymptomatic hyperuricemia. ULT should remain focused on gout and symptomatic hyperuricemia, with phenotype-guided strategies to identify patients most likely to benefit.

38. Emerging Tree Diseases Driven by Climate Change: A Critical Perspective on Current Challenges and Future Directions.

期刊: Annual review of phytopathology 发表日期: 2026-Jun-17 链接: PubMed

摘要

Climate change is fundamentally reshaping forest disease dynamics through direct effects on pathogen biology and indirect impacts on host physiology. Rising temperatures, altered precipitation patterns, and extreme weather events are driving disease emergence by disrupting ecological relationships between trees and their microbial associates. This review examines how climate change compounds biotic and abiotic risks to forest health, distinguishing between climate-pathogen diseases, where climatic shifts directly favor pathogen activity, and climate-stress diseases, where physiological stress predisposes trees to decline. We explore the continuum from native pathogens gaining new opportunities to exotic pathogens establishing in previously unsuitable environments while considering distinctions among endophytes and latent and nonlatent pathogens. The review emphasizes critical knowledge gaps and highlights emerging research directions, including integration of genomics, remote sensing, and predictive modeling for disease surveillance, adaptive forest management strategies balancing disease mitigation with climate adaptation and new solutions for enhancing forest resilience under accelerating environmental change.

39. Research Progress of Single/Multi-Mode Optical Sensors on Visual Monitoring of Food Freshness: A Review.

期刊: Small (Weinheim an der Bergstrasse, Germany) 发表日期: 2026-Jun-17 链接: PubMed

摘要

As a critical issue impacting public health and social development, food safety calls for the advancement of efficient, precise, and easily implementable detection technologies to ensure food quality. In recent years, optical sensors have demonstrated significant advantages in food freshness monitoring due to their high sensitivity, excellent selectivity, and real-time response capabilities (e.g., detection limits: 5.1 nm for BAs, 0.3 µm for H2S; response times: 3 s-30 min; detection ranges: pH 3-9, analyte concentrations from nm to mm). This paper systematically reviews the latest progress in single-mode, dual-mode, and multi-mode optical sensors, focusing on their performance in detecting key biomarkers-such as biogenic amines, hydrogen sulfide, and organic acids-during the storage of perishable foods. Research indicates that the introduction of novel functional materials, including metal-organic frameworks, natural pigments, and carbon dots, significantly enhances sensor performance. Meanwhile, the integration of smartphone visual recognition with deep learning algorithms is driving the development of integrated signal acquisition and analysis systems. Although challenges remain in areas such as resistance to environmental interference, simultaneous multi-parameter detection, and commercial packaging, interdisciplinary collaboration and sustainable material innovation hold the promise of establishing optical sensing technology as a key enabler for building intelligent, food quality and safety monitoring systems.

40. Targeting metabolism and membrane: Neferine synergizes with gentamicin against Escherichia coli by disrupting FNR/ArcA-Mediated homeostasis.

期刊: Virulence 发表日期: 2026-Jun-17 链接: PubMed

摘要

The escalating prevalence of antimicrobial-resistant bacteria, particularly in food and environmental settings, poses a severe global health threat. E. coli with rising resistance to gentamicin exemplifies this crisis, necessitating novel strategies to restore antibiotic efficacy. This study identified Neferine, a bisbenzylisoquinoline alkaloid from Nelumbo nucifera, as a potent synergistic adjuvant for gentamicin against E. coli. Integrating high-throughput screening with bioinformatic and molecular biological approaches, we systematically investigated its synergistic efficacy and underlying mechanism.Our results demonstrated that Neferine, while lacking intrinsic bactericidal activity, dramatically enhanced gentamicin’s potency, reducing its MIC by ≥16-fold, accelerating bactericidal kinetics, and delaying resistance development in vitro. Mechanistically, Neferine specifically targeted the global transcriptional regulators FNR and ArcA with high affinity (K_D = 1.3 μM and 658.6 nM, respectively), inducing conformational changes and disrupting their regulatory networks. This interaction hyper-activated the TCA cycle, leading to NAD+ /NADH imbalance, severe ATP depletion, and ROS burst, ultimately causing metabolic catastrophe. Concurrently, Neferine synergized with gentamicin to severely disrupt bacterial membrane integrity, increasing fluidity and provoking rapid depolarization. In vivo validation demonstrated that the combination significantly enhanced host survival, reduced bacterial loads in organs, and attenuated excessive inflammatory responses.In conclusion, Neferine synergizes with gentamicin through a dual mechanism: targeting FNR/ArcA to induce metabolic collapse and co-disrupting membrane integrity, offering a promising therapeutic strategy to combat multidrug-resistant E. coli infections.

41. The IL-17A/Neutrophil axis play a critical role in lethal infection induced by an emerging ultra-virulent Streptococcus suis serotype 5 strain.

期刊: Virulence 发表日期: 2026-Jun-17 链接: PubMed

摘要

Streptococcus suis (S. suis) is an important emerging zoonotic pathogen. In recent years, ultra-virulent serotype 5 clinical strains have emerged in China, characterized by causing high mortality in mice at early infection, even at low inoculation doses. In this study, we investigated the characteristics of lethal infection induced by the ultra-virulent S. suis serotype 5 strain SC2022MYS167 isolated from a patient with Streptococcal toxic shock-like syndrome (STSLS) and severe pneumonia. The lethal infection was associated with excessive bacterial loads and pro-inflammatory cytokines in peripheral blood and organs. Blocking IL-17A activity effectively reduced mouse mortality at infection stages 1 and 2. The lung tissues exhibited significantly higher levels of pro-inflammatory cytokines compared to liver and spleen tissues, with elevated IL-17A levels observed exclusively in the lung tissues of moribund mice at infection stage 1. CD11b+ Ly6G+ neutrophils recruited from peripheral blood significantly colocalized with IL-17A within lung tissues. Post-infection depletion of neutrophils rescued mice from lethal infection by significantly reducing the bacterial burden and levels of IL-17A, IL-6, and TNF-α in peripheral blood. A dose-dependent relationship was observed between neutrophil-depleting antibody and protection from lethal infection. These findings indicate the critical role of the IL-17A - neutrophil axis in STSLS development, pulmonary inflammation, pathological lesions, and subsequent acute host death induced by ultra-virulent serotype 5 strains, thereby providing a promising therapeutic target for reducing patient mortality.

42. [Working conditions in endocrine surgery : A study among participants of the 43rd annual conference of the Surgical Working Group Endocrinology].

期刊: Chirurgie (Heidelberg, Germany) 发表日期: 2026-Jun-17 链接: PubMed

摘要

Working conditions in surgical specialties are increasingly characterized by high workload and growing job dissatisfaction, negatively affecting recruitment, retention, and the long-term sustainability of healthcare services. While extensive data are available for surgery as a whole, working conditions in endocrine surgery as a subspecialty of visceral surgery have not yet been investigated separately. The aim of the present study was, for the first time, to assess job satisfaction, occupational stressors, and working conditions among endocrine surgeons in Germany and to compare these factors according to the extent of endocrine surgical practice. An anonymous cross-sectional survey was conducted during the 43rd Annual Meeting of the Surgical Working Group for Endocrinology (CAEK). The standardized questionnaire comprised 28 items addressing sociodemographic characteristics, professional activity, workload, and job satisfaction. A total of 84 fully completed questionnaires were included in the analysis. Overall, 85% of respondents reported high or very high job satisfaction. Predominant involvement in endocrine surgery was associated with significantly higher overall job satisfaction (OR = 2.78; p = 0.021). Differences were particularly pronounced regarding opportunities for continuing medical education (OR = 4.41; p = 0.001), working time arrangements (OR = 3.21; p = 0.006), and surgical training and professional development (OR = 2.93; p = 0.014). Furthermore, 75% of respondents stated that they would unequivocally choose endocrine surgery again as their specialty. The main sources of occupational burden were bureaucratic and organizational demands. Overall stress levels differed only marginally between groups. The only significant difference was a higher burden from night shifts among surgeons whose endocrine surgical practice constituted a secondary part of their professional activity. Physicians predominantly engaged in endocrine surgery demonstrate significantly higher job satisfaction despite experiencing comparable levels of occupational burden. These findings suggest that specialized clinical profiles, structured training pathways, and favorable working time models contribute substantially to the attractiveness of this field. Promoting specialized training with the goal of subspecialization may therefore represent an important strategy for improving job satisfaction, enhancing recruitment and retention, and ensuring the long-term provision of surgical care in other areas of visceral surgery as well. EINLEITUNG: Die Arbeitsbedingungen in chirurgischen Fachdisziplinen sind zunehmend durch hohe Belastung und wachsende Unzufriedenheit geprägt, was sich negativ auf Nachwuchsgewinnung, Berufsverbleib und langfristige Versorgungsstrukturen auswirkt. Während hierzu umfangreiche Daten für die Chirurgie insgesamt vorliegen, wurden die Arbeitsbedingungen in der endokrinen Chirurgie als Subspezialisierung der Viszeralchirurgie bislang nicht gesondert untersucht. Ziel der vorliegenden Studie war es, erstmals die berufliche Zufriedenheit, Belastungsfaktoren und Arbeitsbedingungen endokrin-chirurgisch tätiger Ärztinnen und Ärzte in Deutschland zu erfassen und diese in Abhängigkeit vom Umfang der endokrinen Tätigkeit zu vergleichen. Im Rahmen der 43. Jahrestagung der Chirurgischen Arbeitsgemeinschaft Endokrinologie (CAEK) wurde eine anonyme Querschnittsumfrage durchgeführt. Der standardisierte Fragebogen umfasste 28 Items zu soziodemografischen Daten, beruflicher Tätigkeit, Arbeitsbelastung und beruflicher Zufriedenheit. Insgesamt konnten 84 vollständig ausgefüllte Fragebögen in die Analyse eingeschlossen werden. Insgesamt berichteten 85 % der Befragten von einer eher hohen oder sehr hohen beruflichen Zufriedenheit. Eine überwiegende Tätigkeit in der endokrinen Chirurgie war mit einer signifikant höheren allgemeinen Zufriedenheit assoziiert (OR = 2,78; p = 0,021). Besonders ausgeprägt waren die Unterschiede in den Bereichen Fortbildungsmöglichkeiten (OR = 4,41; p = 0,001), Arbeitszeitregelung (OR = 3,21; p = 0,006) und Weiterbildung (OR = 2,93; p = 0,014); 75 % der Befragten gaben an, dass sie sich erneut uneingeschränkt für die endokrine Chirurgie entscheiden würden. Hauptbelastungsfaktoren waren hingegen bürokratische und organisatorische Anforderungen. Das Belastungsniveau unterschied sich insgesamt kaum zwischen den Gruppen. Lediglich die Belastung durch Nachtdienste war bei nachrangig endokrin-chirurgisch Tätigen signifikant höher. Ärztinnen und Ärzte mit überwiegender Tätigkeit in der endokrinen Chirurgie weisen trotz vergleichbarer Belastung ein signifikant höheres Maß an beruflicher Zufriedenheit auf. Die Ergebnisse legen nahe, dass insbesondere geeignete strukturelle und organisatorische Rahmenbedingungen eine zentrale Rolle für die Attraktivität dieses Fachgebiets spielen könnten. Die Schaffung entsprechender Voraussetzungen könnte dazu beitragen, die berufliche Zufriedenheit zu fördern und die Nachwuchsbindung langfristig zu stärken.

43. When errors become etched in stone: The U.S. Navy's deeply flawed, never retracted World War II asbestos epidemiology study.

期刊: New solutions : a journal of environmental and occupational health policy : NS 发表日期: 2026-Jun-17 链接: PubMed

摘要

In January 1946, the Journal of Industrial Hygiene and Toxicology published “A Health Survey of Pipe Covering Operations in Constructing Naval Vessels.” This cross-sectional epidemiological study is one of the most consequential in the history of industrial hygiene and occupational medicine as it errantly concluded that insulation work on ships using asbestos-containing materials was “…not a dangerous occupation.” As a consequence of this innocuous conclusion, the U.S. Navy and others neglected to protect insulators and other employees from asbestos dust for the next 25 years, leading to an epidemic of asbestos-related diseases in active and retired workers. Subsequently, attorneys and expert witnesses used this exculpating conclusion to mount “state of the art/science” defenses for asbestos manufacturers in tort actions, arguing that their clients relied on this publication when they failed to protect their own employees from asbestos or warn their customers of the hazard. Both the industrial hygiene and the medical components of this study were deeply flawed. The successor publisher to the original journal has refused to consider retracting this paper, so this catastrophic blunder may remain a part of the literature, available to asbestos tort defense attorneys and their experts. Publishing industry policies and precedent related to retracting very old articles are reviewed.

44. Dual-view cross-semantic graph neural network for predicting intraoperative complications in patients with acute myocardial infarction undergoing percutaneous coronary intervention.

期刊: Medical engineering & physics 发表日期: 2026-Jun-17 链接: PubMed

摘要

For acute myocardial infarction (AMI) patients undergoing percutaneous coronary intervention (PCI), accurate prediction of intraoperative complications (IOCs) in AMI patients undergoing PCI is critical for timely risk stratification and clinical intervention. However, existing approaches lack a patient-indicator dual-view synergy modeling framework, leading to semantic isolation between patient and indicator representations. Yet current risk prediction approaches often treat patient characteristics and clinical indicators as separate, disconnected pieces of information. What’s missing is a unified framework that jointly models both the ‘patient’ and the ‘indicators’ in a synergistic way, capturing how they interact and influence each other. Without this dual-view perspective, valuable clinical insights remain hidden, limiting the accuracy and real-world utility of risk predictions. Guided by a gain-aware feature distillation strategy, an indicator heterogeneous collaborative graph (IHCG) is constructed to disentangle inter-indicator semantics via meta-path-constrained propagation, thereby encoding structured clinical logic beyond raw statistical associations. Concurrently, a patient neighborhood topology graph (PNTG) is instantiated based on high-order phenotypic affinity modeling to capture contextualized risk signatures, with manifold-preserving neighborhood propagation enabling the encoding of population-level pathophysiological coherence beyond isolated clinical profiles. According to IHCG and PNTG, semantic integration across views is achieved through a patient-query asymmetric propagation paradigm. In the paradigm, patient nodes actively drive risk-informed semantic aggregation from clinical indicators via cross-attentional indicator fusion, while indicator nodes provide auxiliary contextual feedback through a lightweight residual semantic feedback pathway, thereby establishing a structured yet asymmetric information flow that aligns individualized risk assessment with population-level clinical semantics. To further ensure coherent bidirectional representation learning, aligning structurally projected embeddings with semantically cross-attended outputs. On the basis of the above modeling, this study develop a novel method for predicting IOCs in patients with AMI undergoing PCI called dual-view cross-semantic graph neural network (DCGNN), and the method resolves cross semantic isolation and grounds intraoperative risk prediction in mechanism-aware clinical reasoning. On the dataset collected from Shanghai Sixth People’s Hospital South Campus, DCGNN achieved an AUC of 89.8% and a sensitivity of 90.2%, significantly outperforming baseline methods. Ablation studies, hyperparameter sensitivity analysis, and semantic-aware risk factor attribution (SARFA) further validated the effectiveness, robustness, and interpretability of the proposed method. The study method achieves superior predictive accuracy while enabling traceable risk attribution through dual-view asymmetric cross-semantic alignment, providing an intelligent decision support tool for perioperative risk stratification in AMI patients undergoing PCI with significant clinical translation potential.

45. Interaction Between Air Pollution and Genetic Predisposition to Blood Pressure and LDL-C on Cardiovascular Events.

期刊: European journal of preventive cardiology 发表日期: 2026-Jun-17 链接: PubMed

摘要

Particulate matter ≤2.5μm (PM2.5) air pollution is a leading global environmental risk factor. We investigated the impact of PM2.5 on cardiovascular risk with lifetime genetic predisposition to low-density lipoprotein cholesterol (LDL-C) and systolic blood pressure (SBP). We conducted a Mendelian Randomization (MR) study of participants from the UK Biobank study (n = 412,446) over 13.85 years. Polygenic Risk Scores (PRS) for LDL-C and SBP were used as instrument variables to estimate association and causal effects with major adverse cardiovascular events (MACE). The interaction between exogenous PM2.5 exposure with individual or combined LDL-C, SBP PRS, and clinical phenotypes was assessed using adjusted survival regression, causal inference, and machine learning models. A significant negative interaction was observed between PM2.5 and PRS on MACE incidence for both SBP and LDL-C. The association of 1-SD PRS increase for SBP (≈ 10 mm Hg) and LDL-C (≈38.6 mg/dl) with MACE was attenuated at higher PM2.5 levels (HR = 0.947, p = 0.039, HR = 0.943, p = 0.025, respectively). Analyses with phenotype showed a similar trend for SBP, further confirmed by causal effects interactions (HR = 0.9979, p < 0.001, HR = 0.9995, p = 0.093, respectively). Absolute risk analysis showed that predicted risk remained highest in the high-PRS groups across PM2.5 levels. Higher-genetic-risk groups for SBP and LDL-C carried the greatest absolute cardiovascular risk when exposed to air pollution, even though PM2.5 conferred lower relative risk, perhaps related to high baseline risk. These findings support a gene-environment interaction between air pollution exposure and genetically proxied cardiovascular risk factors. Air pollution, especially fine particulate matter (PM2.5), is the world’s leading environmental risk factor. Does it change cardiovascular risk related to inherited tendency for higher systolic blood pressure (SBP) or low-density lipoprotein cholesterol (LDL-C)? In Mendelian randomization analyses of 412,446 UK Biobank participants, genetic variants linked to higher tendency for LDL-C and SBP were confirmed to be independently associated with higher risks of major adverse cardiovascular events (MACE). Air pollution-related risk appeared relatively smaller among people with higher genetic risk for SBP and LDL-C than among lower-genetic-risk groups, most likely because these individuals already were saturated with baseline risk. However, these higher-genetic-risk individuals still carried the greatest predicted cardiovascular risk burden when exposed to air pollution risk. Air pollution interacts with genetic risk for LDL-C and SBP supporting a gene by environment interaction. The findings reinforce that air pollution remains an important cardiovascular hazard and support the consensus that environmental and genetic risks are synergistic. These findings underscore the importance of ongoing air quality regulation, especially for people at higher baseline risk.

46. Age-related macular degeneration and secondary fracture risk in patients with hip fractures.

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

摘要

Research on the relationship between age-related macular degeneration (AMD) and secondary fracture risk following hip fractures is scant. We aimed to examine whether AMD increases the risk of secondary fractures following hip fracture surgery. This retrospective cohort study was conducted using data from the Korean National Health Insurance Service Senior Cohort (2002-2019). Secondary fractures were defined as hip, wrist, humerus, spine, ankle, or pelvic fractures occurring within 6 months after hip fracture surgery. Patients diagnosed with AMD within 6 months postoperatively were identified. Covariates included age, sex, income, insurance type, Charlson Comorbidity Index, residential area, disability status, and hospital size and type. Associations between AMD and secondary fractures were analyzed using Cox proportional hazards models. Among 18 611 patients with hip fractures, 93 were diagnosed with AMD and 26 experienced secondary fractures. Patients with AMD had a significantly higher risk of secondary fractures than those without AMD (adjusted hazard ratio, 1.70; 95% confidence interval, 1.16-2.51). Overall, AMD was associated with an increased risk across all fracture types. Effective management of AMD may help reduce the risk of secondary fractures.

47. Progress in purification and downstream processing strategies toward ectoine as an emerging substance for food and pharmaceutical systems.

期刊: Advances in colloid and interface science 发表日期: 2026-Jun-12 链接: PubMed

摘要

Food processing and pharmaceutical sectors demand the finding of new chemical substances from either natural and microbial origin to be applied in commercial products and formulations. However, such industries seek non-conventional solutes and substances that may not only provide improved properties to the new commercial product but also offer health benefits to the consumers. Currently, ectoine, which is a microbial-derived extremolyte, has been identified, produced and extracted with the purpose of new applications in food, cosmetical and pharmaceutical health care formulations. However, despite there is deep research toward its production via biotechnological approaches, recent reports suggest that its purification and isolation represent a current challenge due to its intracellular presence and the complexity of the microbial fermentation system. To date, there is no universal recovery strategy toward such valuable substance, even if the research community is aware of the great potential of this substance, needed solutions for its purification for post-application are still under rigorous investigation. Therefore, the core of this review paper focuses on analyzing the progress toward this tough recovery and isolation of ectoine from different biotechnological systems, giving a critical discussion on the reported cases of the study and relevant strategies involving several downstream processing stages.

48. Chlorella vulgaris as a functional food and nutraceutical: bioactive composition, health-promoting mechanisms, applications, and current challenges.

期刊: Food & function 发表日期: 2026-Jun-08 链接: PubMed

摘要

The increasing demand for sustainable and nutrient-dense food sources has intensified interest in microalgae like Chlorella vulgaris (C. vulgaris). This review explores the therapeutic potentials of C. vulgaris, as well as related mechanisms, hurdles, and prospects, signifying its ability to improve nutritional enhancement and disease risk reduction. It was found that C. vulgaris comprises alkaline earth metals, vitamins, polyunsaturated fatty acids, phenolics, proteins, and pigments, and therefore is considered a functional food, a feed supplement for fish farming, and stock feed. C. vulgaris exhibits significant nutraceutical potential with antioxidant, antimicrobial, anti-inflammatory, antidiabetic, and immunomodulatory properties. Current findings have supported the multifaceted nutritional and health benefits of C. vulgaris. Moreover, ongoing exploration is uncovering further therapeutic potential, fostering its incorporation into dietary strategies for disease prevention and vitality promotion. The high macronutrient and micronutrient value, as well as various therapeutic properties, make C. vulgaris a reliable ingredient in the human diet, ranging from confectionery to beverages. However, its large-scale application in functional foods and dietary supplements is constrained by challenges such as limited bioavailability, sensory acceptance issues, production scalability, and regulatory barriers. Addressing these limitations, multi-omics approaches, and harmonized regulatory frameworks are recommended for a comprehensive understanding of C. vulgaris’s nutraceutical potential.

49. Simple against advanced imaging for the selection of stroke therapy in the extended window (VESTA study).

期刊: European stroke journal 发表日期: 2026-Jun-02 链接: PubMed

摘要

The optimal imaging modality for selecting stroke patients for revascularisation in the extended window remains uncertain. The VESTA study compared simple (non-contrast CT + CTA) vs advanced imaging (including perfusion) in the extended window in terms of clinical outcomes, mortality and safety. This multicentre cohort study included 1262 stroke patients (last seen well 6-24 h, NIHSS ≥ 6) from the Catalan Stroke Registry (2019-2021). A central core lab re-evaluated images, and blinded investigators assessed 90-day functional outcomes. Inverse probability weighting (IPW) and multivariable methods were applied. Median age was 76 years, NIHSS 12 and 48% were women. Simple imaging was used in 44% (n = 550), advanced in 56% (n = 712). Simple imaging had higher rates of no arterial occlusion (49% vs 37%, P = .006) and slightly lower endovascular treatment rates (36% vs 40%, P = .117). Time metrics were similar. In the IPW analysis, (advanced imaging as reference), simple imaging showed numerically worse point estimates across all outcomes, although most differences did not reach statistical significance: a worse mRS shift (adjusted odds ratio [aOR] 1.17 [95% CI, 0.96-1.43]; P = .11), a lower good functional outcome (mRS 0-2; aOR 0.83 [0.66-1.06]; P = .13), a higher mortality (aOR 1.20 [0.91-1.58]; P = .20), more frequent sICH (aOR 1.25 [0.61, 2.57]; P = .55) and a higher risk of any ICH (aOR 1.57 [1.00-2.47]; P = .05). In moderate-to-severe stroke (NIHSS ≥ 6) within 6-24 h, simple imaging did not show a statistically significant difference vs advanced imaging for guiding stroke treatment. However, advanced imaging may improve patient selection for reperfusion and reduce haemorrhagic risk. This study was registered at ClinicalTrials.gov under NCT05299034.

50. A Comparison of Medical Student and Resident Assessments of Internal Medicine Faculty.

期刊: Journal of graduate medical education 发表日期: 2026-Jun 链接: PubMed

摘要

Learner assessments of attendings are used for self-improvement, academic promotion, and teaching awards, as well as remediation. If assessment differences exist between learners, this could help inform faculty development and institutional evaluation policies. To compare medical student and resident assessments of internal medicine attendings’ teaching. Ten years (2013-2023) of medical student and resident end-of-rotation assessments of internal medicine attendings were evaluated, excluding faculty who weren’t rated at least 10 times by both students and residents. Students and residents rated attendings in 9 domains, with 5 overlapping (overall, clarity, rapport, communication, and feedback). We analyzed data using mixed-effects ordered logistic regression with random effects adjustment for clustering on faculty. There were 35 433 assessments of 496 faculty by 2520 medical students and 1847 residents. Residents rated faculty higher in all domains assessed (overall teaching effectiveness OR=1.39, 99% CI, 1.29-1.49; clarity OR=1.37, 99% CI, 1.27-1.47; rapport OR=2.24, 99% CI, 2.07-2.41; decisions OR=1.48, 99% CI, 1.38-1.59; feedback OR=1.27, 99% CI, 1.19-1.37). Most ratings of overall effectiveness were excellent (medical students: 60%; residents: 67%), and ratings increased from learners from the third-year medical students through senior internal medicine residents. Most attendings’ teaching was rated as “excellent” in all domains assessed. Higher level of trainee was associated with higher faculty ratings in all domains.

51. Burden, Epidemiologic Patterns, and Risk Factors of Early-Onset GI Cancers in China, With Projections Till 2035: A National Ecologic Study.

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

摘要

GI cancers contribute substantially to global cancer morbidity and mortality. China experiences a high burden of GI cancers, yet the burden, epidemiologic trends, and attributable risk factors of early-onset GI cancers in China have not been systematically investigated. We conducted a population-based ecologic study with data from the Global Burden of Disease 2023. Early-onset GI cancers were defined with the diagnosis during age 20-49 years. Temporal trends were evaluated using Joinpoint regression and age-period-cohort models. Risk-attributable mortality was assessed using the comparative risk assessment framework. Exponential smoothing models were applied to project incidence rates through 2035. In 2023, early-onset colorectal cancer had the highest incidence rate (7.31 [95% CI, 5.73 to 9.58] per 100,000), whereas stomach cancer had the highest mortality rate (3.30 [95% CI, 2.45 to 4.47] per 100,000). From 2000 to 2023, both incidence and mortality rates generally declined across early-onset GI cancers (average annual percent change range: -0.85 to -4.21 for incidence; -0.97 to -4.86 for mortality). However, all GI cancer sites showed increasing trends during 2020-2022. Risk-attributable patterns varied by sex, age group, and cancer type, with tobacco and alcohol contributing more prominently to mortality among males. Forecasts suggested largely stable trends for most sites through 2035, with persistent sex disparities. Early-onset GI cancers in China showed overall declines over the past two decades but a concerning rebound since 2020, alongside substantial heterogeneity in attributable risks by sex and age. These findings support longitudinal monitoring, alongside strengthened risk-stratified screening and targeted, integrated prevention strategies in alignment with the Healthy China 2030 agenda.

52. Gestational Exposure to 10 Classes of Priority Chemicals and Birth Outcomes in the ECHO Cohort.

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

摘要

Gestational environmental chemical exposures are widespread. Some chemicals are known to adversely affect birth outcomes, but many remain understudied. To evaluate associations of gestational exposure to a priori identified chemicals in 10 classes with birth outcomes in a large, diverse US cohort. In the prospective Environmental influences on Child Health Outcomes Cohort study, 5318 mother-child pairs were enrolled from January 1, 2000, to December 31, 2021, with data on gestational urinary chemical concentrations, gestational age at birth, and birth weight. Statistical analysis was performed from January 2024 to February 2026. In single, midgestation (median, 25 weeks [IQR, 21-30 weeks]) urine samples, concentrations of 113 analytes (chemicals or their metabolites) from 10 chemical classes were simultaneously measured: fungicides and herbicides (n = 11), insecticides (n = 20), halogenated phenols (n = 5), organophosphate esters (n = 10), benzophenones (n = 6), bisphenols (n = 14), parabens (n = 6), antimicrobials (n = 2), phthalates or alternative plasticizers (n = 32), and polycyclic aromatic hydrocarbons (PAHs) (n = 7). Linear mixed-effects regression models with a random effect for site were used to estimate covariate-adjusted differences in gestational age at birth (days) and birth weight-for-gestational age (BW-GA) z scores per IQR increase in urinary analyte concentrations. In secondary analyses, odds ratios (ORs) for preterm birth and small for gestational age (SGA) were estimated. In the sample of 5318 mother-child pairs, most infants (2667 female [50%]; median gestational age at birth, 39.0 weeks [IQR, 38.0-40.0 weeks]) were born to college-educated (67% [3218 of 4785]), parous (56% [2815 of 5007]) mothers (median age at delivery, 30.7 years [IQR, 26.1-34.3 years]). A total of 43 of 113 analytes (38%) were detected in 50% or more of samples. Multiple phthalates or alternative plasticizers were associated with younger gestational age at birth or lower BW-GA z scores; for example, summed diisononyl phthalate metabolites were associated with a 0.6-day (95% CI, -1.0 to -0.1 days) younger gestational age (preterm birth OR, 1.16 [95% CI, 1.01-1.34]), and summed phthalate or alternative plasticizers were associated with a 0.06 (95% CI, -0.11 to -0.02) lower BW-GA z score (SGA OR, 1.09 [95% CI, 0.93-1.27]). Two halogenated phenols, benzophenone 8, bisphenol F, and several PAHs were associated with lower BW-GA z scores; for example, 1- and 9-hydroxphenanthrene were associated with a 0.04 (95% CI, -0.08 to -0.01) lower BW-GA z score (SGA OR, 1.13 [95% CI, 1.01-1.27]). This large cohort study of diverse US pregnancies found widespread exposure to 10 classes of environmental chemicals, many of which were associated with differences in gestational age at birth or lower BW-GA z scores. These findings indicate that reducing gestational exposure to chemicals, particularly phthalates or alternative plasticizers and PAHs, could promote healthy deliveries and better child outcomes.

53. Exertional rhabdomyolysis among U.S. active component service members, 2021-2025.

期刊: MSMR 发表日期: 2026-May-20 链接: PubMed

摘要

Exertional rhabdomyolysis is a pathologic muscle breakdown associated with strenuous physical activity. A largely preventable condition, it persists as an occupational hazard of military training and operations, especially in high heat environments among individuals pushing their endurance limits. A total of 521 cases of exertional rhabdomyolysis were identified in the U.S. Armed Forces in 2025, corresponding to a crude incidence rate of 39.7 cases per 100,000 person-years. This rate is consistent with 2023-2024 levels but remains higher than rates from 2021-2022. The percentage of inpatient cases rose to a 5-year peak of 46.3% in 2025, however, a 21.6% relative increase from the low of 38.0% recorded in 2022. In 2025, the Air Force demonstrated the most significant rate increase, 60.0%, followed by the Army, with a 16.4% increase. In contrast, the Marine Corps and Navy showed rate decreases of 32.4% and 34.8%, respectively, when compared to 2024. The Coast Guard’s annual case numbers remained low, ranging 4-6 cases throughout the 5-year surveillance period. Consistent with prior reports, subgroup-specific crude rates in 2025 were highest among men, those younger than age 20 years, non-Hispanic Black service members, Marine Corps or Army members, and those in combat-specific or ‘other’ military occupations. In 2025, recruit trainees continued to experience the highest rates of exertional rhabdomyolysis, with a rate more than 6 times greater than officers and enlisted members.

54. Mapping the Evidence on Cardiovascular Disease Risk among Individuals Experiencing Disability: A Scoping Review.

期刊: American journal of physical medicine & rehabilitation 发表日期: 2026-May-06 链接: PubMed

摘要

To map the existing evidence on CVD risk among individuals with complex and disabling health conditions including traumatic brain injury (TBI), multiple sclerosis (MS), spinal cord injury (SCI), cerebral palsy (CP), spina bifida (SB), and poliomyelitis and identify gaps to guide future research. A scoping review was conducted following an established framework and pre-registered protocol. We searched MEDLINE, Embase, Web of Science, and Google Scholar from inception until March 17, 2025. Data on study characteristics, populations, outcomes, and risk factors were extracted and synthesized descriptively. A total of 38 observational studies published between 2001 and 2024, comprising more than 1.6 million individuals, met the inclusion criteria. Most studies compared these populations with the general population, focusing on stroke-related outcomes, and revealed a limited, fragmented, and geographically uneven evidence base with little attention to within-group determinants. Overall, the literature reflects growing interest in cardiovascular risk among individuals with complex and disabling health conditions but is limited by methodological heterogeneity, uneven condition representation, and reliance on administrative data. Future research would benefit from standardized disability definitions using consistent diagnostic criteria, improved reporting of patient-level factors, and broader representation across impairment groups and regions.

55. The effects of upper airway obstruction on oxygen consumption and ventilatory variables in Colombian criollo horses.

期刊: Journal of veterinary internal medicine 发表日期: 2026-May-04 链接: PubMed

摘要

While conditions associated with upper airway obstruction (UAO) are reported in Colombian Criollo horses, their effect on ventilation and performance is unknown. To investigate how oxygen consumption ($\dot{\rm V}$O2), ventilation,, and exercise-induced pulmonary hemorrhage (EIPH) are affected by UAO in horses performing at natural gaits. Twenty-three client-owned Colombian Criollo horses. A cross-sectional observational study assigned horses to a control (C), or UAO group after overground endoscopy. All horses performed a standardized submaximal exercise test while wearing an ergospirometry facemask. Post-exercise blood lactate concentration and bronchoalveolar lavage cytological results were assessed. Twelve horses had UAO, with 6/12 having multiple diagnoses. Recurrent laryngeal neuropathy was most prevalent (83%), followed by nasopharyngeal collapse (42%). Mean $\dot{\rm V}$O2 and minute ventilation were not different between C (79.4 ± 22.0 mL/(kg min); 723 ± 203 L/min) and UAO (88.2 ± 23.2 mL/(kg min); 648 ± 190 L/min). UAO resulted in lower peak inspiratory (25.2 ± 5.3 L/s, P = .01) and expiratory (33.6 ± 7.3 L/s, P = .03) flow than C (28.3 ± 10.0 and 38.0 ± 9.0 L/s). Longer inspiratory and expiratory durations in UAO resulted in lower breathing frequency (76.0 ± 16.0 vs. 89.2 ± 12.4 breaths/min). Post-exercise [lactate] was greater (P = .05) in UAO (6.8 [4.6-9.3] mmol/L) than C (3.5 [3.0-5.5] mmol/L). No evidence of EIPH was noted. Horses with UOA had marked changes in ventilation, however, $\dot{\rm V}$O2 and EIPH severity were not different to C, likely because the exercise was submaximal.

56. The Future of InSCI: Perspectives for Policy and Practice Implementation of the International Spinal Cord Injury Cohort Study.

期刊: American journal of physical medicine & rehabilitation 发表日期: 2026-Apr-10 链接: PubMed

摘要

The International Spinal Cord Injury (InSCI) Community Survey is the most comprehensive global data source describing the lived experience of persons with spinal cord injury or disease (SCI/D) living in the community. By collecting standardized, self-reported data across countries and health systems, InSCI operationalizes the World Health Organization’s concept of functioning and provides a 360° perspective on health, participation, and social inclusion. This paper adopts a prospective perspective and examines how InSCI data can be implemented to inform practice and policy. It explores how InSCI can support the development of evidence-based Theories of Change (ToC) to guide implementation strategies addressing unmet needs and inequities experienced by persons with SCI/D. Building on findings from the first two waves of the InSCI survey, conducted between 2017-2019 and 2022-2024, this paper synthesizes methodological principles for implementation, situates InSCI within contemporary implementation science, and examines real-world applications of InSCI data at the national and international levels. InSCI provides a unique evidentiary foundation for ToC development by integrating biomedical, personal, social, and environmental dimensions of functioning. Its comprehensive data model enables identification of priority gaps, formulation of realistic implementation pathways, and definition of measurable indicators for monitoring change. Existing national applications, including the Swiss National Strategy for Spinal Cord Injury, demonstrate the feasibility of translating InSCI evidence into coordinated policy and system-level reforms. InSCI is uniquely positioned to guide evidence-informed implementation of practice, programs, and policies for persons with SCI/D. By aligning with emerging global initiatives-particularly those led by the World Health Organization-and by grounding implementation in the concept of functioning and human rights, InSCI can support meaningful progress toward full inclusion, participation, and long-term wellbeing of persons living with SCI/D.

57. REPROGRAM: REsilience PROmotion with GeRoprotectors: AssessMent of biological effect: Rationale and protocol for a trial of biological effect.

期刊: PloS one 发表日期: 2026 链接: PubMed

摘要

Ageing is associated with reduced resilience to physiological stressors such as infection and surgery. This reduced resilience is believed to be underpinned by the hallmarks of ageing, the key biological mechanisms driving the aged phenotype. Geroprotectors are drugs that are proposed to slow down the ageing process and promote longevity and healthspan. Despite this, mechanistic studies in healthy older adults are lacking. This trial will test the hypothesis that geroprotectors targeted towards biological mechanisms associated with poor resilience can reverse these pathways within a three-week period. Three geroprotectors with a good safety profile in older adults and evidence of effect on the hallmarks of ageing will be administered to 60 (30 female; 30 male) adults 70 + . Participants will be randomised to one of three arms (Metformin MR 1500 mg, Fisetin 100 mg or Spermidine 15 mg). Participants will be extensively clinically characterised at baseline. Blood, abdominal adipose tissue and stool samples will be taken at baseline and following the three-week intervention. The primary research question will answer whether a three-week course of Metformin, Spermidine, or Fisetin reduce the number of senescent cells as measured by SA-β-GAL in adipose biopsies in healthy older volunteers. Additionally, there will be assessment of the effect of the geroprotectors on other hallmarks of ageing, including autophagy, immunosenescence, chronic inflammation, dysregulated mTOR signalling, epigenetic age, DNA damage, dysregulated metabolism, stem cell exhaustion and microbial composition. Ethical approval is in place (24/LO/0549). The main trial report and any sub-studies will be published in high impact peer-reviewed gerontology journals, presented at academic conferences and through a series of public engagement events. Participants enrolled in the study will be informed of the results by a written summary. REPROGRAM was registered with ISRCTN on 10/09/24. ISRCTN47919839. Available at https://www.isrctn.com/search?q=47919839.

58. Modeling the association between psychological capital and nurses' job performance: The moderating role of intolerance of uncertainty.

期刊: PloS one 发表日期: 2026 链接: PubMed

摘要

This cross-sectional analytical study aimed to examine the relationship between psychological capital (PsyCap) and nurses’ job performance, as well as the moderating role of intolerance of uncertainty (IU). A total of 212 nurses working in hospitals affiliated with Iran University of Medical Sciences participated. Verbal informed consent was obtained from all participants, as approved by the Ethics Committee of Iran University of Medical Sciences (IR.IUMS.REC.1401.561). Data collection tools included standardized questionnaires on PsyCap, IU, and job performance. Data were analyzed using structural equation modeling (SEM) with SmartPLS software. The measurement model was assessed for reliability and validity, and the structural model was tested for the study hypotheses. The findings indicated that PsyCap was positively and significantly associated with nurses’ job performance (β = 0.38, p < 0.001). IU was not significantly associated with job performance. However, IU negatively moderated the PsyCap-performance relationship (β = -0.16, p = 0.005). These findings suggest that PsyCap may be positively related to nurses’ job performance, although its positive effects may be attenuated under high IU. Interventions aimed at strengthening PsyCap alongside uncertainty-management strategies may help optimize performance in clinical settings.

59. Factors influencing the participation of people with disabilities in digital skills training in Poland.

期刊: PloS one 发表日期: 2026 链接: PubMed

摘要

The modern world is largely built around the use of digital technologies, which are present in life. The effective use of such technologies requires appropriate competences. People with disabilities, like everyone else, require access to digital technologies to fully participate in modern life. However, considering user diversity and the accessibility of digital technologies, digital competence training can play a key role. Therefore, the aim of this article is to present the determinants of participation in digital skills training among people with disabilities in Poland. To identify these factors, a questionnaire-based study was conducted with a group of 449 people with different disabilities. Logistic regression analysis revealed that perceived availability of accessible training significantly affects participation. When training is seen as inaccessible, the likelihood of participation decreases significantly by more than 70%. These findings highlight the need to improve the accessibility of digital skills training to ensure equal opportunities for all.